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1.
Cancer Causes Control ; 27(6): 721-7, 2016 06.
Article in English | MEDLINE | ID: mdl-27097910

ABSTRACT

PURPOSE: To describe the utilization of gene expression profiling (GEP) among California breast cancer patients, identify predictors of use of GEP, and evaluate how utilization of GEP influenced treatment of early-stage breast cancer. METHODS: All women diagnosed with hormone-receptor-positive, node-negative breast cancer reported to the California Cancer Registry between January 2008 and December 2010 were linked to Oncotype DX (ODX) assay results. RESULTS: Overall, 26.7 % of 23,789 eligible patients underwent the assay during the study period. Women age 65 or older were much less likely than women under age 50 to be tested (15.1 vs. 41.4 %, p < 0.001). Black women were slightly less likely and Asian women were slightly more likely than non-Hispanic white women to undergo GEP with the ODX assay (22.2 and 28.9 vs. 26.9 %, respectively, p < 0.001). Patients residing in low SES census tracts had the lowest use of the test (8.9 %), with the proportion increasing with higher SES category. Women with Medicaid health insurance were less likely than other women to be tested (17.7 vs. 27.5 %, p < 0.001). Receipt of adjuvant chemotherapy (ACT) was associated with the ODX recurrence score, although only 63 % of patients whose recurrence scores indicated a high benefit received ACT. Of patients not tested, 15 % received ACT. CONCLUSIONS: Nearly three-fourths of eligible breast cancer patients in California during the 3-year period 2008 through 2010 did not undergo GEP. As a result, it is likely that many women unnecessarily received ACT and suffered associated morbidity. In addition, some high-risk women who would have benefited most from ACT were not identified.


Subject(s)
Breast Neoplasms/genetics , Gene Expression Profiling/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Neoplasm Recurrence, Local , Registries , Social Class , Black or African American/statistics & numerical data , Age Factors , Aged , Asian/statistics & numerical data , Breast Neoplasms/pathology , Breast Neoplasms/therapy , California , Chemotherapy, Adjuvant , Female , Healthcare Disparities/ethnology , Humans , Mastectomy , Medicaid/statistics & numerical data , Middle Aged , Neoplasm Staging , Risk , United States , White People/statistics & numerical data
2.
Obstet Gynecol ; 126(3): 491-497, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26244529

ABSTRACT

OBJECTIVE: To identify characteristics associated with long-term survival for patients with epithelial ovarian cancer using the California Cancer Registry. METHODS: A descriptive analysis of survival of all California residents diagnosed with epithelial ovarian cancer between 1994 and 2001 was conducted using patients identified through the cancer registry with follow-up through 2011. Characteristics of the patients who survived more than 10 years (long-term survivors) were compared with three other cohorts: patients who survived less than 2 years, those who survived at least 2 but no more than 5 years, and those who survived at least 5 but no more than 10 years. RESULTS: A total of 3,582 out of 11,541 (31%, confidence interval 30.2-31.8%) of the patients survived more than 10 years. Younger age, early stage, low-grade, and nonserous histology were significant predictors of long-term survival, but long-term survivors also included women with high-risk cancer. CONCLUSION: Long-term survival is not unusual in patients with epithelial ovarian cancer, even in those with high-risk disease. Many of the prognostic factors are well known, but it remains to be determined why some patients with advanced-stage high-grade cancers survive longer than others with the same histology. These findings are important for patient counseling. LEVEL OF EVIDENCE: III.


Subject(s)
Neoplasms, Glandular and Epithelial/mortality , Neoplasms, Glandular and Epithelial/pathology , Ovarian Neoplasms/mortality , Ovarian Neoplasms/pathology , Registries , Survivors/statistics & numerical data , Adolescent , Adult , Age Factors , Aged , California , Carcinoma, Ovarian Epithelial , Chi-Square Distribution , Combined Modality Therapy , Cross-Sectional Studies , Female , Humans , Logistic Models , Middle Aged , Multivariate Analysis , Neoplasm Invasiveness/pathology , Neoplasm Staging , Neoplasms, Glandular and Epithelial/therapy , Odds Ratio , Ovarian Neoplasms/therapy , Ovariectomy/methods , Prognosis , Retrospective Studies , Time Factors , Young Adult
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