Disparities in Access to Multigene Testing in Early-Stage, HR-positive, HER2-negative, Lymph Node-negative Breast Cancer

María Herrán; Emily C Zabor; Saad Sabbagh; Nadeem Bilani; Ali Hijazi; Mohamed Mohanna; Mira Itani; Zeina Nahleh

doi:10.1016/j.clbc.2025.05.018

Disparities in Access to Multigene Testing in Early-Stage, HR-positive, HER2-negative, Lymph Node-negative Breast Cancer

Clin Breast Cancer. 2025 May 24:S1526-8209(25)00149-1. doi: 10.1016/j.clbc.2025.05.018. Online ahead of print.

Authors

María Herrán¹, Emily C Zabor², Saad Sabbagh¹, Nadeem Bilani³, Ali Hijazi¹, Mohamed Mohanna¹, Mira Itani⁴, Zeina Nahleh⁵

Affiliations

¹ Department of Hematology and Oncology, Maroone Cancer Center, Weston, FL.
² Department of Quantitative Health Sciences, Taussig Cancer Institute, Cleveland, OH.
³ Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside-West Hospital System, New York, NY.
⁴ Department of Family and Preventive Medicine, Emory University, Dunwoody, GA.
⁵ Department of Hematology and Oncology, Maroone Cancer Center, Weston, FL. Electronic address: nahlehz@ccf.org.

PMID: 40541467
DOI: 10.1016/j.clbc.2025.05.018

Abstract

Background: Multigene testing (MGT) has refined breast cancer treatment. We examined real-world access to MGT for early-stage (I-II), HR-positive, HER2-negative, node-negative breast cancer and identified factors related to disparities.

Materials and methods: This retrospective analysis used the National Cancer Database (2007-2017). Socio-demographic and clinical-pathologic factors of interest were included in a multivariable logistic regression to examine associations with MGT use. Multiple imputation was used to find missing data.

Results: A total of N = 107,642 patients were eligible, of which 65,066 (60%) underwent MGT. The odds of undergoing MGT were lower among Black patients compared to White (OR 0.83, 95% CI, 0.79-0.87, P < .001), Hispanic compared to non-Hispanic (OR 0.91, 95% CI, 0.86-0.97, P = .004), uninsured compared to privately insured (OR 0.73,95% CI, 0.64-0.83, P < .001), and those in the West South-Central compared to New England region (OR 0.76, 95% CI, 0.70-0.82, P < .001). Increased odds were observed among those treated at an Integrated Network Cancer Program (OR 1.12, 95% CI, 1.05-1.19, P < .001), higher education level (OR 1.12, 95% CI, 1.06-1.18, P < .001), and a household income between $50,354 to $63,332 (OR 1.08, 95% CI, 1.02-1.14, P = .006). Those with access to MGT had higher odds of receiving adjuvant chemotherapy (OR 1.89,95% CI, 1.80-1.99, P < .001) and hormonal therapy (OR 3.17, 95% CI, 3.02-3.32, P < .001) compared to those without access to MGT after adjusting for other factors of interest.

Conclusions: This study highlights gaps in access to MGT in breast cancer. Ensuring equitable access to diagnostic and prognostic precision tools could positively impact the odds of receiving appropriate adjuvant therapy and improve patient outcomes.

Keywords: Adjuvant therapy; Cancer care access; Disparities; Multigene testing; Socio-demographic factors.