In a study of SEER (Surveillance, Epidemiology, and End Results) data reported in JAMA Network Open, Stephens et al found that approximately 5% of patients with invasive breast cancer had missing components of receptor status and identified several factors associated with the lack of information.
Study Details and Key Findings
The study involved data from 18 SEER registries on patients with a diagnosis of invasive breast cancer between January 2012 and December 2016.
Among 321,913 patients with invasive breast cancer included in the analysis, 1,928 (1%) were American Indian/Alaska Native; 28,173 (9%) were Asian/Pacific Islander; 36,357 (11%) were Black; and 252,447 (78%) were White. Among the 321,913 patients, 15,250 (4.7%) had missing components of receptor status.
On multivariate analysis, likelihood of missing components of receptor status was greater for patients aged ≥ 80 years vs < 49 years (adjusted odds ratio [aOR] = 1.75, 95% confidence interval [CI] = 1.65–1.88), Black vs White patients (aOR = 1.09, 95% CI = 1.00–1.16), and patients with distant-stage (aOR = 3.33, 95% CI = 3.17–3.50) or unknown stage/unstaged cancer (aOR= 19.39, 95% CI= 18.15–20.72) at diagnosis vs local-stage disease at diagnosis.
Compared with hospital inpatient/outpatient or clinic reporting of cases, missing components of receptor status was more likely for cases reported by laboratory only (aOR = 1.42, 95% CI = 1.28–1.60), nursing/convalescent home/hospice (aOR = 9.37, 95% CI = 6.03–14.53), and physicians’ office (aOR = 2.32, 95% CI = 2.06–2.62).
Compared with known insured status, likelihood of missing components of receptor status was greater with insured/no specifics status (aOR = 1.75, 95% CI = 1.60–1.92) and insurance status unknown (aOR = 1.27, 95% CI = 1.12–1.43). Likelihood of missing components of receptor status was greater in rural vs urban areas (aOR = 1.08, 95% CI = 1.03–1.15).
The investigators concluded, “The results of this cross-sectional study of women with a diagnosis of invasive breast cancer suggest that despite a standard of care recommended by all expert guidelines, there needs to be greater focus on hormone receptor and [HER2] testing in all women with invasive breast cancer. The results of this study may help clinicians, public health practitioners, and policymakers target affected populations to minimize or eliminate this critical health disparity and help save more lives.”
Julie A. Stephens, MS, of the Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, is the corresponding author for the JAMA Network Open article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
