A Big Gap In Breast Cancer Testing
A new study by UCLA researchers concludes that income plays a significant role for women seeking front-line diagnostic screenings to help treat their breast cancers.
The study, which focused on more than 1,800 breast cancer patients in 31 states, showed a distinct division by income and race among women who have access to the latest testing, known as gene expression profiling. The study’s cohorts were about equally divided by three income levels, ranging from less than $50,000 a year to more than $100,000.
Such a test analyzes the genetic structure of breast cancer tumors. The data leads clinicians to making specific decisions about how medications, chemotherapy and radiation should be deployed in the treatment of the cancer.
Although such tests have proliferated in recent years, the study focused on Oncotype DX, a specific cancer test developed and distributed by Genomic Health. The company’s U.S. headquarters is in Redwood City. It did not immediately respond to a request seeking comment.
UCLA researchers pored over de-identified data provided by insurer Aetna. They concluded that there was a double-digit percentage gap in the number of higher-income women who use genetic profiling in their breast cancer treatment compared to those with lower incomes, even though they may have the same level of insurance.
Overall, 16.2% of women who earned more than $100,000 a year underwent such testing. But only 12.4% of women who earned between $50,000 and $100,000 used such tests for their oncology care. Among those who earn below $50,000, it dropped to 9.5%, far below the overall test uptake of 12.5%. Moreover, women who resided in regions with high income inequality were 8.4% more likely to undergo testing than those who resided in regions with a smaller income gap.
Such molecular tests are pricey, with some versions costing $2,000 or more. The study did not take into consideration issues such as co-payments and deductibles.
“Our study shows that even among women who have insurance, where they live and how income is distributed in their community were closely linked to their chance of getting access to an effective innovation in the early years of its diffusion,” said Ninez Ponce, associate director of the UCLA Center for Health Policy Research. Ponce was lead author of the study.
Aside from the gaps in test usage based on income, there was also larger chasms by ethnicity. Only 8.6% of African-Americans underwent the test, and just 1.5% of Latinas.
According to data from the California Cancer Registry, the mortality rate among African-American women in the state is 33 per 100,000, more than 50% higher than the statewide average of 21.8 per 100,000. The rate among Latinas is 17.1 per 100,000.
“Income inequality is at an all-time high right now,” said Jennifer Haas, M.D., a study co-author and associate professor at Harvard Medical School’s Brigham and Women’s Hospital. “That it should have a bearing on who gets an innovative test and who doesn’t could lead to more social disparities in cancer care.”
The study was released just weeks after the Obama administration called for extra funding to accelerate the use of such tests as part of a precision medicine initiative, particularly for the treatment of various forms of cancer.
