Background: Women with a lower socioeconomic status (SES) have an increased risk of dying from breast cancer (BC) than those with a higher SES. The association of SES with BC survival may be partially mediated by factors such as Oncotype DX (ODX) testing and stage at diagnosis. This study aims to examine SES disparities in survival among HR+/HER2- BC women and to quantify the mediating effects of the ODX test and stage. Methods: We used data from the Louisiana Tumor Registry to identify women aged 20–90 years diagnosed with stage I–II in 2011–2014 and stage I–III in 2015–2017 HR+/HER2- BC who underwent BC surgery. The follow-up cutoff date was 31 December 2020. Cox proportional hazard regression and generalized mediation analysis were both performed. Results: Of 8931 BC women, 41.4% underwent ODX testing. After adjusting for sociodemographic, tumor characteristic, and treatment variables, low SES women had a higher hazard of overall death (HR = 1.16, 95% CI: 1.02–1.32) and BC-specific death (HR = 1.37; 95% CI: 1.01–1.87) compared to high SES women. The ODX test and stage explained 9.0% and 11.2% SES differences in the hazard of overall death and 4.4% and 13.3% in BC-specific death, respectively. Conclusions: Low SES is associated with higher hazard rates of overall and cause-specific death among women with breast cancer, even after adjustment. Differences in Oncotype DX (ODX) testing and stage at diagnosis explained part of these disparities. Targeted interventions are needed to improve access to genomic testing and early detection to reduce SES-related disparities in breast cancer outcomes.
背景：社会经济地位较低的女性死于乳腺癌的风险高于社会经济地位较高的女性。社会经济地位与乳腺癌生存率之间的关联可能部分由Oncotype DX检测和诊断分期等因素介导。本研究旨在探讨HR+/HER2-乳腺癌女性生存率的社会经济地位差异，并量化Oncotype DX检测和分期的中介效应。 方法：我们利用路易斯安那肿瘤登记处的数据，纳入2011-2014年诊断为I-II期、2015-2017年诊断为I-III期且接受乳腺癌手术的20-90岁HR+/HER2-乳腺癌女性患者。随访截止日期为2020年12月31日。研究同时采用Cox比例风险回归模型和广义中介效应分析方法。 结果：在8931名乳腺癌女性中，41.4%接受了Oncotype DX检测。在调整社会人口学特征、肿瘤特征和治疗变量后，低社会经济地位女性相比高社会经济地位女性具有更高的全因死亡风险（HR=1.16，95% CI：1.02-1.32）和乳腺癌特异性死亡风险（HR=1.37；95% CI：1.01-1.87）。Oncotype DX检测和诊断分期分别解释了全因死亡风险中9.0%和11.2%的社会经济地位差异，以及乳腺癌特异性死亡风险中4.4%和13.3%的社会经济地位差异。 结论：即使在调整相关因素后，低社会经济地位仍与乳腺癌女性患者较高的全因死亡和特异性死亡风险相关。Oncotype DX检测和诊断分期的差异部分解释了这些生存差异。需要采取针对性干预措施，改善基因组检测的可及性和早期诊断，以减少乳腺癌结局中与社会经济地位相关的差异。
肿瘤(癌症)患者之家