Disparities in compliance with the Oncotype DX breast cancer test in the United States: A National Cancer Data Base assessment

Background: Oncotype DX (ODX) is a multi-gene tumor assay for breast cancer patients. Our objective is to assess whether eligible ODX patients received the test and whether recommendations were followed based on respective risk. Methods: We retrospectively analyzed testing in patients deemed eligible for ODX using the National Cancer Data Base. Results: A total of 158,235 patients met ODX eligibility criteria. Sixty-four percent of eligible patients did not receive the test. Non-testing rose with age. White patients were more likely to be tested (56%) versus black patients (46%, p < 0.0001). Testing was highest at academic facilities (40%). Privately insured patients were more likely to get the test compared to uninsured (45 versus 34%, p < 0.0001). Those in the highest income quartile were more likely to be tested (p < 0.001). Conclusions: ODX is under-utilized, with racial and socio-economic factors influencing testing. Further studies are necessary to identify ways to remove disparities and increase testing when appropriate.