What does this research mean for the field?

Socioeconomic, racial, and clinicopathological factors frequently influence chemotherapy decisions in early-stage ER+/PR+ HER2- breast cancer, leading to significant deviations from genomic-guided recommendations. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to evaluate how socioeconomic and racial factors influence chemotherapy decisions in early-stage ER+/PR+ HER2- breast cancer patients.

May 29, 2026

Socioeconomic and racial disparities in receipt of treatment among early-stage ER+/PR+ HER2- breast cancer: Insights from invasive breast cancer OncoDX recurrence score database.

Key Points

This research aims to evaluate how socioeconomic and racial factors influence chemotherapy decisions in early-stage ER+/PR+ HER2- breast cancer patients.
Analyzed data from 208,674 patients in the SEER OncoDX RS database (2004-2019).
Evaluated treatment disparities using chi-square tests and multivariable logistic regression to identify independent predictors of chemotherapy utilization.
Focused on various variables, including socioeconomic status, race, hormonal receptor status, and clinicopathological characteristics.
Among post-menopausal women with Recurrence Score ≥26, 60.6% of the lowest socioeconomic status received chemotherapy compared to 66.5% of the highest (P<0.001).
In post-menopausal women with Recurrence Score <26, 9.0% of Black patients received treatment compared to 7.9% of White patients (P<0.001).
For pre-menopausal women with N1-3 disease, 42.9% of those living in rural areas received chemotherapy compared to 47.1% of urban residents (P=0.004).

Abstract

520 Background: Oncotype DX Recurrence Score (RS) predicts recurrence risk and potential benefit from chemotherapy (CT) in early-stage ER+ and HER2- breast cancer (BC). However, real-world CT decision patterns remain poorly understood. This work evaluated how socioeconomic, racial and clinical factors influence CT decisions beyond RS-guided recommendations. Methods: We analyzed patients with early-stage ER+/PR+, HER2- BC in SEER OncoDX RS Database (2004-2019). Variables included age, rurality, poverty status, socioeconomic status (SES), RS, histology, tumor grade, nodal status, PR status, and CT receipt. Treatment disparities among patients with similar RS were evaluated using chi-square tests. Multivariable logistic regression model (MVA) identified independent predictors of CT utilization among patients with similar RS. Results: A total of 208,674 patients were included (median age 60). Median follow up was 4.9 years. Among postmenopausal (post-M, ≥50yrs) women with RS≥26 (CT indicated), lowest SES (60.6% vs 66.5% highest, P15, highest SES (41.0% vs 44.2% lowest, P=0.032) and White race (41.2% vs 46.8 Black, P15 Pre-M, N1-3 Post-M, <26 Post-M, ≥26 SES (highest vs lowest) - 0.88 (0.78-0.99) - - 1.34 (1.22-1.49) Race (B vs W) - - - 1.10 (1.01-1.19) 1.14 (1.03-1.26) Histology (IDC vs ILC) - 1.22 (1.11-1.33) 1.16 (1.01-1.32) 0.84 (0.80-0.88) 1.19 (1.09-1.28) Grade (III vs I) 4.89 (3.72-6.42) 7.13 (6.42-7.93) 5.91 (4.96-7.04) 4.07 (3.80-4.36) 2.44 (2.21-2.71) PR (pos vs neg) - 0.49 (0.43-0.56) 0.44 (0.32-0.60) 0.53 (0.50-0.57) 0.82 (0.77-0.87) Not statistically significant.

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Socioeconomic and racial disparities in receipt of treatment among early-stage ER+/PR+ HER2- breast cancer: Insights from invasive breast cancer OncoDX recurrence score database.

Key Points

Abstract

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