270244 Underrepresentation of minorities and poor women in studies of gene-expression profiling of breast tumors potentially increases disparities in breast cancer outcomes

Wednesday, October 31, 2012 : 1:10 PM - 1:30 PM

Donna H. Odierna, DrPH, MS , Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA
Aimee Afable-Munsuz, PhD, MPH , Department of Community Health Sciences, SUNY Downstate School of Public Health, Brooklyn, NY
Ogechi Ikediobi, PhD , Clinical Pharmacy, University of California, San Francisco, San Francisco
Mary Beattie, MD , General Internal Medicine, University of California, San Francisco, San Francisco, CA
Sara Knight, PhD , VAMC, University of California, San Francisco, San Francisco, CA
Michelle Ko, MD, PhD , School of Medicine, University of California, San Francisco, San Francisco, CA
Adrienne Wilson , Department of Public Health, San Francisco State University, San Francisco, CA
Ninez Ponce, MPP, PhD , Department of Health Services, UCLA, Los Angeles, CA
Background: New prognostic tests, such as gene-expression profiling (GEP) of breast tumors, are purported to prolong survival and improve the quality of life for many breast cancer patients. Biological and social factors affect breast cancer incidence, progression, and mortality in diverse U.S. populations. Methods: We drew on the CDC's Evaluation of Genomic Applications in Practice and Prevention Program Working Group report, “Impact of GEP tests on breast cancer outcomes” aug¬mented by more recent literature to examine evidence on testing and validation in minority populations of three GEP assays that are used in the USA to predict clinical outcomes in patients with breast cancer. Results: Of the 22 studies we examined, six, reported race/ethnicity. Of over 6500 total study participants, about 7% as nonwhite and 2% as black. Of the six studies that reported race/ethnic¬ity, approximately 23% of patients were nonwhite, 6% was black. Outcomes were not separately evaluated by race or, generally, by estrogen receptor status. No studies reported subjects' socioeconomic status (SES).Conclusions: Evidence-based medicine has the potential for greatly improving popula¬tion health. However, under-representation and under-reporting of minority racial/ethnic groups, and the lack of information about SES in GEP studies limits the evidence-base for evaluating the utility of the tests in diverse populations. The black-white breast cancer mor¬tality gap could persist or even widen if such tests are not developed for, validated in, and accessed by underserved and minority populations. We need to build a large and diverse evidence base for GEP and other emerging technologies in personalized medicine.

Learning Areas:
Clinical medicine applied in public health
Planning of health education strategies, interventions, and programs
Public health or related public policy
Public health or related research

Learning Objectives:
Compare representation of minority populations in studies of genomic tests in breast cancer. Evaluate the generalizability of the evidence base to diverse populations.

Keywords: Evidence Based Practice, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am interested in how research itself may act as a social health determinant. I am the lead author on several papers examining representation in research of diverse populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.