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Gaps in Breast Cancer Receptor Testing for Certain Groups

M. Alexander Otto



A cross-sectional study of more than 300,000 patients with invasive breast cancer found that breast cancer receptor status testing lags in certain populations, including older women, Black women, women from rural areas, as well as those with distant or unstaged cancers.


  • Guidelines universally recommend estrogen, progesterone, and HER2 receptor status testing to guide breast cancer treatment. 
  • To gauge uptake, investigators reviewed information on 321,913 women with invasive breast cancer in the Surveillance, Epidemiology and End Results (SEER) database from 2012-2016.


  • Overall, 4.7% of women had missing components of receptor status. 
  • Odds of having missing components of receptor status were higher in women age 80 years or older compared with those younger than 49 (adjusted odds ratio [aOR], 1.75), Black compared with White women (aOR, 1.09), and women with distant stage or unknown/unstaged cancer at diagnosis compared with local stage (aOR, 3.33 for distant; aOR, 19.39 for unknown/unstaged). 
  • Cases reported by a laboratory, nursing/convalescent home/hospice, or a physician's office, vs a hospital, were more likely to have missing components of receptor status (aOR 1.42, aOR, 9.37, aOR, 2.32, respectively). 
  • Missing components of receptor status was also more likely for women who lived in rural vs urban areas (aOR, 1.08) and for women who had unknown insurance status at the time of diagnosis (aOR, 1.27).


Missing components of receptor status "is still occurring, especially in some socioeconomic populations," the authors write. "The results of this study may help clinicians, public health practitioners, and policymakers target affected populations to minimize or eliminate this critical health disparity and help save more lives."


The work, led by Julie Stephens, MS, of Ohio State University, Columbus, was published online August 24 in JAMA Network Open. 


The data don't capture severe comorbidities, very poor prognosis, and other factors which may obviate the need for receptor testing. The data also don't capture more recent trends after 2016. 


The work was funded by the Ohio Department of Health. Senior investigator Electra Paskett, PhD, is an advisor for GSK and reported grants from Genentech, Merck, Pfizer, and Guardant Health.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape. Alex is also an MIT Knight Science Journalism fellow. Email:

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