LDI Research Seminar- Targeted Testing & Treatment for Breast Cancer 11_18_11
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LDI Research Seminar- Targeted Testing & Treatment for Breast Cancer 11_18_11
- 1. Targeted Testing & Treatment for Breast Cancer Implications for Disparities Jennifer Haas, MD, MSPH November 18, 2011 Leonard Davis Institute
- 3. Twice as Deadly, the Race Gap in Breast Cancer Chicago Public Radio, November 22, 2009
- 4. Breast Cancer, U.S. Women Ries et al: SEER Cancer Statistics Review, 2007 Age-adjusted incidence rate/100,000 Incidence Mortality
- 5. SOURCE: CDC (http://apps.nccd.cdc.gov/uscs/Table.aspx?Group=TableAll&Year=2005&Display=n ) US Breast Cancer Cases by Race Age-adjusted incidence rate/100,000
- 6. Human genetic variation Without variation: identical With variation: diversity “ Golden Rule” Norman Rockwell
- 7. Self-identified race not a good marker of genetics Bryc, PNSA 2009
- 10. Geographic Barriers to Trial Participation?
- 12. Knowledge and Discussion of Genetic Testing for Cancer (2005) Baer. JGIM 2010 Knowledge Discussion
- 13. The Role of the Media in Shaping Beliefs, Expectations… Jan 2001
- 14. Mass Marketing of Genomics
- 22. Trastuzumab Use p<0.0001 Haas et al. JOP 2011
- 23. Predictors of Trastuzumab Use Among HER2+( “appropriate use”) 4.8 Suggests fairly global underuse Adjusted: age, race/ethnicity, income, comorbidity, stage, surgery, region Haas et al. JOP 2011
- 24. Predictors of Trastuzumab Use Among Non-HER2+( “overuse”) 2.5 Not much “overuse” ~ 4% Adjusted: age, race/ethnicity, income, comorbidity, stage, surgery, region Haas et al. JOP 2011
- 25. Predictors of GEP Use 2.1 0.4 0.5 0.5 0.4 Adjusted: age, race/ethnicity, income, comorbidity, stage, surgery, HER2, region Haas et al. JOP 2011
- 26. Predictors of Adjuvant Chemo Use 2.1 0.4 0.5 0.5 0.4 Adjusted: age, race/ethnicity, income, comorbidity, stage, surgery, HER2, GEP, region 0.5 7.4 15.6 Haas et al. JOP 2011
- 27. GEP, Chemo, ADEs, and Costs Received GEP test: 26% Received adjuvant chemotherapy: 68% Low clinical risk 10% High clinical risk 93% Experienced ADE: 11% Low clinical risk 3% High clinical risk 12% Median total charges: $89,000 Low clinical risk $73,000 High clinical risk $103,000
- 28. Odds of Chemotherapy Use (Women with vs. without GEP Test) Adjusted for propensity to receive GEP test
- 29. Income inequality and disparities in GEP Ninez Ponce, in progress
- 35. Documentation in Charts vs. Claims