--- title: "Gene expression profiling & chemotx in early-stage breast ca | Sutter Health" description: "Although there was greater use of RS for patients who sought care in more than one health care setting, use of chemotherapy followed RS guidance in University and Community health care systems. These results suggest that precision medicine may help optimize cancer treatment across health care settings." url: "https://www.sutterhealth.org/research/publications/gene-expression-profile-chemotx-breast-ca-1055312292" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Gene expression profiling & chemotx in early-stage breast ca # Use of gene expression profiling and chemotherapy in early-stage breast cancer: a study of linked electronic medical records, cancer registry data, and genomic data across two health care systems. Afghahi A, Mathur M, Thompson CA, Mitani A, Rigdon J, Desai M, Yu PP, de Bruin MA, Seto T, Olson C, Kenkare P, Gomez SL, Das AK, Luft HS, Sledge GW Jr, Sing AP, & Kurian AW. _J Oncol Pract. pii: JOPR009803. \[Epub ahead of print\]_ 2016-05-24 ## Abstract PURPOSE: The 21-gene recurrence score (RS) identifies patients with breast cancer who derive little benefit from chemotherapy; it may reduce unwarranted variability in the use of chemotherapy. We tested whether the use of RS seems to guide chemotherapy receipt across different cancer care settings. METHODS: We developed a retrospective cohort of patients with breast cancer by using electronic medical record data from Stanford University (hereafter University) and Palo Alto Medical Foundation (hereafter Community) linked with demographic and staging data from the California Cancer Registry and RS results from the testing laboratory (Genomic Health Inc., Redwood City, CA). Multivariable analysis was performed to identify predictors of RS and chemotherapy use. RESULTS: In all, 10,125 patients with breast cancer were diagnosed in the University or Community systems from 2005 to 2011; 2,418 (23.9%) met RS guidelines criteria, of whom 15.6% received RS. RS was less often used for patients with involved lymph nodes, higher tumor grade, and age < 40 or ≥ 65 years. Among RS recipients, chemotherapy receipt was associated with a higher score (intermediate v low: odds ratio, 3.66; 95% CI, 1.94 to 6.91). A total of 293 patients (10.6%) received care in both health care systems (hereafter dual use); although receipt of RS was associated with dual use (v University: odds ratio, 1.73; 95% CI, 1.18 to 2.55), there was no difference in use of chemotherapy after RS by health care setting. CONCLUSION: Although there was greater use of RS for patients who sought care in more than one health care setting, use of chemotherapy followed RS guidance in University and Community health care systems. These results suggest that precision medicine may help optimize cancer treatment across health care settings. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/27221993) ## Research topics - [All Cancer](https://www.sutterhealth.org/research-search-results?query=%22%5C%22All+Cancer%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Genetics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Genetics%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) - [Women's Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Women%27s+Health%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Higher absolute lymphocyte counts predict lower mortality from early-stage triple-negative breast cancer.](https://www.sutterhealth.org/research/publications/higher-lyphocyte-count-predict-lower-mortality-breast-ca-1055312328) Afghahi A, Purington N, Han SS, Desai M, Pierson E, Mathur MB, Seto T, Thompson CA, Rigdon J, Telli ML, Badve SS, Curtis C, West RB, Horst K, Gomez SL, Ford JM, Sledge GW, Kurian AW. Clin Cancer Res. pii: clincanres.1323.2017. doi: 10.1158/1078-0432.CCR-17-1323. \[Epub ahead of print\] 2018 Mar 26 - Publication ### [Selecting new upfront regimens for advanced ovarian cancer with biomarker guidance.](https://www.sutterhealth.org/research/publications/select-upfront-regimens-in-ovarian-cancer-with-biomarkers-1055312825) Chan JK, Liang SY, Kapp DS, Chan JE, Herzog TJ, Coleman RL, Monk BJ, Richardson MT. Gynecol Oncol. S0090-8258(20)33910-X. doi: 10.1016/j.ygyno.2020.09.017. Online ahead of print. 2020 Sep 26 - Publication ### [Tradeoffs of using administrative claims and medical records to identify the use of personalized medicine for patients with breast cancer.](https://www.sutterhealth.org/research/publications/identify-use-of-personalized-med-in-breast-cancer-1055312577) Liang SY, Phillips KA, Wang G, Keohane C, Armstrong J, Morris WM, Haas JS. Med Care. 49(6):e1-8. doi: 10.1097/MLR.0b013e318207e87e. 2011 Jun 01 - Publication ### [The Healthcare Systems Research Network (HCSRN) as an environment for dissemination and implementation research: a case study of developing a multi-site research study in precision medicine.](https://www.sutterhealth.org/research/publications/hcsrn-as-environment-for-implementation-research-1055312447) Rahm AK, Ladd I, Burnett-Hartman AN, Epstein MM, Lowery JT, Lu CY, Pawloski PA, Sharaf RN, Liang SY, Hunter JE. EGEMS (Wash DC). 7(1):16. doi: 10.5334/egems.283. 2019 Apr 12 - Publication ### [Mapping the decision-making process for adjuvant endocrine therapy for breast cancer: the role of decisional resolve.](https://www.sutterhealth.org/research/publications/decision-making-adjuvant-endocr-tx-breast-ca-1055312417) Beryl LL, Rendle KA, Halley MC, Gillespie KA, May SG, Glover J, Yu P, Chattopadhyay R, Frosch DL. Med Decis Making. pii: 0272989X16640488. \[Epub ahead of print\] 2016 Apr 06 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/gene-expression-profile-chemotx-breast-ca-1055312292#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Gene expression profiling & chemotx in early-stage breast ca"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/gene-expression-profile-chemotx-breast-ca-1055312292#medicalscholarlyarticle","name":"Use of gene expression profiling and chemotherapy in early-stage breast cancer: a study of linked electronic medical records, cancer registry data, and genomic data across two health care systems.","headline":"Gene expression profiling & chemotx in early-stage breast ca","abstract":"PURPOSE: The 21-gene recurrence score (RS) identifies patients with breast cancer who derive little benefit from chemotherapy; it may reduce unwarranted variability in the use of chemotherapy. We tested whether the use of RS seems to guide chemotherapy receipt across different cancer care settings. METHODS: We developed a retrospective cohort of patients with breast cancer by using electronic medical record data from Stanford University (hereafter University) and Palo Alto Medical Foundation (hereafter Community) linked with demographic and staging data from the California Cancer Registry and RS results from the testing laboratory (Genomic Health Inc., Redwood City, CA). Multivariable analysis was performed to identify predictors of RS and chemotherapy use. RESULTS: In all, 10,125 patients with breast cancer were diagnosed in the University or Community systems from 2005 to 2011; 2,418 (23.9%) met RS guidelines criteria, of whom 15.6% received RS. RS was less often used for patients with involved lymph nodes, higher tumor grade, and age \u003c 40 or ≥ 65 years. Among RS recipients, chemotherapy receipt was associated with a higher score (intermediate v low: odds ratio, 3.66; 95% CI, 1.94 to 6.91). A total of 293 patients (10.6%) received care in both health care systems (hereafter dual use); although receipt of RS was associated with dual use (v University: odds ratio, 1.73; 95% CI, 1.18 to 2.55), there was no difference in use of chemotherapy after RS by health care setting. CONCLUSION: Although there was greater use of RS for patients who sought care in more than one health care setting, use of chemotherapy followed RS guidance in University and Community health care systems. These results suggest that precision medicine may help optimize cancer treatment across health care settings.","description":"Although there was greater use of RS for patients who sought care in more than one health care setting, use of chemotherapy followed RS guidance in University and Community health care systems. 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