Breast Cancer Research and Treatment

, Volume 170, Issue 2, pp 361–371 | Cite as

Association between physician characteristics and the use of 21-gene recurrence score genomic testing among Medicare beneficiaries with early-stage breast cancer, 2008–2011

  • Lauren E. Wilson
  • Craig Evan Pollack
  • Melissa A. Greiner
  • Michaela A. Dinan



We sought to determine whether physician-level characteristics were associated with 21-gene recurrence score (RS) genomic testing to evaluate recurrence risk and benefit of adjuvant chemotherapy in patients with estrogen receptor-positive, node-negative breast cancer.


Retrospective cohort study of a nationally representative sample of Medicare beneficiaries using Surveillance, Epidemiology, and End Results program-Medicare data linked with the American Medical Association physician master file. The main outcome was receipt of genomic testing within 1 year of diagnosis as a function of physician-level factors.


A total of 24,463 patients met the study criteria; they received care from 3172 surgeons and 2475 medical oncologists. Of 4124 tests ordered, 70% were ordered by a medical oncologist and 16% by a surgeon. In multivariable regression models, multiple variables were associated with receipt of testing, including having a medical oncologist (odds ratio [OR] 2.77; 95% CI 2.00–3.82), a surgeon specializing in surgical oncology (OR 1.20; 95% CI 1.09–1.31), and a female medical oncologist (OR 1.10; 95% CI 1.02–1.20). Having a medical oncologist with 5 or more years in practice was associated with lower odds of testing (OR 0.83; 95% CI 0.76–0.92). Surgical procedures performed at academic centers were associated with higher odds of testing (OR 1.11; 95% CI 1.02–1.20).


Although most RS testing was ordered by medical oncologists, physicians in other specialties ordered roughly one-third of the tests. Physician characteristics, including gender and time in practice, were associated with receiving testing, creating opportunities for targeting interventions to help patients receive optimal care.


Biomarkers Tumor Breast neoplasms Chemotherapy Adjuvant Gene expression profiling Genetic testing Practice patterns Physicians’ SEER program 



American Medical Association


Estrogen receptor


Human epidermal growth factor receptor 2


International classification of diseases, ninth revision, clinical modification


National Comprehensive Cancer Network


Odds ratio


Recurrence score


Surveillance, Epidemiology, and End Results



This work was supported by the Agency for Healthcare Research and Quality, US Department of Health and Human Services (Grant R00HS022189). Erin Campbell, MS, and Damon M. Seils, MA, Duke University, provided editorial assistance and prepared the manuscript. They did not receive compensation for their assistance apart from their employment at the institution where the study was conducted. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare & Medicaid Services; Information Management Services, Inc; and the SEER Program tumor registries in the creation of the SEER-Medicare database.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

The institutional review board of the Duke University Health System approved the study.

Supplementary material

10549_2018_4746_MOESM1_ESM.pdf (554 kb)
Supplementary material 1 (PDF 554 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Lauren E. Wilson
    • 1
  • Craig Evan Pollack
    • 2
  • Melissa A. Greiner
    • 1
  • Michaela A. Dinan
    • 1
  1. 1.Department of Population Health SciencesDuke University School of MedicineDurhamUSA
  2. 2.Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA

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