PO.PS01.08 · 人群科学
韩国男性乳腺癌种系基因检测中的社会经济和地理差异
Socioeconomic and geographic disparities in germline genetic testing for Korean male breast cancer
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
引言：男性乳腺癌（MBC）占所有乳腺癌的<1%。推荐对所有MBC患者进行种系基因检测（GT），以用于治疗和家族风险评估。在韩国，纳入报销的GT最初聚焦于BRCA1/2，随后于2017年扩展至多基因panel检测（MGPT）。全国数据显示，从2019年至2023年MGPT使用量增加了2.6倍；然而，89.7%的检测在三级中心进行，引发了对公平可及性的担忧。我们旨在考察GT使用的时间趋势，并量化韩国MBC患者在可及性方面的社会经济和地理差异。
方法：我们使用K-CURE（韩国临床数据卓越研究利用网络）中的癌症公共图书馆数据库评估了根据GT接受情况的时间趋势、决定因素和生存结局，K-CURE是一个连接癌症发病率、保险理赔和死亡率数据的全国性登记库。在应用2年洗脱期后，共识别出2014年至2019年间诊断的774例MBC病例（ICD-10 C50），随访数据可至2021年。GT定义为诊断后12个月内进行的BRCA或MGPT检测。评估了GT接受情况的时间趋势及相关因素（收入水平、医院类型和地区）。使用Cox比例风险模型结合倾向评分匹配和逆概率加权探讨了根据GT接受情况的生存。
结果：总体而言，360例患者（46.5%）接受了GT，接受检测的比例从2014年的7.0%显著上升至2021年的68.9%（p<0.001）。这一趋势主要由BRCA检测驱动，其占总体增长的92.3%，而MGPT仅贡献7.7%。医疗救助受助者接受GT的比例显著低于最高收入五分位数的患者（20.0% vs. 51.4%，p<0.01），小型医院也显著低于三级中心（25.0% vs. 52.6%，p<0.01）。地理集中化明显，42.8%的GT在首尔进行，其中48.0%为非首尔居民。在多变量模型中，较高收入（p=0.013）和居住于首尔（p=0.023）独立地与较高的GT接受率相关，而医院类型不显著（p=0.087）。就总生存（OS）而言，GT接受情况与OS改善相关[校正HR 0.55（95% CI 0.36-0.83）；p<0.01]。
结论：尽管GT使用量持续增加，但可及性方面显著的社会经济和地理差异表明，韩国MBC的精准肿瘤学仍不公平。这些发现突显了国家报销政策与指南一致护理的现实交付之间的差距。需要进一步采取有针对性的干预措施，以减少基于收入和地区的GT障碍。（本研究由韩国国家癌症中心资助，资助编号NCC2410821和NCC2510430）
查看英文原文 English abstract
Introduction: Male breast cancer (MBC) accounts for <1% of all breast cancers. Germline genetic testing (GT) is recommended for all MBC patients for treatment and family risk assessment. In Korea, reimbursed GT initially focused on BRCA1/2 then expanded to multigene panel testing (MGPT) in 2017. Nationwide data demonstrate a 2.6-fold increase in MGPT utilization from 2019 to 2023; however, 89.7% of tests were performed in tertiary centers raising concerns about equitable access. We aimed to examine time trends in GT utilization and quantify socioeconomic and geographic disparities in access among Korean MBC patients.
Methods: We assessed time trends, determinants and survival outcomes according to GT receipt using the Cancer Public Library Database in K-CURE (Korea-Clinical data Utilization network for Research Excellence), a nationwide registry linking cancer incidence, insurance claims, and mortality data. Total of 774 MBC cases (ICD-10 C50) diagnosed between 2014 and 2019 were identified after applying a 2-year washout period, with follow-up available through 2021. GT was defined as BRCA or MGPT within 12 months of diagnosis. Time trends and associated factors (income level, hospital type, and region) of GT receipt was evaluated. Survival according to GT receipt was explored using Cox proportional hazards models with propensity score matching and inverse probability weighting.
Results: Overall, 360 patients (46.5%) received GT, and the proportion undergoing testing increased significantly from 7.0% in 2014 to 68.9% in 2021 (p<0.001). This trend was driven predominantly by BRCA testing, which accounted for 92.3% of the overall increase, whereas MGPT contributed only 7.7%. GT receipt was significantly lower among medical aid recipients than among patients in the highest income quintile (20.0% vs. 51.4%, p<0.01), and in small hospitals compared to tertiary centers (25.0% vs. 52.6%, p<0.01). Geographic centralization was prominent that 42.8% of GT was performed in Seoul, among them 48.0% were non-Seoul residents. Higher income (p=0.013) and residence in Seoul (p=0.023) were independently associated with higher GT receipt, while hospital type was not significant (p=0.087) in multivariable models. For overall survival (OS), GT receipt was associated with improved OS [adjusted HR 0.55 (95% CI 0.36-0.83); p<0.01].
Conclusion: Despite sustained increases in GT utilization, marked socioeconomic and geographic disparities in access indicate that precision oncology for Korean MBC remains inequitable. These findings highlight gaps between national reimbursement policies and the real-world delivery of guideline-concordant care. Further targeted interventions to reduce income- and region-based barriers to GT would be needed. (This study was supported by grants from the National Cancer Center, Korea Grant No. NCC2410821 & NCC2510430)
利益披露 Disclosure
J. Jang, None..
E. Lee, None..
H. Kim, None..
K. Sun-Young, None.