Racial Differences in the Use of <EMPH>BRCA1/2</EMPH> Testing Among Women With a Family History of Breast or Ovarian Cancer

Abstract

Context Given the current context of racial disparities in health and health care and the historical context of eugenics, racial disparities in the use of genetic susceptibility testing have been widely anticipated. However, to our knowledge there are no published studies examining the magnitude and determinants of racial differences in the use of genetic susceptibility testing. Objectives To investigate the relationship between race and the use of BRCA1/2 counseling among women with a family history of breast or ovarian cancer and to determine the contribution of socioeconomic characteristics, cancer risk perception and worry, attitudes about genetic testing, and interactions with primary care physicians to racial differences in utilization. Design, Setting, and Participants Case-control study (December 1999-August 2003) of 408 women with a family history of breast or ovarian cancer, of whom 217 underwent genetic counseling for BRCA1/2 testing (cases) and 191 women did not (controls). Participants received primary care within a large health system in greater Philadelphia, Pa. Main Outcome Measures Probability of carrying a BRCA1/2 mutation, socioeconomic characteristics, perception of breast and ovarian cancer risk, worry about breast and ovarian cancer, attitudes about BRCA1/2 testing, and primary care physician discussion of BRCA1/2 testing were measured prior to undergoing BRCA1/2 counseling for cases and at the time of enrollment for controls. Results African American women with a family history of breast or ovarian cancer were significantly less likely to undergo genetic counseling for BRCA1/2 testing than were white women with a family history of breast or ovarian cancer (odds ratio, 0.22; 95% confidence interval, 0.12-0.40). This association persisted after adjustment for probability of BRCA1/2 mutation, socioeconomic characteristics, breast and ovarian cancer risk perception and worry, attitudes about the risks and benefits of BRCA1/2 testing, and primary care physician discussion of BRCA1/2 testing (adjusted odds ratio for African American vs white, 0.28; 95% confidence interval, 0.09-0.89). Conclusions Racial disparities in the use of BRCA1/2 counseling are large and do not appear to be explained by differences in risk factors for carrying a BRCA1/2 mutation, socioeconomic factors, risk perception, attitudes, or primary care physician recommendations. The benefit of predictive genetic testing will not be fully realized unless these disparities can be addressed.

A cancer genetics toolkit improves access to genetic services through documentation and use of the family history by primary-care clinicians

“…This finding is different from studies that have found reduced rates of cancer family history documentation 34 and genetic counseling 35 for nonwhite patients that may underlie the racial disparities observed in uptake of genetic testing for HBOC. 15,36 The number of medical problems was significantly related to documentation of the cancer family history, suggesting that time to discuss family history may have been limited for patients with multiple active medical problems, or clinicians may have perceived collection and documentation of cancer family history as less relevant for these patients.…”

Acceptance of genetic testing for hereditary breast ovarian cancer among study enrollees from an African American kindred

“…Available data indicate that African-Americans may be less knowledgeable about genetic testing than non-Hispanic whites and are less likely to have access to genetic services because of lower incomes and limited health insurance coverage . A recent study reported that substantially fewer African American women used genetic testing than white women in a single health care system in a large northeastern U.S. city [Armstrong et al, 2005].…”

Development of a Brochure for Increasing Awareness of Inherited Breast Cancer in Black Women

“…Yet, previous studies systematically document underutilization of risk-appropriate BRCA genetic counseling and testing services among the black community (Chen et al, 2002;Armstrong et al, 2005). One possible explanation lies in lower levels of awareness and knowledge related to HBOC risk and availability of genetic testing services (Hughes et al, 1997;Wideroff et al, 2003b;Simon and Petrucelli, 2009).…”

“…Given the younger age of onset, a proportion of cases may be due to mutations in the BRCA genes (Chen et al, 2002;Armstrong et al, 2005). However, black women with a family history of breast and/or ovarian cancer are much less likely to access genetic counseling and testing services compared to women from other racial and ethnic groups.…”

“…A study investigating the characteristics of 646 women who received BRCA mutation testing in nonacademic settings between the years 1998 and 2000 found 94% were Caucasian, <1% were uninsured, and the median annual household income exceeded $75,000 (Chen et al, 2002). In a more recent case-control study of 408 women with a family history of breast or ovarian cancer, black women were significantly less likely to undergo BRCA genetic counseling than white women with a family history of breast or ovarian cancer (Armstrong et al, 2005). In addition to the substantial evidence suggesting that there may be underutilization of cancer genetic counseling and testing services in the black community (Chen et al, 2002;Armstrong et al, 2005;Levy et al, 2009), there have been a number of contributing factors identified including: low levels of awareness and knowledge about hereditary cancer and genetic testing (Hughes et al, 1997;Wideroff et al, 2003b;Simon and Petrucelli, 2009); inaccurate risk perception (Salant et al, 2006;Spector et al, 2009); communication of family history information (Matthews et al, 2000;Underwood et al, 2008); attitudes and cultural beliefs (Hughes et al, 2003;Thompson et al, 2003;Peters et al, 2004;Edwards et al, 2008;Simon and Petrucelli, 2009); patient-initiated inquiry (Wideroff et al, 2003a); and access to services (Hall and Olopade, 2006).…”