Use of Cancer Genetics Services in African-American Young Breast Cancer Survivors

Jones, Tarsha; Lockhart, Joan Such; Mendelsohn-Victor, Kari; Duquette, Debra; Northouse, Laurel; Duffy, Susan; Donley, Rosemary; Merajver, Sofía D.; Milliron, Kara J.; Roberts, J. Scott; Katapodi, Maria C.

doi:10.1016/j.amepre.2016.03.016

Cited by 44 publications

(67 citation statements)

References 42 publications

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“…The majority of BRCA testing has occurred in Caucasian populations, 24, 34–37 with disproportionately lower rates among Blacks and Hispanics, 23, 24, 37 consistent with our results among Blacks and Spanish-speaking Hispanics. However, English-speaking Hispanics and NHW had similar testing rates which may reflect acculturation of Hispanics over generations.…”

Section: Discussionsupporting

confidence: 90%

“…In particular, multiple studies demonstrate the importance of healthcare provider recommendations in receipt of genetic testing, with lack of physician referral amongst the most highly cited barriers to testing among BC survivors. 23, 35, 47–50 Our findings that healthcare provider discussion of testing was the strongest predictor for receipt of BRCA testing with lowest rates of both testing discussion and testing receipt among Blacks, is consistent with prior studies. Although not explored through our study, other potential explanations for observed differences include provider characteristics and distribution, as well as variability in clinical practice situations, which should be explored further through future efforts.…”

Section: Discussionsupporting

confidence: 90%

“…Furthermore, our estimates of provider discussion and genetic testing across diverse populations provides updated and novel data, compared to prior efforts with limited minority representation, non-population based sampling, or sampling frame of women diagnosed before 2008. 23, 35, 47–50 Furthermore, BRCA testing confirmation in over 72% of all cases further strengthens the accuracy and validity of our observations.…”

Section: Discussionsupporting

confidence: 83%

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Racial disparities in BRCA testing and cancer risk management across a population‐based sample of young breast cancer survivors

Cragun

Weidner

Lewis

et al. 2017

Cancer

226

193

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Background Breast cancer (BC) disparities may widen with genomic advances. We compared non-Hispanic white (NHW), Black, and Hispanic BC survivors for: 1) cancer risk management practices (CRM) among BRCA carriers; and 2) provider discussion and receipt of genetic testing. Methods A population-based sample of NHW, Black, and Hispanic women diagnosed with invasive BC ≤ age 50 in 2009–2012 were recruited through the state cancer registry. Using multiple logistic regression we compared CRM in BRCA carriers and association of demographic and clinical variables with provider discussion and receipt of testing. Results Of the 1622 participants, 36.1% (159/440) Blacks, 64.5% (579/897) NHW, 49.6% (58/117) Spanish-speaking Hispanics, and 69.0% (116/168) English-speaking Hispanics had BRCA testing, of whom 90 had a pathogenic BRCA mutation. Among BRCA carriers, RRM and RRSO rates were significantly lower among Blacks compared to Hispanics and NHW after controlling clinical and demographic variables (p=0.025 and 0.008, respectively). Compared to NHW, discussion of genetic testing with a provider was 16 times less likely among Blacks (p<0.0001) and nearly two times less likely among Spanish-speaking Hispanics (p=0.04) after controlling clinical and sociodemographic factors. Conclusions Our results suggest lower rates of RRSO among Black compared to Hispanic and NHW BRCA carriers, which is concerning as benefits from genetic testing arise from CRM options. Furthermore, lower BRCA testing rates among Blacks may partially be due to lower likelihood of provider discussion. Future studies are needed to improve cancer risk identification and management practices across all populations to prevent the widening of disparities.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 83%

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Racial disparities in BRCA testing and cancer risk management across a population‐based sample of young breast cancer survivors

Cragun

Weidner

Lewis

et al. 2017

Cancer

226

193

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“…Although we have successfully used the same recruitment method (patient recruiting relative) in our prior studies targeting women completing genetic testing and young breast cancer survivors [11,15,80], the usability and feasibility study indicated that recruitment of mutation carriers and relatives for a family-based intervention requires personal contact and follow-up phone calls. The pre-post pilot study indicated that personal contact with mutation carriers is necessary first, to assess their eligibility to participate in the Family Gene Toolkit© (i.e., confirmed BRCA mutation, not all relatives have been tested) and second, to prepare them how to broach family participation in an intervention study with their relative, and help minimize relative refusal rate.…”

Section: Enhancing Recruitment: Personal Contact To Mutation Carriersmentioning

confidence: 99%

“…Lack of communication skills and non-helpful coping (e.g., avoidance) inhibit disclosure of test results to relatives [12][13][14]. While helping family members learn more about their cancer risk is a leading motivation among women pursuing genetic testing [15,16], positive test results may also generate conflicts. Poor communication about the implications of increased cancer risks associated with the pathogenic mutation may leave family members unaware of the need for genetic counseling.…”

Section: Introductionmentioning

confidence: 99%

Development of a Web-based Family Intervention for BRCA Carriers and Their Biological Relatives: Acceptability, Feasibility, and Usability Study (Preprint)

Katapodi¹,

Jung²,

Schafenacker³

et al. 2017

Preprint

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Predictors of BRCA1/2 genetic testing among Black women with breast cancer: a population‐based study

et al. 2017

Self Cite

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Evidence shows that Black women diagnosed with breast cancer are substantially less likely to undergo BRCA testing and other multipanel genetic testing compared to White women, despite having a higher incidence of early‐age onset breast cancer and triple‐negative breast cancer (TNBC). Our study identifies predictors of BRCA testing among Black women treated for breast cancer and examines differences between BRCA testers and nontesters. We conducted an analysis of 945 Black women ages 18–64 diagnosed with localized or regional‐stage invasive breast cancer in Pennsylvania and Florida between 2007 and 2009. Logistic regression was used to identify predictors of BRCA 1/2 testing. Few (27%) (n = 252) of the participants reported having BRCA testing. In the multivariate analysis, we found that perceived benefits of BRCA testing (predisposing factor) ([OR], 1.16; 95% CI: 1.11–1.21; P < 0.001), income (enabling factor) ([OR], 2.10; 95% CI: 1.16–3.80; p = 0.014), and BRCA mutation risk category (need factor) ([OR], 3.78; 95% CI: 2.31–6.19; P < 0.001) predicted BRCA testing. These results suggest that interventions to reduce disparities in BRCA testing should focus on identifying patients with high risk of mutation, increasing patient understanding of the benefits of BRCA testing, and removing financial and other administrative barriers to genetic testing.

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Use of Cancer Genetics Services in African-American Young Breast Cancer Survivors

Cited by 44 publications

References 42 publications

Racial disparities in BRCA testing and cancer risk management across a population‐based sample of young breast cancer survivors

Racial disparities in BRCA testing and cancer risk management across a population‐based sample of young breast cancer survivors

Development of a Web-based Family Intervention for BRCA Carriers and Their Biological Relatives: Acceptability, Feasibility, and Usability Study (Preprint)

Predictors of BRCA1/2 genetic testing among Black women with breast cancer: a population‐based study

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