Health Care Segregation, Physician Recommendation, and Racial Disparities inBRCA1/2Testing Among Women With Breast Cancer

Abstract

Although black and white patients with breast cancer tend to see different surgeons and oncologists, this distribution does not contribute to disparities in BRCA1/2 testing. Instead, residual racial differences in testing after accounting for patient and physician characteristics are largely attributable to differences in physician recommendations. Efforts to address these disparities should focus on ensuring equity in testing recommendations.

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

“…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.…”

“…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.…”

Health Care Disparities in Hereditary Ovarian Cancer: Are We Reaching the Underserved Population?

“…Multiple studies confirm that AA women are substantially less likely to undergo BRCA1/2 testing than White women [22,[29][30][31][32][33]. A case-control evaluation of women with family histories of breast or ovarian cancer at a large urban hospital showed that AA women were much less likely to receive genetic counseling than White women [29].…”

“…Similarly, Susswein and colleagues found significant disparities in uptake of BRCA1/2 testing between AA and White women, though there was a considerably increased uptake observed in AA women with a recent diagnosis of breast cancer. This disparity persists even after adjusting for mutation risk, insurance coverage, and attitudes about the benefits and risks of testing [22,29,33] and appears to be driven by inadequate access to testing among AA women including lack of awareness of testing, lack of recognition of risk in part due to incomplete family history information, lack of provider recommendation for testing, and lack of support for obtaining counseling and testing, particularly in resource-limited settings [34]. Addressing this large and unacceptable disparity will require novel approaches to increasing awareness of testing and mutation risk among AA women and supporting women interested in testing through the process of BRCA counseling and testing.…”

CDC Grand Rounds: Family History and Genomics as Tools for Cancer Prevention and Control

“…¶ Some have raised concerns that genomic technologies and precision medicine initiatives could increase health disparities (14). For example, studies have found lower use of genetic counseling and testing for BRCA mutations among black women (15). To ensure that implementation of genomics applications results in health benefits for all, a public health approach is needed that promotes strategies for equitable access and protection for persons identified as being at higher-than-average risk; addresses education of providers and the public to increase appropriate use; and supports surveillance to monitor and evaluate use (14).…”