Black Women Less Apt to Get Breast Cancer Gene Test

Reasons for disparity not clear, but study suggests more education, outreach needed

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By
HealthDay Reporter

TUESDAY, April 12, 2005 (HealthDay News) -- Black women are nearly 80 percent less likely than women of other ethnicities to seek genetic testing for two common mutations linked to breast and ovarian cancer.

However, according to study author Dr. Katrina Armstrong, black women aren't significantly less likely than other women to develop breast or ovarian cancer, which means testing and prevention efforts are just as important for them as for everyone else.

"We found one of the strongest influences in the use of genetic counseling for BRCA testing was a woman's race," said Armstrong, an assistant professor of medicine and epidemiology at the University of Pennsylvania School of Medicine. "Women who came in for genetic counseling were five times more likely to be white than women who didn't come in for genetic counseling."

Results of the study appear in the April 13 issue of the Journal of the American Medical Association.

Mutations in either the BRCA1 or BRCA2 genes indicate an increased risk of breast and ovarian cancer. A mutation in either of these genes means a 50 percent to 85 percent increased risk of breast cancer and between a 14 percent and 40 percent increased lifetime risk of developing ovarian cancer, according to the study.

While commercial tests for these mutations became available in 1996, Armstrong and her colleagues felt little was known about who seeks these tests and what factors keep women from getting tested. Armstrong said that, at the start of the study, the researchers expected differences in insurance coverage and other socioeconomic factors, as well as personal perception of cancer risk, would be the largest factors in determining who had these genetic tests.

In the study, the researchers compared the profiles of 217 women who had genetic counseling for BRCA1/2 testing to those of 191 women who did not have the tests. The women were between the ages of 18 and 80, and all were seen by primary-care physicians within the University of Pennsylvania Health System. Patients within this health system are primarily white (85.4 percent), with just over 5 percent black, 7.7 percent Asian and 1.5 percent Hispanic.

All of the women included in the study had a family history of breast or ovarian cancer, putting them at higher risk for those cancers.

Contrary to their expectations, the researchers found the most significant predictor of whether or not someone at high risk for breast or ovarian cancer would seek genetic counseling was race. Black women were 78 percent less likely to seek genetic counseling regarding their cancer risk compared to women of other races.

Even after the researchers adjusted for other potential factors, such as socioeconomic status and the perception of cancer risk, black women were still 72 percent less likely to seek genetic testing.

Armstrong said she thought differences in insurance coverage or in perception of risk would explain these differences, but they didn't. That leaves two likely possibilities, she said, though the researchers weren't able to look at these factors in the current study.

The first possibility, she said, is that women of different races may be seeing different types of primary-care physicians, and that certain physicians may be more likely to recommend genetic testing. The second factor may be a concern about the potential misuse of genetic information, Armstrong said.

Dr. Jay Brooks, chairman of hematology and oncology at the Ochsner Clinic Foundation Hospital in New Orleans, said he does see a cultural difference in the perception of cancer risk and outcome in his practice. He said many of his white patients feel that "you can do something about cancer," while some black patients seem to exhibit "more of a fatalistic acceptance of cancer. They feel that you can't do anything about it."

He also believes genetic testing is a very complex subject, one that even many doctors don't fully understand. "When the subject is genetic testing, people's eyes start to glaze over," Brooks said.

Both Armstrong and Brooks advocated more physician education so that doctors can reach out to their patients and let them know what tests are available to people at a high risk of developing cancer.

In an accompanying editorial, researchers from the University of Chicago point out the results should be interpreted with caution because the study population was fairly small, and the number of black women included in the analysis was less than 10 percent of those who received genetic counseling.

But, they wrote, "The benefits gained from risk assessment, genetic counseling, intensive screening, as well as risk modifying behavior, medications and surgeries will remain unrealized for the majority of mutation carriers until efforts are increased to define and bridge the racial, ethnic, economic and knowledge-based disparities that contribute to the unequal access and utilization of preventive and medical services."

More information

If you'd like to learn more about the BRCA genes, visit the National Cancer Institute.

SOURCES: Katrina Armstrong, M.D., MSCE, assistant professor, medicine and epidemiology, University of Pennsylvania School of Medicine, Philadelphia; Jay Brooks, M.D., chairman, hematology/oncology, Ochsner Clinic Foundation Hospital, New Orleans; April 13, 2005, Journal of the American Medical Association

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