Racial Differences in the Use of BRCA 1/2 Testing Among Women with a Family History of Breast or Ovarian Cancer

The authors investigated if race was a factor in whether women with a family history of breast or ovarian cancer received counseling concerning availability of genetic testing for BRCA 1/2 mutations. Mutations in BRCA1 or BRCA2 confer a significant risk for development of breast and ovarian cancers (a lifetime breast cancer risk of 50–85% and a lifetime ovarian cancer risk of 14–40%). BRCA 1/2 testing became available in 1996, but little is known about its use in the general population, including how race operates as a factor in determining who undergoes genetic counseling.

This paper describes a case-control study of 408 women with a family history of either cancer. Of the women, 217 underwent genetic counseling for BRCA 1/2 testing and 191 did not. African-American women were significantly less likely to undergo counseling than White women with similar family histories, an association that persisted after adjustment for socioeconomic factors, cancer risk perception and worry, attitudes about the benefits of testing, and primary care physician discussion of the testing. Use of BRCA counseling was also positively associated with younger age, probability of having a BRCA mutation, higher breast and ovarian cancer risk perception, attitudes about discrimination, and having discussed the test with a gynecologist or primary care physician.

The authors believe that this is the first study to document racial disparity in the clinical use of genetic susceptibility testing, although the issue has been widely discussed. In this study, White women were five times more likely to undergo counseling than African-American women, even though predicted probability of a BRCA mutation differed little between the two groups. The authors hypothesize that many factors may be at work, such as possible health-care related distrust by African Americans (which may include slower uptake of new technologies) and differences in primary care physicians rather than differences in the women themselves. Further research is necessary to untangle effects that the "highly charged relationship" between race and genetics may be having in utilization of genetic testing.

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