Racial differences in the use of BRCA1/2 testing among women with a family history of breast or ovarian cancer

JAMA. 2005 Apr 13;293(14):1729-36. doi: 10.1001/jama.293.14.1729.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • African Continental Ancestry Group / genetics
  • African Continental Ancestry Group / psychology
  • African Continental Ancestry Group / statistics & numerical data*
  • Aged
  • Attitude to Health / ethnology
  • Breast Neoplasms / ethnology*
  • Breast Neoplasms / genetics*
  • Breast Neoplasms / psychology
  • Case-Control Studies
  • European Continental Ancestry Group / genetics
  • European Continental Ancestry Group / psychology
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Genes, BRCA1*
  • Genes, BRCA2*
  • Genetic Counseling / psychology
  • Genetic Counseling / statistics & numerical data
  • Genetic Testing / psychology
  • Genetic Testing / statistics & numerical data*
  • Humans
  • Logistic Models
  • Middle Aged
  • Mutation
  • Ovarian Neoplasms / ethnology*
  • Ovarian Neoplasms / genetics*
  • Ovarian Neoplasms / psychology
  • Philadelphia
  • Risk Factors
  • Socioeconomic Factors