Impact of Genetic Testing on Risk-Management Behavior of Black Breast Cancer Survivors: A Longitudinal, Observational Study

Ann Surg Oncol. 2020 May;27(5):1659-1670. doi: 10.1245/s10434-019-07982-9. Epub 2019 Nov 1.

Abstract

Background: Black women are overrepresented among premenopausal breast cancer (BC) survivors. These patients warrant genetic testing (GT) followed by risk-reducing behaviors. This study documented patterns and predictors of cancer risk-management behaviors among young black BC survivors after GT.

Methods: Black women (n = 143) with a diagnosis of BC at the age of 50 years or younger received GT. At 1 year after GT, participants reported receipt of risk-reducing mastectomy, risk-reducing salpingo-oophorectomy, mammogram, breast magnetic resonance imaging (MRI), CA125 test, and transvaginal/pelvic ultrasound. Logistic regression was used to examine predictors of BC risk management (risk-reducing mastectomy or breast MRI) and ovarian cancer risk management (risk-reducing salpingo-oophorectomy, CA125 test, or transvaginal/pelvic ultrasound).

Results: Of the study participants, 16 (11%) were BRCA1/2-positive, 43 (30%) had a variant of uncertain significance, and 84 (59%) were negative. During the 12 months after GT, no women received risk-reducing mastectomy. The majority (93%) received a mammogram, and a smaller proportion received breast MRI (33%), risk-reducing salpingo-oophorectomy (10%), CA125 test (11%), or transvaginal/pelvic ultrasound (34%). Longer time since the BC diagnosis predicted lower likelihood of BC risk management (odds ratio [OR] 0.54). BRCA1/2 carrier status (OR 4.57), greater perceived risk of recurrence (OR 8.03), and more hereditary breast and ovarian cancer knowledge (OR 1.37) predicted greater likelihood of ovarian cancer risk management.

Conclusions: Young black BC survivors appropriately received mammograms and ovarian cancer risk management based on their BRCA1/2 test result. However, the low usage of MRI among BRCA1/2 carriers contrasts with national guidelines. Future research should examine barriers to MRI among black BC survivors. Finally, modifiable variables predicting risk management after GT were identified, providing implications for future interventions.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • African Americans / statistics & numerical data
  • Breast Neoplasms / ethnology*
  • Breast Neoplasms / genetics
  • Breast Neoplasms / mortality
  • CA-125 Antigen
  • Cancer Survivors
  • Female
  • Genes, BRCA1
  • Genes, BRCA2
  • Genetic Predisposition to Disease
  • Genetic Testing / statistics & numerical data*
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Magnetic Resonance Imaging
  • Mastectomy / statistics & numerical data*
  • Middle Aged
  • Mutation
  • Ovarian Neoplasms / ethnology*
  • Ovarian Neoplasms / genetics
  • Ovarian Neoplasms / prevention & control*
  • Risk Assessment
  • Salpingo-oophorectomy / statistics & numerical data*
  • United States / epidemiology

Substances

  • CA-125 Antigen