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


OBJECTIVE
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.


METHODS
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.


METHODS
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.
Armstrong
Katrina
K
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pa, USA. karmstro@mail.med.upenn.edu
Micco
Ellyn
E
Carney
Amy
A
Stopfer
Jill
J
Putt
Mary
M
D000328:Adult; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology; D044383:Black People / Q000235:genetics / Q000523:psychology / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000208:ethnology* / Q000235:genetics* / Q000523:psychology; D016022:Case-Control Studies; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005817:Genetic Counseling / Q000523:psychology / Q000706:statistics & numerical data; D005820:Genetic Testing / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009154:Mutation; D010051:Ovarian Neoplasms / Q000208:ethnology* / Q000235:genetics* / Q000523:psychology; D015143:Philadelphia; D012307:Risk Factors; D012959:Socioeconomic Factors; D044465:White People / Q000235:genetics / Q000523:psychology / Q000706:statistics & numerical data*; D001741:Black or African American