Use of Cancer Genetics Services in African-American Young Breast Cancer Survivors.
African-American women have higher rates of early-onset breast cancer compared with their Caucasian counterparts; yet, when diagnosed with breast cancer at a young age, they underuse genetic counseling and testing to manage their risk of developing future cancers.



Self-reported baseline data were collected between September 2012 and January 2013 and analyzed in 2014 from a subpopulation of 340 African-American young breast cancer survivors (YBCSs) enrolled in an RCT. YBCSs were diagnosed with invasive breast cancer or ductal carcinoma in situ between ages 20 and 45 years and were randomly selected from a statewide cancer registry. Logistic regression examined predictors of using cancer genetics services.



Overall, 28% of the sample reported having genetic counseling and 21% reported having genetic testing, which were significantly lower (p≤0.005) compared with white/other YBCSs participating in the parent study. In a multivariate analysis, income was positively associated with counseling (B=0.254, p≤0.01) and testing (B=0.297, p≤0.01), whereas higher education levels (B=-0.328, p≤0.05) and lack of access to healthcare services owing to cost (B=-1.10, p≤0.03) were negatively associated with genetic counseling. Lower income and lack of care because of high out-of-pocket costs were commonly reported barriers.



Despite national recommendations for genetic evaluation among women with early-onset breast cancer, few African-American YBCSs reported undergoing genetic counseling and testing. Most reported that their healthcare provider did not recommend these services. Interventions addressing patient, provider, and structural healthcare system barriers to using genetic counseling and testing in this population are needed.
The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services at Dana-Farber Cancer Institute, Boston, Massachusetts; Duquesne University School of Nursing, Pittsburgh, Pennsylvania.
Tarsha
T
Jones
Duquesne University School of Nursing, Pittsburgh, Pennsylvania.
Joan S
JS
Lockhart
University of Michigan School of Nursing, Ann Arbor, Michigan.
Kari E
KE
Mendelsohn-Victor
Michigan Department of Health and Human Services, Cancer Genomics Program, Lansing, Michigan.
Debra
D
Duquette
University of Michigan School of Nursing, Ann Arbor, Michigan.
Laurel L
LL
Northouse
Ohio State University College of Nursing, Columbus, Ohio.
Sonia A
SA
Duffy
Duquesne University School of Nursing, Pittsburgh, Pennsylvania.
Rosemary
R
Donley
University of Michigan School of Medicine, Ann Arbor, Michigan.
Sofia D
SD
Merajver
University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan.
Kara J
KJ
Milliron
University of Michigan School of Public Health, Ann Arbor, Michigan.
J Scott
JS
Roberts
University of Michigan School of Nursing, Ann Arbor, Michigan; University of Basel, Institute of Nursing Science, Basel, Switzerland. Electronic address: maria.katapodi@unibas.ch.
Maria C
MC
Katapodi
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000208:ethnology / Q000235:genetics*; D000073116:Cancer Survivors / Q000706:statistics & numerical data*; D005260:Female; D052138:Genes, Neoplasm; D005820:Genetic Testing / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged