Health Care Disparities in Hereditary Ovarian Cancer: Are We Reaching the Underserved Population?
Ovarian cancer is an uncommon but deadly disease. There is no effective screening for the disease, and the majority of women with ovarian cancer present in advanced stage and eventually die from their disease. The majority of families with multiple cases of breast and ovarian cancer are found to carry germline mutations in BRCA1/2. Recent, more sensitive sequencing techniques have shown that nearly 20 % of ovarian cancer is associated with germline mutations in cancer susceptibility genes, with approximately 15 % accounted for by deleterious mutations in BRCA1/2. Women found to have mutations in BRCA1/2 can be empowered to make decisions on reproduction, cancer prevention, or treatment that may either avoid cancer or prolong survival. Though initial studies suggested that African American (AA) women were significantly less likely than White women to have mutations in BRCA1/2, this has been found to be untrue. Despite this revelation, and the clear importance of BRCA1/2 mutation status to appropriate clinical management, AA women still undergo genetic counseling and testing at much lower rates than do comparable White women. This disparity is not explained by factors such as calculated risk of a mutation, insurance coverage, or previous knowledge of the availability of testing. To date, no effective strategies have been identified that can overcome this disparity. Possible approaches include use of patient navigators, online social media, or EMR-based decision support aids. Funders should support research in this area, as it represents an actionable means to decrease the burden of ovarian and breast cancer in AA women.
Department of Obsterics and Gynecology, The Massachusetts General Hospital, 55 Fruit Street, Founders' 520B, Boston, MA, 02108, USA. trandall@mgh.harvard.edu.
Thomas C
TC
Randall
Department of Medicine, The Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02108, USA.
Katrina
K
Armstrong
D061345:Early Medical Intervention; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006580:Genetic Carrier Screening; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D054625:Healthcare Disparities; D061325:Hereditary Breast and Ovarian Cancer Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics / Q000517:prevention & control; D006801:Humans; D009154:Mutation; D035862:Vulnerable Populations
BRCA1/2; Disparities; Genetic counseling; Hereditary ovarian cancer