Racial disparities in BRCA testing and cancer risk management across a population-based sample of young breast cancer survivors.
BACKGROUND
Breast cancer (BC) disparities may widen with genomic advances. The authors compared non-Hispanic white (NHW), black, and Hispanic BC survivors for 1) cancer risk-management practices among BRCA carriers and 2) provider discussion and receipt of genetic testing.


METHODS
A population-based sample of NHW, black, and Hispanic women who had been diagnosed with invasive BC at age 50 years or younger from 2009 to 2012 were recruited through the state cancer registry. Multiple logistic regression was used to compare cancer risk-management practices in BRCA carriers and associations of demographic and clinical variables with provider discussion and receipt of testing.


RESULTS
Of 1622 participants, 159 of 440 (36.1%) black women, 579 of 897 (64.5%) NHW women, 58 of 117 (49.6%) Spanish-speaking Hispanic women, and 116 of 168 (69%) English-speaking Hispanic women underwent BRCA testing, of whom 90 had a pathogenic BRCA mutation identified. Among BRCA carriers, the rates of risk-reducing mastectomy and risk-reducing salpingo-oophorectomy were significantly lower among black women compared with Hispanic and NHW women after controlling for clinical and demographic variables (P = .025 and P = .008, respectively). Compared with NHW women, discussion of genetic testing with a provider was 16 times less likely among black women (P < .0001) and nearly 2 times less likely among Spanish-speaking Hispanic women (P = .04) after controlling for clinical and sociodemographic factors.


CONCLUSIONS
The current results suggest that the rates of risk-reducing salpingo-oophorectomy are lower among black BRCA carriers compared with their Hispanic and NHW counterparts, which is concerning because benefits from genetic testing arise from cancer risk-management practice options. Furthermore, lower BRCA testing rates among blacks may partially be because of a lower likelihood of provider discussion. Future studies are needed to improve cancer risk identification and management practices across all populations to prevent the widening of disparities. Cancer 2017;123:2497-05. © 2017 American Cancer Society.
Population Sciences, Moffitt Cancer Center, Tampa, Florida.|Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida.
Deborah
D
Cragun
Population Sciences, Moffitt Cancer Center, Tampa, Florida.
Anne
A
Weidner
Population Sciences, Moffitt Cancer Center, Tampa, Florida.
Courtney
C
Lewis
Population Sciences, Moffitt Cancer Center, Tampa, Florida.
Devon
D
Bonner
Population Sciences, Moffitt Cancer Center, Tampa, Florida.
Jongphil
J
Kim
Population Sciences, Moffitt Cancer Center, Tampa, Florida.
Susan T
ST
Vadaparampil
Population Sciences, Moffitt Cancer Center, Tampa, Florida.
Tuya
T
Pal
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology*; D061325:Hereditary Breast and Ovarian Cancer Syndrome / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy; D006579:Heterozygote; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control*; D010052:Ovariectomy / Q000706:statistics & numerical data*; D000072036:Prophylactic Mastectomy / Q000706:statistics & numerical data*; D065286:Prophylactic Surgical Procedures / Q000706:statistics & numerical data; D018570:Risk Assessment; D058994:Salpingectomy / Q000706:statistics & numerical data*; D017741:Survivors; D044465:White People / Q000706:statistics & numerical data
breast cancer; cancer disparities; cancer risk management genetic testing; hereditary cancer