Last Updated: 2008-01-17 10:59:34 -0400 (Reuters Health)
NEW YORK (Reuters Health) - In general, African American women are less likely than white women to pursue genetic testing for BRCA1/2, researchers report. However, African American women with a recent diagnosis of breast cancer are much more likely to do so, according to the article in the January 1st issue of the Journal of Clinical Oncology.
"Especially in the acute setting, everybody deserves consideration for testing if their clinical and family history situation warrant it," Dr. James P. Evans, from the University of North Carolina at Chapel Hill, told Reuters Health. "And regardless of race, one has to approach genetic testing as an important option and explain the pros and cons to the patient."
Dr. Evans and associates examined race and the timing of breast cancer diagnosis in relation to uptake of BRCA1/2 genetic testing among patients seen by the UNC Cancer Genetics Service.
Among 768 women with a diagnosis of breast cancer who were offered BRCA1/2 testing, African American and white patients did not differ with respect to their median a priori risk of harboring a BRCA1/2 mutation, the authors report.
Overall, African American women were less likely than white women (odds ratio, 0.54) to undergo BRCA1/2 genetic testing, the author report.
Women diagnosed recently had a higher odds of pursuing testing than did women diagnosed more than 1 year before genetic evaluation, the investigators say, but this difference was statistically significant only for African American women (OR, 2.77).
"Elucidation of why a recent diagnosis of breast cancer increases African Americans' uptake of BRCA1/2 genetic testing so dramatically could contribute to a better understanding of racial disparities in genetic testing and medicine," the authors conclude.
"We continue to aggressively try to find avenues for women who need testing but can't afford it," Dr. Evans said. "One of the most interesting (and distressing) features of our study in my mind is that almost half of the patients who could benefit from testing can't get it...either because they had no insurance or their insurance was inadequate. Only through our special program were we able to provide it for all those patients."
Maximizing BRCA1/2 testing uptake requires "good genetic counseling and a personalized attentive approach on the side of the medical team," Dr. Evans advised. "We try to take a lot of time to explain the nuances to women and why testing can be of help to them and their families. I think this is especially important with African American patients where there is traditionally a lower level of trust in the medical profession (understandably)."
J Clin Oncol 2008;26:32-36.