Among breast cancer survivors, black women are far less likely to receive BRCA testing and preventive surgery than white or Hispanic women, according to a new study presented at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 3–7 in Chicago (abstract LBA1504).
“Young black women with breast cancer are much less likely to have BRCA testing and to undergo risk-reducing salpingo-oophorectomy if they carry a BRCA mutation,” said lead author Tuya Pal, MD, a clinical geneticist at the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Florida, at a press briefing. “People only benefit from genetic testing for cancer risk if they act on the information the test reveals and receive appropriate follow-up care.”
Researchers recruited 897 non-Hispanic white (NHW), 440 black, and 284 Hispanic women diagnosed with an invasive breast cancer at or before the age of 50, through the Florida State Cancer Registry. Among the 1,621 participants, 917 women reported BRCA testing following their breast cancer diagnosis, and 92 women tested positive for the mutations.
“We found disparities in the receipt of BRCA testing,” said Pal. About two-thirds of NHW (65%) and Hispanic women (62%) received testing as compared with only about one-third of black women (36%). The lower rates of clinical genetic testing for BRCA mutations in black women mean they may be missing opportunities to take advantage of preventive interventions after breast cancer, she said.
Among the 92 women who tested positive for BRCA mutations, black women had the lowest rates of both bilateral mastectomy (68%) and oophorectomy (32%). Compared with NHW women, Hispanic women had lower rates of mastectomy (85% vs 94%), but higher rates of oophorectomy (85% vs 71%). The differences between blacks and the other two groups remained significant after controlling for age at enrollment, time since diagnosis, income, family history of breast cancer and ovarian cancer, and insurance status.
“The findings require confirmation given the limited sample size of carriers. The study was a snapshot in time,” acknowledged Pal. She also noted that women may choose to pursue breast cancer treatment prior to addressing ovarian cancer risk management.
The women were diagnosed with breast cancer between 2009 and 2012. Since then, recent changes have impacted the US healthcare system, including expiration of the BRCA gene patent, in conjunction with tremendous technologic advances in DNA sequencing technologies. This has led to the lower costs of testing, which is expected to make the test accessible to more people.
In addition, screening guidelines now have shifted to include testing of anyone under age 50, and public awareness of genetic testing and bilateral mastectomy has grown.
“BRCA testing and options for cancer risk management are a choice. We need to understand the reasons for these findings,” said Pal. “The study highlights the need to ensure access to testing and cancer risk management practices across all populations. We need interventions to address the disparities.”