Fewer Genetic Testing Referrals for Minorities With Ovarian Cancer

Following diagnosis, only one-third of black women in this retrospective study were referred to genetic counselors-and none actually received counseling.

Women of non-European ancestry and those enrolled in Medicare have lower rates of referral to genetic testing following an ovarian cancer diagnosis, researchers reportedin Gynecologic Oncology.

“We have not yet reached the Society of Gynecologic Oncology recommendation for referral to genetics,” reported Lee-may Chen, MD, from the University of California Helen Diller Family Comprehensive Cancer Center, and coauthors. “This disparity in care impacts cancer treatment options and prevents appropriate screening for other hereditary malignancies.”

Only one-third of black women in the single-institutional, retrospective records review were referred to genetic counselors-and none of them actually received counseling.

“Similarly, just over one-third of Latina and Asian patients were referred for counseling,” the researchers reported. “Minority patients with ovarian cancer at our institution received less genetics care, and a full array of treatment options may not have been available as a result. Ultimately, this results in lower-quality care for minority women.”

The role of genetic testing in clinical decision making is growing rapidly for patients with ovarian cancer. The study team reviewed pathology reports for 246 women diagnosed with ovarian cancer between 2012 and 2016, excluding 10 who had previously received genetic counseling. Fifty-three percent of the remaining patients had been referred to genetic counselors, 4.6 months after diagnosis, on average.  

While age and family cancer history did not predict which patients were referred to genetic counseling, race did: 61% of white patients were given referrals, compared with 40% of Asian women, 38% of Hispanic women, and 33% of African-American women (P = .035).

Language barriers were one possible factor accounting for the lower rates of referral for Asian and Hispanic women. Women who spoke English were more likely to have undergone genetic testing and counseling (P < .0001).

“Our data showed lower referral and counseling rates for non-Caucasian, non-English speaking women, and those with public insurance,” the authors reported.

The investigators proposed several steps to reduce racial disparities in access to genetic testing among women with ovarian cancer. These include provider training about implicit racial bias; the availability of patient-education literature in Spanish, Chinese, and other languages; and putting procedures in place to ensure clinician language competency or the availability of interpreter services for patients.