Survey Finds Racial Differences in Physicians’ Perceived Barriers to Genetic Testing in Breast Cancer

A nationwide survey of breast oncologists in the United States found racial differences in the perceived barriers of oncology physicians with regard to accessing genetic counseling and testing for patients with breast cancer.

Results published in the Journal of Clinical Oncology highlight the need for further education and interventions addressing bias among physicians and can help in understanding physician determinants of genetic counseling and testing for African American women. In total, 1.8% of physicians suggested they were more likely to refer a White patient for genetic counseling and testing than an African American patient. Moreover, 82.2% of physicians said all patients with breast cancer should be tested only after counseling compared, and 73.8% of physicians stated that African American women should obtain testing only after counseling (P = .0002). Additionally, 51.6% of respondents believed that genetic testing increased psychologic distress, and 54.8% thought African American patients were more likely to experience increased psychologic distress because of testing than White patients (P = .5413).

“Racial differences exist in physicians’ perceived barriers to genetic counseling and testing for patients with breast cancer. Physicians’ self-reported practices regarding genetic counseling and testing for African Americans are not consistent with those reported in the previous literature,” the investigators wrote.

The surveys consisted of 49 items from 4 domains including demographics, genetic counseling and testing knowledge, attitudes regarding genetic counseling and testing for patients with breast cancer—specifically African American patients—and perceived barriers to genetic counseling and testing for the 2 groups. Race, sex, and employment characteristics were included in the respondent demographics.

The survey was reviewed for validity by 3 medical oncologists who specialize in breast cancer, an expert focused on genetic contributions to complex diseases in underserved populations, and a primary care physician.

The final cohort included responses from 277 physicians, of whom most were female (58.8%), White (67.1%), and medical oncologists (75.1%).

Additional findings from the survey indicated that most respondents (63.4%) believed that African American patients deal with more barriers than White patients. Moreover, 21.0% of respondents felt African American patients need more information and guidance to facilitate the decision-making process for genetic counseling and testing than White patients.

Thirty-two percent of respondents claimed lack of trust was a barrier in the way of genetic counseling and testing for all patients with breast cancer. Further, 58.1% of respondents suggested that trust was a greater barrier to genetic counseling and testing for African American patients vs White patients (P < .0001).

“This study raises some concerning questions regarding patterns in US oncologists’ attitudes, practices, and perception of barriers regarding genetic counseling and testing in African American patients with breast cancer. Racial differences in several perceived barriers to genetic counseling and testing were apparent, and physicians’ self-reported practices regarding genetic counseling and testing for African Americans were not consistent with those directly measured and reported in previous literature,” the investigators concluded.

Reference

Ademuyiwa FO, Salyer P, Tao Y, et al. Genetic counseling and testing in African American patients with breast cancer: A nationwide survey of US breast oncologists. J Clin Oncol. 2021;39(36):4020-4028. doi:10.1200/JCO.21.01426