"BUT Not Because They See Different Doctors"
Several studies suggest that black women are less likely to have genetic testing for an abnormal BRCA1 or BRCA2 gene. Researchers haven't been sure why this is happening -- it doesn't seem to be based on attitudes about genetic testing, insurance, income levels, or a difference in the risk of having a mutation.
A study suggests that the difference in genetic testing rates in black and white women isn't because they tend to see different doctors. Instead, it seems that many oncologists and surgeons are less likely to recommend genetic testing to black women.
The research was published online on May 9, 2016 by the Journal of Clinical Oncology. Most inherited cases of breast cancer are associated with one of two abnormal genes: BRCA1 (BReast CAncer gene one) or BRCA2 (BReast CAncer gene two). Women with an abnormal BRCA1 or BRCA2 gene: 1) have up to an 85% lifetime risk of developing breast cancer; and 2) have a much higher-than-average lifetime risk of ovarian cancer; estimates range from 15% to 60%.
U.S. guidelines say that BRCA testing should be considered when:
In the study, researchers surveyed 3,016 women diagnosed with stage I or stage II breast cancer in Pennsylvania and Florida between 2007 and 2009, as well as their surgeons and oncologists:
The results from the women's surveys found that:
The results from the survey of the oncologists and surgeons found that:
"…More than 15 years after BRCA1/2 testing became available, racial disparities in BRCA1/2 testing among women with breast cancer remain large, with black women nearly half as likely as white women to undergo testing," the researchers wrote. "As seen in an earlier study of a primary care population, this disparity is only partially explained by differences in the risk of carrying a mutation, tumor characteristics, and sociodemographic characteristics, or attitudes about testing. Our study demonstrates that the disparity in testing is not explained by differences in the doctors that black and white women see for their cancer treatment. Rather, it is driven, in part, by differences in the recommendations that are given to black versus those given to white women, with both oncologists and surgeons being less likely to recommend BRCA1/2 testing to black women than they are to white women even after adjusting for the predicted risk of a mutation."
The results of this study are troubling and suggest that many women who should have genetic testing aren't being recommended for it by their doctors.
If you've been diagnosed with breast cancer, you and your doctors will put together a treatment plan that meets the needs of your unique situation and takes into account your overall medical condition and your personal style of making decisions. Your treatment plan may or may not include genetic testing. Still, if three or more women in your family have been diagnosed with breast or ovarian cancer, especially if they were diagnosed younger than 50, you may want to consider genetic testing. If you doctor doesn't recommend it, it's a good idea to ask why. If you're not comfortable with the treatment plan and genetic testing options your doctor recommends or want to see if another doctor recommends the same options, you may want to consider getting a second opinion from another doctor.
No matter your age or ethnicity, you absolutely deserve the best medical care possible. Don't be afraid to ask questions and be a strong advocate for your care.
SOURCE: Journal of Clinical Oncology, May 9, 2016. Synopsis and analysis by breastcancer.org.