Factors associated with genetic counseling and BRCA testing in a population-based sample of young Black women with breast cancer
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Concerns about the potential for genomic advances to increase health disparities have been raised. Thus, it is important to assess referral and uptake of genetic counseling (GC) and testing in minority populations at high risk for hereditary breast and ovarian cancer (HBOC). Black women diagnosed with invasive breast cancer ≤age 50 in 2009–2012 were recruited through the Florida State Cancer Registry 6–18 months following diagnosis and completed a baseline questionnaire. Summary statistics, Chi-square tests, and path modeling were conducted to examine which demographic and clinical variables were associated with referral and access to genetic services. Of the 440 participants, all met national criteria for GC, yet only 224 (51 %) were referred for or received GC and/or HBOC testing. Variables most strongly associated with healthcare provider referral for GC included having a college education (OR 2.1), diagnosis at or below age 45 (OR 2.0), and triple negative tumor receptor status (OR 1.7). The strongest association with receipt of GC and/or HBOC testing was healthcare provider referral (OR 7.9), followed by private health insurance at diagnosis (OR 2.8), and household income greater than $35,000 in the year prior to diagnosis (OR 2.0). Study findings suggest efforts are needed to improve genetic services access among a population-based sample of high-risk Black women. These results indicate that socioeconomic factors and physician referral patterns contribute to disparities in access to genetic services within this underserved minority population.
KeywordsBRCA testing Genetic counseling Hereditary breast cancer Cancer registry Disparities
This work was supported by grants through the Bankhead Coley Granting agency (IBG10-34199) and the American Cancer Society (RSG-11-268-01-CPPB). Support for Deborah Cragun’s time was provided by a NCI R25T training grant awarded to Moffitt Cancer Center (5R25CA147832-04). This work has been supported in part by the Biostatistics Core (5P30CA076292-16) and Survey Core at the Moffitt Cancer Center, a National Cancer Institute Comprehensive Cancer Center (P30-CA076292). Cancer data for this study (analysis) were provided by the Florida Department of Health, Florida Cancer Data System (FCDS). Cancer data are made available to aid public health surveillance and research to advance cancer control and prevention activities to better serve the population at risk for developing cancer and improve treatment for cancer patients. The contents of this study are solely the responsibility of the authors and do not necessarily reflect the official view of the Florida Department of Health, Florida Cancer Data System. We thank the following members of our Community Advisory Panel for their valuable input: Joyce Austin, Sue Friedman, Benita Hayes, Evora Pimento, Peggie Sherry, Cheryl Clinton, Gwendolyn Dawson, Gloria Wood, Linda Paige, Deneen Wyman, Khaliah Fleming, and Valerie Poindexter.
Conflict of interest
The authors report no conflicts of interest.
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