Impact of Genetic Testing on Risk-Management Behavior of Black Breast Cancer Survivors: A Longitudinal, Observational Study
Black women are overrepresented among premenopausal breast cancer (BC) survivors. These patients warrant genetic testing (GT) followed by risk-reducing behaviors. This study documented patterns and predictors of cancer risk-management behaviors among young black BC survivors after GT.
Black women (n = 143) with a diagnosis of BC at the age of 50 years or younger received GT. At 1 year after GT, participants reported receipt of risk-reducing mastectomy, risk-reducing salpingo-oophorectomy, mammogram, breast magnetic resonance imaging (MRI), CA125 test, and transvaginal/pelvic ultrasound. Logistic regression was used to examine predictors of BC risk management (risk-reducing mastectomy or breast MRI) and ovarian cancer risk management (risk-reducing salpingo-oophorectomy, CA125 test, or transvaginal/pelvic ultrasound).
Of the study participants, 16 (11%) were BRCA1/2-positive, 43 (30%) had a variant of uncertain significance, and 84 (59%) were negative. During the 12 months after GT, no women received risk-reducing mastectomy. The majority (93%) received a mammogram, and a smaller proportion received breast MRI (33%), risk-reducing salpingo-oophorectomy (10%), CA125 test (11%), or transvaginal/pelvic ultrasound (34%). Longer time since the BC diagnosis predicted lower likelihood of BC risk management (odds ratio [OR] 0.54). BRCA1/2 carrier status (OR 4.57), greater perceived risk of recurrence (OR 8.03), and more hereditary breast and ovarian cancer knowledge (OR 1.37) predicted greater likelihood of ovarian cancer risk management.
Young black BC survivors appropriately received mammograms and ovarian cancer risk management based on their BRCA1/2 test result. However, the low usage of MRI among BRCA1/2 carriers contrasts with national guidelines. Future research should examine barriers to MRI among black BC survivors. Finally, modifiable variables predicting risk management after GT were identified, providing implications for future interventions.
This work was supported by grants from the American Cancer Society (RSG-11-268-01-CPPB, PI: Vadaparampil), the Florida Biomedical Research Program (IBG10-34199, PI: Pal), and the National Cancer Institute (K01 CA211789 [PI: Gonzalez], P30CA076292 [PI: Sellers], and R25 CA090314 [PI: Brandon]).
Conflict of interest
There are no conflicts of interest.
- 1.Ferla R, Calo V, Cascio S, et al. Founder mutations in BRCA1 and BRCA2 genes. Ann Oncol. 2007;18(Suppl_6):93–8.Google Scholar
- 5.National Comprehensive Cancer Network (NCCN). Breast cancer risk reduction (version 2.2018). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) 2018. https://www.nccn.org/professionals/physician_gls/pdf/breast_risk.pdf. Retrieved 12 Nov 2018.
- 6.National Comprehensive Cancer Network (NCCN). Genetic/familial high-risk assessment: breast and ovarian (version 2.2019). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) 2018. https://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdf. Retrieved 12 Nov 2018.
- 15.BIC. Breast Cancer Information Core. Web-site: http://www.nhgri.nih.gov/Intramural_research/Lab_transfer/BIC/. Retrieved 19 March 2015.
- 18.Lipkus IM, Kuchibhatla M, McBride CM, et al. Relationships among breast cancer perceived absolute risk, comparative risk, and worries. Cancer Epidemiol Biomark Prev. 2000;9:973–5.Google Scholar
- 55.National Research Council. From cancer patient to cancer survivor: lost in transition. Washington, DC: National Academies Press; 2005.Google Scholar