Advertisement

Impact of Genetic Testing on Risk-Management Behavior of Black Breast Cancer Survivors: A Longitudinal, Observational Study

  • Claire C. Conley
  • Monica L. Kasting
  • Bianca M. Augusto
  • Jennifer D. Garcia
  • Deborah Cragun
  • Brian D. Gonzalez
  • Jongphil Kim
  • Kimlin Tam Ashing
  • Cheryl L. Knott
  • Chanita Hughes-Halbert
  • Tuya Pal
  • Susan T. VadaparampilEmail author
Breast Oncology

Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.

Notes

Acknowledgments

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.

References

  1. 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
  2. 2.
    Nilsson MP, Hartman L, Kristoffersson U, et al. High risk of in-breast tumor recurrence after BRCA1/2-associated breast cancer. Breast Cancer Res Treat. 2014;147:571–8.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Graeser MK, Engel C, Rhiem K, et al. Contralateral breast cancer risk in BRCA1 and BRCA2 mutation carriers. J Clin Oncol. 2009;27:5887–92.CrossRefGoogle Scholar
  4. 4.
    Metcalfe KA, Lynch HT, Ghadirian P, et al. The risk of ovarian cancer after breast cancer in BRCA1 and BRCA2 carriers. Gynecol Oncol. 2005;96:222–6.CrossRefGoogle Scholar
  5. 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. 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.
  7. 7.
    Cragun D, Weidner A, Lewis C, et al. Racial disparities in BRCA testing and cancer risk management across a population-based sample of young breast cancer survivors. Cancer. 2017;123:2497–505.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Levy DE, Byfield SD, Comstock CB, et al. Underutilization of BRCA1/2 testing to guide breast cancer treatment: black and Hispanic women particularly at risk. Genet Med. 2011;13:349–55.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kinney AY, Bloor LE, Mandal D, et al. The impact of receiving genetic test results on general and cancer-specific psychologic distress among members of an African American kindred with a BRCA1 mutation. Cancer. 2005;104:2508–16.CrossRefGoogle Scholar
  10. 10.
    Halbert C, Kessler L, Troxel A, Stopfer J, Domchek S. Effect of genetic counseling and testing for BRCA1 and BRCA2 mutations in African American women: a randomized trial. Public Health Genomics. 2010;13:440–8.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Halbert CH, Kessler L, Stopfer JE, Domchek S, Wileyto EP. Low rates of acceptance of BRCA1 and BRCA2 test results among African American women at increased risk for hereditary breast-ovarian cancer. Genet Med. 2006;8:576.CrossRefGoogle Scholar
  12. 12.
    Bonner D, Cragun D, Reynolds M, Vadaparampil ST, Pal T. Recruitment of a population-based sample of young black women with breast cancer through a state cancer registry. Breast J. 2016;22:166–72.CrossRefGoogle Scholar
  13. 13.
    Pal T, Bonner D, Cragun D, et al. A high frequency of BRCA mutations in young black women with breast cancer residing in Florida. Cancer. 2015;121:4173–80.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Plon SE, Eccles DM, Easton D, et al. Sequence variant classification and reporting: recommendations for improving the interpretation of cancer susceptibility genetic test results. Hum Mutat. 2008;29:1282–91.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    BIC. Breast Cancer Information Core. Web-site: http://www.nhgri.nih.gov/Intramural_research/Lab_transfer/BIC/. Retrieved 19 March 2015.
  16. 16.
    Vos J, Otten W, van Asperen C, Jansen A, Menko F, Tibben AJPO. The counsellees’ view of an unclassified variant in BRCA1/2: recall, interpretation, and impact on life. Psycho‐Oncology. 2008;17:822–30.CrossRefGoogle Scholar
  17. 17.
    Garcia C, Lyon L, Littell RD, Powell CBJGiM. Comparison of risk-management strategies between women testing positive for a BRCA variant of unknown significance and women with known BRCA deleterious mutations. Genet Med. 2014;16:896.CrossRefGoogle Scholar
  18. 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
  19. 19.
    Scherr CL, Christie J, Vadaparampil ST. Breast cancer survivors’ knowledge of hereditary breast and ovarian cancer following genetic counseling: an exploration of general and survivor-specific knowledge items. Public Health Genomics. 2016;19:1–10.CrossRefGoogle Scholar
  20. 20.
    Hosmer DW, Lemesbow S. Goodness-of-fit tests for the multiple logistic regression model. Commun. Stat Theory Methods. 1980;9:1043–69.CrossRefGoogle Scholar
  21. 21.
    Botkin JR, Smith KR, Croyle RT, et al. Genetic testing for a BRCA1 mutation: prophylactic surgery and screening behavior in women 2 years post testing. Am J Med Gen Part A. 2003;118:201–9.CrossRefGoogle Scholar
  22. 22.
    Heshka JT, Palleschi C, Howley H, Wilson B, Wells PS. A systematic review of perceived risks, psychological and behavioral impacts of genetic testing. Genet Med. 2008;10:19.CrossRefGoogle Scholar
  23. 23.
    Beery TA, Williams JK. Risk reduction and health promotion behaviors following genetic testing for adult-onset disorders. Genet Test. 2007;11:111–23.CrossRefGoogle Scholar
  24. 24.
    Schwartz MD, Isaacs C, Graves KD, et al. Long-term outcomes of BRCA1/BRCA2 testing: risk reduction and surveillance. Cancer. 2012;118:510–17.CrossRefGoogle Scholar
  25. 25.
    Metcalfe KA, Birenbaum-Carmeli D, Lubinski J, et al. International variation in rates of uptake of preventive options in BRCA1 and BRCA2 mutation carriers. Int J Cancer. 2008;122:2017–22.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Beattie MS, Crawford B, Lin F, Vittinghoff E, Ziegler J. Uptake, time course, and predictors of risk-reducing surgeries in BRCA carriers. Genet Test Mol Biomark. 2009;13:51–6.CrossRefGoogle Scholar
  27. 27.
    Bradbury AR, Ibe CN, Dignam JJ, et al. Uptake and timing of bilateral prophylactic salpingo-oophorectomy among BRCA1 and BRCA2 mutation carriers. Genet Med. 2008;10:161.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Kauff ND, Domchek SM, Friebel TM, et al. Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter, prospective study. J Clin Oncol. 2008;26:1331.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Metcalfe KA, Lubinski J, Ghadirian P, et al. Predictors of contralateral prophylactic mastectomy in women with a BRCA1 or BRCA2 mutation: the Hereditary Breast Cancer Clinical Study Group. J Clin Oncol. 2008;26:1093–7.CrossRefGoogle Scholar
  30. 30.
    Friebel TM, Domchek SM, Neuhausen SL, et al. Bilateral prophylactic oophorectomy and bilateral prophylactic mastectomy in a prospective cohort of unaffected BRCA1 and BRCA2 mutation carriers. Clin Breast Cancer. 2007;7:875–82.CrossRefGoogle Scholar
  31. 31.
    Watson M, Foster C, Eeles R, et al. Psychosocial impact of breast/ovarian (BRCA 1/2) cancer-predictive genetic testing in a UK multi-centre clinical cohort. Br J Cancer. 2004;91:1787.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Garcia C, Wendt J, Lyon L, et al. Risk-management options elected by women after testing positive for a BRCA mutation. Gynecol Oncol. 2014;132:428–33.CrossRefGoogle Scholar
  33. 33.
    Hall MJ, Olopade OI. Disparities in genetic testing: thinking outside the BRCA box. J Clin Oncol. 2006;24(14):2197–2203.CrossRefGoogle Scholar
  34. 34.
    Oloparde OI. Genetics in clinical cancer care: a promise unfulfilled among minority populations. Cancer Epidemiol Biomark Prev. 2004;13:1683–6.PubMedGoogle Scholar
  35. 35.
    Hall MJ, Reid JE, Burbidge LA, et al. BRCA1 and BRCA2 mutations in women of different ethnicities undergoing testing for hereditary breast-ovarian cancer. Cancer. 2009;115:2222–33.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Thompson HS, Valdimarsdottir HB, Jandorf L, Redd W. Perceived disadvantages and concerns about abuses of genetic testing for cancer risk: differences across African American, Latina, and Caucasian women. Patient Educ Couns. 2003;51:217–27.CrossRefGoogle Scholar
  37. 37.
    Hughes C, Fasaye G-A, LaSalle VH, Finch C. Sociocultural influences on participation in genetic risk assessment and testing among African American women. Patient Educ Couns. 2003;51:107–14.CrossRefGoogle Scholar
  38. 38.
    Guidry JJ, Matthews-Juarez P, Copeland VA. Barriers to breast cancer control for African American women: the interdependence of culture and psychosocial issues. Cancer. 2003;97:318–23.CrossRefGoogle Scholar
  39. 39.
    Furr LA. Perceptions of genetics research as harmful to society: differences among samples of African Americans and European Americans. Genet Test. 2002;6:25–30.CrossRefGoogle Scholar
  40. 40.
    Mohamed IE, Williams KS, Tamburrino M, Wryobeck J, Carter S. Understanding locally advanced breast cancer: what influences a woman’s decision to delay treatment? Prev Med. 2005;41:399–405.CrossRefGoogle Scholar
  41. 41.
    Spurlock WR, Cullins LS. Cancer fatalism and breast cancer screening in African American women. ABNF J. 2006;17:38–43.PubMedGoogle Scholar
  42. 42.
    Kessler L, Collier A, Brewster K, et al. Attitudes about genetic testing and genetic testing intentions in African American women at increased risk for hereditary breast cancer. Genet Med. 2005;7:230.CrossRefGoogle Scholar
  43. 43.
    Edwards TA, Thompson HS, Kwate NOA, et al. Association between temporal orientation and attitudes about BRCA1/2 testing among women of African descent with family histories of breast cancer. Patient Educ Couns. 2008;72:276–82.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Meiser B, Eisenbruch M, Barlow-Stewart K, Tucker K, Steel Z, Goldstein D. Cultural aspects of cancer genetics: setting a research agenda. J Med Genet. 2001;38:425–9.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Holt CL, Caplan L, Schulz E, Blake V, Southward VL, Buckner AV. Development and validation of measures of religious involvement and the cancer experience among African Americans. J Health Psychol. 2009;14:525–35.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Moorman PG, Barrett NJ, Wang F, et al. Effect of cultural, folk, and religious beliefs and practices on delays in diagnosis of ovarian cancer in African American women. J Women Health. 2018;28:444–51.CrossRefGoogle Scholar
  47. 47.
    Woodward E, Sleightholme H, Considine A, Williamson S, McHugo J, Cruger D. Annual surveillance by CA125 and transvaginal ultrasound for ovarian cancer in both high‐risk and population-risk women is ineffective. Br J Obstet Gynecol. 2007;114:1500–9.CrossRefGoogle Scholar
  48. 48.
    Lehman CD. Role of MRI in screening women at high risk for breast cancer. J Magn Reson Imaging. 2006;24:964–70.CrossRefGoogle Scholar
  49. 49.
    Gramling R, Nash J, Siren K, Eaton C, Culpepper L. Family physician self-efficacy with screening for inherited cancer risk. Ann Fam Med. 2004;2:130–2.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Gramling R, Clarke J, Simmons E. Racial distribution of patient population and family physician endorsed importance of screening patients for inherited predisposition to cancer. J Health Care Poor Underserved. 2009;20:50–4.CrossRefGoogle Scholar
  51. 51.
    Haas JS, Hill DA, Wellman RD, et al. Disparities in the use of screening magnetic resonance imaging of the breast in community practice by race, ethnicity, and socioeconomic status. Cancer. 2016;122:611–7.CrossRefGoogle Scholar
  52. 52.
    Onega T, Hubbard R, Hill D, et al. Geographic access to breast imaging for US women. J Am Coll Radiol. 2014;11:874–82.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    George SA. Barriers to breast cancer screening: an integrative review. Health Care Women Int. 2000;21:53–65.CrossRefGoogle Scholar
  54. 54.
    Miles R, Wan F, Onega TL, et al. Underutilization of supplemental magnetic resonance imaging screening among patients at high breast cancer risk. J Women Health. 2018;27:748–54.CrossRefGoogle Scholar
  55. 55.
    National Research Council. From cancer patient to cancer survivor: lost in transition. Washington, DC: National Academies Press; 2005.Google Scholar
  56. 56.
    Biesecker BB. Goals of genetic counseling. Clin Genet. 2001;60:323–30.CrossRefGoogle Scholar
  57. 57.
    Bonner D, Cragun D, Reynolds M, Vadaparampil ST, Pal TJ. Recruitment of a population-based sample of young black women with breast cancer through a state cancer registry. Breast J. 2016;22:166–72.CrossRefGoogle Scholar
  58. 58.
    Kinney AY, Steffen LE, Brumbach BH, et al. Randomized noninferiority trial of telephone delivery of BRCA1/2 genetic counseling compared with in-person counseling: 1-year follow-up. J Clin Oncol. 2016;34:2914.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Kinney AY, Butler KM, Schwartz MD, et al. Expanding access to BRCA1/2 genetic counseling with telephone delivery: a cluster randomized trial. J Natl Cancer Inst. 2014;106:dju328.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Wevers M, Schmidt M, Engelhardt E, et al. Timing of risk-reducing mastectomy in breast cancer patients carrying a BRCA1/2 mutation: retrospective data from the Dutch HEBON study. Fam. Cancer. 2015;14:355–63.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Claire C. Conley
    • 1
  • Monica L. Kasting
    • 2
  • Bianca M. Augusto
    • 1
  • Jennifer D. Garcia
    • 1
  • Deborah Cragun
    • 3
  • Brian D. Gonzalez
    • 1
  • Jongphil Kim
    • 4
  • Kimlin Tam Ashing
    • 5
  • Cheryl L. Knott
    • 6
  • Chanita Hughes-Halbert
    • 7
  • Tuya Pal
    • 8
  • Susan T. Vadaparampil
    • 1
    Email author
  1. 1.Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer CenterTampaUSA
  2. 2.Department of Health and KinesiologyPurdue UniversityWest LafayetteUSA
  3. 3.College of Public HealthUniversity of South FloridaTampaUSA
  4. 4.Division of Biostatistics and BioinformaticsH. Lee Moffitt Cancer CenterTampaUSA
  5. 5.Department of Population SciencesCity of Hope National Medical CenterDuarteUSA
  6. 6.School of Public HealthUniversity of MarylandCollege ParkUSA
  7. 7.Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonUSA
  8. 8.Department of MedicineVanderbilt University Medical CenterNashvilleUSA

Personalised recommendations