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Black women with breast cancer less likely to undergo BRCA testing, risk-reducing surgery
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CHICAGO — Black women with breast cancer were less likely than white women to be tested for BRCA and undergo risk-reducing procedures, according to results of a population-based study presented at the ASCO Annual Meeting.
“Young black women with breast cancer were much less likely to have BRCA testing and to undergo risk-reducing salpingo-oophorectomy if they carried a BRCA mutation,” Tuya Pal, MD, clinical geneticist at the H. Lee Moffitt Cancer and Research Institute, said at a press briefing. “Our findings were a snapshot of data between 2009 and 2012, which align with previous research.”
Historically, the rates of risk-reducing bilateral mastectomy or risk-reducing prophylactic oophorectomy are based on data from white women, whereas few data exist for black and Hispanic women.
Pal and colleagues sought to investigate potential disparities in BRCA screening and subsequent cancer risk management between black, Hispanic and non-Hispanic white women. They also compared risk management for ovarian cancer by the rate of risk-reducing salpingo-oophorectomy, and breast cancer by the rate of risk-reducing mastectomy or MRI screening.
Researchers used the Florida State Cancer Registry to identify 1,621 women aged younger than 50 years who received a diagnosis of invasive breast cancer between 2009 and 2012. Of these women, 440 were black, 284 were Hispanic and 897 were non-Hispanic white.
In total, 917 women reported BRCA testing, 92 of whom harbored a BRCA mutation.
In analysis controlled for National Comprehensive Cancer Network criteria, provider referral and socioeconomic factors. A smaller proportion of black women (36%, n = 158) underwent BRCA testing than Hispanic women (62%, n = 176) and white women (65%, n = 583; P = 0.025).
Of the 92 BRCA carriers, 28 were black, 13 were Hispanic and 51 were non-Hispanic white.
Thirty-two percent of black women underwent risk-reducing oophorectomy, compared with 85% of Hispanic women (P = .01) and 71% of white women (P = .02).
Further, 68% of black women underwent bilateral mastectomy, compared with 85% of Hispanic women and 94% of white women (P = .03).
These differences remained significant after controlling for age at enrollment, time since diagnosis, income, family history of breast and ovarian cancer, and insurance status.
Researchers acknowledged their study was limited by the small number of BRCA carriers in each ethnic group. Further, some black women enrolled on the study were still receiving active treatment which may have contributed to the lower rates of oophorectomy in this cohort.
“These data show a snapshot in which disparities existed in testing and risk management,” Pal said. “BRCA testing and cancer risk management are a choice. It is imperative to understand the reason these women are not being screened and are not experiencing the same cancer risk management as their counterparts.” – by Nick Andrews
References:
Pal T, et al. Abstract LBA1504. Presented at: ASCO Annual Meeting; June 3-7, 2016; Chicago.
Disclos ure: Pal reports no relevant financial disclosures. One researcher reports a speakers bureau role with GlaxoSmithKline.
Perspective
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Patricia Ganz, MD, FASCO
This study was conducted in women who had their cancer diagnosed between 2009 and 2012, and many relevant events have happened since that time. Angelina Jolie disclosed that she had BRCA mutation and had risk-reducing surgery, which led to a substantial rise in awareness. Many women are now aware of BRCA and its relationship to cancer who may not have been between 2009 and 2012 and they are asking their physicians about testing.
Additionally, guidelines have changed since the time period in which these women were diagnosis. At the time, family history was a bigger focus, whereas now, most women aged younger than 50 years are being tested for BRCA. I suggest that temporal trends may have alleviated some of this disparity, and I am interested to see data from more contemporary participants to examine whether these disparities exist still.
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