Black women face more barriers to genetic counseling, testing, breast oncologists say
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A survey of physicians showed most believe Black women face more barriers to genetic counseling and testing for breast cancer than white women, according to a study published in Journal of Clinical Oncology.
“Genetic testing for mutations such as BRCA1 and BRCA2 can identify individuals at high risk for developing disease such as breast cancer. In individuals who are found to have these gene mutations, enhanced screening with both mammograms and MRIs are offered, preventive medications or surgeries are options and family members can get tested for the same genes,” Foluso O. Ademuyiwa, MD, MPH, MSCI, associate professor of medical oncology at Washington University School of Medicine in St. Louis, told Healio.
“In addition, for those who develop breast cancer due to gene mutations, targeted therapies are now approved and improve outcomes,” she said. “We and others have shown that physicians do not refer Black individuals for genetic counseling and testing at the same frequency as white individuals, even though they have similar rates of mutations. Therefore, Black individuals and their families miss out on these important health benefits.”
Ademuyiwa and colleagues sent a 49-item national survey to U.S. breast oncology physicians to determine if physicians’ self-reported knowledge, attitudes and practices of genetic counseling and testing vary according to a patient’s race. The 277 respondents (58.8% women, 75.1% medical oncologists, 61.7% academic physicians and 67.1% white) were asked about their own demographics, clinical characteristics, knowledge, attitudes, practices and perceived barriers in providing genetic testing to patients with breast cancer.
Results showed 1.8% of respondents were more likely to refer a white individual than a Black individual for genetic testing and nearly 70% believed Black women with breast cancer have lower rates of genetic testing than white women.
“Less than 2% of doctors said that they refer White individuals for genetic counseling and testing more frequently than Black individuals,” Ademuyiwa said. “This is not consistent with the literature that shows that, even when eligible, less than 60% of Black patients are referred vs. over 90% of eligible White patients.”
Moreover, 63.4% of respondents reported that Black women face more barriers to genetic testing and 21% indicated Black women require more information and guidance during the decision-making process for genetic testing than white women.
“Imagine a busy clinic where a physician has only 15 to 20 minutes with a patient. If that doctor has an implicit bias and thinks the patient has too many barriers and will not be compliant with testing, the doctor may skip that important part of the patient’s management,” Ademuyiwa said.
Regarding trust in the medical system, 32% of physicians reported that lack of trust was a barrier to genetic counseling and testing for all patients, whereas 58.1% felt that lack of trust was a greater barrier for Black women (P < .0001).
Nearly 14% of respondents indicated that noncompliance with genetic counseling and testing is a barrier for all patients; however, 30.6% believed Black women are more likely than white women to be noncompliant (P < .0001).
“It is critical that we as physicians take stock of our individual practices to make sure that we are providing equitable care with the best evidence-based medicine for all patients,” Ademuyiwa said. “We also need to simplify the referral process and immediately expand testing criteria. The medical community needs to enhance training of oncologists and improve diversity in the oncology workforce. We need to continue targeted outreach to underserved communities.”
Investigators are piloting clinic-based interventions to help increase genetic counseling and referral rates for Black individuals.
“We also have studies trying to elicit specific barriers faced by physicians in clinic so that we can design interventions to mitigate those,” Ademuyiwa said. “We recently hired several genetic counselors to help with capacity issues and, in collaboration with the pediatrics department, we started a genetic counseling training program. We have also partnered with churches and community organizations to increase cancer screenings and evaluations and have hired breast health navigators in North St. Louis County to help our underserved patients with breast cancer and also provide free rides to appointments for those eligible based on income.”
For more information:
Foluso O. Ademuyiwa, MD, MPH, MSCI, can be reached at Washington University School of Medicine, 660 S. Euclid Ave., Box 8056, St. Louis, MO 63110; email: bisiademuyiwa@wustl.edu.
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