Health Care Segregation, Physician Recommendation, and Racial Disparities in BRCA1/2 Testing Among Women With Breast Cancer
Health Care Segregation, Physician Recommendation, and Racial Disparities in BRCA1/2 Testing Among Women With Breast Cancer
复制标题
DOI：
10.1200/jco.2015.66.0019
复制
发表时间：
2016-08-01
影响因子：
45.3
通讯作者：
Armstrong, Katrina
中科院分区：
文献类型：
--
作者：
McCarthy, Anne Marie;Bristol, Mirar;Armstrong, Katrina
BRCA 1/2测试中的种族差异已被记录在案，但这些差异的原因知之甚少。该研究的目的是调查在癌症提供者中黑人和白色患者的分布是否导致BRCA 1/2检测的差异。患者和方法我们对宾夕法尼亚州和佛罗里达的18至64岁的妇女进行了基于人群的研究，她们在2007年至2009年之间被诊断为浸润性乳腺癌，将癌症登记数据，美国医学协会医师主文件，以及患者和医师调查。这项研究包括3,016名妇女（69%白色，31%黑色），808名医学肿瘤学家，和732 surgical.ResultsBlack妇女不太可能接受BRCA 1/2测试比白色妇女（比值比[OR]，0.40; 95%CI，0.34至0.48; P < .001）。通过调整突变风险、临床因素、社会人口学特征和对检测的态度，这种差异有所减弱，但并未消除（OR，0.66; 95%CI，0.53 - 0.81; P <0.001）。黑人和白色妇女的护理在外科医生和肿瘤学家之间高度隔离（差异指数分别为64.1和61.9），但调整医生或医生特征内的聚类并没有改变测试差异的大小。黑人妇女不太可能报告说，他们已经收到了BRCA 1/2测试医生的建议，即使在调整突变风险（OR，0.66; 95%CI，0.54至0.82; P，0.001）。调整医生的建议，进一步削弱了测试的差异（OR，0.76; 95%CI，0.57至1.02; P = 0.06）。结论虽然黑人和白色乳腺癌患者往往看到不同的外科医生和肿瘤学家，这种分布并没有贡献BRCA 1/2测试的差异。相反，在考虑患者和医生特征后，测试中剩余的种族差异主要归因于医生建议的差异。解决这些差异的努力应侧重于确保测试建议的公平性。(C)2016年美国临床肿瘤学会
PurposeRacial disparities in BRCA1/2 testing have been documented, but causes of these disparities are poorly understood. The study objective was to investigate whether the distribution of black and white patients across cancer providers contributes to disparities in BRCA1/2 testing.Patients and MethodsWe conducted a population-based study of women in Pennsylvania and Florida who were 18 to 64 years old and diagnosed with invasive breast cancer between 2007 and 2009, linking cancer registry data, the American Medical Association Physician Masterfile, and patient and physician surveys. The study included 3,016 women (69% white, 31% black), 808 medical oncologists, and 732 surgeons.ResultsBlack women were less likely to undergo BRCA1/2 testing than white women (odds ratio [OR], 0.40; 95% CI, 0.34 to 0.48; P < .001). This difference was attenuated but not eliminated by adjustment for mutation risk, clinical factors, sociodemographic characteristics, and attitudes about testing (OR, 0.66; 95% CI, 0.53 to 0.81; P < .001). The care of black and white women was highly segregated across surgeons and oncologists (index of dissimilarity 64.1 and 61.9, respectively), but adjusting for clustering within physician or physician characteristics did not change the size of the testing disparity. Black women were less likely to report that they had received physician recommendation for BRCA1/2 testing even after adjusting for mutation risk (OR, 0.66; 95% CI, 0.54 to 0.82; P,.001). Adjusting for physician recommendation further attenuated the testing disparity (OR, 0.76; 95% CI, 0.57 to 1.02; P = .06).ConclusionAlthough black and white patients with breast cancer tend to see different surgeons and oncologists, this distribution does not contribute to disparities in BRCA1/2 testing. Instead, residual racial differences in testing after accounting for patient and physician characteristics are largely attributable to differences in physician recommendations. Efforts to address these disparities should focus on ensuring equity in testing recommendations. (C) 2016 by American Society of Clinical Oncology