Racial Disparities in BRCA Testing and Cancer Risk Management Across a Population-Based Sample of Young Breast Cancer Survivors
Racial Disparities in BRCA Testing and Cancer Risk Management Across a Population-Based Sample of Young Breast Cancer Survivors
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DOI：
10.1002/cncr.30621
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发表时间：
2017-07-01
期刊：
影响因子：
6.2
通讯作者：
Pal, Tuya
中科院分区：
文献类型：
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作者：
Cragun, Deborah;Weidner, Anne;Pal, Tuya
背景：乳腺癌（BC）的差异可能会随着基因组的进步而扩大。作者比较了非西班牙裔白色（NHW）、黑人和西班牙裔BC幸存者的1）BRCA携带者的癌症风险管理实践和2）提供者讨论和接受基因检测。方法：通过国家癌症登记处招募了2009年至2012年在50岁或以下被诊断患有侵袭性BC的NHW，黑人和西班牙裔女性的人群样本。采用多元logistic回归分析比较BRCA携带者的癌症风险管理实践，以及人口统计学和临床变量与提供者讨论和接受检测的相关性。研究结果：在1622名参与者中，440名黑人女性中有159名（36.1%），897名NHW女性中有579名（64.5%），117名西班牙语西班牙裔女性中有58名（49.6%），168名英语西班牙裔女性中有116名（69%）接受了BRCA检测，其中90名发现了致病性BRCA突变。在BRCA携带者中，在控制了临床和人口统计学变量后，黑人女性的降低风险乳房切除术和降低风险输卵管卵巢切除术的比率显著低于西班牙裔和NHW女性（分别为P = .025和P = .008）。与NHW女性相比，在控制了临床和社会人口学因素后，黑人女性与提供者讨论基因检测的可能性低16倍（P < .0001），讲西班牙语的西班牙裔女性与提供者讨论基因检测的可能性低近2倍（P = .04）。结论：目前的结果表明，与西班牙裔和NHW同行相比，黑人BRCA携带者降低输卵管卵巢切除术风险的比率较低，这是令人担忧的，因为基因检测的益处来自癌症风险管理实践选择。此外，黑人中较低的BRCA检测率可能部分是因为提供者讨论的可能性较低。未来的研究需要改善所有人群的癌症风险识别和管理实践，以防止差距扩大。(C)2017美国癌症协会
BACKGROUND: Breast cancer (BC) disparities may widen with genomic advances. The authors compared non-Hispanic white (NHW), black, and Hispanic BC survivors for 1) cancer risk-management practices among BRCA carriers and 2) provider discussion and receipt of genetic testing. METHODS: A population-based sample of NHW, black, and Hispanic women who had been diagnosed with invasive BC at age 50 years or younger from 2009 to 2012 were recruited through the state cancer registry. Multiple logistic regression was used to compare cancer risk-management practices in BRCA carriers and associations of demographic and clinical variables with provider discussion and receipt of testing. RESULTS: Of 1622 participants, 159 of 440 (36.1%) black women, 579 of 897 (64.5%) NHW women, 58 of 117 (49.6%) Spanish-speaking Hispanic women, and 116 of 168 (69%) English-speaking Hispanic women underwent BRCA testing, of whom 90 had a pathogenic BRCA mutation identified. Among BRCA carriers, the rates of risk-reducing mastectomy and risk-reducing salpingo-oophorectomy were significantly lower among black women compared with Hispanic and NHW women after controlling for clinical and demographic variables (P = .025 and P = .008, respectively). Compared with NHW women, discussion of genetic testing with a provider was 16 times less likely among black women (P < .0001) and nearly 2 times less likely among Spanish-speaking Hispanic women (P = .04) after controlling for clinical and sociodemographic factors. CONCLUSIONS: The current results suggest that the rates of risk-reducing salpingo-oophorectomy are lower among black BRCA carriers compared with their Hispanic and NHW counterparts, which is concerning because benefits from genetic testing arise from cancer risk-management practice options. Furthermore, lower BRCA testing rates among blacks may partially be because of a lower likelihood of provider discussion. Future studies are needed to improve cancer risk identification and management practices across all populations to prevent the widening of disparities. (C) 2017 American Cancer Society.