There are large racial disparities in the use of genetic testing for breast and ovarian cancer, according to a study published in the Journal of the American Medical Association.

Mutations in the genes BRCA1 or BRCA2 confer a significantly increased risk of breast and ovarian cancer, according to background information in the article. Women with a BRCA1/2 mutation have a lifetime breast cancer risk of 50 percent to 85 percent and a lifetime ovarian cancer risk of 14 percent to 40 percent. Testing for mutations in BRCA1/2 can provide individual information about breast and ovarian cancer risk that may affect decisions about prophylactic surgery, chemoprevention, and screening. Although clinical testing for BRCA1/2 mutations became available in 1996, relatively little is known about the determinants of testing use in the general population, including potential racial differences in utilization.

Katrina Armstrong, M.D., M.S.C.E., of the University of Pennsylvania School of Medicine, Philadelphia, and colleagues conducted a study to assess the association between race and use of genetic counseling for BRCA1/2 testing among women at risk of carrying a BRCA1/2 mutation and to evaluate the potential contributions of cancer risk perception and worry, socioeconomic characteristics and attitudes about genetic testing.

The study, conducted from December 1999 to August 2003, included 408 women with a family history of breast or ovarian cancer, of whom 217 underwent genetic counseling for BRCA1/2 testing (cases) and 191 women did not (controls).

The researchers found that "African American women with a family history of breast or ovarian cancer are much less likely [78 percent less likely] to undergo genetic counseling for BRCA1/2 testing than are white women with a family history of breast or ovarian cancer. Furthermore, this racial disparity is not explained by differences in the probability of carrying a BRCA1/2 mutation, socioeconomic status, cancer risk perception and worry, attitudes about BRCA1/2 testing, or primary care physician discussions of BRCA1/2 testing."

"The complex and highly charged relationship between race and genetics presents a substantial challenge to the translation of advances in human genetics into improvements in health. Although empirical evidence of racial disparities in the utilization of BRCA1/2 counseling provides important information about this challenge, it only further highlights the need to move forward in developing health and social policy that ensures the potential benefits of the Human Genome Project are realized for all segments of the U.S. population," the authors write.

SOURCE:
Journal of the American Medical Association, April 13, 2005