Racial gap seen in genetic testing and counseling

African-American women are less likely than white women to undergo genetic testing for cancer risk, investigators report.

Dr. Katrina Armstrong at the University of Pennsylvania School of Medicine in Philadelphia and colleagues conducted a study to identify any factors linked to the use of genetic counseling for BRCA1/2 testing among women with a family history of breast or Ovarian cancer.

Mutations in the BRCA 1 and BRCA2 genes are linked to a high risk for these cancers.

The study drew on a population of women 18 to 80 years old, with a first- or second-degree relative with a diagnosis of breast or ovarian cancer, who had seen a primary care physician within the University of Pennsylvania Health System during the 3 years prior to the study.

The analysis focused on 217 women who were seen for genetic counseling between 1999 and 2003, compared with a "control" group made up of a random sample of 191 women who had not participated in genetic counseling.

The genetic counseling group included 16 black women (7.4%) and 184 white women (84.8%). Controls included 55 blacks (28.8%) and 126 whites (65.8%).

White women were almost five times more likely to undergo BRCA1/2 counseling than African-American women, the researchers report in the Journal of the American Medical Association for April 13th.

"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," Armstrong's group writes.

They also point out that the likelihood of having a mutation differed little by race, so differences in BRCA1/2 counseling cannot be attributed to the perception that genetic testing is not very useful for black women.

The investigators suggest that patient distrust of health-care providers, concern about racial discrimination based on genetic testing, or differences in primary-care physician characteristics may lead African-Americans to forego genetic counseling.

"Poor access to basic preventive health care, not to mention specialized cancer prevention such as genetic counseling and testing, remains an important barrier that must be eliminated to ensure equal high-quality care in the US health care system," two editorialists assert in an accompanying commentary.

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