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Disparities in Genetic Testing: Thinking Outside the BRCA Box

Michael J. Hall, Olufunmilayo I. Olopade

From the Department of Medicine; Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons; the Department of Epidemiology and Biostatistics, Mailman School of Public Health, Columbia University, New York, NY; and the Departments of Medicine and Human Genetics, University of Chicago, Chicago, IL

Address reprint requests to Olufunmilayo I. Olopade, MD, University of Chicago, 5841 S Maryland Ave, MC2115, Chicago, IL, 60637-1463; e-mail: folopade{at}medicine.bsd.uchicago.edu

The impact of predictive genetic testing on cancer care can be measured by the increased demand for and utilization of genetic services as well as in the progress made in reducing cancer risks in known mutation carriers. Nonetheless, differential access to and utilization of genetic counseling and cancer predisposition testing among underserved racial and ethnic minorities compared with the white population has led to growing health care disparities in clinical cancer genetics that are only beginning to be addressed. Furthermore, deficiencies in the utility of genetic testing in underserved populations as a result of limited testing experience and in the effectiveness of risk-reducing interventions compound access and knowledge-base disparities. The recent literature on racial/ethnic health care disparities is briefly reviewed, and is followed by a discussion of the current limitations of risk assessment and genetic testing outside of white populations. The importance of expanded testing in underserved populations is emphasized.

O.I.O. is a Doris Duke Distinguished Clinical Scientist and the recipient of a fellowship from the MacArthur Foundation.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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