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Increased Uptake of BRCA1/2 Genetic Testing Among African American Women With a Recent Diagnosis of Breast Cancer

Lisa R. Susswein, Cécile Skrzynia, Leslie A. Lange, Jessica K. Booker, Mark L. Graham, III, James P. Evans

From the Department of Genetics, Department of Pathology, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill; and Waverly Hematology Oncology, Cary, NC

Corresponding author: James P. Evans, MD, PhD, University of North Carolina at Chapel Hill, Department of Genetics, CB#7264, Chapel Hill, NC 27599-7264; e-mail: jpevans{at}med.unc.edu

Purpose Studies suggest that African American women are less likely to pursue BRCA1/2 genetic testing than white women. However, such studies are often confounded by unequal access to care.

Methods Data from 132 African American and 636 white women, obtained from a clinical database at the University of North Carolina (Chapel Hill, NC) between 1998 and 2005, were analyzed to assess BRCA1/2 genetic testing uptake. Importantly, the clinical setting minimized barriers of both cost and access. Race and time of new breast cancer diagnosis (recent v > 1 year before genetic evaluation) were assessed for association with BRCA1/2 testing uptake using multivariable logistic regression models.

Results Both race (P = .0082) and a recent diagnosis of breast cancer (P = .014) were independently associated with testing uptake. African American women had a lower estimated odds of pursuing testing than white women (odds ratio [OR], 0.54; 95%CI, 0.34 to 0.85), and women with a recent diagnosis had a higher OR than those with a remote diagnosis (OR, 1.58; 95% CI, 1.10 to 2.29). In a race-stratified analysis, there was no statistical evidence for association between recent status and testing uptake in the larger white stratum (OR, 1.38, P = .13) while there was for the smaller African American sample (OR, 2.77, P = .018). The test of interaction between race and remote status was not significant (P = .15).

Conclusion African American race was associated with an overall decreased uptake of BRCA1/2 genetic testing, even when barriers of ascertainment and cost were minimized. However, among African American women, a recent diagnosis of breast cancer was associated with substantially increased uptake of testing.

This manuscript represents original work. A subset of the data included in this article was presented as posters at the American College of Medical Genetics Meeting, March 17-20, 2005, Dallas, TX, and at the 28th Annual San Antonio Breast Cancer Meeting, December 8-11, 2005, San Antonio, TX.

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

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