Highlights
- •Black women were more likely referred for genetic assessment by surgical oncology or a genetic counselor than white women.
- •Black women evaluated in our clinic were more than twice as likely as white women to have a BRCA2 pathogenic variant.
- •No black women were referred by primary care physicians to the genetic assessment clinic.
- •Opportunities exist for improving minority referral patterns for genetic evaluation.
Abstract
Objective
To compare referral patterns, genetic testing and pathogenic variant rates in Black
women (BW) and White women (WW) in a large academic Gynecologic Cancer Risk Assessment
Clinic (GCRAC).
Methods
Cross sectional study of an IRB-approved prospective, cohort study from a GCRAC. Data
evaluated included: age, race, referral provider specialty and indication, genetic
testing frequency, as well as frequency and types of pathogenic variants.
Results
588 WW and 57 BW were evaluated from 1/2010–12/2015. Although approximately one-third
of BW and WW were referred for family history alone, referral indications varied.
BW were more likely referred for a known pathogenic variant (20.0% vs. 6.2%) although
less likely referred for a personal history of ovarian cancer (24.0% vs. 46.8%; p = 0.0023). While gynecologic oncologists referred most patients (BW 43.6% vs. WW
63.0%), BW were more likely to be referred by surgical oncologist (23.0% vs. 12.8%)
or genetic counselor (12.8% vs. 5.9%) than WW (p = 0.0234). Referral from non-OBGYN primary care providers was <3% in both groups.
Genetic testing rates were similar in both races (82.4% vs. 85.5%). Rates of BRCA1 mutations (12.7% vs. 11.5%) were similar; however, BW had more BRCA2 mutations (21.3% vs. 9.5%; p = 0.0194).
Conclusions
Since BW are more likely to be referred by surgical oncology or genetics counselor,
breast clinics might be an entry point to ensure genetic counseling and testing. Continued
efforts to increase awareness regarding the importance of patient referral at the
primary care level may help identify the subset of women not currently undergoing
counseling and testing.
Keywords
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Article info
Publication history
Published online: June 10, 2019
Accepted:
May 29,
2019
Received in revised form:
May 28,
2019
Received:
March 19,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
