- •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.
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).
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.
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).
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.
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- Cancer statistics, 2018.CA Cancer J. Clin. 2018; 68: 7-30
- Mutations in 12 genes for inherited ovarian, fallopian tube, and peritoneal carcinoma identified by massively parallel sequencing.Proc. Natl. Acad. Sci. U. S. A. 2011; 108: 18032-18037
- Inherited mutations in women with ovarian carcinoma.JAMA Oncol. 2016; 2: 482-490
- Maintenance olaparib in patients with newly diagnosed advanced ovarian cancer.N. Engl. J. Med. 2018; 379: 2495-2505
- Risk-reducing salpingo-oophorectomy: a meta-analysis on impact on ovarian cancer risk and all cause mortality in BRCA 1 and BRCA 2 mutation carriers.BMC Womens Health. 2014; 14: 150
- Recent trends in ovarian cancer incidence and relative survival in the United States by race/ethnicity and histologic subtypes.Cancer Epidemiol. Biomarkers Prev. 2017; 26: 1511-1518
- Global ovarian cancer health disparities.Gynecol. Oncol. 2013; 129: 258-264
- Characteristics of African American women at high-risk for ovarian cancer in the southeast: results from a Gynecologic Cancer Risk Assessment Clinic.Gynecol. Oncol. 2018; 149: 337-340
- BRCA sequencing and large rearrangement testing in young black women with breast cancer.J Community Genet. 2014; 5: 157-165
- Early onset breast cancer in a registry-based sample of African-American women: BRCA mutation prevalence, and other personal and system-level clinical characteristics.Breast J. 2013; 19: 189-192
- Prevalence of BRCA mutations among women with triple-negative breast cancer (TNBC) in a genetic counseling cohort.Ann. Surg. Oncol. 2013; 20: 3254-3258
- Racial differences in the use of BRCA1/2 testing among women with a family history of breast or ovarian cancer.Jama. 2005; 293: 1729-1736
- Recruitment, genetic counseling, and BRCA testing for underserved women at a public hospital.Genet. Test. 2005; 9: 306-312
- Predictors of BRCA1/2 genetic testing among black women with breast cancer: a population-based study.Cancer Med. 2017; 6: 1787-1798
- BRCA1 and BRCA2 mutations account for a large proportion of ovarian carcinoma cases.Cancer. 2005; 104: 2807-2816
- Moving toward personalized medicine: treatment-focused genetic testing of women newly diagnosed with ovarian cancer.Int. J. Gynecol. Cancer. 2010; 20: 704-716
- NCCN guidelines insights: genetic/familial high-risk assessment: breast and ovarian, version 2.2017.J. Natl. Compr. Cancer Netw. 2017; 15: 9-20
- Society of Gynecologic Oncology statement on risk assessment for inherited gynecologic cancer predispositions.Gynecol. Oncol. 2015; 136: 3-7
- Primary care providers' cancer genetic testing-related knowledge, attitudes, and communication behaviors: a systematic review and research agenda.J. Gen. Intern. Med. 2017; 32: 315-324
- Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 mutation.Jama. 2006; 296: 185-192
- Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality.Jama. 2010; 304: 967-975
- Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter, prospective study.J. Clin. Oncol. 2008; 26: 1331-1337
- Risk-reducing bilateral salpingo-oophorectomy in women with BRCA1 or BRCA2 mutations.Cochrane Database Syst. Rev. 2018; 8Cd012464
- Risk reduction and survival benefit of prophylactic surgery in BRCA mutation carriers, a systematic review.Am. J. Surg. 2016; 212: 660-669
Published online: June 10, 2019
Accepted: May 29, 2019
Received in revised form: May 28, 2019
Received: March 19, 2019
© 2019 Elsevier Inc. All rights reserved.