Black women are less likely than whites to get counseling for BRCA1 and BRCA2 gene mutations screening. The mutations are linked to increased breast cancer risk.

“White women have almost five times the odds of undergoing BRCA1/2 counseling as African-American women,” write Katrina Armstrong, MD, and colleagues in The Journal of the American Medical Association.

The reasons for the racial gap aren’t clear. Until the differences are addressed, “the benefit of predictive gene testing will not be fully realized,” Armstrong writes. Testing provides information about breast cancer risks that effects decisions about treatment. In addition, it allows other family members to define their own risk, write the authors.

About the Test

BRCA1 and BRCA2 genetic testing is done through a blood test. The testing in at-risk women helps in cancer prevention. It’s used for women with a family history that suggests a higher risk of breast cancer.

The results don’t mean that a woman definitely will or won’t get breast cancer. Instead, it gauges her genetic risks of the disease. The test does not screen for breast cancer itself.

Getting the results can take several weeks. Understandably, the decision and process of getting tested can be emotional. Counseling is strongly encouraged before and after screening to help patients understand the test and weigh their options.

Breast Cancer Is Widespread

Breast cancer is women’s most common cancer, apart from skin cancer. It’s second only to lung cancer in women’s cancer deaths, says the American Cancer Society.

More white women are diagnosed with breast cancer, but black women who are diagnosed are more likely to be younger, have more aggressive cancers, and are more likely to die of it.

How do the BRCA genes play in? While the mutations are rare in the general population, “Women with a BRCA1/2 mutation have a lifetime breast cancer risk of 50-85 percent and a lifetime ovarian cancer risk of 14-40 percent,” says Armstrong’s study.

Who Gets Genetic Testing, Who Doesn’t

Armstrong’s study included about 400 women enrolled in a large Philadelphia health care system. All had at least one first- or second-degree relative with breast or ovarian cancer, but they hadn’t had those diseases themselves.

The group included 217 women who got counseling for genetic screening and 191 who did not. They completed a questionnaire about their decision.

Black women with a family history of breast or ovarian cancer were significantly less likely to get counseling for genetic screening than white women.

Among women with a family history of breast cancer, women who underwent counseling were significantly less likely to be black than women who did not undergo counseling (7.4 percent vs. 29 percent).

Common Traits for Screened Patients

Women who got counseling for screening tended to have certain traits, such as:

--White race

--Greater probability of carrying a BRCA1/2 mutation

--Younger age

--More likely to be married

--More likely to be Jewish

--Higher education level

--Higher household income

--More likely to have talked to their gynecologist or primary care physician about BRCA1/2 counseling

--Higher perceived breast cancer risk

--Higher worry about ovarian cancer

--Attitudes about discrimination

--Reassurance from testing

Why the Gap?

No reason explained the large black-white gap.

The researchers say it was not due to:

--Differences in risk factors for carrying a BRCA1/2 gene mutation

--Socioeconomic factors

--Risk perception

--Attitudes

--Primary care physician recommendations

Type of health insurance coverage was not associated with BRCA1/2 screening. The researchers say they aren’t sure if the same patterns hold for women in other cities.

Distrust, Discrimination Fears?

Distrust of the health care system has been shown to be higher among blacks than whites, and new technologies (such as genetic testing) might be particularly sensitive, say researchers.

But only four out of 88 black women who did not get screened agreed with the statement that “testing leads to discrimination.” That question didn’t specifically get at the possibility of racial discrimination. Some groups may be more reluctant to undergo genetic testing because of concerns about how testing information might be used, write the researchers.

They say that the study further highlights the need to move forward in developing health and social policy that ensures the potential benefit of the Human Genome Project for all segments of the population.

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: Armstrong, K. The Journal of the American Medical Association, April 13, 2005; vol 293: pp 1729-1736. WebMD Medical Reference from Healthwise: “Breast Cancer (BRCA) Gene Testing.” News release, JAMA/Archives.