School of Medicine and Health Sciences Poster Presentations

Title

Evaluating Racial Disparities in Breast Cancer Referrals for Hereditary Risk Assessment

Document Type

Poster

Abstract Category

Cancer/Oncology

Keywords

genetic testing, racial disparities

Publication Date

Spring 5-1-2019

Abstract

Washington, D.C. had the highest national incidence of breast cancer in African Americans (AA) patients between 2010-2015 and the worst outcomes (American Cancer Society). Previous studies demonstrate a higher incidence of deleterious BRCA1/2 mutations in AA patients compared to other groups (Hall 2009). Despite this, AA women meeting National Comprehensive Cancer Network (NCCN) criteria for genetic testing are less likely to complete testing compared to Caucasian women nationally. We hypothesize that lack of physician referral for cancer genetic counseling and testing for AA women contributes to this disparity. Non-Hispanic African Americans (BNH) and non-Hispanic whites (WNH) treated for breast cancer between 2014-2018 were identified using the George Washington Cancer Center (GWCC) Registry. Individuals selected for inclusion were BNH and WNH patients who met NCCN criteria for referral for genetic evaluation including breast cancer diagnosis under age 50, triple negative breast cancer (TNBC) under age 60, and two primary breast cancers. Excluded patients were individuals who were not BNH or WNH or who did not meet NCCN criteria. Patients were stratified by race according to who underwent genetic evaluation by reviewing GWCC, RPCGPS, and clinic records. Physician referral was determined through patient chart review. 1180 patients (BNH n=502; WNH n=435) were treated at the GWCC for breast cancer (in situ and invasive carcinoma) between 2014–2018. Twenty-seven percent of BNH and WNH patients met the study criteria for referral for genetic evaluation (n=252; BNH n=115, WNH n=137), including breast cancer diagnosis under age 50 (BNH n=76; WNH n=108), TNBC under age 60 (BNH n=14; WNH n=5), and two primary breast cancers (BNH n=18, WNH n=16). Several patients met two or more criteria for referral (BNH n=7, WNH n=8). Physician referral rates differed significantly by race (BNH 76%, n=87 and WNH 91%; n=125; χ2=11.4, p-value<0.001). Of referred patients, there was no significant difference in those who followed-up at RPCGPS by race (BNH 93%, n=81; WNH= 93%, n=116, χ2 =0.0072, p-value=0.93). Low genetic testing rates for AA breast cancer patients are an impediment to resolving the prominent onco-racial disparities. Physician referral is a potential contributor to racial disparity in the utilization of cancer genetics services. Potential reasons for the discrepancy in referral may include lag in physician education on hereditary risk and barriers in physician-patient communication. These findings need to be confirmed and explored at other sites to help improve the identification of at-risk women in the AA community.

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Presented at Research Days 2019.

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Evaluating Racial Disparities in Breast Cancer Referrals for Hereditary Risk Assessment

Washington, D.C. had the highest national incidence of breast cancer in African Americans (AA) patients between 2010-2015 and the worst outcomes (American Cancer Society). Previous studies demonstrate a higher incidence of deleterious BRCA1/2 mutations in AA patients compared to other groups (Hall 2009). Despite this, AA women meeting National Comprehensive Cancer Network (NCCN) criteria for genetic testing are less likely to complete testing compared to Caucasian women nationally. We hypothesize that lack of physician referral for cancer genetic counseling and testing for AA women contributes to this disparity. Non-Hispanic African Americans (BNH) and non-Hispanic whites (WNH) treated for breast cancer between 2014-2018 were identified using the George Washington Cancer Center (GWCC) Registry. Individuals selected for inclusion were BNH and WNH patients who met NCCN criteria for referral for genetic evaluation including breast cancer diagnosis under age 50, triple negative breast cancer (TNBC) under age 60, and two primary breast cancers. Excluded patients were individuals who were not BNH or WNH or who did not meet NCCN criteria. Patients were stratified by race according to who underwent genetic evaluation by reviewing GWCC, RPCGPS, and clinic records. Physician referral was determined through patient chart review. 1180 patients (BNH n=502; WNH n=435) were treated at the GWCC for breast cancer (in situ and invasive carcinoma) between 2014–2018. Twenty-seven percent of BNH and WNH patients met the study criteria for referral for genetic evaluation (n=252; BNH n=115, WNH n=137), including breast cancer diagnosis under age 50 (BNH n=76; WNH n=108), TNBC under age 60 (BNH n=14; WNH n=5), and two primary breast cancers (BNH n=18, WNH n=16). Several patients met two or more criteria for referral (BNH n=7, WNH n=8). Physician referral rates differed significantly by race (BNH 76%, n=87 and WNH 91%; n=125; χ2=11.4, p-value<0.001). Of referred patients, there was no significant difference in those who followed-up at RPCGPS by race (BNH 93%, n=81; WNH= 93%, n=116, χ2 =0.0072, p-value=0.93). Low genetic testing rates for AA breast cancer patients are an impediment to resolving the prominent onco-racial disparities. Physician referral is a potential contributor to racial disparity in the utilization of cancer genetics services. Potential reasons for the discrepancy in referral may include lag in physician education on hereditary risk and barriers in physician-patient communication. These findings need to be confirmed and explored at other sites to help improve the identification of at-risk women in the AA community.