US black women are less likely to have genetic tests for breast cancer
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《英国医生杂志》
Black women who have close relatives with breast or ovarian cancer are nearly five times less likely to be offered genetic testing for these cancers than white women, a US study reported this week.
The case-control study looked at 408 women receiving primary healthcare services from the University of Pennsylvania Health System who had a first degree or second degree relative with breast or ovarian cancer ( JAMA 2005;293: 1729-36). The women were followed up from December 1999 to August 2003.
Just over half (217) received genetic counselling for BRCA1 and BRCA2 gene testing (and so were considered cases), while 191 women did not (controls). Testing for mutations in the genes, which confer a greater risk of breast and ovarian cancer, provides information about women's risk of breast and ovarian cancer that may affect decisions about prophylactic surgery, chemoprevention, and screening.
The results showed that women who underwent genetic counselling were significantly less likely to be black (7.4% of the women) than the controls (28.8%) (odds ratio 0.22 (95% confidence interval 0.12 to 0.40)). This association remained after adjustment was made for the probability of having a BRCA1 or BRCA2 mutation, socioeconomic characteristics, the women's perception of their risk of breast and ovarian cancer, attitudes about the risks and benefits of genetic testing, and whether the primary care physician had recommended the testing (adjusted odds ratio 0.28 (0.09 to 0.89)).
The study's lead researcher, Katrina Armstrong, from the University of Pennsylvania School of Medicine, Philadelphia, said: "Our results indicated racial disparities in the use of BRCA1/2 counselling are large and do not appear to be explained by differences in risk factors for carrying a BRCA1/2 mutation, socioeconomic factors, risk perception, attitudes, or primary care physician recommendations."
Dr Armstrong said that the lower rate of genetic testing in black women may be due to greater distrust of health care, which other studies have shown in black people. This distrust may apply particularly to new technologies such as genetic testing. Previous research has also shown that black people were more likely to be concerned about racial discrimination on the basis of genetic testing. She concluded: "The benefit of predictive genetic testing will not be fully realised unless these disparities can be addressed."(Susan Mayor)
The case-control study looked at 408 women receiving primary healthcare services from the University of Pennsylvania Health System who had a first degree or second degree relative with breast or ovarian cancer ( JAMA 2005;293: 1729-36). The women were followed up from December 1999 to August 2003.
Just over half (217) received genetic counselling for BRCA1 and BRCA2 gene testing (and so were considered cases), while 191 women did not (controls). Testing for mutations in the genes, which confer a greater risk of breast and ovarian cancer, provides information about women's risk of breast and ovarian cancer that may affect decisions about prophylactic surgery, chemoprevention, and screening.
The results showed that women who underwent genetic counselling were significantly less likely to be black (7.4% of the women) than the controls (28.8%) (odds ratio 0.22 (95% confidence interval 0.12 to 0.40)). This association remained after adjustment was made for the probability of having a BRCA1 or BRCA2 mutation, socioeconomic characteristics, the women's perception of their risk of breast and ovarian cancer, attitudes about the risks and benefits of genetic testing, and whether the primary care physician had recommended the testing (adjusted odds ratio 0.28 (0.09 to 0.89)).
The study's lead researcher, Katrina Armstrong, from the University of Pennsylvania School of Medicine, Philadelphia, said: "Our results indicated racial disparities in the use of BRCA1/2 counselling are large and do not appear to be explained by differences in risk factors for carrying a BRCA1/2 mutation, socioeconomic factors, risk perception, attitudes, or primary care physician recommendations."
Dr Armstrong said that the lower rate of genetic testing in black women may be due to greater distrust of health care, which other studies have shown in black people. This distrust may apply particularly to new technologies such as genetic testing. Previous research has also shown that black people were more likely to be concerned about racial discrimination on the basis of genetic testing. She concluded: "The benefit of predictive genetic testing will not be fully realised unless these disparities can be addressed."(Susan Mayor)