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Physician Recommendation May Influence Racial Disparity in BRCA1/2 Testing in Women With Breast Cancer

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Key Points

  • Disparity in BRCA1/2 testing between white and black women remained after adjustment for mutation risk, clinical factors, sociodemographic characteristics, and attitudes about testing, according to a population-based study.
  • Adjustment for physician recommendation resulted in a reduction in the disparity to a statistically nonsignificant level.

A disparity in BRCA1/2 testing between white and black women was influenced by patient-reported physician recommendation, in a population-based study reported by McCarthy et al in the Journal of Clinical Oncology.

Study Details

The study involved data from 3,016 women (69% white, 31% black) in Pennsylvania and Florida who were 18 to 64 years old and diagnosed with invasive breast cancer between 2007 and 2009, linked cancer registry data, the American Medical Association Physician Masterfile, and patient and physician surveys. Surveys were completed by 210 of 808 oncologists and 208 of 732 surgeons.

Disparity in Testing

Overall, 26.7% of black women vs 47.5% of white women underwent BRCA1/2 testing (odds ratio [OR] = 0.40, P < .001). The difference was smaller but still significant after adjustment for mutation risk, clinical factors, sociodemographic characteristics, and physician attitudes about testing (OR = 0.66, P < .001). The care of black and white women was segregated among surgeons (index of dissimilarity = 64.1) and oncologists (index of dissimilarity = 61.9), but the magnitude of the testing disparity was not affected by adjustment for clustering within patient or physician characteristics.

Effect of Recommendation

Black women were less likely to report that they had received a physician recommendation for testing after adjusting for mutation risk (OR = 0.66, P < .001). Adjustment for physician recommendation resulted in a reduction in the disparity to a statistically nonsignificant level (OR = 0.76, P = .06).

The investigators concluded: “Although black and white patients with breast cancer tend to see different surgeons and oncologists, this distribution does not contribute to disparities in BRCA1/2 testing. Instead, residual racial differences in testing after accounting for patient and physician characteristics are largely attributable to differences in physician recommendations. Efforts to address these disparities should focus on ensuring equity in testing recommendations.”

The study was supported by the National Cancer Institute.

Anne Marie McCarthy, PhD, of Massachusetts General Hospital, Boston, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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