ASCO 2016: Minority BRCA-Positive Breast Cancer Survivors Appear Less Likely to Receive Preventive Surgery
For breast cancer survivors who carry mutations in BRCA genes, preventive surgery may substantially reduce the risk of future breast and ovarian cancers. However, it appears that black women are far less likely to receive these widely recommended procedures than white or Hispanic women, according to a population-based study of breast cancer survivors in Florida. The study was presented by Pal et al at the 2016 ASCO Annual Meeting (Abstract LBA1504).
“People only benefit from genetic testing for cancer risk if they act on the information the test reveals and receive appropriate follow-up care,” said lead study author Tuya Pal, MD, a clinical geneticist at the H. Lee Moffitt Cancer Center & Research Institute. “Our data showing lower uptake of risk-reducing surgery among minority BRCA carriers may prompt clinicians to provide more intensive, targeted follow-up efforts, especially for black women.”
Risk Management for BRCA Carriers
Once a woman who carries a BRCA mutation is diagnosed with breast cancer, she faces up to a 50% lifetime risk of a second breast cancer and up to a 44% risk of ovarian cancer. Preventive bilateral mastectomy greatly reduces the risk of a second breast cancer.
Similarly, oophorectomy cuts the risk of ovarian cancer by 90%. As there are no reliable screening options for early detection of ovarian cancer, preventive oophorectomy is a critical strategy to lower deaths from ovarian cancer in this population.
About the Study
The researchers recruited non-Hispanic white, black, and Hispanic women diagnosed with an invasive breast cancer at or before the age of 50 through the Florida State Cancer Registry. According to the authors, this is the first study to explore follow-up care among BRCA carriers across an entire population treated in diverse settings, including a significant number of minority women. Prior studies were limited to a single academic center or health system.
Among the 1,621 participants, 917 reported BRCA testing following their breast cancer diagnosis, and 92 of those tested positive for the mutations.
Key Findings
The researchers identified genetic testing rates varied by racial group: 65% of non-Hispanic white women and 62% of Hispanic women received testing, compared with only 36% of black women.
Among the 92 women who tested positive for BRCA mutations, the researchers also found significant differences in receipt of mastectomy and oophorectomy among the three racial groups. Black women had the lowest rates of both bilateral mastectomy (68%) and oophorectomy (32%). Compared with non-Hispanic white women, Hispanic women had lower rates of mastectomy (85% vs 94%) but higher rates of oophorectomy (85% vs 71%). The differences among blacks and the other two groups remained significant after controlling for age at enrollment; time since diagnosis; income; family history of breast and ovarian cancers; and insurance status.
The authors acknowledged that the study has some limitations, which include:
- Small numbers of women with BRCA mutations in each racial/ethnic group (51 non-Hispanic white, 28 black, and 12 Hispanic).
- The fact that four black women enrolled in this study were still in active treatment may contribute to lower rates of oophorectomy seen in this group.
- It is possible that women may choose to pursue breast cancer treatment prior to addressing ovarian cancer risk management. Thus, it is important to conduct follow-up studies among these women to determine their cancer risk management choices over time.
“I hope that our findings will raise awareness of disparities pertaining to inherited cancer predisposition that exist across the cancer care continuum. It is now imperative to understand why these disparities exist, so we can develop interventions to address them to ensure that women with inherited disease make informed decisions about their cancer risk management,” said Dr. Pal.
This study received funding from the Bankhead Coley Granting agency (IBG10-34199) and the American Cancer Society (RSG-11-268-01-CPPB).
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®.
