As reported in the Journal of Clinical Oncology by Ademuyiwa et al, a survey of U.S. breast oncologists showed that physicians believe that Black women with breast cancer face more barriers to genetic counseling and testing compared to White women with breast cancer.
Study Details
The study consisted of a nationwide 49-item survey of breast oncology physicians covering their own demographics, clinical characteristics, knowledge, attitudes, practices, and perceived barriers in providing genetic counseling and testing to patients with breast cancer.
We demonstrated that racial differences exist in oncology physicians’ perceived barriers to genetic counseling and testing for patients with breast cancer... Awareness of such physician biases can enable further work to address inequities, ultimately leading to improved genetic counseling and testing equity for [Black] women with breast cancer.— Ademuyiwa et al
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Key Findings
A total of 317 physicians responded to the survey (response rate of 25%). Of these, 40 indicated that they did not manage patients with breast cancer and were excluded from analysis, with a total of 277 respondents constituting the final analysis cohort.
Among the 277 respondents: 58.8% were female; 67.1% were White, 23.8% were Asian/Pacific Islander, and 3.3% were Black; 75.1% were medical oncologists; 61.7% were academic physicians; and 63.2% had been in clinical practice for more than 10 years.
Overall, 1.8% of respondents indicated that they were more likely to refer a White patient than a Black patient for genetic counseling and testing, whereas 66.9% believed that Black women have lower rates of genetic counseling and testing than White women. A total of 63.4% indicated that Black women face more barriers to genetic counseling and testing than White women, and 21% believed that Black women require more information and guidance during the genetic counseling and testing decision-making process.
A total of 54.8% believed that Black patients with breast cancer are more likely than White patients to experience increased psychological distress as a result of undergoing genetic counseling and testing. Lack of trust as a barrier to genetic counseling and testing among all patients was cited by 32%, whereas 58.1% indicated that lack of trust was a greater barrier among Black women (P < .0001).
While 13.9% believed that noncompliance with genetic counseling and testing is a barrier for all patients, 30.6% believed that Black women are more likely than White women to be noncompliant (P < .0001). A total of 76.6% had patients refuse genetic counseling and testing; 25.7% believed that Black women are more likely than White women to refuse genetic counseling and testing (P < .0001).
Overall, 30.8% indicated that genetic testing is fraught with ambiguous results, with 19.5% believing that genetic testing in Black women is more likely to produce ambiguous results than in White women (P = .0046). In addition, 64.1% believed cost is a barrier to genetic counseling and testing among all patients, with 46% reporting that they believe that cost is a greater barrier for Black women (P < .0001).
The investigators concluded, “We demonstrated that racial differences exist in oncology physicians’ perceived barriers to genetic counseling and testing for patients with breast cancer. This nationwide survey will serve as a basis for understanding physicians’ determinants of genetic counseling and testing for [Black] women and highlights the necessity of education and interventions to address bias among physicians. Awareness of such physician biases can enable further work to address inequities, ultimately leading to improved genetic counseling and testing equity for [Black] women with breast cancer.”
Foluso O. Ademuyiwa, MD, MPH, MSCI, of Washington University School of Medicine in St. Louis, is the corresponding author for the Journal of Clinical Oncology article.
