Women With Breast Cancer Concerned About Genetic Risk

Veronica Hackethal, MD

April 09, 2015

About 35% of women with nonmetastatic breast cancer would like to have genetic testing, but only 43% have had a discussion about genetic risk with a healthcare provider, according to a study published online April 6 in the Journal of Clinical Oncology.

In addition, minorities with a strong desire for genetic testing were significantly less likely than white women to have discussed genetic testing with a provider.

"Many women diagnosed with breast cancer have concerns about the genetic risk of developing other cancers or that their family members will develop cancer in the future," said first author Reshma Jagsi, MD, DPhil, associate professor of radiation oncology at the University of Michigan Medical School in Ann Arbor.

"Even patients who don't have an elevated risk may benefit from a discussion to clarify risks and potentially alleviate long-term worry," she told Medsacpe Medical News.

Genetic testing can help guide decisions about preventive measures, surveillance, the counseling of family members, and whether aggressive treatment is necessary, the researachers explain.

About 5% to 10% of patients with breast cancer carry germline mutations, putting them at risk for other cancers. Such mutations, like BRCA1 and BRCA2, have been found in all racial and ethnic subgroups, they report.

Physicians should talk about genetic risk with patients, even when they don't ask about it, Dr Jagsi said.

"Patients are hearing a lot about genetic risk these days, given media attention to celebrity experiences and court cases, so it is particularly important to discuss these issues directly," she noted. Discussion could "make sure that patients at high risk receive appropriate counseling and consider testing, and may be equally important to reassure patients who are not at elevated risk that they are unlikely to harbor a genetic mutation that would increase risk of future cancers or put family members at risk."

Study Results

Dr Jagsi and colleagues used the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database to identify women in Los Angeles and Detroit diagnosed with nonmetastatic breast cancer from 2005 to 2007. They surveyed these women about 9 months after diagnosis and again 4 years later.

The inclusion of just two geographic areas could limit the generalizability of the results, as could the reliance on self-report and the exclusion of men with breast cancer, the authors acknowledge.

The cohort of 1536 women was 41.8% white, 39.0% Latina, and 17.1% black.

Of these, 35% said they had a strong desire for genetic testing, 28% had discussed genetic testing with a provider, and 19% had undergone genetic testing.

A strong desire for testing was more common in younger women, Latinas, and women with a family history of breast cancer.

However, 196 of the 493 women (39.8%) who expressed a strong desire for testing had no discussion about genetic risk with their provider. And minority women who expressed this desire were significantly more likely than white women to have this need unmet; in fact, for Spanish-speaking Latinas, the odds ratio was 7.39, for English-speaking Latinas it was 2.44, and for black women, it was 1.68.

Women with this unmet need for discussion were more worried than those who had the discussion about cancer recurrence and about family members developing the disease (24.9% vs 48.7%; P < .001). There was a significant association between the rate of worry and race/ethnicity (P < .001); this was highest in Spanish-speaking Latinas (83.1%), followed by English-speaking Latinas (56.7%), white women (38.4%), and black women (31.1%).

Several factors related to the complex nature of racial and ethnic differences in healthcare could explain the findings, Dr Jagsi said.

"It may be that some providers think of genetic mutations as being implicated primarily in Ashkenazi Jewish patients, and they could fail to recognize that such mutations are not less frequent in minority patients," she explained. It might also be that "minority patients are less likely than white patients to ask their providers about these issues, or that the settings in which minority patients receive care are different in meaningful ways."

The authors have disclosed no relevant financial relationships.

J Clin Oncol. Published online April 6, 2015. Abstract

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