A nationwide survey of breast oncologists found that their self-reported practices and attitudes regarding genetic counseling and testing (GCT) for African American women with breast cancer show a discrepancy with what is seen in the real world.
In the survey, nearly 90% of respondents said they would get tested for any African American breast cancer patient who met the guidelines.
However, previous studies have shown significantly lower GCT referral rates for African American patients: they make up less than 10% of those who undergo genetic counseling and testing for BRCA1 / 2 or other breast cancer susceptibility genes, compared to more than 65% of white women.
“The reasons for the lower referral rates of doctors to GCT in African American patients are unknown, but may be due to implicit bias,” say the survey authors. “It is possible that doctors fail to realize that they are inadvertently contributing to racial inequalities.”
The survey also found that 63.4% of doctors believe that African Americans have more barriers to GCT than white patients, especially in terms of the costs involved. In addition, 58.1% felt that lack of confidence was a bigger barrier for African American patients, and 30.6% thought that African American patients were less likely to adhere to GCT recommendations than white patients.
“To the best of our knowledge, this is the first study to provide insight into US physicians’ self-reports investigating racial inequalities in health care,” say the authors, led by Foluso Ademuyiwa, MD, MPH, Washington University School of Medicine, St. Louis, Missouri.
The study was published online in the Journal of Clinical Oncology on October 18.
This study is “important because it throws a mirror in front of us all to counter our prejudices and prejudices,” write the authors of an accompanying editorial, Sophie Sun, MD, and Karen Gelmon, MD, both of the British Columbia Cancer Agency in Vancouver. Canada.
It is a “reminder that cancer must be treated fairly with the best of evidence-based medicine and” [that the] Guidelines apply to all patients, “they add.
In the short term, updating and simplifying referral and testing criteria should help improve patient referral rates and access to GCT. “Revised guidelines should also reflect new treatment indications and include subjects who may not have an immediate indication, but where knowledge of a germline mutation can affect the patient or the family,” add the editors.
“Most patients are interested in answering the question ‘Why do I have cancer’? Corresponding germline information can help, ”they emphasize.
Details of the survey responses
The survey included responses from 277 doctors, three-quarters of whom were medical oncologists and two-thirds of whom were white.
Two-thirds of respondents said they refer all patients who meet the National Cancer Comprehensive Network’s guidelines for genetic counseling and testing, but the same proportion of respondents also said that black women with breast cancer are less likely to get GCT than white women .
Just over 37% of respondents said that any patient with breast cancer should undergo GCT, and only 1.8% of respondents said they would be more likely to refer a white patient for GCT than an African American patient.
Approximately 75% of respondents said that patients were opposed to GCT, and 25.7% of respondents believed that African American women were more likely than white women to reject GCT (P <0.0001).
About half of respondents said they view patient complaints as a general barrier to GCT, although previous studies have suggested that GCT-related cancer incidence is low.
The results “underscore the urgent need for interventions to improve GCT rates and ultimately guideline-compliant care in African-American breast cancer patients,” the authors conclude.
Given that physicians have a direct impact on the use of GCT in all women with breast cancer, “fairer use of GCT for African Americans could be a critical component through which we can potentially address racial differences in breast cancer mortality,” they add added.
Ademuyiwa reports having received honoraria from Best Doctors, Advance Medical, advisor / consultant and research funding from a number of pharmaceutical companies. Editors Sun and Gelmon also report relationships with several pharmaceutical companies, as described in the article.
JClin Oncol. Published online October 18, 2021. Abstract, Editorial
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