Disparities in BRCA1/2 testing in black and white women is attributable to differences in physician recommendations, according to a study in the Journal of Clinical Oncology.1
Because racial disparities in BRCA1/2 testing are poorly understood, researchers sought to determine whether distribution of black and white patients across cancer providers contributes to these disparities.
The researchers conducted a population-based study of women in Pennsylvania and Florida that included 3106 women, 808 medical oncologists, and 732 surgeons. The women were age 18 to 64 years with invasive breast cancer diagnosed between 2007 and 2009. Sixty-nine percent of the women were white and 31% were black.
Care of the women was highly segregated across surgeons and oncologists (index of dissimilarity 64.1 and 61.9, respectively); however, adjusting for clustering within physician or physician characteristics did not change the size of the testing disparity.
Study findings showed that black women were still less likely to undergo BRCA1/2 testing than white women (odds ratio [OR], 0.40; 95% CI, 0.34 to 0.48; P < .001). Adjusting for mutation risk, clinical factors, sociodemographic characteristics, and attitudes about testing diminished the difference but did not eliminate it (OR, 0.66; 95% CI, 0.53 to 0.81; P < .001).
Black women were less likely to report that they had received physician recommendation for BRCA1/2 testing even after adjusting for mutation risk (OR, 0.66; 95% CI, 0.54 to 0.82; P < .001). Adjusting for physician recommendation further reduced the testing disparity (OR, 0.76; 95% CI, 0.57 to 1.02; P = .06).
Black and white women with breast cancer tend to get their care from different surgeons and oncologists; however, this distribution does not contribute to disparities in BRCA1/2 testing. Persistence of racial differences in testing is attributable to physical recommendation, and the researchers suggest focusing on ensuring equity in testing recommendations.
1. McCarthy AM, Bristol M, Domchek SM, et al. Health care segregation, physical recommendation, and racial disparities in BRCA1/2 testing among women with breast cancer [published online ahead of print May 9, 2016]. J Clin Oncol. doi:10.1200/JCO.2015.66.0019.