Black Women With BRCA Mutations Less Likely to Receive Preventive Surgery

A new study of breast cancer survivors with BRCA gene mutations found that black women are far less likely to receive preventive surgery than white or Hispanic women with the mutations. The study was presented at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.

Lead study author Tuya Pal, MD, clinical geneticist at the H. Lee Moffitt Cancer Center and Research Institute, Inc, in Tampa, Florida, said the study data showed lower uptake of risk-reducing surgery among minority BRCA carriers, which may prompt clinicians to provide more intensive, targeted follow-up efforts, especially for black women.

“It is now imperative to understand why these disparities exist, so that we can develop interventions to address them to ensure that women with inherited disease make informed decisions about their cancer risk management,” said Pal.

Once a woman with a BRCA mutation is diagnosed with breast cancer, she faces up to a 50% lifetime risk of developing a second breast cancer and up to a 44% risk of developing ovarian cancer. Preventive bilateral (both breasts) mastectomy greatly reduces the risk of a second breast cancer, and preventive oophorectomy (removal of ovaries and fallopian tubes) reduces the risk of ovarian cancer by 90%.

The study recruited non-Hispanic white, black, and Hispanic women diagnosed with an invasive breast cancer at or before the age of 50 between 2009 and 2012 through the Florida State Cancer Registry. Among the 1621 study participants, 917 reported undergoing BRCA testing following their breast cancer diagnosis. Ninety-two of those women tested positive for the BRCA mutations. The researchers found that genetic testing rates varied by racial group: 65% of non-Hispanic whites and 62% of Hispanic women received testing, compared with only 36% of black women. The lower rates of clinical genetic testing for BRCA mutations in black women unfortunately prevents them from taking advantage of preventive interventions after breast cancer.

Among the 92 women who tested positive for BRCA mutations, the researchers found significant differences in receipt of mastectomy and oophorectomy between the three racial groups. Black women had the lowest rates of 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%). Even after controlling for age at study enrollment, time since diagnosis, income, family history of breast cancer and ovarian cancer, and insurance status, the differences between blacks and the other two groups of women remained significant.

Despite some limitations inherent to the study, including the small number of women with BRCA mutations in each racial/ethnic group, the investigators believe their findings should increase awareness of disparities pertaining to inherited cancer predisposition that exists across the cancer continuum.

“This study is an important reminder that we must tackle racial disparities in breast and ovarian cancers on multiple fronts,” said Patricia Ganz, MD, ASCO expert in breast cancer, said at a press briefing at the annual meeting. “The decision to undergo preventive breast and ovarian surgery is also a very personal one, and it’s important that all women and their physicians have that discussion about the benefits and risks, no matter their race.”