Joining FORCES is the FORCE newsletter with news, views and supportive information for individuals concerned about hereditary breast and ovarian cancer.
by Tuya Pal, M.D. and Susan Vadaparampil, Ph.D.
African-American women in the United States who develop breast cancer are more likely to be diagnosed at younger ages and more likely to die from the disease when compared with Caucasian women.
Many factors may contribute to the higher death rate. According to the American Cancer Society, several studies document treatment differences between African- American women and Caucasian women. Alarmingly, more African-American women than white women experience a delay in treatment after an abnormal screening, according to data from the American Society of Clinical Oncology’s annual meeting. The delay is documented in the largest and most systematic evaluation of disparities based on ethnicity and race, according to researcher Sherri N. Sheinfeld Gorin, Ph.D., of Columbia University Medical Center.
Scientists are exploring the relationship between younger age at diagnosis among African-American women and a variety of factors, including genetic predisposition. Although multiple genes are involved in breast cancer development, BRCA1 and BRCA2 gene mutations are believed to account for the majority of hereditary breast cancers. The likelihood of a mutation is higher when the disease is diagnosed at a younger age. Thus, some breast cancers in young African-American women may be due to a hereditary component.
There is a disparity in access to and use of general preventive healthcare services in the African-American community. The disparity is even greater in access to and use of newer technologies such as genetic testing for hereditary breast cancer risk. A much lower percentage of African Americans are aware of their personal risk of cancer and genetic testing options. Studies indicate African-American women are less familiar with genetic testing and how it might benefit them in making decisions about screening or treatment compared to Caucasian women.
Research led by Dr. Katrina Armstrong at the University of Pennsylvania found African-American women with a family history of cancer are less likely to seek information about genetic testing than Caucasian women. In fact, Caucasian women were almost five times more likely than African-American women to undergo genetic counseling to determine whether or not they should be tested. This difference remained even when women of similar socioeconomic and medical risk backgrounds were compared.
Factors not explored in the study include limited knowledge about genetic counseling and testing among both African- American women and the physicians who care for them. Worries within the African-American community about how genetic information is used may also pose a barrier for advancing knowledge. People may be concerned that their genetic test results will be used against them if they are found to carry one of the hereditary breast cancer gene mutations. Women need to understand that having one of these mutations may increase their risk for developing the disease, but it does not automatically mean they will develop breast cancer.
Because of lower rates of genetic testing among African-American women, it is uncertain whether genetic factors for breast cancer risk are common in the African-American community. This lack of information can complicate interpretation of genetic testing results. However, if more African-American women with certain risk factors were to participate in research involving genetic testing, the information could be used to develop new technologies to help detect and treat their cancers earlier, when chances of cure are more likely.
To increase awareness of inherited cancer syndromes, a strong need for nationwide education exists about the role of genetics in cancer. This is especially true among minority populations. Ultimately, the benefits of increased participation in cancer genetics research and testing have great potential as geneticsbased medicines will likely become available in the near future. However, these benefits will remain unrealized until efforts increase to bridge racial disparities that contribute to unequal access and use of preventative medical services, which can then lead to reduce disparities in health outcomes.
Dr. Tuya Pal is a clinical geneticist and an Assistant Professor
of Interdisciplinary Oncology at
H. Lee Moffitt Cancer Center and Research Institute.
Dr. Susan Vadaparampil is a behavioral scientist and an Assistant Professor of Interdisciplinary Oncology at H. Lee Moffitt Cancer Center and Research Institute.
S N Sheinfeld Gorin, J E Heck. New York Physicians against Cancer.
Delay in breast cancer diagnosis by race/ethnicity.
Abstract #6004 from American Society of Clinical Oncology Annual Conference, May 2005.
K Armstrong, E Micco, A Carney, J Stopfer, M Putt.
Racial differences in the use of BRCA1/2 testing among women with a family history of breast or ovarian cancer.
Journal of the American Medical Association, April 2005; vol. 293, no. 14: 293:1729-1736.