medwireNews: A survey of US oncologists and physicians has shown that their perceived barriers toward genetic counseling and testing (GCT) for breast cancer vary by patients' race.
Foluso Ademuyiwa (Washington University School of Medicine, St Louis, Missouri, USA) and colleagues have previously shown that African–American women are “much less likely” than White women to be referred for or undergo GCT when they meet the criteria.
Yet, just 1.8% of participants in the current analysis said that they were more likely to refer a White patient than an African–American patient for GCT, while 11.6% disagreed with the statement that African–American women with breast cancer have lower rates of GCT than White women and a further 21.5% were unsure.
“This underscores the need for programs to enhance awareness among oncologists to enable effective and guideline-concordant GCT for African Americans,” Ademuyiwa and co-authors write in the Journal of Clinical Oncology.
In all, 277 physicians responded to a 49-item survey about their own demographics, knowledge, attitudes, practices, and perceived barriers in providing GCT to patients with breast cancer. Of these, 67.1% were White, 23.8% were Asian or Pacific Islander, 3.3% were African American, and 5.8% were of other or unknown race. In addition, 58.8% were women, 75.1% were medical oncologists, and 61.7% practiced in an academic setting.
Nearly all (92.2%) respondents said they obtain genetic testing for all patients who meet National Comprehensive Cancer Network guidelines, whereas 89.1% said that they obtain testing for all African–American patients who meet guidelines. The corresponding proportions for counseling were 66.9% and 65.4%.
In terms of perceived barriers to GCT, 63.4% of participants agreed with the statement that African–American women have more barriers than White women, while 21.0% believed that African–American women require more education during the decision-making process for GCT than White women.
Just under a third (32.0%) of respondents agreed that lack of trust was a barrier to GCT among all patients with breast cancer, but 58.1% felt that it was a greater barrier for African–American versus White patients.
Only a small number of respondents (13.9%) believed that noncompliance with GCT is a barrier for all patients, but 30.6% felt that African–American women are more likely to be noncompliant than White women.
“It is notable that a previous study did not show any racial differences in compliance with nor uptake of recommendations in those appropriately referred for GCT,” Ademuyiwa et al remark.
The authors say their findings raise “some concerning questions regarding patterns in US oncologists’ attitudes, practices, and perception of barriers regarding GCT in African American patients with breast cancer.”
They continue: “Racial differences in several perceived barriers to GCT were apparent, and physicians’ self-reported practices regarding GCT for African Americans were not consistent with those directly measured and reported in previous literature.”
Ademuyiwa and team therefore conclude that the “data indicate a considerable need for implicit bias education for physicians and evaluation of physicians’ barriers and facilitators of GCT for African American patients.”
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