Physicians believe Black women experience more barriers to genetic counseling and testing for their cancer, according to new findings from Washington University School of Medicine in St. Louis published in the Journal of Clinical Oncology. The study revealed that doctors’ also believe Black women would be less likely to comply with recommendations for genetic counseling and testing.
“Oncologists have very different views of what the barriers to genetic testing are for white and black patients,” Laura Jean Bierute, senior author of the study and a professor of psychiatry told Inside Precision Medicine. “Their beliefs may be driving the testing rate.”
This idea challenges the notion that black patients are overall just more reticent about genetic testing. “We should not lay all the responsibility for these disparities on the patients,” said Bierute. “We need to take part of the blame.”
The researchers surveyed 277 cancer doctors around the country to learn why referrals are made so much less frequently for Black women. Of the doctors surveyed, 67% were white, less than 4% were Black, almost 59% were female and almost 62% practiced at academic medical centers.
Although fewer than 2% of doctors surveyed said they were less likely to refer a Black patient than a white patient, other research has found that Black patients are being referred for genetic counseling and testing less than 60% of the time that such testing is recommended by National Comprehensive Cancer Network guidelines. That compares with a referral rate of 93% for white patients.
The team asked doctors whether they believed Black patients were more likely than white patients to refuse genetic counseling and testing. Almost 26% said yes. Another 46% of respondents cited cost as a barrier for Black patients and a potential reason not to refer. Almost 59% said that their Black patients were less likely to trust their doctors’ diagnoses and referrals than white patients were.
“The survey indicated that 14% of physicians felt their patients, in general — regardless of race—probably would not follow through with genetic testing and counseling recommendations,” said lead author, Foluso O. Ademuyiwa, M.D., in a press release. “But more than twice as many, 31%, thought their Black patients would be less likely than white patients to comply with their recommendations for genetic counseling and testing. We feel there is some bias here, and we want to understand how we as physicians can do better in closing this gap.”
“For breast cancer patients with genetic mutations, the treatment is different; the surgical options are different; the screening and surveillance going forward is very different — so it’s important to identify those patients through genetic counseling and testing services,” Ademuyiwa added in her statement.
It’s been established that while they do share breast cancer mutations in common, black women can carry certain mutations that are unique to them. These may, therefore, be usual and cause more consternation than reassurance. Data also suggest Black patients are more comfortable working with providers of the same race, but only about 3% of U.S. oncologists are Black.
But the start, say the researchers, is to do more of the testing as recommended.
“We want doctors to check themselves, to take stock of what they have been doing and to take a little more time to make sure they are referring patients eligible for genetic counseling and testing,” Ademuyiwa said. “Correctly referring women, regardless of their skin color, is very important and can improve survival for breast cancer patients of all colors in a very real way.”
