New study shows racial disparities in genetic testing referrals for women

A recent study suggests that unconscious or implicit bias may exist when it comes to physicians referring African American patients with breast cancer for genetic counseling and testing.

A survey in the Journal of Clinical Oncology shows that physician’s attitudes may be part of why less Black women with breast cancer are sent for genetic counseling and testing (GCT) than their White counterparts.

The key objectives for the study, noted the researchers, included gaining an understanding of the attitudes and practices regarding GCT in African Americans with breast cancer. “There is a need for implicit bias education for physicians regarding GCT for African American patients and for interventions to improve GCT rates … in African-American women with breast cancer,” the investigators said. “Racial differences exist in physicians’ perceived barriers to GCT for patients with this kind of cancer, and physicians’ self-reported practices regarding GCT for African Americans are not consistent with those reported in the previous literature.”

Nearly 300 (277) oncology physicians nationwide were given a 49-item survey. Respondents were queried about their own demographics, clinical characteristics, knowledge, attitudes, practices and perceived barriers in providing GCT to patients with breast cancer.

In the study, 67% of the doctors were white and less than 4% were Black. Almost 59% were female, and more than half (62%) practiced at academic medical centers.

While less than 2% of the physicians surveyed said they were less likely to refer a Black patient than a White patient, the study noted that other research found Black patients being referred for GCT less than 60% of the time, compared to a referral rate of 93% for white patients. A majority of respondents stated that testing guidelines for hereditary breast and ovarian cancer were complicated. “The use of complicated GCT guidelines in a busy clinic is likely to exacerbate existing racial inequities in care,” observed the investigators. “If physicians perceive existing barriers that further interfere with obtaining GCT, they may not take the time to evaluate complicated guidelines and refer eligible patients for GCT.” The survey seemed to prove this theory, since 63.4% of physicians perceive that African Americans have more barriers to GCT than White patients.

When asked whether they believed that Black patients were more likely than White patients to refuse GCT, almost 26% of respondents said yes. Although 32% of respondents said that lack of trust was a barrier to GCT for all patients, nearly 60% said this was a greater barrier for African American women.

Additionally, nearly 52% of respondents believed that genetic testing increases psychological distress, and 55% believed that African American patients with breast cancer are more likely than Whites to experience increased psychological distress as a result of genetic testing.

And, although research also showed that Black patients are more comfortable going to physicians of their same race, only about 3% of oncologists in the United States currently are black.

The investigators concluded that the study “Raises some concerning questions regarding patterns in US oncologists’ attitudes, practices, and perception of barriers regarding GCT in African American patients with breast cancer. 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 [previously].” The investigators said that this survey highlights the necessity of education and interventions to address bias among physicians. “In this personalized medicine era, the knowledge of a patient’s genetic status can lead to improved clinical management, cascade family testing, and prevention of other malignancies in patients and their relatives. Therefore, achieving appropriate use of GCT in African American patients is an essential step in minimizing ongoing and future racial disparities in clinical outcomes.”

Reference

Ademuyiwa FO, Salyer P, Tao Y, et al. Genetic counseling and testing in African American patients with breast cancer: a nationwide survey of US breast oncologists. J Clin Oncol. Published online October 18, 2021. doi:10.120