Racial/Ethnic Disparities in BRCA Counseling and Testing: a Narrative Review
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Racial/Ethnic Disparities in BRCA Counseling and Testing: a Narrative Review Christina D. Williams 1,2 & Alyssa Jasmine Bullard 1 Karen Goldstein 3,4
&
Meghan O’Leary 1 & Reana Thomas 1 & Thomas S. Redding IV 1 &
Received: 20 September 2018 / Revised: 13 December 2018 / Accepted: 18 December 2018 # This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2019
Abstract Background/objective Despite increases in BRCA mutation testing, racial/ethnic disparities in counseling and testing have persisted for decades. The purpose of the review was to summarize recent literature as it relates to detecting, understanding, and reducing disparities in BRCA counseling and testing. Design This is a narrative review of articles published January 2012 to July 2017 relevant to genetic testing and counseling, breast and ovarian cancer, and minority health and heath disparities. Twenty-three articles were included in this review. Results Studies report lower counseling and/or testing rates for eligible racial/ethnic minorities among family members of high-risk individuals as well as among breast cancer survivors. Key barriers and facilitators of disparate BRCA counseling/testing that emerged in this review included awareness, cost-related factors, stress and distrust, family concerns and communication, and provider communication and referral. To address differential access to and use of BRCA testing services and expand testing in minority populations, it is necessary for interventions to focus on improving awareness, risk-perception, and family and patient-provider communication. Conclusion Multi-level and targeted interventions are needed to reduce persistent racial/ethnic disparities and improve assessment, provider recommendations, counseling and testing among minority populations. Keywords Breast cancer . Health care disparities . Hereditary cancer syndrome . Genetic testing . Genetic counseling
Introduction Genetic testing for cancer risk is the component of personalized medicine that focuses on identifying individuals with an inherited risk for cancer. Although individuals with certain genetic mutations and/or from families with an inherited susceptibility may have a higher risk of cancer, it is not inevitable that * Christina D. Williams [email protected] 1
Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC 27705, USA
2
Department of Medicine, Division of Medical Oncology, Duke University, Durham, NC, USA
3
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC 27705, USA
4
Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, USA
they will develop cancer and initiating appropriate cancer prevention and surveillance can help reduce morbidity and mor
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