Jones Tarsha, McCarthy Anne Marie, Kim Younji, Armstrong Katrina
Florida Atlantic University, Boca Raton, Florida.
Dana Farber Cancer Institute, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Boston, Massachusetts.
Cancer Med. 2017 Jul;6(7):1787-1798. doi: 10.1002/cam4.1120. Epub 2017 Jun 19.
Evidence shows that Black women diagnosed with breast cancer are substantially less likely to undergo BRCA testing and other multipanel genetic testing compared to White women, despite having a higher incidence of early-age onset breast cancer and triple-negative breast cancer (TNBC). Our study identifies predictors of BRCA testing among Black women treated for breast cancer and examines differences between BRCA testers and nontesters. We conducted an analysis of 945 Black women ages 18-64 diagnosed with localized or regional-stage invasive breast cancer in Pennsylvania and Florida between 2007 and 2009. Logistic regression was used to identify predictors of BRCA 1/2 testing. Few (27%) (n = 252) of the participants reported having BRCA testing. In the multivariate analysis, we found that perceived benefits of BRCA testing (predisposing factor) ([OR], 1.16; 95% CI: 1.11-1.21; P < 0.001), income (enabling factor) ([OR], 2.10; 95% CI: 1.16-3.80; p = 0.014), and BRCA mutation risk category (need factor) ([OR], 3.78; 95% CI: 2.31-6.19; P < 0.001) predicted BRCA testing. These results suggest that interventions to reduce disparities in BRCA testing should focus on identifying patients with high risk of mutation, increasing patient understanding of the benefits of BRCA testing, and removing financial and other administrative barriers to genetic testing.
有证据表明，与白人女性相比，被诊断出患有乳腺癌的黑人女性接受BRCA检测及其他多基因检测的可能性要低得多，尽管她们患早发性乳腺癌和三阴性乳腺癌（TNBC）的几率更高。我们的研究确定了接受乳腺癌治疗的黑人女性中BRCA检测的预测因素，并研究了进行BRCA检测者与未检测者之间的差异。我们对2007年至2009年期间在宾夕法尼亚州和佛罗里达州被诊断患有局部或区域阶段浸润性乳腺癌的945名18至64岁的黑人女性进行了分析。采用逻辑回归来确定BRCA 1/2检测的预测因素。很少有参与者（27%，n = 252）报告进行过BRCA检测。在多变量分析中，我们发现BRCA检测的感知益处（诱发因素）（[比值比]，1.16；95%置信区间：1.11 - 1.21；P < 0.001）、收入（促成因素）（[比值比]，2.10；95%置信区间：1.16 - 3.80；p = 0.014）以及BRCA突变风险类别（需求因素）（[比值比]，3.78；95%置信区间：（2.31 - 6.19）；P < 0.001）可预测BRCA检测。这些结果表明，减少BRCA检测差异的干预措施应侧重于识别具有高突变风险的患者，增强患者对BRCA检测益处的理解，并消除基因检测的财务和其他管理障碍。
