番茄社区

CHICAGO -- A snapshot study of breast cancer survivors suggested racial and ethnic disparities in the use of cancer prevention strategies among women carrying high-risk mutations, a researcher said here.

Black women were significantly less likely than whites or Hispanics to get tested for the BRCA mutations that confer a markedly higher lifetime risk of both breast and ovarian cancer, according to, of the H. Lee Moffitt Cancer and Research Institute in Tampa, Fla.

And, once tested, they were less likely to take advantage of some of the available risk-management strategies, Pal told reporters at the American Society of Clinical Oncology annual meeting.

The findings are based on an analysis of 1,621 women -- 440 black, 284 Hispanic, and 897 white -- who were 50 or younger when they were diagnosed with breast cancer from 2009 to 2012. Participants were recruited through the, Pal said.

The investigators compared rates of BRCA testing among the women as well as what preventive strategies they undertook if they had a high-risk mutation, Pal said.

The health value of gene tests, Pal told 番茄社区, lies not in the testing itself, "it's what you do with the information."

The gene mutations in BRCA1 and BRCA2 confer a high lifetime risk of breast or ovarian cancer -- 60% to 70% and up to 44%, respectively -- as well as a 50% increase in the risk of second breast cancer, Pal noted.

For breast cancer, people with the BRCA mutations have two choices -- enhanced screening for new tumors and a prophylactic bilateral mastectomy. Screening for ovarian cancer has not been shown to improve outcomes, so the only effective prevention strategy is a prophylactic salpingo-oophorectomy, Pal said.

Analysis of the Florida cohort showed that just 36% of the black women got BRCA testing, compared with 62% of the Hispanics and 65% of the whites. The differences were significant (P=0.025), Pal reported.

Among the 28 black women who had high-risk mutations, 68% opted for a bilateral mastectomy, compared with 85% of the 12 Hispanics and 94% of the 51 whites. But when the use of screening was included, the disparity was much less, Pal said.

On the other hand, just 32% of the black women opted for a salpingo-oophorectomy, compared with 85% of the Hispanics and 71% of the whites for differences that were significant (P=0.01 and P=0.02, respectively).

Aside from race and ethnicity, a factor that was associated with women's choices was provider recommendation, Pal said.

But she cautioned that the study needs confirmation in a larger sample of BRCA mutation carriers. Also, the study was a snapshot and "it will be of interest to see over time what happens with these women, and if there is an improvement in their risk management."

Indeed, the study is "lovely" but might have been overtaken by events, commented ASCO spokesperson , of the University of California Los Angeles, who moderated the media briefing

The study included women diagnosed between 2009 and 2012 and "a lot has happened since then," Ganz said.

Most notably, actress Angelina Jolie famously had a prophylactic bilateral mastectomy on learning that she carries a high-risk mutation, Ganz noted. The publicity surrounding Jolie's decision might have increased awareness of the issue of cancer risk-management.

Also, treatment guidelines have changed, shifting focus from family history to gene testing for women diagnosed when they are 50 or younger, Ganz said.

"Temporal trends may have alleviated some of this disparity," she said, "and it would be very interesting -- if Dr. Pal or others recruits a more contemporary sample -- to see if there are shifts in this pattern."

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