Minority Women Who Survive BRCA-Positive Breast Cancer Less Likely to Receive Preventive Surgery

Women diagnosed with breast cancer who carry a BRCA mutation have up to a 50% lifetime risk of developing a second breast cancer.

A racial disparity was found among BRCA-positive breast cancer survivors, with black women far less likely to receive preventative surgery, a procedure known to significantly reduce the risk of breast or ovarian cancer development.

A study presented at the American Society of Clinical Oncology (ASCO) Annual Meeting noted that women diagnosed with breast cancer who carry a BRCA mutation have up to a 50% lifetime risk of developing a second breast cancer and up to a 44% risk of ovarian cancer.

Preventative measures such as a bilateral mastectomy can substantially reduce the risk of developing a second breast cancer and an oophorectomy reduces the risk of ovarian cancer by 90%, according to the study.

Through the Florida State Cancer Registry, researchers recruited 1621 non-Hispanic white (NHW), Hispanic, and black women diagnosed with an invasive breast cancer before they were 50-years-old. The study included 917 patients who reported BRCA testing after they received their diagnosis, 92 of which tested BRCA-positive.

The results of the study found that genetic testing rates varied across the different racial groups, with 65% of NHWs and 62% of Hispanic women compared with only 36% of black women.

A significant difference among the racial groups was also found in 92 BRCA-positive patients receiving a mastectomy and an oophorectomy. The study revealed that with both the bilateral mastectomy and the oophorectomy, black women had significantly lower testing rates, at 68% and 32%, respectively.

“People only benefit from genetic testing for cancer risk if they act on the information the test reveals and receive appropriate follow-up care,” said lead study author Tuya Pal, MD. “Our data showing lower uptake of risk reducing surgery among minority BRCA carriers may prompt clinicians to provide more intensive, targeted follow-up efforts, especially for black women.”

Hispanic women were found to have lower rates of mastectomy 85% compared with NHW women, and higher rates of oophorectomy compared with NHW women (85% versus 71%). The differences remained consistent after adjusting for factors including age at enrollment, time of diagnosis, family history of breast and ovarian cancers, income, and insurance status.

Limitations to the study included the small sample of BRCA-positive women in each racial group. Four black women were still in active treatment during the study, which could have contributed to the lower rates of oophorectomy that this group saw.

Additionally, women may pursue breast cancer treatment prior to addressing ovarian cancer risk management. Authors note that because of the study’s limitations, follow-up analysis among these women should be conducted to determine their choices over time for cancer risk management.

“I hope that our findings will raise awareness of disparities pertaining to inherited cancer predisposition that exist across the cancer continuum,” Pal said. “It is now imperative to understand why these disparities exist, so we can develop interventions to address them to ensure that women with inherited disease make informed decisions about their cancer risk management.”