Abstract B4: Providers perceptions and practices regarding BRCA1/2 counseling and testing in black women

Background: Since testing for abnormal breast cancer genes began in 1996, a limited number of black families have been tested for BRCA1/2 mutations. However, deleterious BRCA1/2 mutations have been identified in bwomen. Overall, referrals to cancer genetic counseling and testing (GC/T) services for risk assessment are becoming more common. Yet, compared to whites, black women remain less likely to receive GC/T even after controlling for knowledge, cancer worry, family history, and demographic factors. Providers have a key role in facilitating access to these services but few studies have examined their practices and perceptions regarding black women.

Methods: As part of descriptive study examining attitudes about GC/T for BRCA1/2 we conducted interviews with providers to examine their practices and perceptions about GC/T in black women. Twenty in-depth interviews were audiotaped and transcribed verbatim. Researchers independently coded transcripts according to key themes.

Results: Providers included: medical oncologists (n=8), surgeons (n=5), obstetrician gynecologists (n=2), and genetic counselors (n=5). Most (n=17) were female and had practiced medicine for an average of 12 years. The majority of providers followed the U.S. Preventive Services Task Force guidelines for making referrals based on risk factors (e.g., family history, etc). Few providers actually tracked patients to determine whether they had testing or counseling services. Suggestions to better engage black women in GC/T were: having a same-race genetic counselor, involving extended family members in the GC/T process, and acknowledging spirituality. Several providers perceived that black women did not participate in GC/T due to cost, insurance discrimination, or simply “not wanting to know”. Community physicians were less knowledgeable about where to refer women for GC/T than those based in universities or cancer centers.

Conclusions: While providers were aware of guidelines for making referrals, they typically did not actively follow patients to determine uptake of GC/T. Better linkages with GC/T services may enable improved follow-up and also facilitate referrals for clinicians in non-academic settings. Further exploration of women's psychosocial factors and information preferences may help to target patient centered intervention approaches.