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Iwai Y, Toumbou K, Zuze T, Morgan JS, Simwinga L, Wright ST, Fedoriw Y, Oladeru OT, Balogun OD, Roberson ML, Olopade OI, Tomoka T, Elmore SN. Breast Cancer Germline Genetic Counseling and Testing for Populations of African Heritage Globally: A Scoping Review on Research, Practice, and Bioethical Considerations. JCO Glob Oncol 2023; 9:e2300154. [PMID: 37944088 PMCID: PMC10645409 DOI: 10.1200/go.23.00154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/05/2023] [Accepted: 09/05/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Despite the disproportionately high risk of breast cancer among women of African heritage, little is known about the facilitators and barriers to implementing germline genetic testing and counseling (GT/C). METHODS This scoping review followed guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Published manuscripts from database inception through 2021 were sourced from PubMed, Cumulative Index to Nursing and Allied Health Literature via EBSCO, Embase, Cochrane Library, and Scopus. Search terms were used to retrieve articles addressing (1) African heritage, (2) breast cancer, and (3) GT or GC. The screening involved abstract and title review and full-text review. Data were extracted for all articles meeting the inclusion criteria. RESULTS A total of 154 studies were included. Most studies that took place were conducted in the United States (71.4%), and most first authors (76.9%) were from the United States. GT was conducted in 73 (49.7%) studies. BRCA1/BRCA2 were the most commonly studied genes for germline mutations. GC was conducted in 49 studies (33.3%), and perspectives on GC were evaluated in 43 (29.3%). The use of racial/ethnic categories varied broadly, although African American was most common (40.1%). Racism was mentioned in three studies (2.0%). CONCLUSION There is a growing body of literature on GT/C for breast cancer in women of African heritage. Future studies on GT/C of African populations should consider increased clarity around racial/ethnic categorizations, continued community engagement, and intentional processes for informed consent.
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Affiliation(s)
- Yoshiko Iwai
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Jenny S. Morgan
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
- Department of Clinical Medicine, Indiana University School of Medicine, Indianapolis, IN
- Department of Global Health, Indiana University School of Medicine, Indianapolis, IN
| | | | - Sarah T. Wright
- UNC Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Oluwadamilola T. Oladeru
- Department of Radiation Oncology, University of Florida, Gainesville, FL
- Department of Radiation Oncology, Mayo Clinic in Florida, Jacksonville, FL
| | | | - Mya L. Roberson
- Department of Health Policy, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | | | | | - Shekinah N.C. Elmore
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
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Abstract
Since the completion of the Human Genome Project, considerable progress has been made in translating knowledge about the genetic basis of disease risk and treatment response into clinical services and public health interventions that have greater precision. It is anticipated that more precision approaches to early detection, prevention, and treatment will be developed and will enhance equity in healthcare and outcomes among disparity populations. Reduced access to genomic medicine research, clinical services, and public health interventions has the potential to exacerbate disparities in genomic medicine. The purpose of this article is to describe these challenges to equity in genomic medicine and identify opportunities and future directions for addressing these issues. Efforts are needed to enhance access to genomic medicine research, clinical services, and public health interventions, and additional research that examines the clinical utility of precision medicine among disparity populations should be prioritized to ensure equity in genomic medicine. Expected final online publication date for the Annual Review of Genomics and Human Genetics, Volume 23 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA; .,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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Compadre AJ, Simonson ME, Gray K, Runnells G, Kadlubar S, Zorn KK. Challenges in recruiting African-American women for a breast cancer genetics study. Hered Cancer Clin Pract 2018; 16:8. [PMID: 29760829 PMCID: PMC5937804 DOI: 10.1186/s13053-018-0091-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background African-American women, especially in the southern United States, are underrepresented in cancer genetics research. A study was designed to address this issue by investigating the germline mutation rate in African-American women in Arkansas with a personal and/or family history of breast cancer. Women were tested for these mutations using a large panel of breast cancer susceptibility genes. In this analysis, we discuss the challenges encountered in recruiting African-American women from an existing biorepository to participate in this study. Methods We attempted to contact 965 African-American women with a personal and/or family history of breast cancer who participated in Spit for the Cure (SFTC) between 2007 and 2013 and provided consent to be recontacted. The SFTC participants were invited by telephone and email to participate in the genetic study. Enrollment required completion of a phone interview to obtain a family and medical history and return of a signed consent form. Results Among eligible SFTC participants, 39.6% (382/965) were able to be contacted with the phone numbers and email addresses they provided. Of these, 174 (45.5%) completed a phone interview and returned a signed consent form. Others were not able to be contacted (n = 583), declined to participate (n = 57), did not keep phone interview appointments (n = 82), completed the phone interview but never returned a signed consent (n = 54), were deceased (n = 13), or were too confused to consent to participate (n = 2). Conclusions Recruiting African-American women into our breast cancer genetics study proved challenging primarily due to difficulty establishing contact with potential participants. Given their prior participation in breast cancer research, we anticipated that this would be a highly motivated population. Indeed, when we were able to contact SFTC participants, only 14.9% declined to participate in our study. Innovative communication, retention, and recruitment strategies are needed in future studies to address the recruitment challenges we faced.
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Affiliation(s)
- Amanda J Compadre
- 1Division of Gynecologic Oncology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St. Slot 793, Little Rock, AR 72205 USA
| | - Melinda E Simonson
- 1Division of Gynecologic Oncology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St. Slot 793, Little Rock, AR 72205 USA
| | - Katy Gray
- 1Division of Gynecologic Oncology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St. Slot 793, Little Rock, AR 72205 USA
| | - Gail Runnells
- 2Division of Medical Genetics, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St., Little Rock, AR 72205 USA
| | - Susan Kadlubar
- 2Division of Medical Genetics, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St., Little Rock, AR 72205 USA
| | - Kristin K Zorn
- 1Division of Gynecologic Oncology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St. Slot 793, Little Rock, AR 72205 USA
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Young JL, Werner-Lin A, Mueller R, Hoskins L, Epstein N, Greene MH. Longitudinal cancer risk management trajectories of BRCA1/2 mutation-positive reproductive-age women. J Psychosoc Oncol 2017; 35:393-408. [PMID: 28332940 DOI: 10.1080/07347332.2017.1292574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Young women with BRCA1/2 mutations face difficult health-care decisions regarding family formation, fertility, breastfeeding, and whether/when to undergo cancer risk-reducing surgery. This longitudinal qualitative study investigated these life choices during the reproductive years. We conducted two semistructured interviews over three years with 12 reproductive-age BRCA1/2-positive women. Researchers coded transcripts to examine the evolution of risk perceptions, risk management, and family planning decisions. To cope with the conflict between cancer risk reduction versus plans for pregnancy, breastfeeding, and child rearing, participants deliberately prioritized either risk reducing surgery or family formation goals. Implications for mutation carriers and health-care providers are outlined.
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Affiliation(s)
- Jennifer Louise Young
- a Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch , National Cancer Institute , Bethesda , MD , USA.,b Department of Family Science , University of Maryland at College Park , College Park , MD , USA
| | - Allison Werner-Lin
- c School of Social Policy and Practice , University of Pennsylvania , Philadelphia , PA , USA
| | - Rebecca Mueller
- d School of Arts and Sciences , University of Pennsylvania , Philadelphia , PA , USA
| | - Lindsey Hoskins
- a Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch , National Cancer Institute , Bethesda , MD , USA
| | - Norman Epstein
- b Department of Family Science , University of Maryland at College Park , College Park , MD , USA
| | - Mark H Greene
- a Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch , National Cancer Institute , Bethesda , MD , USA
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Halbert CH, McDonald J, Vadaparampil S, Rice L, Jefferson M. Conducting Precision Medicine Research with African Americans. PLoS One 2016; 11:e0154850. [PMID: 27441706 PMCID: PMC4956119 DOI: 10.1371/journal.pone.0154850] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/20/2016] [Indexed: 11/18/2022] Open
Abstract
Importance Precision medicine is an approach to detecting, treating, and managing disease that is based on individual variation in genetic, environmental, and lifestyle factors. Precision medicine is expected to reduce health disparities, but this will be possible only if studies have adequate representation of racial minorities. Objective It is critical to anticipate the rates at which individuals from diverse populations are likely to participate in precision medicine studies as research initiatives are being developed. We evaluated the likelihood of participating in a clinical study for precision medicine. Design, Setting, Participants Observational study conducted between October 2010 and February 2011 in a national sample of African Americans. Main Outcome Measure Intentions to participate in a government sponsored study that involves providing a biospecimen and generates data that could be shared with other researchers to conduct future studies. Results One third of respondents would participate in a clinical study for precision medicine. Only gender had a significant independent association with participation intentions. Men had a 1.86 (95% CI = 1.11, 3.12, p = 0.02) increased likelihood of participating in a precision medicine study compared to women in the model that included overall barriers and facilitators. In the model with specific participation barriers, distrust was associated with a reduced likelihood of participating in the research described in the vignette (OR = 0.57, 95% CI = 0.34, 0.96, p = 0.04). Conclusion and Relevance African Americans may have low enrollment in PMI research. As PMI research is implemented, extensive efforts will be needed to ensure adequate representation. Additional research is needed to identify optimal ways of ethically describing precision medicine studies to ensure sufficient recruitment of racial minorities.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States of America
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States of America
- Ralph H. Johnson Veteran’s Administration Medical Center, Charleston, SC, United States of America
- * E-mail:
| | - Jasmine McDonald
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | | | - LaShanta Rice
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States of America
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States of America
| | - Melanie Jefferson
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, United States of America
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Halbert CH, Bellamy S, Briggs V, Bowman M, Delmoor E, Johnson JC, Kumanyika S, Melvin C, Purnell J, Rogers R, Weathers B. Intervention completion rates among African Americans in a randomized effectiveness trial for diet and physical activity changes. Cancer Epidemiol Biomarkers Prev 2014; 23:1306-13. [PMID: 24755713 DOI: 10.1158/1055-9965.epi-13-1064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The intervention completion rate is an important metric in behavioral and intervention research; trials with limited intervention completion rates may have reduced internal validity. We examined intervention completion rates among 530 African Americans who had been randomized to an integrated (INT) or disease-specific (DSE) risk education protocol as part of a comparative effectiveness trial from September 2009 to August 2012. METHODS The interventions were developed by an academic-community partnership using community-based participatory research. Intervention completion rates were determined based on attendance at all four intervention sessions. Intervention completers were participants who completed all four sessions and noncompleters were those who did not complete any session or only completed one to three sessions following randomization. RESULTS Seventy-three percent of participants were intervention completers and 27% were noncompleters. There were no differences in intervention completion based on randomization to INT (72%) or DSE (75%), sociodemographic factors, or body mass index (BMI) in the total sample. Different factors were associated significantly with intervention completion within study groups. Among participants randomized to INT, the odds of intervention completion were greater with higher levels of intrinsic motivation, less exposure to information about diet and cardiovascular disease, and greater BMI. Among participants randomized to DSE, the odds of completing the intervention were associated significantly with older age and greater dietary self-efficacy. CONCLUSIONS Many African Americans are likely to complete risk education interventions. IMPACT Psychologic characteristics should be considered when determining intervention completion rates following randomization in behavioral and intervention trials.
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Affiliation(s)
- Chanita Hughes Halbert
- Authors' Affiliations: Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center;
| | - Scarlett Bellamy
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics
| | | | - Marjorie Bowman
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Ernestine Delmoor
- National Black Leadership Initiative on Cancer, Philadelphia Chapter
| | | | - Shiriki Kumanyika
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics
| | - Cathy Melvin
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | | | - Rodney Rogers
- Christ of Calvary Community Development Corporation, Philadelphia, Pennsylvania; and
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Halbert CH, Kessler L, Collier A, Weathers B, Stopfer J, Domchek S, McDonald JA. Low rates of African American participation in genetic counseling and testing for BRCA1/2 mutations: racial disparities or just a difference? J Genet Couns 2012; 21:676-83. [PMID: 22790832 PMCID: PMC3773724 DOI: 10.1007/s10897-012-9485-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 01/13/2012] [Indexed: 01/19/2023]
Abstract
Low rates of genetic counseling among African American women have generated concerns about disparities; however, to the extent that women's decisions to accept or decline counseling are consistent with their values, then lower participation may reflect preferences and not disparities. We evaluated the extent to which women were satisfied with their decision about participating in genetic counseling for BRCA1/2 mutations and identified variables that were associated significantly with satisfaction. Prospective study of decision satisfaction with 135 African American women who had a minimum 5% prior probability of having a BRCA1/2 mutation. Decision satisfaction was evaluated one month after women were offered participation in genetic counseling using a structured questionnaire. Women were satisfied with their participation decision; more than 80% reported that their decision was consistent with their family values. However, women who declined pre-test counseling had significantly lower satisfaction scores. Our findings highlight the importance ensuring that racial differences that are due to preferences and values are not misclassified as disparities in order to identify and address the root causes of disparate treatment.
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Affiliation(s)
- Chanita Hughes Halbert
- Center for Community-Based Research and Health Disparities, Department of Psychiatry, University of Pennsylvania, Philadelphia, 19104, USA.
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Graves KD, Christopher J, Harrison TM, Peshkin BN, Isaacs C, Sheppard VB. Providers' perceptions and practices regarding BRCA1/2 genetic counseling and testing in African American women. J Genet Couns 2011; 20:674-89. [PMID: 21822773 PMCID: PMC3286616 DOI: 10.1007/s10897-011-9396-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Accepted: 07/13/2011] [Indexed: 01/11/2023]
Abstract
We examined healthcare providers' perceptions of genetic counseling and testing in African American women at moderate to high-risk of carrying a BRCA1/2 mutation. We conducted 20 in-depth interviews with genetic counselors (n = 5), medical oncologists (n = 8), obstetrician/gynecologists (n = 2) and surgeons (n = 5). Interviews were audiotaped, transcribed and independently coded by two individuals using a content analysis approach. Seven themes emerged relevant to providers' perceptions of African American women's use of BRCA1/2 genetic services: access factors, cultural beliefs and preferences, effects of testing, patient motivators for genetic counseling and testing, patient-provider communication, reasons for provider referral, and reasons for patient refusal. Providers identified individual- and system-level barriers to African American women's use of genetic services, including lack of follow-up after referrals to genetic specialists and challenges to obtaining financial coverage for under- and uninsured high-risk women. Results have implications for physician and patient education regarding appropriate referrals to and uptake of genetic services in at-risk African American women.
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Affiliation(s)
- Kristi D. Graves
- Lombardi Comprehensive Cancer Center, Fisher Center for Familial Cancer Research, Georgetown University, Washington, DC
| | - Juleen Christopher
- Lombardi Comprehensive Cancer Center, Fisher Center for Familial Cancer Research, Georgetown University, Washington, DC
| | - Toni Michelle Harrison
- Lombardi Comprehensive Cancer Center, Fisher Center for Familial Cancer Research, Georgetown University, Washington, DC
| | - Beth N. Peshkin
- Lombardi Comprehensive Cancer Center, Fisher Center for Familial Cancer Research, Georgetown University, Washington, DC
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Fisher Center for Familial Cancer Research, Georgetown University, Washington, DC
- Breast Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Vanessa B. Sheppard
- Lombardi Comprehensive Cancer Center, Fisher Center for Familial Cancer Research, Georgetown University, Washington, DC
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Sadler GR, Ko CM, Wu P, Alisangco J, Castañeda SF, Kelly C. A cluster randomized controlled trial to increase breast cancer screening among African American women: the black cosmetologists promoting health program. J Natl Med Assoc 2011; 103:735-45. [PMID: 22046851 PMCID: PMC4153602 DOI: 10.1016/s0027-9684(15)30413-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND African American women have disproportionately higher rates of breast cancer mortality than all other ethnic groups, thus highlighting the importance of promoting early detection. METHODS African American women (N = 984) from San Diego, California, participated in a randomized controlled trial testing the efficacy of breast cancer education sessions offered in beauty salons. Cosmetologists received ongoing support, training, and additional culturally aligned educational materials to help them engage their clients in dialogues about the importance of breast cancer early detection. Posters and literature about breast cancer early detection were displayed throughout the salons and cosmetologists used synthetic breast models to show their clients how breast cancer lumps might feel. Participants in the control group received a comparable diabetes education program. Baseline and 6-month follow-up surveys were administered to evaluate changes in women's breast cancer knowledge, attitudes, and screening behaviors. RESULTS This intervention was well received by the participants and their cosmetologists and did not interfere with or prolong the client's salon visit. Women in the intervention group reported significantly higher rates of mammography compared to women in the control group. Training a single educator proved sufficient to permeate the entire salon with the health message, and salon clients agreed that cosmetologists could become effective health educators. CONCLUSIONS Cosmetologists are in an ideal position to increase African American women's breast cancer knowledge and adherence to breast cancer screening guidelines.
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Cyrus-David MS. Knowledge and accuracy of perceived personal risk in underserved women who are at increased risk of breast cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2010; 25:617-623. [PMID: 20229073 PMCID: PMC2907455 DOI: 10.1007/s13187-010-0097-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The state of knowledge and personal risk perception among women who are underserved or racial minorities at increased risk of breast cancer (BC) who may be eligible for chemoprevention is limited. The BC knowledge and accuracy of perceived personal risk of a cross-sectional study population of such women residing in the greater Houston Texas area were assessed. The majority had below average knowledge scores and perceived risk inaccurately. The lesser educated were also less knowledgeable. Educational interventions targeted towards this population would enhance their knowledge of BC and empower them to make informed decisions about BC chemoprevention.
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Affiliation(s)
- Mfon S Cyrus-David
- Department of Internal Medicine, The University of Texas Health Science Center-Medical School, UT Professional Building, 6410 Fannin Street, Suite 722, Houston, TX 77030, USA.
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