Psychosocial factors associated with genetic testing status among African American women with ovarian cancer: Results from the African American Cancer Epidemiology Study

Colleen M McBride, Sarita Pathak, Courtney E Johnson, Anthony J Alberg, Elisa V Bandera, Jill S Barnholtz-Sloan, Melissa L Bondy, Michele L Cote, Patricia G Moorman, Lauren C Peres, Edward S Peters, Ann G Schwartz, Paul D Terry, Joellen M Schildkraut, Colleen M McBride, Sarita Pathak, Courtney E Johnson, Anthony J Alberg, Elisa V Bandera, Jill S Barnholtz-Sloan, Melissa L Bondy, Michele L Cote, Patricia G Moorman, Lauren C Peres, Edward S Peters, Ann G Schwartz, Paul D Terry, Joellen M Schildkraut

Abstract

Background: Racial disparities in the uptake of cancer genetic services are well documented among African American (AA) women. Understanding the multiple social and psychological factors that can influence the uptake of genetic testing among AA women is needed.

Methods: Data came from 270 AA women diagnosed with ovarian cancer and participating in a population-based, case-control study of ovarian cancer who were asked about genetic testing. Logistic regression analyses tested the associations of predisposing, enabling, and need factors with reported genetic testing uptake.

Results: One-third of the sample (35%) reported having had genetic testing. In the multivariable model, AA women with higher incomes had more than double the odds of being tested than those with the lowest income (odds ratio [OR] for $25,000-$74,999, 2.04; 95% confidence interval [CI], 1.06-3.99; OR for ≥$75,000, 2.32; 95% CI, 0.92-5.94). AA women who reported employment discrimination were significantly less likely to report genetic testing than those who did not report job discrimination (OR, 0.39; 95% CI, 0.14-0.95). Marital status, Medicaid versus other insurance, prayer frequency, and perceived social support were significantly associated with genetic testing uptake in bivariate analyses but were not significant contributors in multivariable analyses.

Conclusions: Consistent with other studies of AA women, a minority of African American Cancer Epidemiology Study participants had undergone genetic testing. Having a lower income and experiencing job discrimination decreased the likelihood of testing. These results provide foundational evidence supporting the need for interventions to improve the uptake of genetic testing among AA women by reducing cost barriers and providing credible assurances that genetic results will be kept private and not affect social factors such as employability.

Keywords: African American; disparities; genetic testing; ovarian cancer; prevention.

Conflict of interest statement

Lauren C. Peres reports funding from the National Cancer Institute to her institution (K99/R00CA218681). The other authors made no disclosures.

© 2021 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.

Figures

Figure 1
Figure 1
Conceptual model of factors associated with the uptake of genetic testing.

References

    1. Armstrong DK, Alvarez RD, Bakkum‐Gamez JN, et al. NCCN Guidelines Insights: Ovarian Cancer, Version 1.2019: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2019;17:896‐909. doi:10.6004/jnccn.2019.0039
    1. Pruthi S, Gostout BS, Lindor NM. Identification and management of women with BRCA mutations or hereditary predisposition for breast and ovarian cancer. Mayo Clin Proc. 2010;85:1111‐1120. doi:10.4065/mcp.2010.0414
    1. Daly B, Olopade OI. A perfect storm: how tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change. CA Cancer J Clin. 2015;65:221‐238. doi:10.3322/caac.21271
    1. Hann KEJ, Freeman M, Fraser L, et al. Awareness, knowledge, perceptions, and attitudes towards genetic testing for cancer risk among ethnic minority groups: a systematic review. BMC Public Health. 2017;17:503. doi:10.1186/s12889-017-4375-8
    1. Levy DE, Byfield SD, Comstock CB, et al. Underutilization of BRCA1/2 testing to guide breast cancer treatment: Black and Hispanic women particularly at risk. Genet Med. 2011;13:349‐355. doi:10.1097/gim.0b013e3182091ba4
    1. Butrick M, Kelly S, Peshkin BN, et al. Disparities in uptake of BRCA1/2 genetic testing in a randomized trial of telephone counseling. Genet Med. 2015;17:467‐475. doi:10.1038/gim.2014.125
    1. Kinney AY, Butler KM, Schwartz MD, et al. Expanding access to BRCA1/2 genetic counseling with telephone delivery: a cluster randomized trial. J Natl Cancer Inst. 2014;106:dju328. doi:10.1093/jnci/dju328
    1. Schwartz MD, Valdimarsdottir HB, Peshkin BN, et al. Randomized noninferiority trial of telephone versus in‐person genetic counseling for hereditary breast and ovarian cancer. J Clin Oncol. 2014;32:618‐626. doi:10.1200/jco.2013.51.3226
    1. Sheppard VB, Graves KD, Christopher J, Hurtado‐de‐Mendoza A, Talley C, Williams KP. African American women's limited knowledge and experiences with genetic counseling for hereditary breast cancer. J Genet Couns. 2014;23:311‐322. doi:10.1007/s10897-013-9663-6
    1. Sheppard VB, Mays D, LaVeist T, Tercyak KP. Medical mistrust influences Black women's level of engagement in BRCA 1/2 genetic counseling and testing. J Natl Med Assoc. 2013;105:17‐22. doi:10.1016/s0027-9684(15)30081-x
    1. Sherman KA, Miller SM, Shaw L‐K, Cavanagh K, Sheinfeld Gorin S. Psychosocial approaches to participation in BRCA1/2 genetic risk assessment among African American women: a systematic review. J Community Genet. 2014;5:89‐98. doi:10.1007/s12687-013-0164-y
    1. Leyva B, Nguyen AB, Allen JD, Taplin SH, Moser RP. Is religiosity associated with cancer screening? Results from a national survey. J Relig Health. 2015;54:998‐1013. doi:10.1007/s10943-014-9843-1
    1. Moorman PG, Barrett NJ, Wang F, et al. Effect of cultural, folk, and religious beliefs and practices on delays in diagnosis of ovarian cancer in African American women. J Womens Health (Larchmt). 2019;28:444‐451. doi:10.1089/jwh.2018.7031
    1. Ford CL, Airhihenbuwa CO. Critical race theory, race equity, and public health: toward antiracism praxis. Am J Public Health. 2010;100(suppl 1):S30‐S35. doi:10.2105/ajph.2009.171058
    1. Graham L, Brown‐Jeffy S, Aronson R, Stephens C. Critical race theory as theoretical framework and analysis tool for population health research. Crit Public Health. 2011;21:81‐93. doi:10.1080/09581596.2010.493173
    1. Fazeli Dehkordy S, Hall KS, Dalton VK, Carlos RC. The link between everyday discrimination, healthcare utilization, and health status among a national sample of women. J Womens Health (Larchmt). 2016;25:1044‐1051. doi:10.1089/jwh.2015.5522
    1. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1‐10.
    1. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Q. 2005;83:1‐28. doi:10.1111/j.1468-0009.2005.00428.x
    1. Schildkraut JM, Alberg AJ, Bandera EV, et al. A multi‐center population‐based case–control study of ovarian cancer in African‐American women: the African American Cancer Epidemiology Study (AACES). BMC Cancer. 2014;14:688. doi:10.1186/1471-2407-14-688
    1. V6 SAS note: point biserial correlations can be obtained from PROC CORR. SAS Support Site. Accessed May 8, 2020.
    1. Lewis TT, Cogburn CD, Williams DR. Self‐reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev Clin Psychol. 2015;11:407‐440. doi:10.1146/annurev-clinpsy-032814-112728
    1. Sternthal MJ, Slopen N, Williams DR. Racial disparities in health. Du Bois Rev. 2011;8:95‐113. doi:10.1017/s1742058x11000087
    1. Anderson LA, Dedrick RF. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient‐physician relationships. Psychol Rep. 1990;67(pt 2):1091‐1100. doi:10.2466/pr0.1990.67.3f.1091
    1. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The Multidimensional Scale of Perceived Social Support. J Pers Assess. 1988;52:30‐41. doi:10.1207/s15327752jpa5201_2
    1. Szaflarski M, Kudel I, Cotton S, Leonard AC, Tsevat J, Ritchey PN. Multidimensional assessment of spirituality/religion in patients with HIV: conceptual framework and empirical refinement. J Relig Health. 2012;51:1239‐1260. doi:10.1007/s10943-010-9433-9
    1. Mai PL, Vadaparampil ST, Breen N, McNeel TS, Wideroff L, Graubard BI. Awareness of cancer susceptibility genetic testing. Am J Prev Med. 2014;46:440‐448. doi:10.1016/j.amepre.2014.01.002
    1. McCarthy AM, Bristol M, Domchek SM, et al. Health care segregation, physician recommendation, and racial disparities in BRCA1/2 testing among women with breast cancer. J Clin Oncol. 2016;34:2610‐2618. doi:10.1200/jco.2015.66.0019
    1. Susswein LR, Skrzynia C, Lange LA, Booker JK, Graham ML, Evans JP. Increased uptake of BRCA1/2 genetic testing among African American women with a recent diagnosis of breast cancer. J Clin Oncol. 2008;26:32‐36. doi:10.1200/jco.2007.10.6377
    1. Kessler RC, Mickelson KD, Williams DR. The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. J Health Soc Behav. 1999;40:208‐230.
    1. Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM. Experiences of discrimination: validity and reliability of a self‐report measure for population health research on racism and health. Soc Sci Med. 2005;61:1576‐1596. doi:10.1016/j.socscimed.2005.03.006
    1. Lewis TT, Williams DR, Tamene M, Clark CR. Self‐reported experiences of discrimination and cardiovascular disease. Curr Cardiovasc Risk Rep. 2014;8:365. doi:10.1007/s12170-013-0365-2
    1. Cuevas AG, Reitzel LR, Cao Y, et al. Mediators of discrimination and self‐rated health among African Americans. Am J Health Behav. 2013;37:745‐754. doi:10.5993/AJHB.37.6.3
    1. Glover LM, Sims M, Winters K. Perceived discrimination and reported trust and satisfaction with providers in African Americans: the Jackson Heart Study. Ethn Dis. 2017;27:209‐216. doi:10.18865/ed.27.3.209

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