Subjects

Abstract

Purpose

Increasing use of genetic services (counseling/testing) among young breast cancer survivors (YBCS) can help decrease breast cancer incidence and mortality. The study examined use of genetic services between Black and White/Other YBCS, attitudes and knowledge of breast cancer risk factors, and reasons for disparities in using genetic services.

Methods

We used baseline data from a randomized control trial including a population-based, stratified random sample of 3000 potentially eligible YBCS, with oversampling of Black YBCS.

Results

Among 883 YBCS (353 Black, 530 White/Other) were significant disparities between the two racial groups. More White/Other YBCS had received genetic counseling and had genetic testing than Blacks. Although White/Other YBCS resided farther away from board-certified genetic counseling centers, they had fewer barriers to access these services. Black race, high out-of-pocket costs, older age, and more years since diagnosis were negatively associated with use of genetic services. Black YBCS had lower knowledge of breast cancer risk factors. Higher education and genetic counseling were associated with higher genetic knowledge.

Conclusion

Racial inequalities of cost-related access to care and education create disparities in genetic services utilization. System-based interventions that reduce socioeconomic disparities and empower YBCS with genetic knowledge, as well as physician referrals, can increase access to genetic services.

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Acknowledgements

This study was supported by the Centers for Disease Control and Prevention (CDC), 5U48DP001901-03, and by the Robert Wood Johnson Foundation (RWJF)—Nurse Faculty Scholars 68039 Award to M.C.K. We thank Jenna McLosky, Michigan Department of Health and Human Services, for YBCS recruitment.

Author information

Affiliations

  1. Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland

    • Christos Nikolaidis PhD
    •  & Maria C. Katapodi PhD, RN
  2. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    • Debra Duquette MS, CGC
  3. Michigan Department of Health and Human Services, Lansing, MI, USA

    • Debra Duquette MS, CGC
    • , Beth Anderson MPH
    •  & Glenn Copeland MBA
  4. University of Michigan School of Nursing, Ann Arbor, MI, USA

    • Kari E. Mendelsohn-Victor MPH
    • , Laurel L. Northouse PhD, RN
    •  & Maria C. Katapodi PhD, RN
  5. Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA

    • Kara J. Milliron MSc, CGC
  6. University of Michigan School of Public Health, Ann Arbor, MI, USA

    • Sofia D. Merajver MD, PhD
    •  & Nancy K. Janz PhD
  7. University of Michigan School of Medicine, Ann Arbor, MI, USA

    • Sofia D. Merajver MD, PhD
  8. Ohio State University College of Nursing, Columbus, OH, USA

    • Sonia A. Duffy PhD, RN

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The authors declare no conflicts of interest.

Corresponding author

Correspondence to Maria C. Katapodi PhD, RN.

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DOI

https://doi.org/10.1038/s41436-018-0349-1