Migrant breast cancer patients and their participation in genetic counseling: results from a registry-based study.

J E Baars,B Van Ooijen,A M Van Dulmen,B C Vrouenraets,M E Velthuizen,M A Van Der Aa,M G E M Ausems,A N Kimmings,A J Witkamp,E B M Theunissen,T Van Dalen

doi:10.1007/s10689-016-9871-y

Abstract

Certain ethnic groups seem to have less access to cancer genetic counseling. Our study was to investigate the participation in cancer genetic counseling among migrant breast cancer patients of Turkish and Moroccan origin. Hospital medical records of Turkish and Moroccan and of a comparative group of non-Turkish/Moroccan newly diagnosed breast cancer patients were studied. All women were diagnosed between 2007 and 2012. Eligibility for genetic counseling was assessed with a checklist. A total of 156 Turkish/Moroccan patients were identified, and 321 patients were assigned to the comparative group. About one third (35 %) of the Turkish/Moroccan patients fulfilled criteria for breast cancer genetic counseling, compared to 21 % of the comparative group (P = 0.001); this was largely due to a relatively young age at diagnosis in the migrant group (26 % <40 years vs 5 % in the comparative group, P = 0.0001). Uptake of genetic counseling among eligible patients was 47 % in the migrant group and 56 % in the comparative group; differences in uptake were seen among the patients diagnosed before 40 years of age (48 % in the migrant group vs 81 % in the comparative group; P = 0.021). When adjusted for age at diagnosis, ethnicity was associated with discussing referral to genetic counseling and its actual uptake. The Turkish/Moroccan ethnicity appears to be associated with a lower uptake of genetic counseling, mainly caused by the lower uptake in the young age-group. The major barrier to participation in genetic counseling seems to lie within the referral process.

Highlights

Preliminary results are presented at the European Human Genetics Conference 2014 in conjunction with The European Meeting on Psychosocial Aspects of Genetics 2014, Milan, Italy, May 31-June 3, 2014.In general, a BRCA mutation is detected in about 10 % of the tested breast cancer patients [1]
11 Comprehensive Cancer Centre the Netherlands (IKNL), Utrecht, The Netherlands family history of breast and/or ovarian cancer are at higher risk of carrying a BRCA1/2 gene mutation, diagnostic DNA testing is offered to this subset of breast cancer patients [2]
For the period 2007–2012 we identified 156 female migrant breast cancer patients (55 with a Turkish and 101 with a Moroccan background) using the name-based approach and 321 female patients were randomly assigned to the comparative group

Summary

Introduction

A BRCA mutation is detected in about 10 % of the tested breast cancer patients [1]. 11 Comprehensive Cancer Centre the Netherlands (IKNL), Utrecht, The Netherlands family history of breast and/or ovarian cancer are at higher risk of carrying a BRCA1/2 gene mutation, diagnostic DNA testing is offered to this subset of breast cancer patients [2]. Once these patients are referred by their physicians to family cancer clinics they can opt for genetic counseling and testing (GCT). Others observed a low uptake of GCT among ethnic minorities, i.e. Afro-Americans and Hispanics in the US [5,6,7,8]

Objectives

Results

Conclusion