Abstract
The Comprehensive Cancer Network (NCCN) recommends genetic cancer risk assessment (GCRA) referral to women at high risk of hereditary breast and ovarian cancer. Latinas affected by breast cancer have the second highest prevalence of BRCA1/2 mutations after Ashkenazi Jews. Compared to non-Hispanic Whites, Latinas have lower GCRA uptake. While some studies have identified barriers for GCRA use in this population, few studies have focused on health care providers’ perspectives. The purpose of the study was to examine providers’ perceptions of barriers and facilitators for at-risk Latina women to participate in GCRA and their experiences providing services to this population. We conducted semi-structured interviews with 20 healthcare providers (e.g., genetic counselors, patient navigators) recruited nationally through snowballing. Interviews were transcribed. Two coders independently coded each interview and then met to reconcile the codes using Consensual Qualitative Research guidelines. Providers identified several facilitators for GCRA uptake (e.g., family, treatment/prevention decisions) and barriers (e.g., cost, referrals, awareness, stigma). Genetic counselors described important aspects to consider when working with at-risk Latina including language barriers, obtaining accurate family histories, family communication, and testing relatives who live outside the US. Findings from this study can inform future interventions to enhance uptake and quality of GCRA in at-risk Latina women to reduce disparities.
Highlights
BRCA1/2 are the most commonly identified genetic mutations responsible for hereditary breast and ovarian cancers (HBOC) [1]
Five providers saw a small proportion of at-risk Latinas, three had an intermediate experience, and twelve had a high experience working with Latinos
Providers identified facilitators for at-risk Latina to participate in genetic cancer risk assessment (GCRA) included informing the risk of family members, informing treatment and prevention decisions, and following doctor’s recommendations
Summary
BRCA1/2 are the most commonly identified genetic mutations responsible for hereditary breast and ovarian cancers (HBOC) [1]. Healthcare 2018, 6, 116 which includes other genes that increase the susceptibility for breast or ovarian cancer. BRCA1/2 carriers have 50–80% and 15–40% lifetime risks of developing breast and ovarian cancer, respectively [2]. Breast cancer survivors with BRCA1/2 mutations are three times more likely to develop contralateral breast cancer than non-carriers [3]. Genetic Cancer Risk Assessment (GCRA) referral to women at high risk based on personal and/or family history of cancer [4]. GCRA includes genetic counseling plus the option of single or multiplex panel genetic testing. A positive test result impacts treatment decisions for newly diagnosed patients [5]
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