Abstract
Breast cancer is a significant health concern for African American women. Nonetheless, uptake of genetic risk assessment (including both genetic counseling and testing) for breast cancer gene mutations among these populations remains low. This paper systematically reviews cognitive (i.e., beliefs) and affective (i.e., emotions) factors influencing BRCA1/2 genetic risk assessment among African American women as well as psychosocial interventions to facilitate informed decision making in this population. A systematic search of CINAHL, PubMed, and PsycINFO was undertaken, yielding 112 published studies. Of these, 18 met the eligibility criteria. African American woman are likely to participate in genetic risk assessment if they are knowledgeable about cancer genetics, perceive a high risk of developing breast cancer, have low expectancies of stigmatization from medical professionals, view themselves as independent from family, and have fatalistic beliefs and a future temporal orientation. Anticipated negative affective responses, such as an inability to “handle” the results of testing, are barriers to uptake. Specific perceptions, beliefs, and emotional factors are associated with genetic risk assessment among African American women. Understanding these factors is key in the development of interventions to facilitate informed decision making in this population.
Highlights
Breast cancer is a significant health concern for African American women
Findings indicate that specific cognitive and affective factors influence an African American woman’s interest in, and decision to undergo, genetic risk assessment. These factors include her perception of risk of developing breast cancer, the extent to which she endorses specific limitations of undergoing genetic testing, her fatalistic beliefs and temporal orientation, and her levels of cancer-related distress
Studies that have drawn direct comparisons between African American and Caucasian women have noted significant differences regarding their knowledge about the genetics of breast cancer (Donovan and Tucker 2000; Hughes et al 1997), perceptions of risk (Donovan and Tucker 2000), endorsement of the benefits and limitations of undergoing counseling and testing (Donovan and Tucker 2000; Thompson et al 2003; Hughes et al 1997), and ability to manage emotional distress associated with the genetic testing process (Donovan and Tucker 2000)
Summary
Breast cancer is a significant health concern for African American women. uptake of genetic risk assessment (including both genetic counseling and testing) for breast cancer gene mutations among these populations remains low. This paper systematically reviews cognitive (i.e., beliefs) and affective (i.e., emotions) factors influencing BRCA1/2 genetic risk assessment among African American women as well as psychosocial interventions to facilitate informed decision making in this population. Women with a strong family history (i.e., at least three first-degree blood relatives on the same side of the family) of breast and/or ovarian cancer may be eligible to undergo genetic counseling and/or testing. This entails risk education, personalized genetic pedigree information, and the provision of recommendations for ongoing risk management, such as the use of regular screening surveillance, chemoprevention, and prophylactic surgical approaches (Bouchard et al 2004). Women who have already been diagnosed with breast cancer and are
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