Pal noted that, “it is important to remember that our findings require confirmation, given that even though we started from a large sample, there were a limited number of [BRCA
] carriers in our study, and the study was a snapshot in time, so it will be of interest to see over time what happens with these groups of women and if there is an improvement in their cancer risk management.”
Panel moderator and ASCO Expert in breast cancer Patricia Ganz, MD, underscored this point in her remarks: “A lot of things have happened since 2009-2012,” including the fact that many more women are asking their doctors about their risk, due to the “Angelina Jolie effect” created when the actress publicly shared her decision to have prophylactic mastectomy and oophorectomy because of her BRCA
status and family history.
“In addition, our guidelines have changed,” Ganz continued. “During that time period, we were much more focused on family history. Now our guidelines have shifted quite a bit so that we are often testing almost anyone under age 50,” she said, noting that now many oncologists and surgeons, when they see a young patient with breast cancer, will recommend testing.
Nevertheless, Pal’s research raises important questions for further study, especially identifying the factors that influence why some groups of women are more likely to pursue genetic testing and then follow up with prophylactic risk management. Pal acknowledged that while several practice-changing events have occurred since her study, questions remain, for example, about the impact of the Affordable Care Act, as well as the substantially lower costs of testing when patent restrictions on the BRCA
test were lifted. “We used to pay more than $4000 for BRCA
testing; we can now get that as low as $200-$250, with multiple genes included,” she said.
In addition, Pal asked, “While the Angelina Jolie disclosure increased awareness, has that equally increased awareness across all populations? I’m not sure about that. I don’t think anyone is.”
“We really need to understand the reasons why women are making these decisions,” Pal concluded. “Are they being given the opportunity to make an informed decision, or are other factors coming into play so that they are not getting the information they need? Our study highlights the need for interventions to ensure access to testing, as well as cancer risk management practices, across all populations.”
Pal T, Cragun D, Lewis C, et al. Disparities in cancer risk management among BRCA
carriers across a diverse sample of young black, Hispanic, and non-Hispanic white breast cancer survivors. J Clin Oncol
. 2016;34(suppl; abstr LBA1504).