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Psychosocial Predictors of BRCA Counseling and Testing Decisions among Urban African-American Women¹

Ruttenberg Cancer Center [H. S. T., H. B. V., J. G., D. H. B.] and Department of Human Genetics [K. B.], Mount Sinai School of Medicine, New York, New York 10029, and Department of Medicine [C. D-B., C. R-A., D. A., K. O.] and Breast Examination Center of Harlem [D. G.], Memorial Sloan-Kettering Cancer Center, New York, New York 10021

Genetic counseling and testing for mutations in XXX (BRCA)1/2 genes that increase breast cancer susceptibilitypotentially offer a number of benefits (e.g., more informed decision making regarding breast cancer prevention options) but also raise potential problems (e.g., issues of discrimination). However, the literature suggests that African-American women underuse genetics-related services. Therefore, the primary aim of the current study was to investigate predictors of the use of genetic counseling and testing for breast cancer susceptibility in this population. Participants were 76 African-Americans at increased risk for breast cancer attributable to their family history of the disease. Participants were recruited from an urban cancer screening clinic and completed measures assessing sociodemographic information, breast cancer knowledge, breast cancer-specific emotional distress, and perceived benefits of and barriers to BRCA testing. Free BRCA counseling and testing were offered to all interested participants, and measures were completed before counseling sessions. On the basis of their subsequent acceptance or refusal of these services, participants were described as having either: (a) declined BRCA-related genetic counseling (GC-); (b) participated in genetic counseling but refused genetic testing (GC+GT-); or (c) participated in both genetic counseling and testing (GC+GT+). Results revealed that participants who declined counseling had significantly less knowledge of breast cancer genetics than those who accepted both counseling and testing. No differences emerged among the three groups in terms of perceived benefits of testing. However, participants declining counseling demonstrated significantly higher perceived barrier scores compared with those accepting counseling and testing. Specifically, those who did not participate in counseling reported greater anticipation of negative emotional responses to testing and more concern about stigmatization, whereas those who underwent both counseling and testing had significantly lower family-related guilt. Finally, cancer-specific distress was positively associated with participation in counseling, regardless of participation in testing. The current findings underscore the need for refinement of outreach and intervention efforts that both increase awareness of BRCA counseling and testing among African-American women and provide information to those considering these options.

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