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Racial Differences in Testing Motivation and Psychological Distress following Pretest Education for BRCA1 Gene Testing¹

Lombardi Cancer Center [C. L., C. H., J. K., J. W.] and Division of Genetics [J. L. B.], Georgetown University Medical Center, Washington, DC 20007; National Human Genome Research Institute, Bethesda, Maryland 20892-1852 [B. B., D. H.]; and Washington Hospital Center, Washington Cancer Institute, Washington, DC 20010 [N. E., J. L.]

Objectives. We conducted a randomized trial to investigate racial differences in response to two alternate pretest education strategies for BRCA1 genetic testing: a standard education model and an education plus counseling (E+C) model.

Materials and Methods. Two hundred twenty-eight Caucasian women and 70 African American women with a family history of breast or ovarian cancer were contacted for a baseline telephone interview to assess sociodemographic characteristics, number of relatives affected with cancer, and race before pretest education. Outcome variables included changes from baseline to 1-month follow-up in cancer-related distress and genetic testing intentions, as well as provision of a blood sample after the education session.

Results. African American women were found to differ significantly from Caucasian women in the effects of the interventions on testing intentions and provision of a blood sample. Specifically, in African American women, E+C led to greater increases than education only in intentions to be tested and provision of a blood sample. These effects were independent of socioeconomic status and referral mechanisms. In Caucasian women, there were no differential effects of the interventions on these outcomes. Reductions in cancer-specific distress were evidenced in all study groups. However, this decrease, although not significantly different, was smallest among African American women who received E+C.

Conclusions. In low- to moderate-risk African American women, pretest education and counseling may motivate BRCA1 testing. Further research is needed to explore the mechanisms of impact of the alternate pretest education strategies and to increase the cultural sensitivity of education and counseling protocols.

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