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      Predictors of BRCA1/2 genetic testing among Black women with breast cancer: a population‐based study

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          Abstract

          Evidence shows that Black women diagnosed with breast cancer are substantially less likely to undergo BRCA testing and other multipanel genetic testing compared to White women, despite having a higher incidence of early‐age onset breast cancer and triple‐negative breast cancer ( TNBC). Our study identifies predictors of BRCA testing among Black women treated for breast cancer and examines differences between BRCA testers and nontesters. We conducted an analysis of 945 Black women ages 18–64 diagnosed with localized or regional‐stage invasive breast cancer in Pennsylvania and Florida between 2007 and 2009. Logistic regression was used to identify predictors of BRCA 1/2 testing. Few (27%) ( n = 252) of the participants reported having BRCA testing. In the multivariate analysis, we found that perceived benefits of BRCA testing ( predisposing factor) ([ OR], 1.16; 95% CI: 1.11–1.21; P < 0.001), income ( enabling factor) ([ OR], 2.10; 95% CI: 1.16–3.80; p = 0.014), and BRCA mutation risk category ( need factor) ([ OR], 3.78; 95% CI: 2.31–6.19; P < 0.001) predicted BRCA testing. These results suggest that interventions to reduce disparities in BRCA testing should focus on identifying patients with high risk of mutation, increasing patient understanding of the benefits of BRCA testing, and removing financial and other administrative barriers to genetic testing.

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          Most cited references43

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          Measures of perceived social support from friends and from family: three validation studies.

          Three studies are described in which measures of perceived social support from friends (PSS-Fr) and from family (PSS-Fa) were developed and validated. The PSS measures were internally consistent and appeared to measure valid constructs that were separate from each other and from network measures. PSS-Fr and PSS-Fa were both inversely related to symptoms of distress and psychopathology but the relationship was stronger for PSS-Fa. PSS-Fr was more closely related to social competence. PSS-Fa was unaffected by either positive or negative mood states (self-statements), but the reporting of PSS-Fr was lowered by negative mood states. High PSS-Fr subjects were significantly lower in trait anxiety and talked about themselves more to friends and sibs than low PSS-Fr subjects. Low PSS-Fa subjects showed marked verbal inhibition with sibs.
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            Mistrust of health care organizations is associated with underutilization of health services.

            We report the validation of an instrument to measure mistrust of health care organizations and examine the relationship between mistrust and health care service underutilization. We conducted a telephone survey of a random sample of households in Baltimore City, MD. We surveyed 401 persons and followed up with 327 persons (81.5 percent) 3 weeks after the baseline interview. We conducted tests of the validity and reliability of the Medical Mistrust Index (MMI) and then conducted multivariate modeling to examine the relationship between mistrust and five measures of underutilization of health services. Using principle components analysis, we reduced the 17-item MMI to 7 items with a single dimension. Test-retest reliability was moderately strong, ranging from Pearson correlation of 0.346-0.697. In multivariate modeling, the MMI was predictive of four of five measures of underutilization of health services: failure to take medical advice (b=1.56, p<.01), failure to keep a follow-up appointment (b=1.11, p=.01), postponing receiving needed care (b=0.939, p=.01), and failure to fill a prescription (b=1.48, p=.002). MMI was not significantly associated with failure to get needed medical care (b=0.815, p=.06). The MMI is a robust predictor of underutilization of health services. Greater attention should be devoted to building greater trust among patients.
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              A perfect storm: How tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change.

              It is well known that there is a significant racial divide in breast cancer incidence and mortality rates. African American women are less likely to be diagnosed with breast cancer than white women but are more likely to die from it. This review explores the factors that may contribute to the racial survival disparity. Consideration is paid to what is known about the role of differences in tumor biology, genomics, cancer screening, and quality of cancer care. It is argued that it is the collision of 2 forces, tumor biology and genomics, with patterns of care that leads to the breast cancer mortality gap. The delays, misuse, and underuse of treatment for African American patients are of increased significance when these patients are presenting with more aggressive forms of breast cancer. In the current climate of health care reform ushered in by the Affordable Care Act, this article also evaluates interventions to close the disparity gap. Prior interventions have been too narrowly focused on the patient rather than addressing the system and improving care across the continuum of breast cancer evaluation and treatment. Lastly, areas of future investigation and policy initiatives aimed at reducing the racial survival disparity in breast cancer are discussed.
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                Author and article information

                Contributors
                Jonest@health.fau.edu
                Journal
                Cancer Med
                Cancer Med
                10.1002/(ISSN)2045-7634
                CAM4
                Cancer Medicine
                John Wiley and Sons Inc. (Hoboken )
                2045-7634
                19 June 2017
                July 2017
                : 6
                : 7 ( doiID: 10.1002/cam4.2017.6.issue-7 )
                : 1787-1798
                Affiliations
                [ 1 ] Florida Atlantic University Boca Raton Florida
                [ 2 ] Dana Farber Cancer Institute Phyllis F. Cantor Center for Research in Nursing and Patient Care Services Boston Massachusetts
                [ 3 ] Massachusetts General Hospital Boston Massachusetts
                [ 4 ] Harvard Medical School Boston Massachusetts
                Author notes
                [*] [* ] Correspondence

                Tarsha Jones, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431. Tel: 561‐297‐4975; Fax: 561‐297‐2416; E‐mail: Jonest@ 123456health.fau.edu

                Author information
                http://orcid.org/0000-0003-2118-5780
                Article
                CAM41120
                10.1002/cam4.1120
                5504315
                28627138
                2ca9ac7f-a563-4652-a037-1121b00c5f7b
                © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 2, Tables: 3, Pages: 12, Words: 8337
                Funding
                Funded by: National Cancer Institute
                Award ID: 5‐R01‐CA133004‐3
                Categories
                Original Research
                Cancer Prevention
                Original Research
                Custom metadata
                2.0
                cam41120
                July 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.1.3 mode:remove_FC converted:11.07.2017

                Oncology & Radiotherapy
                black women,brca 1/2 testing,breast cancer,cancer prevention,genetics
                Oncology & Radiotherapy
                black women, brca 1/2 testing, breast cancer, cancer prevention, genetics

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