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Researchers Examine Genomic Cancer Risk Test Perception in Minority Populations

WASHINGTON, DC (GenomeWeb) – At a conference held here this week to address health disparities in genomic medicine, researchers presented their findings on how minorities viewed the use of genomic tests and whether their knowledge about receiving such testing during the course of cancer treatment differed from white populations.

As one group from Georgetown University recounted at "Why We Can't Wait: Conference to Eliminate Health Disparities in Genomic Medicine," interest in cancer-related genomic testing in a diverse population varied with family history of cancer and income. Another research team found in a separate study that Hispanic and African-American women were less likely to recall having undergone genomic testing to guide their breast cancer treatment, and that they were less likely, if found to have a low risk of breast cancer, to have undergone chemotherapy.

The goal of studies like these is to determine whether there are "ways we can help people make informed choices," Georgetown's Kristi Graves said during her talk.

In many genomic studies, people from minority populations are not well represented, and there was concern among conference attendees that such lower representation might translate into disparities in the use of new genomic technologies in clinical care and affect equity of healthcare.

Graves and Virginia Tech's Michael Muldoon surveyed some 208 patients from a racially diverse sample to gauge their thoughts on undergoing a SNP test that would tell them about their risk of colon cancer — a test that only can gauge a small increase in lifetime risk of the disease, Muldoon noted.

In their 20-minute survey, which respondents filled out either in their doctor's waiting room or at home, the researchers first described genetics, genomics, and the SNP test to the patients. They then collected demographic information about the respondents and asked them whether they'd be interested in such a genomic test and why.

Respondents with a family history of cancer were more likely to be interested in the test, Muldoon said at the conference. Additionally, they found that the more money respondents made, the less interested they were in testing.

These findings, Graves added, held up in multivariate analyses as well.

It's encouraging, she added, that people with a higher risk of cancer are more interested in genomic testing.

Meanwhile, Catherine Chanfreau-Coffinier from the University of California, Los Angeles, looked into whether women who underwent genetic testing of their breast cancer tumors recalled the process and whether test results informed their treatment.

Chanfreau-Coffinier drew on data collected about its customers by the health insurance company Aetna, as well as information from her team's subsequent surveys of those patients. The group waded through data on nearly 900 women who were treated for early stage breast cancer between 2009 and 2013. This patient cohort included 341 minority women, including 108 Hispanic, 112 black, and 97 Asian women, and 549 non-Hispanic white women.

Oncotype Dx, Chanfreau-Coffinier said, is the most common test in the US for tailoring early-stage breast cancer treatment. It measures gene expression within the tumor to develop a predictive score for disease recurrence and benefit from chemotherapy.

The investigators also compared whether the treatment the women received gibed with guidelines put forth by professional organization like the American Society of Clinical Oncology.

African-American women, she reported, were less likely to receive chemotherapy if they received a low-risk score; there was no difference in the treatment of women with a high risk of disease.

Further, she said that more Hispanic and African-American women have less knowledge of being tested. That is, when surveyed by Chanfreau-Coffinier and her team, they couldn't recall undergoing genetic testing. This, she said, might be due to a communication issue between physicians and patients that could then be addressed.

She additionally noted that the study was limited to one health plan, but added that it gives some insight into patients' perspectives and experiences regarding genomic testing.

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