This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The possibility that culture-specific attitudes and beliefs affect BRCA-decision making among African-American women has been raised by several studies. Mistrust of the medical community, fear of stigmatization and fatalistic attitudes towards cancer have been cited as barriers to testing among African American women. However, standard genetic counseling does not specifically address these culture-specific concerns. This may explain why standard genetic counseling has been less effective for African American women than for Caucasian women. In addition, little is known about the impact of genetic counseling on BRCA decision-making among African American breast cancer patients. It is important to understand which factors affect BRCA counseling/testing decisions among breast cancer patients. First, testing affected family members first may be beneficial for other family members as negative BRCA results in an unaffected family member can only be considered true negative when a mutation has been detected in an affected family member. It is clinically incorrect to assign average risk status to an unaffected person if a mutation has not been identified because the increased breast cancer risk in the family may be due to other, as yet unknown, susceptibility genes. Second, patients with a BRCA mutation are at increased risk for developing contralateral breast cancer and/or ovarian cancer, genetic test results may help patients with decision-making regarding options for surveillance and/or prevention for second primary cancers. The goal of this project is to develop and evaluate the impact of culturally tailored genetic counseling on patient decision-making regarding BRCA testing and subsequent cognitive, emotional, and behavioral outcomes. We propose a randomized trial among African American women with newly diagnosed breast cancer with a family history of breast cancer suggestive of hereditary disease in which we will compare standard genetic counseling (SGC) to culturally tailored genetic counseling CT-GC.
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