The Role of Race and Insurance Status in Access to Genetic Counseling and Testing Among High-Risk Breast Cancer Patients

PurposeThe role of germline genetic testing in breast cancer patients is crucial, especially in the setting of the recent trials showing the benefit of PARP inhibitors. The goal of this study was to identify racial disparities in genetic counseling and testing in patients with high-risk breast cancer.MethodsPatients with 2 unique breast cancer diagnoses were examined to understand demographics, insurance coverage, characteristics of breast cancer, and whether they were recommended for and received genetic counseling and testing.ResultsA total of 69 patients with a dual diagnosis of breast cancer between the years 2000 and 2017 were identified (42% identified as White compared to 58% that identified as non-White). White patients were more likely to be recommended for genetic counseling (OR = 2.85; 95% CI, 1.07-7.93, P < .05), be referred for genetic counseling (OR = 3.17; 95% CI, 1.19-8.86, P < .05), receive counseling (OR = 3.82; 95% CI, 1.42-10.83, P < .01), and undergo genetic testing (OR = 2.88; 95% CI, 0.97-9.09, P = .056) compared to non-White patients. Patients with private insurance were significantly more likely to be recommended for genetic counseling (OR 5.63, P < .005), referred (OR 6.11, P < .005), receive counseling (OR 4.21, P < .05), and undergo testing (OR 4.10, P < .05). When controlled for insurance, there was no significant racial differences in the rates of GC recommendation, referral, counseling, or testing.ConclusionThe findings of this study suggest that disparities in genetic counseling and testing are largely driven by differences in health insurance.

Genetic testing of breast cancer patients is necessary for optimal treatment. This article describes genetic testing patterns in a large urban safety-net hospital and evaluates the association between race and genetic testing in women with more than one unique breast cancer diagnosis.

Implications for PracticeThe results of this study showed that a significant disparity exists in access to genetic testing for breast cancer patients, based on insurance coverage, even with these patients meeting the previously outlined criteria for genetic testing by the NCCN and ASCO. The analysis shows a significant difference in rates of recommendation, referral, and receipt of genetic counselling and testing when comparing White versus non-White patients.     

Sero-epidemiology of rubella in the urban population of Addis Ababa, Ethiopia

We conducted a community-based cluster sample survey of rubella sero-epidemiology in Addis Ababa, Ethiopia in 1994. Among 4666 individuals for whom complete data were available, rubella antibody prevalence was 91% (95% confidence interval: 90, 92). On multivariable analysis, seroprevalence was lower among individuals who were resident in Addis Ababa for 1 year or less. Approx. 50% seroprevalence was attained by age 4 years, and the estimated average age at infection was 5.2 years. The highest age-specific force of infection was estimated to occur in 5- to 9-year-olds. The early age at infection corresponded with a low estimated incidence of congenital rubella syndrome (CRS) of 0.3 per 1000 live births, equivalent to nine cases of CRS in 1994. The predicted critical level of immunity for elimination of rubella via vaccination was 85-91%, requiring 89-96% coverage with a vaccine of 95% effectiveness. Unless very high coverage of rubella vaccine could be guaranteed, the introduction of childhood vaccination could increase the incidence of CRS in Addis Ababa.     

Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload

Background  

Intracorporeal suturing is one of the most difficult laparoscopic tasks. The purpose of this study was to assess the impact of robotic assistance on novice suturing performance, safety, and workload in the operating room.     

Higher prevalence of anti-HCV antibodies among HIV-positive compared to HIV-negative inhabitants of Addis Ababa,Ethiopia

Serum samples (n = 4,593) collected in 1994 as part of a representative household community survey of the population of Addis Ababa who were 0-49 years old were tested for hepatitis C (HCV) antibodies. A third generation ELISA was used for primary screening and a line immunoblot assay for confirmation. HCV antibody prevalence was 0.9% (95% CI, 0.6-1.2%) and higher among HIV-positive compared to HIV-negative individuals (4.5% vs. 0.8%, respectively, P < 0.001). Similar higher prevalence of HCV antibodies was seen among HIV-positive compared to HIV-negative antenatal care attenders (2.9% vs. 0.8%, respectively, P = 0.003, n = 1,725), and sex workers (5.3% vs. 1.3%, respectively, P = 0.02, n = 383). Such association between HCV and HIV infection has not been described previously in Africa. After stratification by HIV status, HCV prevalence among women of the general population was identical to that of sex workers, suggesting that HCV sexual transmission is not common in this population and that HIV infection does not enhance susceptibility to HCV sexual transmission.