Timing of <i>BRCA</i> Genetic Testing and Surgical Decision-Making Among Young Black Women With Breast Cancer

IntroductionGenetic testing for hereditary cancer syndromes, particularly <i>BRCA1</i> and <i>BRCA2</i> (<i>BRCA</i>) germline pathogenic or likely pathogenic variants (GPVs), is critical in informing surgical decisions for women with breast cancer. Young Black women are historically underrepresented in genetic testing and research, making it essential to understand how testing timing influences treatment choices. We evaluated how the timing of <i>BRCA</i> testing affected surgical management among young Black women with breast cancer.MethodsParticipants were drawn from a population-based cohort of Black women diagnosed with invasive breast cancer at age 50 or younger, recruited via Florida and Tennessee cancer registries. Data were collected through structured questionnaires, electronic health records, and lab reports, including information on genetic testing, <i>BRCA</i> status, and treatment. Participants were categorized by timing of <i>BRCA</i> testing (pre-surgical vs post-surgical) and GPV status. Chi-squared tests assessed associations between testing timing, <i>BRCA</i> status, and surgical treatment.ResultsAmong 633 participants, people with a <i>BRCA</i> GPV who were tested before surgery (n = 29) were significantly more likely to undergo bilateral mastectomy (82.8%) than those tested after surgery (40%). Timing of testing and <i>BRCA</i> status were both strongly associated with surgery received (<i>P</i> < 0.0001).Conclusion<i>BRCA</i> testing at diagnosis and prior to surgery is significantly associated with surgical management in young Black women with breast cancer. These findings highlight the importance of timely genetic testing, especially in populations with historically lower testing rates.