Screening and Preventing Breast Cancer Among Latinas

story BY: CHARLES A. COULOMBE

When Dr. Jeffrey Weitzel was preparing to launch his medical career back in 1990, he switched from oncology and treatment of cancer and blood-related diseases to the then new field of genetics - based diagnosis. Today, as director of City of Hope’s Division of Clinical Cancer Genetics in the Department of Population Sciences, Dr. Weitzel is extremely satisfied with the choice he made, and his team has made significant contributions to our understanding of the hereditary forms of cancer and how to use that knowledge to more effectively screen for and prevent cancer. With a goal of addressing disparities in access to cancer screening and prevention, Latina women with breast cancer in the United States, Mexico and elsewhere are among the primary beneficiaries of the work he and his colleagues have conducted over the past decade.

“Latinas in general are at lower risk of breast cancer than most women,” Dr. Weitzel explains. “But they have a higher tendency for genetic-based breast cancer, which generally strikes at a younger age. And because they are often underinsured or uninsured, they tend to have it diagnosed far later, when it is more difficult to treat. A lack of cultural awareness on the part of healthcare workers is also part of the problem, as is their own lack of information about preventative care.”

He became involved in this area through a recommendation from a colleague in a serendipitous turn of events: “My friend, Dr. Nancy Feldman, works at Olive View-UCLA Medical Center County hospital which serves a heavily-Hispanic population. Around 2000, she told me that a number of young Latinas were coming in and being diagnosed with advanced breast cancer. With genetic counseling and testing and family histories, we can be in a much better position, not only to treat their immediate problem, but also to give them guidance in preventing future cancers. But in those days, genetic testing was not covered by Medicaid, so even those with family histories of cancer were not getting tested.”

“We wondered, ‘If we build a center where they can be tested, would they use it?’ We took surveys, and the response was very good – if we made it happen, they would come. So we did. We provided bilingual counselors to explain the importance of genetic testing, and we found that it had the desired effect. They shared the information with their families – who of course were also at risk –- and urged them to get tested as well. Once the women saw the importance of genetic testing and preventative care for their families, they were very anxious to get them involved.”

Scientific testing in this country, Mexico, and elsewhere in Latin America revealed that the mutations that caused breast cancer were linked to very specific elements on the Latin American gene pool – mostly Spanish. But one or two were linked to Amerindian and African roots. This allowed the doctors to reduce the number of genetic markers they were testing for, and bring the cost of testing down considerably. As a result, far more women have benefited from the testing – and Medicaid now covers it in most states.

“It is now much more cost effective, and we are now able to take the testing to their relatives in Mexico,” Weitzel says.

Cultural sensitivity is, according to Dr. Weitzel, extremely important. “If you have bilingual counselors, and emphasize the family aspects of the work, the patients are far more receptive, even if the doctors are the ‘other.’ We come to be accepted, and we make sure they understand that what they are doing with us will help not only them but also their relatives. With testing, we can tell them which of their family members are at potential risk for ovarian and other cancers as well. So we provide cultural training to our staff, and include this concept in our training program for doctors nurses and genetic counselor across the country.”