Screening by familial BRCA history can unintentionally exclude people on lower incomes and those from black backgrounds.
This is because access to earlier genetic testing in the UK has not been evenly distributed.
Historically, BRCA testing was offered mainly through breast and ovarian cancer pathways used more often by White, higher-income women who had clearer documented family histories and better access to specialist services.
Lower-income groups and black families were less likely to receive referrals, partly due to reduced engagement with genetic services, fewer recorded family histories, and structural barriers such as transport, time, and awareness.
As a result, BRCA status is known disproportionately for people from higher-income and White backgrounds. If a prostate cancer screening programme relies on “known BRCA mutation status” and family members to inform each other of this so that the men can request enhanced monitoring, it will systematically exclude many Black men and low-income men who may carry BRCA mutations but whose relatives have never been tested.
NorthernMan