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

Introduction Genetic testing for hereditary cancer syndromes, particularly BRCA1 and BRCA2 ( BRCA ) 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 BRCA testing affected surgical management among young Black women with breast cancer. Methods Participants 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, BRCA status, and treatment. Participants were categorized by timing of BRCA testing (pre-surgical vs post-surgical) and GPV status. Chi-squared tests assessed associations between testing timing, BRCA status, and surgical treatment. Results Among 633 participants, people with a BRCA 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 BRCA status were both strongly associated with surgery received ( P < 0.0001). Conclusion BRCA 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.