Black women in the United States know more about cancer genetic testing than many earlier studies have suggested, but even the most knowledgeable among them stumble over some of the most consequential concepts in modern cancer genetics, according to one of the largest surveys of its kind published to date. The new research, which appears in the journal Cancer Causes & Control, found that knowledge, attitudes, and self-efficacy regarding cancer genetic testing were consistently high among U.S. Black women regardless of whether they had a personal history of breast cancer, while simultaneously exposing specific educational gaps that could inform strategies to close long-standing racial disparities in the use of genetic testing.
The study was led by Kimberly A. Bertrand of the Slone Epidemiology Center at Boston University and Boston University Chobanian & Avedisian School of Medicine, together with colleagues including Julie R. Palmer and Catharine Wang. It drew its participants from the Black Women’s Health Study (BWHS), a landmark cohort established in 1995 among respondents to a mailed questionnaire sent to subscribers of Essence magazine and members of selected Black professional organizations. The new analysis is embedded within a randomized controlled trial of alternate disclosure modalities for returning individual-level cancer genetic research results to participants whose DNA had been sequenced as part of a nested case-control study on the genetic etiology of breast cancer.
Of 2,670 eligible women invited to enroll in the parent trial, 927, or 35 percent, consented and completed a baseline questionnaire in 2023 and early 2024. Because the participants had been selected for a case-control study of breast cancer genetics, nearly one-third of the sample, 273 women or 29 percent, had a personal history of breast cancer. Mean age was 67.5 years among survivors and 66.4 years among women without breast cancer. The cohort was highly educated, with more than 65 percent of both groups holding a college degree or higher, and 98 percent reported having health insurance. Nearly 40 percent of the breast cancer survivors reported having had prior genetic testing for cancer, compared with just 3.7 percent of women without a cancer history, a difference the researchers considered when interpreting their results.
The questionnaire assessed three distinct psychological and cognitive constructs. Knowledge was measured as the sum of correct answers to 16 true/false statements adapted from previously validated measures, covering factual understanding of genetics, the genetic risk of cancer, patterns of inheritance, and the clinical and legal implications of genetic testing. Missing responses were coded as incorrect. Attitudes toward testing were captured with a three-item scale measuring perceived benefits, with statements such as “Genetic testing will help me manage my cancer risk” rated on a five-point agreement scale; the scale showed good internal consistency with a Cronbach’s alpha of 0.74. Self-efficacy, defined as confidence in one’s ability to use genetic information, was assessed with a four-item adapted scale featuring statements such as “I have a good idea about how genetics may influence risk for disease generally,” with a Cronbach’s alpha of 0.79. The team then used multivariable linear regression to identify individual-level predictors of each construct, adjusting for age, education, marital status, personal and family cancer history, and prior genetic testing.
The headline result was striking for its uniformity. Overall, mean knowledge score was 12.4 out of 16, equivalent to 77 percent correct, and there was essentially no difference between women with a history of breast cancer, who averaged 12.5 points, and those without, who averaged 12.3. Thirteen of the sixteen questions were answered correctly by at least 70 percent of participants. The authors noted this was somewhat unexpected, since one might assume that women who had undergone cancer treatment, many of whom had been offered genetic testing themselves, would outperform their peers. Instead, the data suggest that the fundamental concepts of hereditary cancer risk have permeated broadly across this population rather than concentrating among those with direct clinical experience.
Yet the item-level analysis revealed precisely where the gaps lie, and the pattern is clinically meaningful. Only 62.8 percent of women without breast cancer and 72.9 percent of those with breast cancer correctly answered “false” to the statement “Most cancer is caused by inherited gene mutations,” indicating that a substantial minority still overestimate the role of inherited mutations in cancer causation. Roughly 43 percent incorrectly believed that “a genetic test can always determine if an individual has a cancer gene mutation,” a misconception about the limitations of testing that could inflate expectations and fuel disappointment or mistrust after a negative result. The most striking deficit concerned variants of uncertain significance, or VUS, a category of genetic finding that has become one of the most common results returned by modern multigene panel testing. Just 31.5 percent of survivors and 27.4 percent of women without breast cancer correctly indicated “false” to the statement “A Variant of Uncertain Significance will usually influence cancer screening recommendations.” In other words, roughly seven in ten participants did not understand that a VUS is an ambiguous finding that generally should not change medical management, a misunderstanding with real potential to drive unnecessary anxiety or inappropriate screening decisions.
The regression models added texture to these findings. Knowledge scores declined by 0.5 points for every 10-year increase in age, and women with 17 or more years of education scored 1.7 points higher than those with 12 or fewer years. Women who were separated, divorced, or widowed scored somewhat lower than those who were married or living as married, a difference the authors suggest may reflect more limited social support or economic instability. Having had prior genetic testing was associated with a 0.66-point higher knowledge score, though the researchers caution that the direction of causality is unclear; greater knowledge may have motivated testing rather than the reverse.
Attitudes and self-efficacy told an equally important story. Mean attitude scores, on a five-point scale, were 4.2 among survivors and 4.0 among women without breast cancer, while mean self-efficacy scores were 3.9 and 3.8 respectively, both indicating strongly favorable dispositions. Personal breast cancer history was associated with slightly more favorable attitudes, as was a first-degree family history of breast cancer. Older age and never having been married were associated with less favorable attitudes. Self-efficacy rose with education, with a first-degree family history of cancer, and, notably, with total knowledge score, suggesting that knowledge itself may feed confidence in the ability to act on genetic information.
For the authors, these findings carry a pointed implication for the debate over why Black Americans engage with cancer genetic testing at far lower rates than non-Hispanic White individuals, even when referred for testing. Black women’s mortality from breast cancer, the most common cancer in women across all racial and ethnic groups, is nearly 40 percent higher than that of White women, and Black individuals consistently report lower uptake of germline testing. Previous research has implicated system-level and provider-level factors, including access to specialists, clinical workflows, biases in physician referral practices, and health care segregation, as well as individual-level factors such as medical mistrust and concerns about genetic discrimination. But if knowledge is high and attitudes are favorable, as this study suggests, then deficits in patient knowledge and negative beliefs are unlikely to be the principal drivers of the disparity. The authors argue that addressing system-level barriers will be critical to improve cancer outcomes among Black women.
The study does have limitations that the researchers themselves acknowledge. The participants, drawn from a cohort that has been engaged in health research for nearly three decades, are unusually educated and health-literate, so the findings may not generalize to less educated populations, and the high baseline scores raise the possibility of a ceiling effect that could have masked true differences between groups. Still, the sample size makes this one of the largest investigations of cancer genetics knowledge and attitudes among Black women to date, and the comprehensive assessment of knowledge, attitudes, and self-efficacy using measures adapted from published literature strengthens its conclusions.
The practical upshot is a roadmap for targeted education. Older women, those with lower educational attainment, women who are not married or living as married, and, counterintuitively, breast cancer survivors themselves all emerged as groups that could benefit from focused messaging, particularly around the inherited etiology of cancer, the limitations of genetic tests, and the meaning of variants of uncertain significance. At the same time, the study affirms that when the doors to genetic testing are opened, Black women arrive with the knowledge and the motivation to walk through them. The barriers, the evidence increasingly suggests, are built into the system, not the patient.
Subject of Research: Knowledge, attitudes, and self-efficacy toward cancer genetic testing among U.S. Black women with and without breast cancer, and the individual-level predictors of these outcomes.
Subject of Research: Cancer
Article Title: Knowledge, attitudes, and self-efficacy toward cancer genetic testing among Black women with and without breast cancer
Article References: Bertrand, K. A., Trevino-Talbot, M., Ruderman, M., Flynn, M., Cabral, H. J., Palmer, J. R., & Wang, C. (2026). Knowledge, attitudes, and self-efficacy toward cancer genetic testing among Black women with and without breast cancer. Cancer Causes & Control, 37(10), Article 158. https://doi.org/10.1007/s10552-026-02234-0
Image Credits: AI Generated
DOI: 10.1007/s10552-026-02234-0
Keywords: cancer genetic testing, breast cancer, Black women, genetic knowledge, self-efficacy, variant of uncertain significance, health disparities, Black Women’s Health Study, hereditary cancer risk, genetic counseling
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Nathaniel Bowman. (September 10, 2026). Black women’s views on cancer genetic testing shaped by breast cancer status. Scienmag. https://scienmag.com/black-womens-views-on-cancer-genetic-testing-shaped-by-breast-cancer-status/
Nathaniel Bowman. “Black women’s views on cancer genetic testing shaped by breast cancer status.” Scienmag, 10 September 2026, https://scienmag.com/black-womens-views-on-cancer-genetic-testing-shaped-by-breast-cancer-status/. Accessed 10 September 2026.
Nathaniel Bowman. “Black women’s views on cancer genetic testing shaped by breast cancer status.” Scienmag. September 10, 2026. https://scienmag.com/black-womens-views-on-cancer-genetic-testing-shaped-by-breast-cancer-status/
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