Awareness and utilization of BRCA1/2 testing among U.S. primary care physicians.
ABSTRACT Testing for mutations in the breast and ovarian cancer susceptibility genes BRCA1 and BRCA2 (BRCA) has been commercially available since 1996.
This study sought to determine, among U.S. primary care physicians, the level of awareness and utilization of BRCA testing and the 2005 U.S. Preventive Services Task Force (USPSTF) recommendations.
In 2009, data were analyzed on 1500 physician respondents to the 2007 DocStyles national survey (515 family practitioners, 485 internists, 250 pediatricians, and 250 obstetricians/gynecologists).
Overall, 87% of physicians were aware of BRCA testing, and 25% reported having ordered testing for at least one patient in the past year. Ordering tests was most prevalent among obstetricians/gynecologists in practice for more than 10 years, with more affluent patients. Physicians were asked to select indications for BRCA testing from seven different clinical scenarios representing increased (4) or low-risk (3) situations consistent with the USPSTF guidelines. Among ordering physicians (pediatricians excluded), 45% chose at least one low-risk scenario as an indication for BRCA testing. Only 19% correctly selected all of the increased-risk and none of the low-risk scenarios.
A substantial majority of primary care physicians are aware of BRCA testing and many report having ordered at least one test within the past year. A minority, however, appear to consistently recognize the family history patterns identified by the USPSTF as appropriate indications for BRCA evaluation. These results suggest the need to improve providers' knowledge about existing recommendations-particularly in this era of increased BRCA direct-to-consumer marketing.
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ABSTRACT: Genetic testing for cancer susceptibility is an emerging technology in medicine. This study assessed the knowledge, attitudes and professional behavior of Italian physicians regarding the use of predictive genetic tests for breast and colorectal cancer, including the BRCA1/2 and APC tests. A cross-sectional survey of a random sample of Italian physicians was performed in 2010 through a self-administered questionnaire. A response rate of 69.6% (1,079 questionnaires) was achieved. A significant lack of knowledge was detected, particularly for APC testing. Less than half of the physicians agreed on the importance of efficacy and cost-effectiveness evidence in the selection of predictive genetic tests to be offered to the patients. Multiple logistic regression analyses showed that education had a positive influence on knowledge, attitudes and, to a lesser extent, professional use. The factor most strongly related to the physicians' use of genetic testing was patients requests for breast (OR=12.65; 95% CI 7.77-20.59) or colorectal cancer tests (OR=7.02; 95% CI 3.61-13.64). A high level of interest for specific training was reported by almost all physicians surveyed. Targeted educational programs are needed to improve the expertise of physicians, and, ultimately, to enhance the appropriate use of genetic tests in clinical practice.Preventive Medicine 07/2013; 57(5). DOI:10.1016/j.ypmed.2013.06.022 · 2.93 Impact Factor
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ABSTRACT: Introduction. Women diagnosed with breast cancer at a young age are more likely to carry a cancer predisposing genetic mutation. Per the current NCCN recommendations, women diagnosed under age 50 should be referred to cancer genetic counseling for further risk evaluation. This study seeks to assess patient-reported barriers and facilitators to receiving genetic counseling and risk assessment among a community-based population of young breast cancer survivors (YBCS). Methods. Through the Michigan Cancer Surveillance Program, a state-based cancer registry, 488 women diagnosed with breast cancer before age 50 in 2006-2007 were identified. They received a mail survey regarding family history and facilitators and barriers to receiving genetic counseling and risk assessment. Results. Responses were received from 289 women (59.2%). One hundred twenty-two (42.2%) reported having received cancer genetic counseling. The most frequent reason identified for receiving services was to benefit their family's future. The top reasons for not attending were "no one recommended it" and "medical insurance coverage issues." Discussion. This study is the first published report using a state cancer registry to determine facilitators and barriers to receiving genetic counseling and risk assessment among YBCS. These findings demonstrate the need for additional awareness and education about appropriate indications for genetic services.Journal of Cancer Epidemiology 10/2012; 2012:298745. DOI:10.1155/2012/298745
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ABSTRACT: Approximately 100,000 cases of cancer in the U.S. each year are due to inherited genetic conditions. Scores of hereditary cancer syndromes have been described, associated with nearly every cancer type, and prevention measures have proven to decrease cancer risk. With the advent of new technology, increasingly complex genetic testing options exist. Specially trained genetic counselors coordinate the identification, testing, education and care of patients with hereditary cancer risks. Thus, genetic counselors are at the forefront of the integration of new technology into medical care for hereditary cancer patients. New methods test many more genes, faster and more affordably but with the potential challenges of uninformative or undesired information. Additionally, algorithms using these tests will revolutionize the screening of large numbers of people for hereditary cancer syndromes. Genetic counselors are prepared to offer a broad range of testing schemas as well as provide education regarding the impact of the results for providers, patients and families.06/2013; 1(2). DOI:10.1007/s40142-013-0015-5