Awareness and Utilization of BRCA1/2 Testing Among U.S. Primary Care Physicians

CDC, Atlanta, Georgia 30333, USA.
American journal of preventive medicine (Impact Factor: 4.53). 01/2011; 40(1):61-6. DOI: 10.1016/j.amepre.2010.09.027
Source: PubMed


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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    • "Furthermore, although obstetricians/gynecologists (OB/GYN) were more likely than the other two physician subspecialties to almost always offer genetic counseling or testing in a high risk scenario, over 32% of OB/GYNs did not do so. Another large survey of primary care physicians indicated that all OB/GYN subspecialists and most internists and family practitioners were aware of BRCA testing [21]. Furthermore, over 60% of OB/GYN and approximately 22% of internists and family practitioners had ordered at least one BRCA test in the last year. "
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    ABSTRACT: Recognizing the importance of identifying patients at high risk for inherited cancer predisposition, the United States Preventive Services Task Force (USPSTF) has outlined specific family history patterns associated with an increased risk for BRCA mutations. However, national data indicate a need to facilitate the ability of primary care providers to appropriately identify high risk patients. Once a patient is identified as high risk, it is necessary for the patient to undergo a detailed genetics evaluation to generate a differential diagnosis, determine a cost-effective genetic testing strategy, and interpret results of testing. With identification of inherited predisposition, risk management strategies in line with national guidelines can be implemented to improve patient outcomes through cancer risk reduction and early detection. As use of genetic testing increasingly impacts patient outcomes, the role of primary care providers in the identification and care of individuals at high risk for hereditary cancer becomes even more important. Nevertheless it should be acknowledged that primary care providers face many competing demands and challenges to identify high risk patients. Therefore initiatives which promote multidisciplinary and coordinated care, potentially through academic-community partnerships, may provide an opportunity to enhance care of these patients.
    Full-text · Article · Dec 2013
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    • "Involving primary care physicians in delivering genetic services may be appropriate, given that the workforce of genetics professionals is limited in size. Primary care physicians generally have a favorable opinion of using cancer genetic data in their practice [2–4]; however, they do not feel adequately informed [5–7]. Effective genetic counseling makes complex genetic information understandable and personally relevant to the patients in terms of values, beliefs and lifestyle. "
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    ABSTRACT: Personalized medicine is a model of healthcare that is predictive, personalized, preventive and participatory ("P4 Medicine"). Genetic counselors are an ideal group to study when designing tools to support cancer P4 Medicine activities more broadly. The goal for this work was to gain a better understanding of the information cancer genetic counselors seek from their patients to facilitate effective information exchange for discussing risk. This was an analysis of a qualitative data set from interviews of eight cancer genetic counselors, recruited from three institutions. Genetic counselors at each site were interviewed using a semi-structured, open-ended questionnaire. A selective coding approach was used to determine major themes associated with genetic counseling information needs for communicating risk. We generated a model for understanding categories of genetic counseling information needs to support risk communication activities. Common activities for risk communication included risk assessment and tailoring communication. Categories of information needs included: (a) clinical patient characteristics, (b) social and cognitive patient characteristics and (c) patient motivation and goals for the genetic counseling session. A logical next step is for this model to inform the design of software systems for pre-visit patient planning and delivering just-in-time educational information to facilitate cancer risk communication activities.
    Full-text · Article · Sep 2013
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    • "Most surveys reported in the literature reveal a lack of knowledge regarding predictive genetic testing for cancer among physicians (Acton et al., 2000; Batra et al., 2002; Bellcross et al., 2011; Escher and Sappino, 2000; Klitzman et al., 2012; Nippert et al., 2011; Pichert et al., 2003; Wideroff et al., 2005; Wilkins-Haug et al., 2000). Table 3 Determinants of physicians knowledge, attitudes and professional behavior concerning predictive genetic testing for cancer. "
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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.
    Full-text · Article · Jul 2013 · Preventive Medicine
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