Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians - Trivers - 2011 - Cancer - Wiley Online Library

Mismatch Between Cancer Genetics Counseling and Testing Guidelines and Physician Practices

A study found that many doctors don't follow evidence-based guidelines on genetic counseling and testing for hereditary breast and ovarian cancers. As a result, too many average-risk women and too few high-risk women receive these important services.

Women with mutations in the BRCA1 or BRCA2 gene have a higher risk of getting breast and ovarian cancers. Medical treatments can reduce the risk sharply, so genetic testing is recommended for women whose personal or family history shows they may have these mutations. Genetic testing is not recommended for women at average risk because the harms of treatment outweigh the benefits.

Reseachers sent surveys to 3,200 doctors in the United States that asked about the services they would provide to women at annual exams, including how often they would refer women to genetic counseling or offer BRCA 1/2 testing. Scenarios in the survey varied the patients' characteristics, such as age, race, insurance status, and ovarian cancer risk.

A total of 1,878 doctors answered the survey, with the following results—

* 41% of the doctors surveyed said they would refer high-risk women for genetic counseling or testing, consistent with the guidelines.
* 29% of the doctors surveyed said they would sometimes or always refer average-risk women for genetic counseling and testing, against the guidelines.

Doctors need to be encouraged to offer genetic counseling and testing services to high-risk women and discouraged from offering them to average-risk women.

Citation: Trivers KF, Baldwin L-M, Miller JW, Matthews B, Andrilla CHA, Lishner DM, Goff BA. Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians: A vignette-based study. Cancer 2011.

open here please ►Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians - Trivers - 2011 - Cancer - Wiley Online Library: "Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians†‡
A Vignette-Based Study

1. Katrina F. Trivers PhD, MSPH1,*,§,
2. Laura-Mae Baldwin MD, MPH2,
3. Jacqueline W. Miller MD1,
4. Barbara Matthews MBA2,
5. C. Holly A. Andrilla MS2,
6. Denise M. Lishner MSW2,
7. Barbara A. Goff MD3

Article first published online: 25 JUL 2011

DOI: 10.1002/cncr.26166

Copyright © 2011 American Cancer Society

Issue
Cover image for Vol. 117 Issue 15
Cancer
Trivers, K. F., Baldwin, L.-M., Miller, J. W., Matthews, B., Andrilla, C. H. A., Lishner, D. M. and Goff, B. A. (2011), Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians. Cancer. doi: 10.1002/cncr.26166
Author Information

1. 1 Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
2. 2 Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
3. 3 Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington

Email: Katrina F. Trivers PhD, MSPH (ktrivers@cdc.gov)

*Correspondence: Katrina F. Trivers PhD, MSPH, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS K-55, Atlanta, GA 30341
Publication History

1. Article first published online: 25 JUL 2011
2. Manuscript Revised: 13 MAR 2011
3. Manuscript Accepted: 4 MAR 2011
4. Manuscript Received: 14 DEC 2010

Abstract
BACKGROUND:

Genetic counseling and testing is recommended for women at high but not average risk of ovarian cancer. National estimates of physician adherence to genetic counseling and testing recommendations are lacking.

METHODS:

Using a vignette-based study, we surveyed 3200 United States family physicians, general internists, and obstetrician/gynecologists and received 1878 (62%) responses. The questionnaire included an annual examination vignette asking about genetic counseling and testing. The vignette varied patient age, race, insurance status, and ovarian cancer risk. Estimates of physician adherence to genetic counseling and testing recommendations were weighted to the United States primary care physician population. Multivariable logistic regression identified independent patient and physician predictors of adherence.

RESULTS:

For average-risk women, 71% of physicians self-reported adhering to recommendations against genetic counseling or testing. In multivariable modeling, predictors of adherence against referral/testing included black versus white race (relative risk [RR], 1.16; 95% confidence interval [CI], 1.03-1.31), Medicaid versus private insurance (RR, 1.15; 95% CI, 1.02-1.29), and rural versus urban location. Among high-risk women, 41% of physicians self-reported adhering to recommendations to refer for genetic counseling or testing. Predictors of adherence for referral/testing were younger patient age [35 vs 51 years [RR, 1.78; 95% CI, 1.41-2.24]), physician sex (female vs male [RR, 1.30; 95% CI, 1.07-1.64]), and obstetrician/gynecologist versus family medicine specialty (RR, 1.64; 95% CI, 1.31-2.05). For both average-risk and high-risk women, physician-estimated ovarian cancer risk was the most powerful predictor of recommendation adherence.

CONCLUSION:

Physicians reported that they would refer many average-risk women and would not refer many high-risk women for genetic counseling/testing. Intervention efforts, including promotion of accurate risk assessment, are needed. Cancer 2011;. © 2011 American Cancer Society.

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