Originally published as JCO Early Release 10.1200/JCO.2008.17.8053 on November 10 2008

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Keating, N. L. Articles by Garber, J. E. Search for Related Content PubMed PubMed Citation Articles by Keating, N. L. Articles by Garber, J. E. Social Bookmarking                            What's this?

Physicians’ Experiences With BRCA1/2 Testing in Community Settings

Nancy L. Keating, Kathryn A. Stoeckert, Meredith M. Regan, Lisa DiGianni, Judy E. Garber

From the Division of General Internal Medicine, Brigham and Women's Hospital; Departments of Health Care Policy and Medicine, Harvard Medical School; and the Departments of Medical Oncology and Biostatistics, Dana-Farber Cancer Institute, Boston, MA

Corresponding author: Nancy L. Keating, MD, MPH, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115; e-mail: keating{at}hcp.med.harvard.edu

Purpose We surveyed a national sample of nonacademic physicians who ordered BRCA1/2 testing to understand their implementation of genetic testing and to assess recommendations for surveillance and cancer risk management of women with positive test results.

Patients and Methods We surveyed physicians (N = 611 of 1,050; response rate, 58.2%) practicing in nonacademic settings who ordered BRCA1/2 testing during 2004 to 2005. We described physicians’ experiences with testing and used multivariable regression models to identify factors associated with more complete counseling and with recommendations for cancer risk management for a BRCA1 mutation carrier.

Results Most physicians (68.2%) usually or always discussed six counseling items before testing. In adjusted analyses, physicians who were assisted by genetic counselors, nurse geneticists, or others (v counseling by themselves), those who spent more than 60 minutes in counseling, and medical oncologists (v surgeons or geneticists) were more likely to discuss all six items (all P < .05). A total of 61.4% of physicians would recommend bilateral prophylactic mastectomy to a 38-year-old BRCA1 mutation carrier who had completed childbearing. After adjustment, geneticists and gynecologists were less likely than medical oncologists and surgeons to recommend prophylactic mastectomy (P < .001), as were physicians in the Northeast versus those in other regions of the United States (P = .01).

Conclusion Community-based physicians seem to be successfully incorporating BRCA1/2 testing into their practices. Physicians’ recommendations for surveillance of mutation carriers are generally consistent with practice guidelines, yet recommendations for preference-based procedures such as prophylactic mastectomy vary by physician characteristics such as specialty and geographic region. The providers whom patients see for testing may contribute to variations in prophylactic treatments.

published online ahead of print at www.jco.org on November 10, 2008.

Supported by the National Human Genome Research Institute ELSI program (Grant No. NHGRI R01 HG02318-0).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?