Mismatch between cancer genetics counseling and testing guidelines and physician practices

July 25, 2011

A new analysis has found that many doctors report that they do not appropriately offer breast and ovarian cancer counseling and testing services to their female patients. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the study indicates that efforts are needed to encourage these services for high-risk women and discourage them for average-risk women.

Women with mutations in the BRCA1 or have a substantially increased risk of developing breast and ovarian cancer, but there are medical treatments that can dramatically decrease their risk. Therefore, genetic counseling and testing are recommended for women at high risk of developing breast or ovarian cancer because of a personal or family history indicative of a BRCA 1/2 mutation; however, they are not recommended for those at average risk because the harms of treatment outweigh the benefits.

Little is known about whether physicians are adhering to recommendations related to genetic counseling and testing for women at average and high risk of ovarian cancer. To investigate, Katrina Trivers, PhD, MSPH, of the in Atlanta, and her colleagues surveyed 3,200 U.S. , general internists, and obstetrician-gynecologists with a questionnaire that asked about the services they would provide to women at annual exams, including how frequently they would refer women to genetic counseling or offer BRCA 1/2 testing. Scenarios in the questionnaire varied the patients' characteristics, such as age, race, , and ovarian .

A total of 1,878 physicians (62 percent) responded to the survey. For high-risk women, less than half (41 percent) of the physicians reported that they would recommend referral for genetic counseling or testing, consistent with guidelines. Twenty-nine percent of physicians reported that they would sometimes or always refer average-risk women for genetic counseling and testing. "Despite the existence of evidence-based guidelines on referral for and testing for hereditary breast and ovarian cancer, many physicians report practices contrary to these recommendations," said Dr. Trivers. She noted that when high-risk women do not receive these services, they could miss out on important interventions that can decrease their risk. On the other hand, when physicians refer average-risk women for counseling and testing, this is an inefficient use of resources that is associated with, at most, a small clinical benefit.

The investigators found that physicians reported that they were more likely to follow guideline recommendations when they were able to accurately estimate their patients' risks of ovarian cancer.

Related Stories

Recommended for you

Immune-cell numbers predict response to combination immunotherapy in melanoma

July 20, 2017
Whether a melanoma patient will better respond to a single immunotherapy drug or two in combination depends on the abundance of certain white blood cells within their tumors, according to a new study conducted by UC San Francisco ...

Discovery could lead to better results for patients undergoing radiation

July 19, 2017
More than half of cancer patients undergo radiotherapy, in which high doses of radiation are aimed at diseased tissue to kill cancer cells. But due to a phenomenon known as radiation-induced bystander effect (RIBE), in which ...

Definitive genomic study reveals alterations driving most medulloblastoma brain tumors

July 19, 2017
The most comprehensive analysis yet of medulloblastoma has identified genomic changes responsible for more than 75 percent of the brain tumors, including two new suspected cancer genes that were found exclusively in the least ...

Novel CRISPR-Cas9 screening enables discovery of new targets to aid cancer immunotherapy

July 19, 2017
A novel screening method developed by a team at Dana-Farber/Boston Children's Cancer and Blood Disorders Center—using CRISPR-Cas9 genome editing technology to test the function of thousands of tumor genes in mice—has ...

Combining CAR T cells with existing immunotherapies may overcome resistance in glioblastomas

July 19, 2017
Genetically modified "hunter" T cells successfully migrated to and penetrated a deadly type of brain tumor known as glioblastoma (GBM) in a clinical trial of the new therapy, but the cells triggered an immunosuppressive tumor ...

How CD44s gives brain cancer a survival advantage

July 19, 2017
Understanding the mechanisms that give cancer cells the ability to survive and grow opens the possibility of developing improved treatments to control or cure the disease. In the case of glioblastoma multiforme, the deadliest ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.