Evaluation of physician knowledge and referral practices for colorectal cancer (CRC) genetic risk assessment: The experience at the Hospital of University of Pennsylvania (HUP).

Abstract

379 Background: 3-5% of CRCs are due to inherited genetic mutations. We surveyed knowledge and practices of academic physicians for identification and care of individuals at risk for inherited CRC. Methods: 264 physicians (oncologists (ON), gastroenterologists (GA), surgeons, internists, gynecologists, and radiation oncologists) at HUP were invited to participate in a web-based 9-min survey. The ability to obtain appropriate medical history and to make referral to genetic services was evaluated. Knowledge of hereditary CRC syndromes was examined both pre and post viewing of an educational web-page on inherited CRCs. Mantel-Haenszel, Fisher exact, and McNemar statistical tests were applied. Results: Response rate was 33.3%; and of those, 97.4% accessed the educational webpage. In the cohort, 98.9 % obtained a medical history very frequently (VF), 88.6% obtained cancer history in 1st and 45.5% in the 2nd degree relatives VF, and 63.9% asked about the relatives' age at time of cancer diagnosis VF. Of those most likely to care for patients with CRC, the GA more frequently asked about relatives' age at cancer diagnosis (p=0.014) and family history of polyps (p< 0.001) than ON. GA were more likely than ON to refer patients for genetic counseling (73.9% vs. 36.8%, p=0.008). GA had superior knowledge of the availability of genetic testing for Lynch syndrome (LS) (95.6% GA vs. 63.2% ON, p=0.005) and for familial adenomatous polyposis (FAP) (100.0% GA vs. 65.8% ON, p<0.001). For the entire cohort, the educational intervention raised awareness of genetic testing for LS (64.5% pre vs. 94.7% post, p<0.001), FAP (69.7% pre vs. 97.4% post, p<0.001), and Peutz-Jeghers Syndrome (31.6% pre vs. 84.2% post, p<0.001); and it significantly improved recognition of LS family pedigrees and selection of appropriate surveillance. Conclusions: Of the respondents, GA are more likely to obtain a detailed family history, utilize genetic services, and have a greater awareness of the availability of genetic testing, than ON. A simple educational intervention improves physician knowledge on inherited CRC risk recognition and surveillance recommendations. No significant financial relationships to disclose.

Assessment of Awareness Levels toward Colorectal Cancer Early Detection and Prevention in Saudi Arabia

“…It was found that about 3-5% of CRCs are due to inherited genetic mutations [15]. Genome-wide association studies have identified 17 germline single nucleotide polymorphisms (SNPs) significantly associated with incident CRC [16].…”

Barriers to and Motivations for Physician Referral of Patients to Cancer Genetics Clinics

“…To address this deficiency, numerous educational efforts regarding hereditary cancer syndrome risk assessment and management have been directed to specialty care providers (e.g., gastroenterologists, colorectal surgeons) via publications in journals, online medical education, and presentations at national meetings (Ellis 2008;Hendricks et al 2006;Terdiman 2005;Wong et al 2008). Despite evidence showing the short-term success of educational programs in raising physician awareness and increasing their ability to recognize hereditary colorectal cancer syndromes, this pattern of under-referral to outside cancer genetics experts persists; these results suggest other barriers may play a role in referral decisions (Jenab-Wolcott et al 2011).…”