Genetic testing for susceptibility to breast and ovarian cancer: Evaluating the impact of a direct-to-consumer marketing campaign on physicians' knowledge and practices

Abstract

Purpose: To assess the impact of direct-to-consumer marketing of genetic testing for risk of breast and ovarian cancer by a biotechnology company on: 1) physicians' knowledge; 2) reasons given when asking questions about the test; and 3) physicians' practice patterns in two pilot cities where the campaign took place and two control cities. Methods: Survey of randomly selected family physicians, internists, obstetrician-gynecologists, and oncologists from May 1-May 21, 2003. Results: Physicians' knowledge did not differ between pilot and control cities. Significant differences (pilot versus control cities) were seen in the reasons patients gave for asking questions about testing. More physicians in pilot cities (14%) than control cities (7%) reported an increase in the number of times they ordered genetic testing for breast and ovarian cancer risk in the previous 6 months (adjusted odds ratio 1.9, 95% confidence interval, 1.2-3.1). Awareness of professional guidelines and being in a practice with a policy on genetic testing for risk of breast and ovarian cancer were associated with physicians' behaviors and interest among patients in testing. Conclusions: Given the complexity and limitations of genetic testing for risk of breast and ovarian cancer, the development and broad dissemination of clinical guidelines and education of physicians are needed.

Genetics in clinical practice: general practitioners' educational priorities in European countries

“…19,20 The awareness of the impact of marketing on the delivery of genetic testing is also a important issue to consider. 21,22 It is not only a question of training but a question of choice of practice for the future. This clearly raises questions about the quality of care delivered but also about policy and training issues for primary care and genetics.…”

Cancer Genetic Risk Assessment and Referral Patterns in Primary Care

“…The research team included cancer clinical geneticists, a certified genetic counselor, a medical oncologist, an obstetrician-gynecologist, and a biostatistician. Some survey items were based on previously published tools to assess cancer genetic practices in a similar target population of physicians (Myers et al, 2006;Brandt et al, 2008;Lowstuter et al, 2008;Shields et al, 2008). Before implementation, the survey was evaluated by oncologists, internal medicine physicians, and family medicine physicians, to assess relevance and face validity of survey items.…”

“…This changing care pattern has been supported by a number of medical professional organizations and government health agencies as a logical mechanism to provide longitudinal and family-centered care in the local community (McKelvey and Evans, 2003;Collins, 2004;Buchanan et al, 2005;Martin and Wilikofsky, 2005). Several factors are accelerating this shift to the primary care setting, including the increase in the number of available genetic technologies, the limited availability of cancer genetic counselors, increased patient demand (driven in part by direct to consumer advertisements), and marketing by the manufacturers of genetic tests to physicians (Acheson and Wiesner, 2004;Calzone et al, 2005;Myers et al, 2006;Tracy, 2007;Chapman, 2008;Mennuti, 2008). As the prevalence and marketing of cancer genetic tests increases, primary care physicians will more commonly be called upon to make decisions about genetic evaluation, risk assessment, and referral (Collins, 2004).…”

PTEN Germline Mutations in Patients Initially Tested for Other Hereditary Cancer Syndromes: Would Use of Risk Assessment Tools Reduce Genetic Testing?

“…This could muddy the risk assessment waters for a provider unfamiliar with less popular genetic syndromes such as PHTS. Direct-to-consumer marketing has increased physician awareness of HBOC [18], creating concern that widespread marketing of a test appropriate for only a small proportion of the population may lead to overconsideration of this syndrome for persons more likely to have sporadic cancer diagnoses or another inherited cancer syndrome. In addition, when genetics specialists (most of whom were genetic counselors) were involved in the patient's initial risk assessment, the underlying PHTS diagnosis was significantly more likely to be recognized and tested for immediately as opposed to first ruling out HBOC, ultimately leading to cost savings.…”