Significant differences among physician specialties in management recommendations of BRCA1 mutation carriers

Abstract

The National Comprehensive Cancer Network (NCCN) has published guidelines for hereditary breast and ovarian cancer syndrome (HBOCS) management. Little data exist on compliance with these guidelines among different physician specialties. We performed an on-line case-based survey by randomly sampling physicians from five specialties, Family Medicine (FM), Obstetrics and Gynecology (OG), General Surgery (GS), Internal Medicine (IM), and Hematology and Oncology (HO). The physicians (n = 225) were asked to provide HBOCS management of healthy women ages 40–42 in the presence of a familial BRCA1 mutation. For women negative for the BRCA1 mutation, 59% of the physicians recommended appropriate surveillance although with significant differences among specialties; P = 0.01. Using an aggregate screening intensity score, physicians clearly recommended more intense screening for mutation positive than negative women (P < 0.0001), but only 16% of physicians followed NCCN guidelines for BRCA1-positive women. Seventy-six percent of all physicians recommended breast MRI with significant variation among specialties ranging from 62% of FM to 89% of OG (P = 0.0020). Similarly, 63% of physicians recommended prophylactic oophorectomy, with 76 and 78% of GS and OG compared to 38% of IM (P < 0.0001) and 57% recommended prophylactic mastectomy ranging from 84% of HO to 32% of FM (P < 0.0001). Independent of specialty, respondents with BRCA testing experience recommended more intense management than those without; P = 0.021. Management recommendations of BRCA1 mutation carriers are not consistent with NCCN guidelines and vary by medical specialty and genetic testing experience. Targeted education of physicians by specialty is needed, so that optimal management is offered to these high-risk women.

Delivery of clinical genetic consultative services in the Veterans Health Administration

“…[13][14][15][16][17][18][19] The Veterans Health Administration (VHA) is the largest integrated health-care system in the United States, serving more than 8.3 million Veterans at 153 Veterans Affairs Medical Centers (VAMCs). 20 The VAMCs are located within 21 Veterans Integrated Service Networks (VISNs) nationwide.…”

Differences Among a Modern Cohort of BRCA Mutation Carriers Choosing Bilateral Prophylactic Mastectomies Compared to Breast Surveillance

“…9,11–13 Published series suggest that country of origin impacts uptake of BPM, with Holland and the United States having higher use of BPM than Poland and Norway. 10 Interestingly, a physician’s specialty also impacts the likelihood that she or he would recommend BPM for risk reduction among BRCA carriers 21 , with surgeons and oncologists most likely to recommend consideration of BPM, and family practitioners and internists least likely to recommend BPM to unaffected BRCA carriers. Our current population consists of women seen by surgeons and breast specialists at a cancer center, which also may bias treatment recommendations.…”

Modes of delivery of genetic testing services and the uptake of cancer risk management strategies in BRCA1 and BRCA2 carriers

“…As for provider-based efforts, a few surveys in diverse groups of physicians who offer BRCA testing have assessed CRM strategies made to BRCA carriers(9, 10). In fact, results suggest general adherence to NCCN surveillance guidelines despite lack proficiency in genetics knowledge (9, 10, 12).…”