Purpose Sequence-based cancer susceptibility testing results are described as negative, deleterious mutation or variant of uncertain significance (VUS). We studied the impact of different types of test results on clinical decision making. Methods Practicing physicians from five specialties in Texas completed an online case-based survey (n=225). Respondents were asked to make genetic testing and management recommendations for healthy at-risk relatives of cancer patients. Results When the patient carried a deleterious BRCA1 mutation or VUS, 98% and 82% of physicians, respectively, recommended testing of at-risk relatives (p<0.0001). In both situations comprehensive BRCA1/2 analysis was selected most with a corresponding 9-fold increase in unnecessary genetic testing costs. There was no difference between physicians with (n=81) or without (n=134) prior BRCA1/2 testing experience (p=0.3869). Cancer risk management recommendations were most intense for the relative with a deleterious mutation compared with VUS, negative or no testing with 63%, 13%, 5% and 2%, respectively recommending oophorectomy (p<0.0001). Conclusions Independent of experience, or specialty, physicians chose more comprehensive testing for healthy relatives than current guidelines recommend. In contrast management decisions demonstrated the uncertainty associated with a VUS. Utilization of genetic professionals and education of physicians on family-centered genetic testing may improve efficacy and substantially reduce costs.

Background: The purpose of this study was to examine Texas physicians' recommendations for the quadrivalent human papillomavirus (HPV) vaccine in 11-to-12-year-old girls, intention to recommend HPV vaccines to 11-to-12-year-old boys, and attitudes about mandated HPV vaccination for 11-to-12-yearold girls. Materials and Methods: We conducted a cross-sectional, web-based survey of Texas physicians who provide direct patient care in family medicine, pediatrics, obstetrics/gynecology, and internal medicine in September 2008. The three outcome variables were: HPV vaccine recommendations to 11-to-12-year-old girls, likelihood of recommending the vaccine to 11-to-12-year-old boys, and agreement with mandated vaccination of 11-to-12-year-old girls. Univariate and logistic regression analyses were used to determine practice-related and attitudinal factors associated with each outcome. Results: Of the 1,122 respondents, 48.5% stated they always recommended HPV vaccines to girls, 68.4% were likely to recommend the vaccine to boys, and 41.7%