Prevalence and Healthcare Actions of Women in a Large Health System with a Family History Meeting the 2005 USPSTF Recommendation for <i>BRCA</i> Genetic Counseling Referral

Bellcross, Cecelia; Leadbetter, Steven; Alford, Sharon Hensley; Peipins, Lucy A.

doi:10.1158/1055-9965.epi-12-1280

Cited by 55 publications

(65 citation statements)

References 35 publications

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“…Nonetheless, participants who perceived that their family history increased their risk for cancer were substantially more likely to report having undergone BRCA testing than those who felt their family history indicated low risk. This is consistent with previous publications demonstrating that women with a strong family history of cancer 21,22,35 and heightened risk perception 36 are more likely to express interest in or undergo genetic counseling and testing.…”

Section: Discussionsupporting

confidence: 92%

Characteristics associated with genetic counseling referral and BRCA1/2 testing among women in a large integrated health system

Bellcross

Peipins

McCarty

et al. 2015

Genetics in Medicine

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Background Evidence shows underutilization of cancer genetics services. To explore the reasons behind this underutilization, this study evaluated characteristics of women who were referred for genetic counseling and/or had undergone BRCA1/2 testing. Methods An ovarian cancer risk perception study stratified 16,720 eligible women from the Henry Ford Health System into average-, elevated-, and high-risk groups based on family history. We randomly selected 3,307 subjects and interviewed 2,524 of them (76.3% response rate). Results Among the average-, elevated-, and high-risk groups, 2.3, 10.1, and 20.2%, respectively, reported genetic counseling referrals, and 0.8, 3.3, and 9.5%, respectively, reported having undergone BRCA testing. Personal breast cancer history, high risk, and perceived ovarian cancer risk were associated with both referral and testing. Discussion of family history with a doctor predicted counseling referral, whereas belief that family history influenced risk was the strongest BRCA testing predictor. Women perceiving their cancer risk as much higher than other women their age were twice as likely (95% confidence interval: 2.0–9.6) to report genetic counseling referral. Conclusion In a health system with ready access to cancer genetic counseling and BRCA testing, women who were at high risk underutilized these services. There were strong associations between perceived ovarian cancer risk and genetic counseling referral, and between a belief that family history influenced risk and BRCA testing.

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Section: Discussionsupporting

confidence: 92%

Characteristics associated with genetic counseling referral and BRCA1/2 testing among women in a large integrated health system

Bellcross

Peipins

McCarty

et al. 2015

Genetics in Medicine

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“…Despite this conflicting finding, our results are consistent with studies that suggest inadequate elicitation and documentation of cancer family history in medical records [16,32,33]. Our finding that those patients with a college education were more likely than those without a college education to report receiving a referral for genetic counseling is consistent with findings from other studies [24,34] and could be the result of several possibilities including: 1) healthcare providers may be more likely to refer college educated patients than those with lower educational attainment, 2) healthcare providers who treat more highly educated patients may be more likely to refer their patients compared to those healthcare providers who treat patients with lower educational attainment, and 3) patients with higher education may be more aware of HBOC and/or more likely to bring this up with their healthcare provider and request a referral even though all of the women in this study would have been eligible for GC based on national guidelines. Congruent with results of other studies [23,17], our results highlight financial and insurance barriers associated with disparities in access to genetic services.…”

Section: Discussionsupporting

confidence: 92%

Factors associated with genetic counseling and BRCA testing in a population-based sample of young Black women with breast cancer

Cragun

Bonner

Kim

et al. 2015

Breast Cancer Res Treat

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Purpose Concerns about the potential for genomic advances to increase health disparities have been raised. Thus it is important to assess referral and uptake of genetic counseling (GC) and testing in minority populations at high risk for hereditary breast and ovarian cancer (HBOC). Methods Black women diagnosed with invasive breast cancer ≤ age 50 in 2009-2012 were recruited through the Florida State Cancer Registry 6-18 months following diagnosis and completed a baseline questionnaire. Summary statistics, Chi-square tests, and path modeling were conducted to examine which demographic and clinical variables were associated with referral and access to genetic services. Results Of the 440 participants, all met national criteria for GC yet only 224 (51%) were referred for or received GC and/or HBOC testing. Variables most strongly associated with healthcare provider referral for GC included having a college education (OR=2.1), diagnosis at or below age 45 (OR=2.0), and triple negative tumor receptor status (OR=1.7). The strongest association with receipt of GC and/or HBOC testing was healthcare provider referral (OR=7.9), followed by private health insurance at diagnosis (OR=2.8), and household income greater than $35,000 in the year prior to diagnosis (OR=2.0). Conclusions Study findings suggest efforts are needed to improve genetic services access among a population-based sample of high-risk Black women. These results indicate that socioeconomic factors and physician referral patterns contribute to disparities in access to genetic services within this underserved minority population.

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“…35,38,39,42,47,48,50 In the other six studies, case scenarios or standardized patients were used to measure PCPs' abilities to identify high-risk patients and appropriate genetic testing situations. 32,34,41,44,49,55 Aside from articles reporting on the same sample, 38,48 there was no overlap in measures. Across Fig.…”

Section: Knowledge Of Genetic Tests For Cancer Riskmentioning

confidence: 98%

Primary care providers’ cancer genetic testing-related knowledge, attitudes, and communication behaviors: A systematic review and research agenda

et al. 2016

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BACKGROUND: Primary care providers (PCPs) can play a critical role in helping patients receive the preventive health benefits of cancer genetic risk information. Thus, the objective of this systematic review was to identify studies of US PCPs' knowledge, attitudes, and communication-related behaviors regarding genetic tests that could inform risk-stratification approaches for breast, colorectal, and prostate cancer screening in order to describe current findings and research gaps. METHODS: We conducted a systematic search of six electronic databases to identify peer-reviewed empirical articles relating to US PCPs and genetic testing for breast, colorectal, or prostate cancer published in English from 2008 to 2016. We reviewed these data and used narrative synthesis methods to integrate findings into a descriptive summary and identify research needs. RESULTS: We identified 27 relevant articles. Most focused on genetic testing for breast cancer (23/27) and colorectal cancer risk (12/27); only one study examined testing for prostate cancer risk. Most articles addressed descriptive research questions (24/27). Many studies (24/27) documented PCPs' knowledge, often concluding that providers' knowledge was incomplete. Studies commonly (11/27) examined PCPs' attitudes. Across studies, PCPs expressed some concerns about ethical, legal, and social implications of testing. Attitudes about the utility of clinical genetic testing, including for targeted cancer screening, were generally favorable; PCPs were more skeptical of direct-to-consumer testing. Relatively fewer studies (9/27) examined PCPs' communication practices regarding cancer genetic testing. DISCUSSION: This review indicates a need for investigators to move beyond descriptive research questions related to PCPs' knowledge and attitudes about cancer genetic testing. Research is needed to address important gaps regarding the development, testing, and implementation of innovative interventions and educational programs that can improve PCPs' genetic testing knowledge, assuage concerns about the appropriateness of cancer genetic testing, and promote open and effective patientprovider communication about genetic risk and genetic testing.

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Prevalence and Healthcare Actions of Women in a Large Health System with a Family History Meeting the 2005 USPSTF Recommendation for BRCA Genetic Counseling Referral

Cited by 55 publications

References 35 publications

Characteristics associated with genetic counseling referral and BRCA1/2 testing among women in a large integrated health system

Characteristics associated with genetic counseling referral and BRCA1/2 testing among women in a large integrated health system

Factors associated with genetic counseling and BRCA testing in a population-based sample of young Black women with breast cancer

Primary care providers’ cancer genetic testing-related knowledge, attitudes, and communication behaviors: A systematic review and research agenda

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