Starting a Cancer Genetics Clinic in a County Hospital

Pirzadeh, Sara

doi:10.1080/10463356.2009.11883469

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…The genetic counselors at all sites are from the UT Southwestern cancer genetics program. Both safety net facilities have had a cancer genetics program in place since 2008 and their physicians are experienced in the management of hereditary cancer syndromes ( Pirzadeh, 2009 ). All facilities offer HBOC patients prophylactic surgeries.…”

Section: Methodsmentioning

confidence: 99%

Prediction of Cancer Prevention: From Mammogram Screening to Identification of BRCA1 / 2 Mutation Carriers in Underserved Populations

et al. 2015

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BackgroundThe US Preventative Service Task Force recommends that physicians perform a genetic risk assessment to identify women at risk for BRCA1/2 mutations associated with hereditary breast and ovarian cancer (HBOC) syndrome. However, outcomes data after a diagnosis of HBOC syndrome especially in diverse populations, are minimal. Here we asked if genetic screening of high-risk underserved women identified in the mammogram population reduces cancer incidence.MethodsWe evaluated 61,924 underserved women at screening mammography for family histories suggestive of HBOC syndrome over the course of 21 months. Data were collected retrospectively from patients at two safety net hospitals through chart review. A computer model was used to calculate the long-term effect of this screening on cancer incidence by assessing both the mutation detection rate and the completion of prophylactic surgeries in BRCA1/2 mutation carriers.FindingsWe identified 20 of the 85 (23.5%) expected BRCA1/2 mutation carriers in the underserved population. The frequencies of prophylactic mastectomies and oophorectomies in the mutation carriers were 25% and 40%, respectively. Using these data, our model predicted only an 8.8% reduction in both breast and ovarian cancer in the underserved patients. This contrasts with a 57% reduction in breast cancer and 51% reduction in ovarian cancer in an insured reference population. Our data indicate that underserved patients with HBOC syndrome are difficult to identify and when identified are limited in their ability to adhere to NCCN guidelines for cancer prevention.InterpretationScreening for women at risk for HBOC syndrome in mammogram populations will only prevent cancers if we can increase compliance with management guidelines. This study provides prototypic baseline data for step-wise analysis of the efficacy of the use of family history analysis in the mammography setting for detection and management of HBOC syndrome.

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Section: Methodsmentioning

confidence: 99%

Prediction of Cancer Prevention: From Mammogram Screening to Identification of BRCA1 / 2 Mutation Carriers in Underserved Populations

et al. 2015

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BRCA1/2 testing and cancer risk management in underserved women at a public hospital

Hamann¹,

Robinson²,

Moldrem³

et al. 2012

Community Oncology

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The strategic defense of physician autonomy: State public health agencies as countervailing powers

Senier

Lee

Nicoll

2017

Social Science & Medicine

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Advances in genetic testing and the aggressive marketing of genetic tests by commercial diagnostic laboratories have driven both consumer demand and the need for unbiased information about how tests should guide healthcare delivery. This paper uses the countervailing powers framework to explore the role of state public health agencies as arbiters of quality and safety, specifically through their efforts to encourage physicians to follow evidence-based recommendations for screening for hereditary cancers. Social scientists have often viewed actions by the state to regulate cost, quality, or safety as a threat to physician autonomy. This paper draws on case studies from two US states—Michigan and Connecticut—to better understand the specific role of state public health agencies, and especially whether their activities to encourage adherence to evidence-based recommendations bolster or subvert the interests of other parties in the healthcare arena. We find that lacking authority to compel provider to follow evidence-based recommendations, they improvised ways to foster compliance voluntarily, for example, by emphasizing the role of the physician as gatekeeper, thus affirming the importance of physician autonomy and clinical judgment. Both states also used public health surveillance data to make rare diseases visible and illustrate gaps between recommendations and practice. Finally, they both showed that following evidence-based recommendations could align the professional and market interests of healthcare stakeholders. Both states employed similar strategies with similar effects, despite substantial differences in the regulatory climate and organizational capacity. Taken as a whole, their activities orchestrated a countervailing response that checked the profit-seeking motives of commercial laboratories. Our findings demonstrate that rather than eroding physician autonomy, state action to monitor healthcare quality and encourage adherence to evidence-based recommendations can actually reinforce physician authority.

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Starting a Cancer Genetics Clinic in a County Hospital

Cited by 3 publications

References 17 publications

Prediction of Cancer Prevention: From Mammogram Screening to Identification of BRCA1 / 2 Mutation Carriers in Underserved Populations

Prediction of Cancer Prevention: From Mammogram Screening to Identification of BRCA1 / 2 Mutation Carriers in Underserved Populations

BRCA1/2 testing and cancer risk management in underserved women at a public hospital

The strategic defense of physician autonomy: State public health agencies as countervailing powers

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