Leland E Hull1, Jennifer S Haas2, Steven R Simon3. 1. Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; Section of General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts. Electronic address: leland.hull@va.gov. 2. Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts. 3. Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; Geriatrics and Extended Care Service, VA Boston Healthcare System, Boston, Massachusetts.
Abstract
INTRODUCTION: The U.S. Preventive Services Task Force recommends that primary care providers screen unaffected women with a family history of BRCA mutation-associated cancers, but without a personal history of BRCA-related cancer, for referral to genetic counseling and potential genetic testing. METHODS: The 2015 National Health Interview Survey was analyzed in January 2017 to determine the rates at which unaffected adult women with a positive family history of BRCA-related cancers, assessed using the Family History Screen-7, reported discussing genetic testing with a provider, using genetic counseling services, and having genetic testing for increased cancer risk. Clinical correlates associated with these outcomes were assessed using multivariable logistic regression (AOR with 95% CI). RESULTS: Among unaffected Family History Screen-7 screen-positive women, 9.5% reported discussing genetic testing with a provider, 5.1% reported genetic counseling, and 2.7% reported uptake of genetic testing. Younger women (aged 18-39 and 40-49 years) were more likely to discuss genetic testing than women aged ≥60 years (AOR=1.50, 95% CI=1.09, 2.06 and AOR=1.64, 95% CI=1.15, 2.33, respectively). Women of black race (AOR=1.50, 95% CI=1.09, 2.07) and women with greater than a high school education (AOR=1.85, 95% CI=1.41, 2.43) were more likely to discuss genetic testing than women of white race and women with a high school education or less, respectively. Among a higher risk subgroup with an even stronger family history of BRCA-associated cancers, 18.5% of women reported discussions. CONCLUSIONS: Despite a decade-old U.S. Preventive Services Task Force recommendation, few unaffected women at risk for BRCA-associated cancer report discussing genetic testing with a provider. Published by Elsevier Inc.
INTRODUCTION: The U.S. Preventive Services Task Force recommends that primary care providers screen unaffected women with a family history of BRCA mutation-associated cancers, but without a personal history of BRCA-related cancer, for referral to genetic counseling and potential genetic testing. METHODS: The 2015 National Health Interview Survey was analyzed in January 2017 to determine the rates at which unaffected adult women with a positive family history of BRCA-related cancers, assessed using the Family History Screen-7, reported discussing genetic testing with a provider, using genetic counseling services, and having genetic testing for increased cancer risk. Clinical correlates associated with these outcomes were assessed using multivariable logistic regression (AOR with 95% CI). RESULTS: Among unaffected Family History Screen-7 screen-positive women, 9.5% reported discussing genetic testing with a provider, 5.1% reported genetic counseling, and 2.7% reported uptake of genetic testing. Younger women (aged 18-39 and 40-49 years) were more likely to discuss genetic testing than women aged ≥60 years (AOR=1.50, 95% CI=1.09, 2.06 and AOR=1.64, 95% CI=1.15, 2.33, respectively). Women of black race (AOR=1.50, 95% CI=1.09, 2.07) and women with greater than a high school education (AOR=1.85, 95% CI=1.41, 2.43) were more likely to discuss genetic testing than women of white race and women with a high school education or less, respectively. Among a higher risk subgroup with an even stronger family history of BRCA-associated cancers, 18.5% of women reported discussions. CONCLUSIONS: Despite a decade-old U.S. Preventive Services Task Force recommendation, few unaffected women at risk for BRCA-associated cancer report discussing genetic testing with a provider. Published by Elsevier Inc.
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Authors: Kimberly A Kaphingst; Wendy Kohlmann; Rachelle Lorenz Chambers; Melody S Goodman; Richard Bradshaw; Priscilla A Chan; Daniel Chavez-Yenter; Sarah V Colonna; Whitney F Espinel; Jessica N Everett; Amanda Gammon; Eric R Goldberg; Javier Gonzalez; Kelsi J Hagerty; Rachel Hess; Kelsey Kehoe; Cecilia Kessler; Kadyn E Kimball; Shane Loomis; Tiffany R Martinez; Rachel Monahan; Joshua D Schiffman; Dani Temares; Katie Tobik; David W Wetter; Devin M Mann; Kensaku Kawamoto; Guilherme Del Fiol; Saundra S Buys; Ophira Ginsburg Journal: BMC Health Serv Res Date: 2021-06-02 Impact factor: 2.655