Steven J Katz1,2, Irina Bondarenko3, Kevin C Ward4, Ann S Hamilton5, Monica Morrow6, Allison W Kurian7,8, Timothy P Hofer1,9. 1. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. 2. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. 3. Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor. 4. Rollins School of Public Health, Emory University, Atlanta, Georgia. 5. Keck School of Medicine, University of Southern California, Los Angeles. 6. Memorial Sloan Kettering Cancer Center, New York, New York. 7. Department of Medicine, Stanford University, Stanford, California. 8. Department of Health Research and Policy, Stanford University, Stanford, California. 9. Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
Abstract
Importance: Genetic testing after diagnosis of breast cancer is common, but little is known about the influence of the surgeon on the variation in testing. Objectives: To quantify and explain the association of attending surgeon with rates of genetic testing after diagnosis of breast cancer. Design, Setting, and Participants: This population-based study identified 7810 women with stages 0 to II breast cancer treated between July 1, 2013, and August 31, 2015, through the Surveillance, Epidemiology, and End Results registries for the state of Georgia, as well as Los Angeles County, California. Surveys were sent approximately 2 months after surgery. Also surveyed were 488 attending surgeons identified by the patients. Main Outcomes and Measures: The study examined the association of surgeon with variation in the receipt of genetic testing using information from patient and surgeon surveys merged to Surveillance, Epidemiology, and End Results and genetic testing data obtained from 4 laboratories. Results: In total, 5080 women (69.6%) of 7303 who were eligible (mean [SD] age, 61.4 [0.8] years) and 377 surgeons (77.3%) of 488 (mean [SD] age, 53.8 [10.7] years) responded to the survey. Approximately one-third (34.5% [1350 of 3910] of patients had an elevated risk of mutation carriage, and 27.0% (1056 of 3910) overall had genetic testing. Surgeons had practiced a mean (SE) of 20.9 (0.6) years, and 28.9% (107 of 370) treated more than 50 cases of new breast cancer per year. The odds of a patient receiving genetic testing increased more than 2-fold (odds ratio, 2.48; 95% CI, 1.85-3.31) if she saw a surgeon with an approach 1 SD above that of a surgeon with the mean test rate. Approximately one-third (34.1%) of the surgeon variation was explained by patient volume and surgeon attitudes about genetic testing and counseling. If a patient with higher pretest risk saw a surgeon at the 5th percentile of the surgeon distribution, she would have a 26.3% (95% CI, 21.9%-31.2%) probability of testing compared with 72.3% (95% CI, 66.7%-77.2%) if she saw a surgeon at the 95th percentile. Conclusions and Relevance: In this study, the attending surgeon was associated with the receipt of genetic testing after a breast cancer diagnosis. Variation in surgeon attitudes about genetic testing and counseling may explain a substantial amount of this association.
Importance: Genetic testing after diagnosis of breast cancer is common, but little is known about the influence of the surgeon on the variation in testing. Objectives: To quantify and explain the association of attending surgeon with rates of genetic testing after diagnosis of breast cancer. Design, Setting, and Participants: This population-based study identified 7810 women with stages 0 to II breast cancer treated between July 1, 2013, and August 31, 2015, through the Surveillance, Epidemiology, and End Results registries for the state of Georgia, as well as Los Angeles County, California. Surveys were sent approximately 2 months after surgery. Also surveyed were 488 attending surgeons identified by the patients. Main Outcomes and Measures: The study examined the association of surgeon with variation in the receipt of genetic testing using information from patient and surgeon surveys merged to Surveillance, Epidemiology, and End Results and genetic testing data obtained from 4 laboratories. Results: In total, 5080 women (69.6%) of 7303 who were eligible (mean [SD] age, 61.4 [0.8] years) and 377 surgeons (77.3%) of 488 (mean [SD] age, 53.8 [10.7] years) responded to the survey. Approximately one-third (34.5% [1350 of 3910] of patients had an elevated risk of mutation carriage, and 27.0% (1056 of 3910) overall had genetic testing. Surgeons had practiced a mean (SE) of 20.9 (0.6) years, and 28.9% (107 of 370) treated more than 50 cases of new breast cancer per year. The odds of a patient receiving genetic testing increased more than 2-fold (odds ratio, 2.48; 95% CI, 1.85-3.31) if she saw a surgeon with an approach 1 SD above that of a surgeon with the mean test rate. Approximately one-third (34.1%) of the surgeon variation was explained by patient volume and surgeon attitudes about genetic testing and counseling. If a patient with higher pretest risk saw a surgeon at the 5th percentile of the surgeon distribution, she would have a 26.3% (95% CI, 21.9%-31.2%) probability of testing compared with 72.3% (95% CI, 66.7%-77.2%) if she saw a surgeon at the 95th percentile. Conclusions and Relevance: In this study, the attending surgeon was associated with the receipt of genetic testing after a breast cancer diagnosis. Variation in surgeon attitudes about genetic testing and counseling may explain a substantial amount of this association.
Authors: Allison W Kurian; Irina Bondarenko; Reshma Jagsi; Christopher R Friese; M Chandler McLeod; Sarah T Hawley; Ann S Hamilton; Kevin C Ward; Timothy P Hofer; Steven J Katz Journal: J Natl Cancer Inst Date: 2018-05-01 Impact factor: 13.506
Authors: Allison W Kurian; Kevin C Ward; Ann S Hamilton; Dennis M Deapen; Paul Abrahamse; Irina Bondarenko; Yun Li; Sarah T Hawley; Monica Morrow; Reshma Jagsi; Steven J Katz Journal: JAMA Oncol Date: 2018-08-01 Impact factor: 31.777
Authors: Mary B Daly; Robert Pilarski; Jennifer E Axilbund; Michael Berry; Saundra S Buys; Beth Crawford; Meagan Farmer; Susan Friedman; Judy E Garber; Seema Khan; Catherine Klein; Wendy Kohlmann; Allison Kurian; Jennifer K Litton; Lisa Madlensky; P Kelly Marcom; Sofia D Merajver; Kenneth Offit; Tuya Pal; Huma Rana; Gwen Reiser; Mark E Robson; Kristen Mahoney Shannon; Elizabeth Swisher; Nicoleta C Voian; Jeffrey N Weitzel; Alison Whelan; Myra J Wick; Georgia L Wiesner; Mary Dwyer; Rashmi Kumar; Susan Darlow Journal: J Natl Compr Canc Netw Date: 2016-02 Impact factor: 11.908
Authors: Mark E Robson; Angela R Bradbury; Banu Arun; Susan M Domchek; James M Ford; Heather L Hampel; Stephen M Lipkin; Sapna Syngal; Dana S Wollins; Noralane M Lindor Journal: J Clin Oncol Date: 2015-08-31 Impact factor: 44.544
Authors: Monica Morrow; Paul Abrahamse; Timothy P Hofer; Kevin C Ward; Ann S Hamilton; Allison W Kurian; Steven J Katz; Reshma Jagsi Journal: JAMA Oncol Date: 2017-10-01 Impact factor: 31.777
Authors: Allison W Kurian; Christopher R Friese; Irina Bondarenko; Reshma Jagsi; Yun Li; Ann S Hamilton; Kevin C Ward; Steven J Katz Journal: JAMA Oncol Date: 2017-03-01 Impact factor: 33.006
Authors: Allison W Kurian; Kent A Griffith; Ann S Hamilton; Kevin C Ward; Monica Morrow; Steven J Katz; Reshma Jagsi Journal: JAMA Date: 2017-02-07 Impact factor: 157.335
Authors: Allison W Kurian; Yun Li; Ann S Hamilton; Kevin C Ward; Sarah T Hawley; Monica Morrow; M Chandler McLeod; Reshma Jagsi; Steven J Katz Journal: J Clin Oncol Date: 2017-04-12 Impact factor: 50.717
Authors: Allison W Kurian; Kevin C Ward; Nadia Howlader; Dennis Deapen; Ann S Hamilton; Angela Mariotto; Daniel Miller; Lynne S Penberthy; Steven J Katz Journal: J Clin Oncol Date: 2019-04-09 Impact factor: 44.544
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Authors: Amelia K Smit; Ainsley J Newson; Louise Keogh; Megan Best; Kate Dunlop; Kylie Vuong; Judy Kirk; Phyllis Butow; Lyndal Trevena; Anne E Cust Journal: BJGP Open Date: 2019-02-20
Authors: Melina Claussnitzer; Judy H Cho; Rory Collins; Nancy J Cox; Emmanouil T Dermitzakis; Matthew E Hurles; Sekar Kathiresan; Eimear E Kenny; Cecilia M Lindgren; Daniel G MacArthur; Kathryn N North; Sharon E Plon; Heidi L Rehm; Neil Risch; Charles N Rotimi; Jay Shendure; Nicole Soranzo; Mark I McCarthy Journal: Nature Date: 2020-01-08 Impact factor: 49.962
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