Physicians successfully incorporate BRCA1/2 testing into clinical practice

Most physicians are incorporating BRCA1/2 genetic testing into their clinical practices in a manner that is consistent with established guidelines, according to the results of a national survey published online Nov. 10 in the Journal of Clinical Oncology.

Nancy L. Keating, MD, of the Harvard Medical School in Boston, and colleagues surveyed 1,050 non-academic physicians who had ordered BRCA1/2 genetic testing during 2004 and 2005. The survey assessed the physicians' experience with BRCA1/2 testing, and determined the physicians' recommendations for surveillance and cancer risk management to patients with positive test results. A total of 611 physicians responded and were included in the analysis.

Approximately two thirds (68.2%) of responding physicians reported usually or always discussing six counseling items with their patients prior to genetic testing. These items included the benefits and limitations of close surveillance, prophylactic mastectomy and prophylactic oophorectomy, as well as the possibility of a psychological reaction, sharing test results with family, and confidentiality issues.

When given a case example of a patient with a positive test result, most physicians reported recommending care consistent with published recommendations. A bilateral prophylactic mastectomy was recommended by 61.4% of respondents, although geneticists and gynecologists were less likely to do this than medical oncologists and surgeons, the report indicates.

“Community-based physicians seem to be successfully incorporating BRCA1/2 testing into their practice,” the authors conclude.Keating NL, Stoeckert KA, Regan MM, et al. Physicians’ experiences with BRCA1/2 testing in community settings. J Clin Oncol. Published online DOI:10.1200/JCO.2008.17.8053.