Provider Discussions of Genetic Tests With U.S. Women at Risk for a BRCA Mutation

• Published in: American journal of preventive medicine Vol. 54; no. 2; pp. 221 - 228
• Main Authors: Hull, Leland E., Haas, Jennifer S., Simon, Steven R.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-02-2018; Elsevier Science Ltd
• Subjects: Adult; Age Factors; Aged; At risk populations; BRCA1 Protein - genetics; BRCA2 Protein - genetics; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - genetics; Breast Neoplasms - prevention & control; Cancer; Correlation analysis; Counseling services; Early Detection of Cancer - methods; Early Detection of Cancer - statistics & numerical data; Family medical history; Female; Genetic counseling; Genetic Counseling - statistics & numerical data; Genetic Predisposition to Disease; Genetic testing; Genetic Testing - methods; Health Surveys - statistics & numerical data; Humans; Medical personnel; Middle Aged; Mutation; Ovarian cancer; Ovarian Neoplasms - diagnosis; Ovarian Neoplasms - genetics; Ovarian Neoplasms - prevention & control; Preventive medicine; Primary care; Race; Referral and Consultation - statistics & numerical data; Risk Factors; United States; Uptake; Women; Womens health; Young Adult; Young women; United States; United States > US
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2017.10.015

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.
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).
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.
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.