Doctors Not Following Their DNA Orders

Genetic testing for breast and ovarian cancers not meeting guidelines

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Established guidelines are in place for providing genetic counseling and testing for women at high risk for breast and ovarian cancers. A new study shows that doctors aren't following these recommendations.

The American Cancer Society surveyed doctors from around the United States to learn how often they provide referrals to genetic counseling or testing for their patients at high risk of developing breast or ovarian cancers. Physicians tend to refer average-risk patients, but not high-risk women, a practice that disregards current evidence-based guidelines.

"Ask for genetic counseling and DNA testing if breast or ovarian cancer runs in your family."

Women who have a family or personal history of breast or ovarian cancers may carry genes that put them at high risk of developing the diseases. Tests for BRCA1 or BRCA2 gene mutations are recommended for these women because treatments are available to reduce their risks. However, this test is not recommended for women with low or average risks.

A total of 3,200 physicans were sent surveys. Participants included family physicians, internists and obstetrician/gynecologists. A total of 1,878 responded.

The surveys were designed as annual visit vignettes in which the doctors were asked about how often they referred patients to genetic counseling/testing. Scenarios varied patient age, race, insurance coverage and risk of ovarian cancer.

Overall, physicians reported that they refer many women who have average-risks, but not high-risk women for counseling and testing:

  • 41 percent said they referred high-risk women as guidelines recommend
  • 29 percent said they sometimes or always referred average-risk women, which is not recommended

“The American Cancer Society study demonstrates that non-genetic specialists are not adhering to guidelines around genetic counseling and testing," said Karin Dent, MS, LCGC, and President of the National Society of Genetic Counselors. "It is important that a certified genetic counselor be involved in risk assessment to ensure that patients are referred for appropriate testing and treatment.”

Study authors suggest intervention efforts are needed to promote accurate risk assessment and compliance with guidelines.

This research was published in the journal Cancer.

Reviewed by: 
Review Date: 
July 26, 2011
Last Updated:
July 27, 2011