Physician knowledge and attitudes concerning breast cancer genetics

The discovery of the breast and ovarian cancer predisposition genes, BRCA1 and BRCA2, has led to the development of lifesaving treatments and cancer risk reduction strategies in families who carry pathogenic variants. Genetic testing techniques have improved over the years and decreased in cost so that many who meet widely accepted testing guidelines based on family and personal histories of cancer are able to afford testing after appropriate counseling. It has been suggested that all women should be offered genetic testing for these genes, regardless of family or personal cancer history. To implement a population-based screening program, primary care physicians would need to know about the BRCA genes as well as understand how best to use genetic test results based on an individual’s medical history; these providers would also need to be willing to incorporate an additional service into their practice. A questionnaire was developed to assess the knowledge and opinions of individuals, within the UPMC network, in the medical specialties of obstetrics/gynecology and family medicine with regard to BRCA1/2 and offering BRCA1/2 testing to patients. The average number of knowledge questions that were answered correctly, across all 64 participants was 9.5 correct out of 13 questions, for an average score of 73.4%; only one individual correctly answered all 13 questions. The question that providers most often answered incorrectly concerned testing policies for variants of uncertain significance; only 29.8% (25/84) correctly answered that they would not test a patient for an unclear genetic finding that was found in a relative. With regard to what would motivate those surveyed to incorporate population-based BRCA1/2 testing into their practice, 70.2% (59/84) indicated that evidence-based professional society guidelines would be their greatest motivator, while only 4.8% (4/86) indicated they were not interested or motivated to offer BRCA1/2 testing to their patients. The results of this study will help to guide future educational programs for physicians as the BRCA genes are considered for population-based screening. The public health significance of this work is that the public will receive proper counseling and consistent care with regard to their BRCA testing, if physicians are trained properly