A new Moffitt Cancer Center study published Thursday in Genetics in Medicine shows that counseling from a genetic health care provider before genetic testing educates patients and may help reduce unnecessary procedures.
Up to 10 percent of cancers are inherited, meaning a person was born with an abnormal gene that increases their risk for cancer. "Pre-test genetic counseling in which a health care provider takes a thorough family history and discusses the potential risks and benefits of genetic testing is standard of care as recommended by the American Society of Clinical Oncology and National Society of Genetic Counselors," said Tuya Pal, M.D., a board-certified geneticist at Moffitt and senior author of the paper.
In the Moffitt study, researchers surveyed 473 patients who had genetic testing for BRCA1 and BRCA2 gene mutations, which are associated with an increased risk of breast and ovarian cancers. Among study participants who saw a board-certified geneticist or genetic counselor, almost all recalled having a pre-test discussion, compared to only 59 percent of those who did not. These findings suggest large differences in quality of care across providers who order testing.
The researchers also suggest there may be cost-of-care implications when genetic health care providers are involved. "Our results suggest that genetic health care providers are less likely to order more expensive comprehensive genetic testing, when less expensive testing may be appropriate," said Deborah Cragun, Ph.D., lead study author and post-doctoral fellow at Moffitt. "Our study found that in cases where less expensive testing may be appropriate, genetic health care providers ordered comprehensive testing for 9.5 percent of participants, compared to 19.4 percent when tests were ordered by other health care providers. At the time of data collection, comprehensive genetic testing cost approximately $4,000, compared to $400 for the less expensive testing."
The findings are important, noted researchers, because costs and quality of care are often the focus of policy-level decisions in health care.
The study was supported by grants from Florida's Bankhead-Coley Cancer Research Program (IBG09-34198) and the National Cancer Institute (5R25 CA147832-04).
- Deborah Cragun, Lucia Camperlengo, Emily Robinson, Meghan Caldwell, Jongphil Kim, Catherine Phelan, Alvaro N. Monteiro, Susan T. Vadaparampil, Thomas A. Sellers, Tuya Pal. Differences in BRCA counseling and testing practices based on ordering provider type. Genetics in Medicine, 2014; DOI: 10.1038/gim.2014.75
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