Uptake of BRCA 1/2 and oncotype DX testing by medical and surgical oncologists
The diffusion of genomic testing is critical to the success of precision medicine, but there is limited information on oncologists’ uptake of genetic technology. We aimed to assess the frequency with which medical oncologists and surgeons order BRCA 1/2 and Oncotype DX testing for breast cancer patients.
We surveyed 732 oncologists and surgeons treating breast cancer patients. Physicians were from Florida, New York, New Jersey, and Pennsylvania, and were listed in the 2010 AMA Masterfile or identified by patients.
80.6% of providers ordered BRCA 1/2 testing at least sometimes and 85.4% ordered Oncotype DX (p = 0.01). More frequent ordering of BRCA 1/2 was associated with more positive attitudes toward genetic innovation (OR 1.14, p = 0.001), a belief that testing was likely to be covered by patients’ insurance (OR 2.84, p < 0.001), and more frequent ordering of Oncotype DX testing (OR 8.69, p < 0.001). More frequent use of Oncotype DX was associated with a belief that testing was likely to be covered by insurance (OR 7.33, p < 0.001), as well as with more frequent ordering of BRCA 1/2 testing (OR 9.48, p < 0.001).
Nearly one in five providers never or rarely ever ordered BRCA 1/2 testing for their breast cancer patients, and nearly 15% never or rarely ever ordered Oncotype DX. Less frequent ordering of BRCA 1/2 is associated with less frequent use of Oncotype DX testing, and vice versa. Those who do not order BRCA 1/2 testing report less positive attitudes toward genetic innovation. Further education of this subset of providers regarding the benefits of precision medicine may enable more rapid diffusion of genetic technology.
KeywordsBreast cancer BRCA1/2 testing Oncotype DX Precision medicine
This work was supported by the National Cancer Institute of the National Institutes of Health, Grant 5-R01-CA133004- 3.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 10.Guth AA, Fineberg S, Fei K, Franco R, Bickell NA (2013) Utilization of Oncotype DX in an Inner City Population: Race or Place? Int J Breast Cancer https://doiorg/2013:653805Google Scholar
- 13.Antoniou A, Pharoah PD, Narod S et al (2003) Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: a combined analysis of 22 studies. Am J Hum Genet 72:1117–1130. https://doi.org/10.1086/375033 CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Marchetti C, De Felice F, Palaia I et al (2014) Risk-reducing salpingo-oophorectomy: a meta-analysis on impact on ovarian cancer risk and all cause mortality in BRCA 1 and BRCA 2 mutation carriers. BMC Womens Health 14:150. https://doi.org/10.1186/s12905-014-0150-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Nelson HD, Smith ME, Griffin JC et al (2013) Use of medications to reduce risk for primary breast cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. https://doi.org/10.7326/0003-4819-158-8-201304160-00005 158:604 – 14.CrossRefPubMedGoogle Scholar
- 20.NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®) (2012) Breast Cancer. Version 3.2012. NCCN.orgGoogle Scholar
- 21.Cronin M, Sangli C, Liu ML et al (2007) Analytical validation of the Oncotype DX genomic diagnostic test for recurrence prognosis and therapeutic response prediction in node-negative, estrogen receptor-positive breast cancer. Clin Chem 53:1084–1091. https://doi.org/10.1373/clinchem.2006.076497 CrossRefPubMedGoogle Scholar
- 25.NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®) (2015) Genetic/ familial high-risk assessment: breast and ovarian. Version 1.2015. NCCN.orgGoogle Scholar
- 30.Van Riel E, Warlam-Rodenhuis CC, Verhoef S, Rutgers EJTH., Ausems MGEM. (2010) BRCA testing of breast cancer patients: medical specialists’ referral patterns, knowledge and attitudes to genetic testing. Eur J Cancer Care (Engl) 19:369 – 76. https://doi.org/10.1111/j.1365-2354.2008.01065.x CrossRefGoogle Scholar
- 31.Cragun D, Weidner A, Lewis C, Bonner D, Kim J, Vadaparampil ST, Pal T (2017) Racial disparities in BRCA testing and cancer risk management across a population-based sample of young breast cancer survivors. Cancer 123:2497–2505. https://doi.org/10.1002/cncr.30621 CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Cragun D, Scherr C, Camperlengo L, Vadaparampil ST, Pal T (2016) Evolution of Hereditary Breast Cancer Genetic Services: Are Changes Reflected in the Knowledge and Clinical Practices of Florida Providers? Genet Test Mol Biomarkers 20:569–578. https://doi.org/10.1089/gtmb.2016.0113 CrossRefPubMedGoogle Scholar
- 35.Hassett MJ, Silver SM, Hughes ME et al (2012) Adoption of gene expression profile testing and association with use of chemotherapy among women with breast cancer. J Clin Oncol 30:2218–2226. https://doi.org/10.1200/JCO.2011.38.5740 Journal of Clinical Oncology 30 no. 18 (June 2012) 2218–2226.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Dinan MA, Mi X, Reed SD, Hirsch BR, Lyman GH, Curtis LH (2015) Initial trends in the use of the 21-gene recurrence score assay for patients With breast cancer in the medicare population, 2005–2009. JAMA Oncol. 1:158–1661:158 – 66. https://doi.org/10.1001/jamaoncol.2015.43 CrossRefPubMedGoogle Scholar
- 43.Armstrong K, Calzone K, Stopfer J, Ftizgerald G, Coyne J, Weber B (2002) Factors associated with decisions about clinical BRCA1/2 testing. Cancer Epidemiol Biomarkers Prev 9:1251–1254Google Scholar
- 45.The American Association for Public Opinion Research. (2011). Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. 7th edn. AAPORGoogle Scholar
- 49.Hurt HT, Joseph K, Cook CD (1977) Scales for the measurement of innovativeness. Human Commun Res 4:58–65. https://doi.org/10.1111/j.1468-2958.1977.tb00597.x CrossRefGoogle Scholar