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Breast Cancer Research and Treatment

, Volume 129, Issue 1, pp 221–227 | Cite as

Significant differences among physician specialties in management recommendations of BRCA1 mutation carriers

  • S. U. Dhar
  • H. P. Cooper
  • T. Wang
  • B. Parks
  • S. A. Staggs
  • S. Hilsenbeck
  • S. E. Plon
Epidemiology

Abstract

The National Comprehensive Cancer Network (NCCN) has published guidelines for hereditary breast and ovarian cancer syndrome (HBOCS) management. Little data exist on compliance with these guidelines among different physician specialties. We performed an on-line case-based survey by randomly sampling physicians from five specialties, Family Medicine (FM), Obstetrics and Gynecology (OG), General Surgery (GS), Internal Medicine (IM), and Hematology and Oncology (HO). The physicians (n = 225) were asked to provide HBOCS management of healthy women ages 40–42 in the presence of a familial BRCA1 mutation. For women negative for the BRCA1 mutation, 59% of the physicians recommended appropriate surveillance although with significant differences among specialties; P = 0.01. Using an aggregate screening intensity score, physicians clearly recommended more intense screening for mutation positive than negative women (P < 0.0001), but only 16% of physicians followed NCCN guidelines for BRCA1-positive women. Seventy-six percent of all physicians recommended breast MRI with significant variation among specialties ranging from 62% of FM to 89% of OG (P = 0.0020). Similarly, 63% of physicians recommended prophylactic oophorectomy, with 76 and 78% of GS and OG compared to 38% of IM (P < 0.0001) and 57% recommended prophylactic mastectomy ranging from 84% of HO to 32% of FM (P < 0.0001). Independent of specialty, respondents with BRCA testing experience recommended more intense management than those without; P = 0.021. Management recommendations of BRCA1 mutation carriers are not consistent with NCCN guidelines and vary by medical specialty and genetic testing experience. Targeted education of physicians by specialty is needed, so that optimal management is offered to these high-risk women.

Keywords

BRCA1 BRCA Surveillance Guidelines Physicians 

Notes

Financial disclosures

None reported.

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Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • S. U. Dhar
    • 1
  • H. P. Cooper
    • 3
  • T. Wang
    • 4
  • B. Parks
    • 2
  • S. A. Staggs
    • 5
  • S. Hilsenbeck
    • 3
    • 4
  • S. E. Plon
    • 2
    • 4
    • 6
  1. 1.Department of Molecular & Human GeneticsBaylor College of MedicineHoustonUSA
  2. 2.Department of Molecular & Human GeneticsBaylor College of Medicine, Feigin CenterHoustonUSA
  3. 3.Department of MedicineBaylor College of MedicineHoustonUSA
  4. 4.Dan L. Duncan Cancer CenterBaylor College of MedicineHoustonUSA
  5. 5.Physician Oncology Education ProgramTexas Medical AssociationAustinUSA
  6. 6.Department of PediatricsBaylor College of MedicineHoustonUSA

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