According to the Los Angeles County Department of Public Health, breast cancer is among the leading causes of death and premature death in the county. Ovarian cancer also strikes many Los Angeles women annually. A number of resources are available in Los Angeles that could improve these statics. One method is the referral of high-risk women for genetic counseling. Unfortunately, however, this is not being done. A report published online on July 25, 2011 in the journal Cancer reported that physicians followed recommendations for breast cancer susceptibility 1 and 2 (BRCA1 and BRCA2) gene mutations in 71% of women of average risk; however, the recommendations were followed by only 41% of women at high risk. For women who carry the BRCA1 or BRCA2 gene mutations, the cumulative risk of developing breast cancer by age 70 is 57% for BRCA1 carriers and 49% for BRCA2 carriers. Ovarian cancer risks by age 70 years are 40% for BRCA1 and 18% for BRCA2. The study was conducted by lead author Katrina Trivers, PhD, MSPH and her colleagues at the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC). Women whose family history suggests they may carry one of the mutations are prime candidates for genetic testing and counseling. If they test positive, they may opt for chemoprevention, and/or prophylactic mastectomy, and/or oophorectomy to reduce breast cancer risk by 95% and ovarian cancer risk by 80%.
The United States Preventive Services Task Force recommends that physicians refer women who have suggestive family histories to genetic counseling and evaluation, and recommends against it for women who do not have such family histories because of potential harm. The American Congress of Obstetrics and Gynecology (ACOG) recommends referral for patients deemed to have at least a 20% to 25% risk of carrying one or the other gene. The American College of Medical Genetics and the National Comprehensive Cancer Network both recommend referral for patients with breast cancer who were diagnosed before age 45 years.
To examine whether physicians follow these guidelines, the researchers conducted a study of 3,200 family physicians, general internists, and obstetrician/gynecologists; 1878 (62%) responded. Correct identification of high-risk women was a strong predictor of counseling and testing referral. Physicians who identified high-risk women were 8.46 times more likely to make a referral than physicians who misidentified high-risk women as average risk.
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