Genetic assessment of breast cancer risk in primary care practice

Wylie Burke, Julie Culver, Linda Pinsky, Sarah Hall, Susan E. Reynolds, Yutaka Yasui, Nancy Press

    Research output: Contribution to journalArticle

    45 Citations (Scopus)

    Abstract

    Family history is increasingly important in primary care as a means to detect candidates for genetic testing or tailored prevention programs. We evaluated primary care physicians' skills in assessing family history for breast cancer risk, using unannounced standardized patient (SP) visits to 86 general internists and family medicine practitioners in King County, WA. Transcripts of clinical encounters were coded to determine ascertainment of family history, risk assessment, and clinical follow-up. Physicians in our study collected sufficient family history to assess breast cancer risk in 48% of encounters with an anxious patient at moderate risk, 100% of encounters with a patient who had a strong maternal family history of breast cancer, and 45% of encounters with a patient who had a strong paternal family history of breast and ovarian cancer. Increased risk was usually communicated in terms of recommendations for preventive action. Few physicians referred patients to genetic counseling, few associated ovarian cancer with breast cancer risk, and some incorrectly discounted paternal family history of breast cancer. We conclude that pedigree assessment of breast cancer risk is feasible in primary care, but may occur consistently only when a strong maternal family history is present. Primary care education should focus on the link between inherited breast and ovarian cancer risk and on the significance of paternal family history. Educational efforts may be most successful when they emphasize the value of genetic counseling for individuals at risk for inherited cancer and the connection between genetic risk and specific prevention measures.

    Original languageEnglish (US)
    Pages (from-to)349-356
    Number of pages8
    JournalAmerican Journal of Medical Genetics, Part A
    Volume149
    Issue number3
    DOIs
    StatePublished - Mar 2009

    Fingerprint

    Primary Health Care
    Breast Neoplasms
    Ovarian Neoplasms
    Genetic Counseling
    Mothers
    Physicians
    Genetic Testing
    Primary Care Physicians
    Pedigree
    Medicine
    Education
    Neoplasms

    Keywords

    • Breast cancer
    • Family history
    • Primary care

    ASJC Scopus subject areas

    • Genetics(clinical)
    • Genetics

    Cite this

    Genetic assessment of breast cancer risk in primary care practice. / Burke, Wylie; Culver, Julie; Pinsky, Linda; Hall, Sarah; Reynolds, Susan E.; Yasui, Yutaka; Press, Nancy.

    In: American Journal of Medical Genetics, Part A, Vol. 149, No. 3, 03.2009, p. 349-356.

    Research output: Contribution to journalArticle

    Burke, W, Culver, J, Pinsky, L, Hall, S, Reynolds, SE, Yasui, Y & Press, N 2009, 'Genetic assessment of breast cancer risk in primary care practice', American Journal of Medical Genetics, Part A, vol. 149, no. 3, pp. 349-356. https://doi.org/10.1002/ajmg.a.32643
    Burke, Wylie ; Culver, Julie ; Pinsky, Linda ; Hall, Sarah ; Reynolds, Susan E. ; Yasui, Yutaka ; Press, Nancy. / Genetic assessment of breast cancer risk in primary care practice. In: American Journal of Medical Genetics, Part A. 2009 ; Vol. 149, No. 3. pp. 349-356.
    @article{3e5c067d2ae54b4b83079e45326f8c4b,
    title = "Genetic assessment of breast cancer risk in primary care practice",
    abstract = "Family history is increasingly important in primary care as a means to detect candidates for genetic testing or tailored prevention programs. We evaluated primary care physicians' skills in assessing family history for breast cancer risk, using unannounced standardized patient (SP) visits to 86 general internists and family medicine practitioners in King County, WA. Transcripts of clinical encounters were coded to determine ascertainment of family history, risk assessment, and clinical follow-up. Physicians in our study collected sufficient family history to assess breast cancer risk in 48{\%} of encounters with an anxious patient at moderate risk, 100{\%} of encounters with a patient who had a strong maternal family history of breast cancer, and 45{\%} of encounters with a patient who had a strong paternal family history of breast and ovarian cancer. Increased risk was usually communicated in terms of recommendations for preventive action. Few physicians referred patients to genetic counseling, few associated ovarian cancer with breast cancer risk, and some incorrectly discounted paternal family history of breast cancer. We conclude that pedigree assessment of breast cancer risk is feasible in primary care, but may occur consistently only when a strong maternal family history is present. Primary care education should focus on the link between inherited breast and ovarian cancer risk and on the significance of paternal family history. Educational efforts may be most successful when they emphasize the value of genetic counseling for individuals at risk for inherited cancer and the connection between genetic risk and specific prevention measures.",
    keywords = "Breast cancer, Family history, Primary care",
    author = "Wylie Burke and Julie Culver and Linda Pinsky and Sarah Hall and Reynolds, {Susan E.} and Yutaka Yasui and Nancy Press",
    year = "2009",
    month = "3",
    doi = "10.1002/ajmg.a.32643",
    language = "English (US)",
    volume = "149",
    pages = "349--356",
    journal = "American Journal of Medical Genetics, Part A",
    issn = "1552-4825",
    publisher = "Wiley-Liss Inc.",
    number = "3",

    }

    TY - JOUR

    T1 - Genetic assessment of breast cancer risk in primary care practice

    AU - Burke, Wylie

    AU - Culver, Julie

    AU - Pinsky, Linda

    AU - Hall, Sarah

    AU - Reynolds, Susan E.

    AU - Yasui, Yutaka

    AU - Press, Nancy

    PY - 2009/3

    Y1 - 2009/3

    N2 - Family history is increasingly important in primary care as a means to detect candidates for genetic testing or tailored prevention programs. We evaluated primary care physicians' skills in assessing family history for breast cancer risk, using unannounced standardized patient (SP) visits to 86 general internists and family medicine practitioners in King County, WA. Transcripts of clinical encounters were coded to determine ascertainment of family history, risk assessment, and clinical follow-up. Physicians in our study collected sufficient family history to assess breast cancer risk in 48% of encounters with an anxious patient at moderate risk, 100% of encounters with a patient who had a strong maternal family history of breast cancer, and 45% of encounters with a patient who had a strong paternal family history of breast and ovarian cancer. Increased risk was usually communicated in terms of recommendations for preventive action. Few physicians referred patients to genetic counseling, few associated ovarian cancer with breast cancer risk, and some incorrectly discounted paternal family history of breast cancer. We conclude that pedigree assessment of breast cancer risk is feasible in primary care, but may occur consistently only when a strong maternal family history is present. Primary care education should focus on the link between inherited breast and ovarian cancer risk and on the significance of paternal family history. Educational efforts may be most successful when they emphasize the value of genetic counseling for individuals at risk for inherited cancer and the connection between genetic risk and specific prevention measures.

    AB - Family history is increasingly important in primary care as a means to detect candidates for genetic testing or tailored prevention programs. We evaluated primary care physicians' skills in assessing family history for breast cancer risk, using unannounced standardized patient (SP) visits to 86 general internists and family medicine practitioners in King County, WA. Transcripts of clinical encounters were coded to determine ascertainment of family history, risk assessment, and clinical follow-up. Physicians in our study collected sufficient family history to assess breast cancer risk in 48% of encounters with an anxious patient at moderate risk, 100% of encounters with a patient who had a strong maternal family history of breast cancer, and 45% of encounters with a patient who had a strong paternal family history of breast and ovarian cancer. Increased risk was usually communicated in terms of recommendations for preventive action. Few physicians referred patients to genetic counseling, few associated ovarian cancer with breast cancer risk, and some incorrectly discounted paternal family history of breast cancer. We conclude that pedigree assessment of breast cancer risk is feasible in primary care, but may occur consistently only when a strong maternal family history is present. Primary care education should focus on the link between inherited breast and ovarian cancer risk and on the significance of paternal family history. Educational efforts may be most successful when they emphasize the value of genetic counseling for individuals at risk for inherited cancer and the connection between genetic risk and specific prevention measures.

    KW - Breast cancer

    KW - Family history

    KW - Primary care

    UR - http://www.scopus.com/inward/record.url?scp=61749084449&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=61749084449&partnerID=8YFLogxK

    U2 - 10.1002/ajmg.a.32643

    DO - 10.1002/ajmg.a.32643

    M3 - Article

    C2 - 19208375

    AN - SCOPUS:61749084449

    VL - 149

    SP - 349

    EP - 356

    JO - American Journal of Medical Genetics, Part A

    JF - American Journal of Medical Genetics, Part A

    SN - 1552-4825

    IS - 3

    ER -