title: Impact of direct-to-consumer advertising for hereditary breast cancer testing on genetic services at a managed care organization: a naturally-occurring experiment.
abstract: OBJECTIVE
  To describe the impact of Myriad Genetics, Inc.'s direct-to-consumer advertising (DTC-ad) campaign on cancer genetic services within two Managed Care Organizations, Kaiser Permanente Colorado (KPCO), Denver, Colorado, where the ad campaign occurred, and Henry Ford Health System (HFHS), Detroit, Michigan, where there were no advertisements.
  
  
  METHODS
  The main outcome measures were the changes in number and pretest mutation probability of referrals approved for cancer genetic services at KPCO and HFHS during the campaign versus the year prior, and mutation probability of those undergoing testing.
  
  
  RESULTS
  At KPCO, referrals increased 244% during the DTC-ad compared to the same time period a year earlier (P value<0.001). The proportion of referrals at high pretest probability of a mutation (10% or greater) dropped from 69% the previous year to 48% during the campaign (P value<0.001). There was no significant change in pretest mutation probability among women who underwent testing between the two time periods. HFHS reported no significant change between the two time periods for numbers or mutation probability of referrals, or for mutation probability of women tested.
  
  
  CONCLUSIONS
  The DTC-ad caused significant increase in demand for cancer genetic services. In the face of potential future DTC-ad for inherited cancer risk, providers and payers need to consider the delivery of genetic services and genetic education for persons of all risk levels.
authors.affiliation: Kaiser Permanente Clinical Research Unit, Denver, Colorado, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Mouchawar
authors.forename: Sharon
authors.initials: S
authors.lastname: Hensley-Alford
authors.forename: Suzanne
authors.initials: S
authors.lastname: Laurion
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ellis
authors.forename: Alanna
authors.initials: A
authors.lastname: Kulchak-Rahm
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Finucane
authors.forename: Richard
authors.initials: R
authors.lastname: Meenan
authors.forename: Lisen
authors.initials: L
authors.lastname: Axell
authors.forename: Rebecca
authors.initials: R
authors.lastname: Pollack
authors.forename: Debra
authors.initials: D
authors.lastname: Ritzwoller
mesh_terms: D000328:Adult; D000329:Advertising; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics* / Q000517:prevention & control; D005260:Female; D019398:Genes, BRCA1 / Q000502:physiology; D024522:Genes, BRCA2 / Q000502:physiology; D005820:Genetic Testing / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D012107:Research Design