title: Risk information exposure and direct-to-consumer genetic testing for BRCA mutations among women with a personal or family history of breast or ovarian cancer.
abstract: BACKGROUND
  Direct-to-consumer (DTC) BRCA testing may expand access to genetic testing and enhance cancer prevention efforts. It is not known, however, if current DTC websites provide adequate risk information for informed medical decision making.
  
  
  METHODS
  A total of 284 women with a personal or family history of breast/ovarian cancer were randomly assigned to view a "mock" DTC commercial website [control condition (CC); n = 93] or the same "mock" website that included information on the potential risks of obtaining genetic testing online. Risk information was framed two ways: risk information attributed to expert sources (ES; n = 98) and unattributed risk information (URI; n = 93). Participants completed an online survey. End points were intentions to get BRCA testing, testing site preference, and beliefs about DTC BRCA testing.
  
  
  RESULTS
  The sample was 82% white, had a mean age of 39 years (range, 18-70 years) and had a mean education of 3 years of college. Women exposed to risk information had lower intentions to get BRCA testing than women in the CC [adjusted odds ratio (OR), 0.48; 95% confidence interval (95% CI) 0.26-0.87; P = 0.016], and less positive beliefs about online BRCA testing (adjusted OR, 0.48; 95% CI, 0.27-0.86; P = 0.014). Women in the ES condition were more likely to prefer clinic-based testing than were women in the CC (adjusted OR, 2.05; 95% CI, 1.07-3.90; P = 0.030).
  
  
  CONCLUSIONS
  Exposing women to information on the potential risks of online BRCA testing altered their intentions, beliefs, and preferences for BRCA testing. Policy makers may want to consider the content and framing of risk information on DTC websites as they formulate regulation for this rapidly growing industry.
authors.affiliation: Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA 02115, USA. stacyw_gray@dfci.harvard.edu
authors.forename: Stacy W
authors.initials: SW
authors.lastname: Gray
authors.forename: Cristin
authors.initials: C
authors.lastname: O'Grady
authors.forename: Lauren
authors.initials: L
authors.lastname: Karp
authors.forename: Daniel
authors.initials: D
authors.lastname: Smith
authors.forename: J Sanford
authors.initials: JS
authors.lastname: Schwartz
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hornik
authors.forename: Katrina
authors.initials: K
authors.lastname: Armstrong