Cancer risk assessment by rural and Appalachian family medicine physicians.
BACKGROUND
Challenges to the identification of hereditary cancer in primary care may be more pronounced in rural Appalachia, a medically underserved region.


OBJECTIVE
To examine primary care physicians' identification of hereditary cancers.


METHODS
A cross-sectional survey was mailed to family physicians in the midwestern and southeastern United States, stratified by rural/non-rural and Appalachian/non-Appalachian practice location (n = 176). Identification of hereditary breast-ovarian cancer (BRCA1/2), hereditary non-polyposis colon cancer (HNPCC), and other hereditary cancers was assessed.


RESULTS
Less than half of physicians (45%) reported having patients with cancer genetic testing. Most (70%) correctly identified the BRCA1/2-relevant scenario; 49% correctly identified the HNPCC-relevant scenario. Factor analysis of psychosocial variables revealed 2 factors: Confidence (knowledge, comfort, confidence) and importance (responsible, important, effective, need) of identifying hereditary cancer. Greater confidence was associated with use of 3 generation pedigree in taking family history. Greater knowledge and access to genetic services were associated with use of genetic testing. More recent graduation year, greater knowledge, and greater confidence were associated with identifying the BRCA1/2-relevant scenario. Greater knowledge and confidence were associated with identifying the HNPCC-relevant scenario.


CONCLUSIONS
Though rural Appalachian physicians do not differ in ability to identify high risk individuals, access barriers may exist for genetic testing. Interventions are needed to boost physician confidence in identifying hereditary cancer and to improve availability and awareness of availability of genetic services.
Human Cancer Genetics, Department of Molecular Virology, The Ohio State University, Columbus, Ohio 43201, USA. Kimberly.Kelly@osumc.edu
Kimberly M
KM
Kelly
Margaret M
MM
Love
Kevin A
KA
Pearce
Kyle
K
Porter
Mary A
MA
Barron
Michael
M
Andrykowski
D001061:Appalachian Region; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005820:Genetic Testing / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis / Q000235:genetics*; D010821:Physicians, Family / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012424:Rural Population; D011795:Surveys and Questionnaires