Can breast surgeons provide breast cancer genetic testing? An American Society of Breast Surgeons survey.
BACKGROUND
Whether breast cancer surgeons are adequately trained, skilled, and experienced to provide breast cancer genetic assessment, testing, and counseling came under debate in September 2013 when a major third-party payer excluded nongenetics specialists from ordering such testing. A literature search having failed to uncover any study on breast surgeons' skill and practice in this area, the American Society of Breast Surgeons (ASBrS) surveyed its members on their experience with the recognized crucial components of such testing.


METHODS
In late 2013, ASBrS e-mailed a link to an online questionnaire to its U.S. members (n = 2,603) requesting a self-assessment of skills and experience in genetic assessment, testing, interpretation, and counseling. After approximately 6 weeks, the results were collated and evaluated.


RESULTS
By January 2, 2014, 907 responses (34.84 %) had arrived from breast surgeons nationwide working in academic settings (20 %), solo or small group private practice (39 %), large multispecialty groups (18 %), and other settings. More than half said they performed 3-generation pedigrees, ordered genetic testing, and provided pre- and posttest counseling. Most noted that they would welcome continuing educational support in genetics.


CONCLUSIONS
Currently the majority of breast surgeons provide genetic counseling and testing services to their patients. They report practices that meet or exceed recognized guidelines, including the necessary elements and processes for best practices in breast cancer genetics test counseling. Because breast cancer genetic testing is grossly underutilized relative to the size of the U.S. BRCA mutation carrier population, these appropriate services should not be restricted but rather supported and expanded.
Dallas Breast Center and Dallas Surgical Group, Dallas, TX, USA.
Peter D
PD
Beitsch
Pat W
PW
Whitworth
D019313:BRCA1 Protein / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D001943:Breast Neoplasms / Q000097:blood / Q000235:genetics*; D005260:Female; D013502:General Surgery; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D033161:Government Regulation; D006306:Health Surveys; D006801:Humans; D008495:Medical Oncology; D009154:Mutation; D018579:Patient Selection; D010375:Pedigree; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D014481:United States
D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D014408:Biomarkers, Tumor