title: Characteristics associated with genetic counseling referral and BRCA1/2 testing among women in a large integrated health system.
abstract: BACKGROUND
  Evidence shows underutilization of cancer genetics services. To explore the reasons behind this underutilization, this study evaluated characteristics of women who were referred for genetic counseling and/or had undergone BRCA1/2 testing.
  
  
  METHODS
  An ovarian cancer risk perception study stratified 16,720 eligible women from the Henry Ford Health System into average-, elevated-, and high-risk groups based on family history. We randomly selected 3,307 subjects and interviewed 2,524 of them (76.3% response rate).
  
  
  RESULTS
  Among the average-, elevated-, and high-risk groups, 2.3, 10.1, and 20.2%, respectively, reported genetic counseling referrals, and 0.8, 3.3, and 9.5%, respectively, reported having undergone BRCA testing. Personal breast cancer history, high risk, and perceived ovarian cancer risk were associated with both referral and testing. Discussion of family history with a doctor predicted counseling referral, whereas belief that family history influenced risk was the strongest BRCA testing predictor. Women perceiving their cancer risk as much higher than other women their age were twice as likely (95% confidence interval: 2.0-9.6) to report genetic counseling referral.
  
  
  CONCLUSIONS
  In a health system with ready access to cancer genetic counseling and BRCA testing, women who were at high risk underutilized these services. There were strong associations between perceived ovarian cancer risk and genetic counseling referral, and between a belief that family history influenced risk and BRCA testing.
authors.affiliation: Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Cecelia A
authors.initials: CA
authors.lastname: Bellcross
authors.affiliation: Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Peipins
authors.affiliation: National Center for Health Statistics, Office of Public Health Science Services, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA.
authors.forename: Frances A
authors.initials: FA
authors.lastname: McCarty
authors.affiliation: Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Juan L
authors.initials: JL
authors.lastname: Rodriguez
authors.affiliation: Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Nikki A
authors.initials: NA
authors.lastname: Hawkins
authors.affiliation: Josephine Ford Cancer Center, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Hensley Alford
authors.affiliation: Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Leadbetter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005817:Genetic Counseling; D005820:Genetic Testing; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics; D062486:Public Health Surveillance; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult