title: Evolution of Hereditary Breast Cancer Genetic Services: Are Changes Reflected in the Knowledge and Clinical Practices of Florida Providers?
abstract: OBJECTIVE
  We describe practitioner knowledge and practices related to hereditary breast and ovarian cancer (HBOC) in an evolving landscape of genetic testing.
  
  
  METHODS
  A survey was mailed in late 2013 to Florida providers who order HBOC testing. Descriptive statistics were conducted to characterize participants' responses.
  
  
  RESULTS
  Of 101 respondents, 66% indicated either no genetics education or education through a commercial laboratory. Although 79% of respondents were aware of the Supreme Court ruling resulting in the loss of Myriad Genetics' BRCA gene patent, only 19% had ordered testing from a different laboratory. With regard to pretest counseling, 78% of respondents indicated they usually discuss 11 of 14 nationally recommended elements for informed consent. Pretest discussion times varied from 3 to 120 min, with approximately half spending <20 min. Elements not routinely covered by >40% of respondents included (1) possibility of a variant of uncertain significance (VUS) and (2) issues related to life/disability insurance. With regard to genetic testing for HBOC, 88% would test an unaffected sister of a breast cancer patient identified with a BRCA VUS.
  
  
  CONCLUSIONS
  Results highlight the need to identify whether variability in hereditary cancer service delivery impacts patient outcomes. Findings also reveal opportunities to facilitate ongoing outreach and education.
authors.affiliation: 1 Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, Florida.|2 Department of Global Health, University of South Florida , Tampa, Florida.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cragun
authors.affiliation: 3 Department of Communication Studies, Northwestern University , Chicago, Illinois.
authors.forename: Courtney
authors.initials: C
authors.lastname: Scherr
authors.affiliation: 1 Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, Florida.
authors.forename: Lucia
authors.initials: L
authors.lastname: Camperlengo
authors.affiliation: 1 Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, Florida.
authors.forename: Susan T
authors.initials: ST
authors.lastname: Vadaparampil
authors.affiliation: 1 Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, Florida.
authors.forename: Tuya
authors.initials: T
authors.lastname: Pal
mesh_terms: D001943:Breast Neoplasms / Q000235:genetics / Q000628:therapy; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards / Q000639:trends; D005260:Female; D005431:Florida; D033142:Genetic Services / Q000458:organization & administration / Q000592:standards / Q000639:trends; D006282:Health Personnel / Q000458:organization & administration / Q000592:standards / Q000639:trends; D006801:Humans
keywords: BRCA; genetic knowledge; genetic service delivery; genetic testing; hereditary breast cancer