Association of Attending Surgeon With Variation in the Receipt of Genetic Testing After Diagnosis of Breast Cancer
Open accessAbstract
Importance: Genetic testing after diagnosis of breast cancer is common, but little is known about the influence of the surgeon on the variation in testing. Objectives: To quantify and explain the association of attending surgeon with rates of genetic testing after diagnosis of breast cancer. Design, Setting, and Participants: This population-based study identified 7810 women with stages 0 to II breast cancer treated between July 1, 2013, and August 31, 2015, through the Surveillance, Epidemiology, and End Results registries for the state of Georgia, as well as Los Angeles County, California. Surveys were sent approximately 2 months after surgery. Also surveyed were 488 attending surgeons identified by the patients. Main Outcomes and Measures: The study examined the association of surgeon with variation in the receipt of genetic testing using information from patient and surgeon surveys merged to Surveillance, Epidemiology, and End Results and genetic testing data obtained from 4 laboratories. Results: In total, 5080 women (69.6%) of 7303 who were eligible (mean [SD] age, 61.4 [0.8] years) and 377 surgeons (77.3%) of 488 (mean [SD] age, 53.8 [10.7] years) responded to the survey. Approximately one-third (34.5% [1350 of 3910] of patients had an elevated risk of mutation carriage, and 27.0% (1056 of 3910) overall had genetic testing. Surgeons had practiced a mean (SE) of 20.9 (0.6) years, and 28.9% (107 of 370) treated more than 50 cases of new breast cancer per year. The odds of a patient receiving genetic testing increased more than 2-fold (odds ratio, 2.48; 95% CI, 1.85-3.31) if she saw a surgeon with an approach 1 SD above that of a surgeon with the mean test rate. Approximately one-third (34.1%) of the surgeon variation was explained by patient volume and surgeon attitudes about genetic testing and counseling. If a patient with higher pretest risk saw a surgeon at the 5th percentile of the surgeon distribution, she would have a 26.3% (95% CI, 21.9%-31.2%) probability of testing compared with 72.3% (95% CI, 66.7%-77.2%) if she saw a surgeon at the 95th percentile. Conclusions and Relevance: In this study, the attending surgeon was associated with the receipt of genetic testing after a breast cancer diagnosis. Variation in surgeon attitudes about genetic testing and counseling may explain a substantial amount of this association.
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Many healthcare professionals lack experience in genomic medicine and need education and guidance.
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- Authors
- Katz, S. J., Bondarenko, I., Ward, K. C., Hamilton, A. S., Morrow, M., Kurian, A. W., & Hofer, T. P.
- Affiliations
- University of Michigan (US)
- Emory University (US)
- University of Southern California (US)
- Memorial Sloan Kettering Cancer Center (US)
- Stanford Medicine (US)
- Corresponding author
- Katz, Steven J.
- ORCID
- Venue
- JAMA Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2018-10-01
- Volume
- 153
- Issue
- 10
- Pages
- 909
- ISSN
- 2168-6254 (ISSN-L)
- PMC
- PMC6233787
- OpenAlex
- W2809887678
- Cited by
- 26
- References
- 19
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 5 · 2020: 6 · 2019: 3 · 2018: 4 · 2017: 1
- FWCI
- 2.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Surgery (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (HHSN261201000034 C, HHSN261201000035C, HHSN261201000140C, P01CA163233, P30CA008748, P30CA046592)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › BRCA gene mutations in cancer
- Health Sciences › Medicine › Pathology and Forensic Medicine › Breast Lesions and Carcinomas
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Keywords
- breast cancer, genetic testing, hereditary cancer predisposition, attending surgeons, variation in care, surgeon attitudes, patient volume, genetic counseling, physician-patient communication, physician-patient relationship, patient satisfaction, patient satisfaction with communication, patient satisfaction with treatment outcomes
- MeSH terms
- Procedures and Techniques Utilization, Adult, Aged, Attitude of Health Personnel, Breast Neoplasms, Delivery of Health Care, Female, Genetic Testing, Georgia, Humans, Middle Aged, Mutation, Los Angeles, SEER Program, Young Adult, Surgeons
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