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Too Few Docs Refer High-Risk Women for Genetic Testing

But most physicians adhere to guidelines against testing women with average ovarian cancer risk

MONDAY, July 25 (HealthDay News) -- Most U.S. physicians adhere to recommendations against genetic counseling and testing for women at average risk of ovarian cancer, but less than half adhere to guidelines for referral for high-risk women, according to a study published online July 25 in Cancer.

Katrina F. Trivers, Ph.D., M.S.P.H., from the Division of Cancer Prevention and Control at the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues investigated whether U.S. physicians adhere to recommended genetic counseling and testing guidelines for women at high or average risk of ovarian cancer. Surveys, including an annual examination vignette, were sent to 3,200 health care providers, of whom 1,878 responded. Patient background and characteristics, including ovarian cancer risk, were varied in the vignette. Estimates of physician adherence to counseling and testing recommendations were weighted to the U.S. primary-care physician population. Independent patient and physician predictors of adherence were identified.

The investigators found that 71 percent of physicians reported adhering to recommendations against testing and genetic counseling for women of average risk. In multivariate analysis, predictors of adherence against referral/testing included black versus white race (relative risk [RR], 1.16), Medicaid versus private insurance (RR, 1.15), and rural versus urban location. For women at high risk, 41 percent of physicians reported adherence to recommendations for testing/counseling referral. Predictors of adherence included younger patient age (35 versus 51 years; RR, 1.78), female versus male physicians (RR, 1.30), and obstetrician/gynecologist versus family medicine specialty (RR, 1.64). For all women, physician-estimated ovarian cancer risk was the strongest predictor of adherence.

"Many physicians report practices contrary to these recommendations, with too many average-risk women being referred for genetic counseling or testing, and too few high-risk women receiving these important services," the authors write.

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