Interest in BRCA1/2 testing in a primary care population

Background. Mutations in the breast cancer susceptibility genes BRCA1 and BRCA2 are found in less than 1/1,000 women in the general population. Experts and professional organizations recommend targeting testing to women with risk factors for carrying a mutation. Over the next decade, BRCA1/2 testing is likely to become substantially less expensive and to move into primary care practice where pretest counseling may be limited. Methods. The objective of the study was to investigate the factors associated with interest in BRCA1/2 testing among primary care patients receiving only limited information about testing. The design was a cross-sectional mailed survey. The setting was a University-based health system in the metropolitan Philadelphia region. The participants were 400 adult women cared for in a faculty General Internal Medicine practice. Results. Two hundred forty-two women (71%) completed surveys; 53% of respondents were aware of BRCA1/2 testing and 58% were interested in undergoing testing if it was both convenient and affordable. Thirty-one percent were both aware of and interested in testing. Awareness of testing was inversely associated with African-American race (OR 0.56, 95% CI 0.38-0.83) and positively associated with college education (OR 2.21, 95% CI 1.23-3.94). Interest in testing was inversely associated with a family history of breast cancer (OR 0.45, 95% CI 0.23-0.92) and increasing age (OR 0.97, 95% CI 0.95-0.99). The inverse association between family history and interest in testing persisted in the subgroup of women who were aware of testing (OR 0.55, 95% CI 0.30-0.98). Conclusions. Among a primary care population, African-American women are less aware of BRCA1/2 testing and, when provided only limited information about BRCA1/2 testing, women at lowest risk of carrying a mutation are most interested in undergoing BRCA1/2 testing. Challenges of moving BRCA1/2 testing into primary care practice include both limiting indiscriminate use by the "worried well" and, as proven cancer prevention strategies become available, ensuring access to all high-risk women regardless of race. (C) 2002 American Health Foundation and Elsevier Science (USA).