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Exploring Breast Surgeons’ Attitudes on Universal Genetic Testing: A Qualitative Study

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The American Society of Breast Surgeons released a consensus statement that genetic testing should be made available to all patients with a personal history of breast cancer. However, it is not clear whether physicians feel comfortable with universal genetic testing (UGT) or if they have sufficient knowledge to interpret results and manage them appropriately.

Objective

The purpose of this study was to explore breast surgeons’ attitudes toward UGT.

Methods

Breast surgeons were consented and scheduled for a semi-structured virtual interview. Transcripts were uploaded into qualitative analysis software where they were exhaustively and iteratively coded. Codes were then organized into higher-order categories and themes and data saturation were assessed.

Results

Thirty-one surgeons completed the qualitative interview. Most surgeons practiced in the academic or community setting and most practiced in the Midwest (71.0%). The majority (90.3%) reported having a structured genetics program. The majority (96.8%) referred their patients to genetics for counseling and most preferred ordering testing through a genetic services provider. Some surgeons had concerns about access to genetic services. A minority of surgeons order UGT for all newly diagnosed breast cancer patients. The majority of respondents thought that more training in genetics was needed for surgeons. Many surgeons expressed concern about the psychosocial effects of UGT on patients.

Conclusions

Many surgeons expressed concerns about UGT, mainly related to discomfort with their training, access to genetic services, and the psychosocial impact on their patients. Future work is needed to determine how to improve surgeon’s comfort level in implementing UGT.

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References

  1. Beitsch PD, Whitworth PW, Hughes K, et al. Underdiagnosis of hereditary breast cancer: are genetic testing guidelines a tool or an obstacle? J Clin Oncol. 2019;37(6):453–60. https://doi.org/10.1200/JCO.18.01631.

    Article  PubMed  Google Scholar 

  2. Yang S, Axilbund JE, O’Leary E, et al. Underdiagnosis of hereditary breast and ovarian cancer in Medicare patients: genetic testing criteria miss the mark. Ann Surg Oncol. 2018;25(10):2925–31. https://doi.org/10.1245/s10434-018-6621-4.

    Article  PubMed  Google Scholar 

  3. Manahan ER, Kuerer HM, Sebastian M, et al. Consensus guidelines on genetic` testing for hereditary breast cancer from the American Society of Breast Surgeons. Ann Surg Oncol. 2019;26(10):3025–31. https://doi.org/10.1245/s10434-019-07549-8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cosgrove J. US Government Accountability Office; 2020. Available at: https://www.gao.gov/products/gao-20-593. Accessed 17 Apr 2023.

  5. Coates WC, Jordan J, Clarke SO. A practical guide for conducting qualitative research in medical education: part 2-Coding and thematic analysis. AEM Educ Train. 2021;5(4):e10645.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hafertepen L, Pastorino A, Morman N, et al. Barriers to genetic testing in newly diagnosed breast cancer patients: do surgeons limit testing? Am J Surg. 2017;214(1):105–10. https://doi.org/10.1016/j.amjsurg.2016.08.012.

    Article  PubMed  Google Scholar 

  7. Introduction to Cancer Genetic Risk Assessment Certification. CGRA Certification. Published December 1, 2022. Available at: https://www.cgracertification.org/introduction/. Accessed 18 Apr 2023.

  8. Bringing genetic testing into your clinic: Moving into the modern DNA era—2023 annual meeting: ASBRS. American Society of Breast Surgeons. Available at: https://www.breastsurgeons.org/meeting/2023/pre/genetic. Accessed 18 Apr 2023.

  9. Childers CP, Childers KK, Maggard-Gibbons M, Macinko J. National estimates of genetic testing in women with a history of breast or ovarian cancer. J Clin Oncol. 2017;35(34):3800–6. https://doi.org/10.1200/jco.2017.73.6314.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Culver JO, Freiberg Y, Ricker C, et al. Integration of universal germline genetic testing for all new breast cancer patients. Ann Surg Oncol. 2022;30(2):1017–25. https://doi.org/10.1245/s10434-022-12595-w.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Evanston Hospital, NorthShore University Health System, Evanston, IL, USA

    Morta Lapkus MD, Elizabeth Poli MD, Thomas W. Smith MD, Katherine Kopkash MD, Katharine Yao MD & Catherine Pesce MD

  2. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

    Morta Lapkus MD, Elizabeth Poli MD, Thomas W. Smith MD, Katherine Kopkash MD, Katharine Yao MD & Catherine Pesce MD

  3. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Bruriah Horowitz Med, Christina Sauer MS & David Victorson PhD

  4. Department of Surgery, Swedish Hospital, NorthShore University Health System, Chicago, IL, USA

    Thomas W. Smith MD

Authors
  1. Morta Lapkus MD
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  2. Bruriah Horowitz Med
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  3. Christina Sauer MS
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  4. David Victorson PhD
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  5. Elizabeth Poli MD
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  6. Thomas W. Smith MD
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  7. Katherine Kopkash MD
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  8. Katharine Yao MD
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  9. Catherine Pesce MD
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Corresponding author

Correspondence to Katharine Yao MD.

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Disclosures

Morta Lapkus, Bruriah Horowitz, Christina Sauer, David Victorson, Elizabeth Poli, Thomas W. Smith, Katherine Kopkash, Katharine Yao, and Catherine Pesce have no commercial interests or financial support in relation to this study.

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Lapkus, M., Horowitz, B., Sauer, C. et al. Exploring Breast Surgeons’ Attitudes on Universal Genetic Testing: A Qualitative Study. Ann Surg Oncol 30, 6108–6116 (2023). https://doi.org/10.1245/s10434-023-13895-5

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  • DOI: https://doi.org/10.1245/s10434-023-13895-5

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