Breast cancer: Many US doctors don't follow evidence-based guidelines

A study found that many doctors in the US don't follow evidence-based guidelines on genetic counselling and testing for hereditary breast and ovarian cancers. As a result, too many average-risk women and too few high-risk women receive these important services.

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Women with mutations in the BRCA1 or BRCA2 gene have a higher risk of getting breast and ovarian cancers. Medical treatments can reduce the risk sharply, so genetic testing is recommended for women whose personal or family history shows they may have these mutations. Genetic testing is not recommended for women at average risk because the harms of treatment outweigh the benefits.

Researchers sent surveys to 3200 doctors in the United States that asked about the services they would provide to women at annual exams, including how often they would refer women to genetic counselling or offer BRCA 1/2 testing. Scenarios in the survey varied the patients' characteristics, such as age, race, insurance status, and ovarian cancer risk.

A total of 1878 doctors answered the survey, with the following results:

41% of the doctors surveyed said they would refer high-risk women for genetic counselling or testing, consistent with the guidelines.
29% of the doctors surveyed said they would sometimes or always refer average-risk women for genetic counselling and testing, against the guidelines.

Doctors need to be encouraged to offer genetic counselling and testing services to high-risk women and discouraged from offering them to average-risk women.