Katz SJ, et al. - In this population-based study, researchers investigated whether there was an association of attending surgeon with rates of genetic testing after the breast cancer diagnosis. After a breast cancer diagnosis, the attending surgeon was correlated with the receipt of genetic testing. Findings suggested that variation in surgeon attitudes about genetic testing and counseling might explain a substantial amount of this association.

Methods

• Participants in the study were 7,810 women with stages 0 to II breast cancer treated between July 1, 2013 and August 31, 2015 from the Surveillance, Epidemiology, and End Results registries for the state of Georgia, and Los Angeles County, CA.
• Approximately 2 months after surgery, surveys were sent.
• Also, 488 attending surgeons identified by the patients were surveyed.
• The relationship of the 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 was assessed.

Results

• According to the findings obtained, 5,080 women (69.6%) of 7,303 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.
• It was observed that 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.
• Data reported that 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.
• Findings revealed that 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.
• It was noted that approximately one-third (34.1%) of the surgeon variation was explained by patient volume and surgeon attitudes about genetic testing and counseling.
• The outcomes exhibited that 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.