Cancer Genetics Risk Assessment and Counseling (PDQ®): Genetics - Health Professional Information [NCI] - The Option of Genetic Testing
Table 1. Clinical Utility of Genetic/Genomic Testsa continued...
Empirical research was conducted immediately following the 2002 campaign. A random digit dialing survey of 1,635 women in the campaign cities (Denver and Atlanta) and two control cities found increased levels of awareness of BRCA1/2 genetic testing in target cities. However, no significant differences were observed in perceived knowledge about testing, concern about breast cancer, or interest in testing. There was no evidence that knowledge was differentially increased in those women with strong family histories of breast cancer, who would most benefit from consideration of testing. No overall increase in anxiety or confusion about testing was reported. Of women who reported exposure to the DTC advertisement, 63% reported no anxiety at all, and 76% reported no confusion. A smaller study of 315 women from the Denver area found that women at increased risk of breast cancer were more knowledgeable about BRCA testing and more likely to recall the advertisement. However, an equal number of high and low risk women felt they would benefit from genetic testing and were interested in testing. A consumer survey based on a cross-sectional, stratified, random sample of at-risk women explored the effects of socioeconomic status (SES) on women's reactions to a BRCA1/BRCA2 genetic testing DTC marketing campaign. The survey was conducted at two intervention sites (n = 811) and two control sites (n = 824), and knowledge of the genetic test, perceptions of personal risk, communications with others about the test, and interest in pursuing the test were evaluated. SES, as measured by income and education, had no differential effect on any of the outcome measures in women at the intervention sites and control sites. However, the study did report a consistent overall effect of SES on most variables measured, independent of the intervention site. For example, women of lower SES reported being less knowledgeable about genetics and risk, yet were more interested in genetic testing. These results suggest that SES could play a role in access to genetic services, how women understand their genetic risk of inherited breast and ovarian cancer susceptibility, and what they do about it.
The impact of the advertising campaign on physicians was also a focus of investigation. Physicians in target cities were more likely to remember hearing an advertisement for testing but did not have increased knowledge compared with physicians in control cities. Physicians in target cities reported increases in patients' questions about genetic testing, genetic counseling referrals, and requests for testing.[30,33] In summary, physicians might have been more likely to make a referral for testing based on the patient's interest in testing, whether or not the doctor is informed enough to consider whether the test is appropriate. The most concerning documented problem with this campaign was that the company targeted the general population, even though genetic testing for BRCA1/2 is only appropriate for a subgroup of women.