Obtaining a thorough family history of cancer should be a key component in evaluating patients and deciding whether to refer those at increased risk of either primary or second cancers for genetic counseling and testing. Many community oncology practices comply with this practice, but there is room for improvement, according to a large survey of 271 practices and more than 10,000 charts of patients with breast cancer or colon cancer.1 The retrospective sample included patients who were diagnosed within the previous 2 years and had at least two visits to the practice within 6 months.
“This survey was a pilot test of quality measures regarding family history-taking and genetic counseling and testing practices, as part of ASCO’s Quality Oncology Practice Initiative (QOPI),” explained Marie Wood, MD, University of Vermont, Burlington. “Family history is the best criterion for identifying patients at risk for hereditary cancer who should be referred for screening.”
Key findings of the survey were as follows: 79% of patients’ charts included first-degree family histories of cancer, and 61% documented second-degree histories as well. A greater number of patients with breast cancer than patients with colon cancer had first- or second-degree family histories documented. However, less than one-third of patients’ charts documented the age of cancer diagnosis of relatives.
Twenty-two percent of all patients were referred for genetic counseling or genetic testing (29% of patients with breast cancer and 19% of those with colorectal cancer). But among patients with hereditary cancer risk, only 52% of patients with breast cancer and 26% of those with colorectal cancer were referred for counseling or testing. The survey also revealed that consent for testing conducted within a practice was documented 77.7% of the time, and result disclosure documented for 78.8% of patients.
“The survey found low rates of referral for those individuals who could benefit from genetic counseling and testing,” Dr. Wood emphasized. “Most insurers will pay for genetic testing,” she added.
Toward More Online Research?
“Taking a family history is laborious. We are hoping that more of these can be done online. It can be surprising how little patients know about their family history,” commented Nicholas Vogelzang, MD, US Oncology, Las Vegas, who moderated an ASCO press conference where these findings were discussed. “I’m delighted to see this presentation,” he concluded. ■
Disclosure: Drs. Wood and Vogelzang reported no potential conflicts of interest.
1. Wood M, Kadlubek P, Lu KH, et al: Quality of cancer family history and referral for genetic counseling and testing among oncology practices: A pilot test of quality measures as part of the ASCO Quality Oncology Practice Initiative (QOPI). 2012 ASCO Annual Meeting. Abstract CRA1505. Presented June 4, 2012.