To the Editor: White et al. (1) examine decision patterns among family physicians presented with a hypothetical clinical scenario depicting a woman (Terry, 47 years) concerned about her risk of breast cancer after the recent diagnosis of breast cancer in her sister (53 years). Terry questions whether she should pursue genetic testing. The authors conclude that physicians are poorly informed of recent U.S. Preventive Services Task Force–outlined criteria for BRCA1/2 genetic counseling and testing (2) and that providers underestimate the costs of low-risk referrals, such as the consumption of scarce genetic services, which would otherwise be available to patients with greater risks.
A bias in the study interpretation merits attention. In the scenario, Terry expresses two concerns: (a) whether she may be at “higher than average risk for getting breast cancer” and (b) whether she should undergo genetic testing. Terry's risk of breast cancer is rated as “moderate” and her risk of having a mutation as “low” by study participants (Table 1). Assessing her breast cancer risk using the National Cancer Institute's Breast Cancer Risk Assessment tool,1
Available from: http://www.cancer.gov/bcrisktool/ [cited 2008 Nov 13].
Genetic services encompass more than BRCA1/2 testing.2
Available from: http://www.cancer.gov/search/geneticsservices/ [cited 2008 Nov 13].
Disclosure of Potential Conflicts of Interest
No potential conflicts of interest were disclosed.