63 Choice Architecture Bias in Genetic Counseling of Breast Cancer Patients

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement41st Annual Miami Breast Cancer Conference® - Abstracts
Volume 38
Issue 4
Pages: 76-77

Background

American Society of Breast Surgeons (ASBrS) consensus guidelines recommend genetic testing be available to all patients with a personal history of breast cancer, with the National Comprehensive Cancer Network allowing for multigene panel testing beyond the most common pathogenic variants of breast cancer. Genetic counseling is typically provided by breast surgeons or genetic counselors. However, there are no formal recommendations for the breadth of genes to be tested.

The ASBrS asserts genetic testing should occur in the context of informed consent. In this context, the breadth of genetic testing should be decided by the patient following pretest counseling.

Choice architecture posits that decisions are influenced by how choices are presented. Depending on the bias of the choice architect, be it surgeon or genetic counselor, there may be differences in the size of panels ordered for which there should be none.

Methods

Breast surgeons (n = 4) and genetic counselors (n = 5) with more than 50 genetic test orders among the breast cancer population within a 7-hospital system were audited over a 3-year period (n = 3912 tests). The median number of genes ordered was used to create order categories: less than median vs at least median. Chi-square analyses were used to compare the relationships between order category and clinician as well as order category and clinician’s role.

Results

Genetic Tests Ordered by Breast Surgeons and Genetic Counselors

Genetic Tests Ordered by Breast Surgeons and Genetic Counselors

The median number of genes tested was 48 (IQR, 32-85). There were significant differences in the proportion of orders above the median among the 4 breast surgeons (P < .001) as well as among the 5 genetic counselors (P < .001). In contrast, there was no difference in the proportion of orders above the median between the 2 clinician groups (P = .50).


Discussion

These data lack propensity-matching of the breast cancer populations, yet there is significant anchoring in 5 of 9 clinicians, where greater than 90% of their panels are either greater or fewer than the median. This suggests a wide variation in the pretest counseling provided among both breast surgeons and genetic counselors. The differences in ordering panels indicates further research and guidelines may be warranted in this rapidly evolving component of the care of patients with breast cancer.

Articles in this issue

47 Can We Identify Factors That Predict DCIS Upgrade to Invasive Cancer at Mastectomy?
47 Can We Identify Factors That Predict DCIS Upgrade to Invasive Cancer at Mastectomy?
48 The Era ‘or Error’ of Second Localization Procedures
48 The Era ‘or Error’ of Second Localization Procedures
49 The Influence of Race on Complications in Breast Conservation Surgery: A Single Institution Study
49 The Influence of Race on Complications in Breast Conservation Surgery: A Single Institution Study
51 Ductal Carcinoma In Situ With Microinvasion on Biopsy—What Are the Predictors of Upstaging?
51 Ductal Carcinoma In Situ With Microinvasion on Biopsy—What Are the Predictors of Upstaging?
52 UK Experience of Non-Radioisotope, Non-Magnetic Guided Breast Wide Local Excision and Sentinel Node Biopsy
52 UK Experience of Non-Radioisotope, Non-Magnetic Guided Breast Wide Local Excision and Sentinel Node Biopsy
53 The Utility of Sentinel Lymph Node Biopsy in High-Grade Ductal Carcinoma In Situ
53 The Utility of Sentinel Lymph Node Biopsy in High-Grade Ductal Carcinoma In Situ
54 The Evaluation of Expression Levels of CXCR4, CXCL12, and LASP1 Genes in Peripheral Blood Samples of Breast Cancer Patients
54 The Evaluation of Expression Levels of CXCR4, CXCL12, and LASP1 Genes in Peripheral Blood Samples of Breast Cancer Patients
55 Language as a Barrier to Deep Inspiration Breath Hold (DIBH) Radiation Therapy for Left  Breast Cancer
55 Language as a Barrier to Deep Inspiration Breath Hold (DIBH) Radiation Therapy for Left Breast Cancer
56 Predictive Factors Correlating With Pathologic Complete Response Rates in Racially Diverse, Minority Populations Receiving Neoadjuvant Therapy for HR+/HER2– Breast Cancer
56 Predictive Factors Correlating With Pathologic Complete Response Rates in Racially Diverse, Minority Populations Receiving Neoadjuvant Therapy for HR+/HER2– Breast Cancer
57 Addressing Barriers to Identifying Patients With HER2-Low Metastatic Breast Cancer in a Large Community Oncology Practice
57 Addressing Barriers to Identifying Patients With HER2-Low Metastatic Breast Cancer in a Large Community Oncology Practice
58 Prospective Longitudinal Assessment of Financial Toxicity Among Breast Cancer Patients
58 Prospective Longitudinal Assessment of Financial Toxicity Among Breast Cancer Patients
59 Acceptability of Microbiome Sampling-Based Surgical Oncology Research in Minority Breast Cancer Patients
59 Acceptability of Microbiome Sampling-Based Surgical Oncology Research in Minority Breast Cancer Patients
60 Racial Disparities in Hospitalization Outcomes Among Women With Metastatic Breast  Cancer in the United States by Palliative Care Utilization
60 Racial Disparities in Hospitalization Outcomes Among Women With Metastatic Breast Cancer in the United States by Palliative Care Utilization
61 High-Risk Screening Compliance in Women Diagnosed With Breast Cancer and a History of Thoracic Radiation Prior to Age 30
61 High-Risk Screening Compliance in Women Diagnosed With Breast Cancer and a History of Thoracic Radiation Prior to Age 30
62 The Impact of Genomic Assays on Breast Cancer Systemic Therapy Treatment Decisions in a Mostly Black Patient Population
62 The Impact of Genomic Assays on Breast Cancer Systemic Therapy Treatment Decisions in a Mostly Black Patient Population
Related Videos
Pegulicianine-guided breast cancer surgery may allow practices to de-escalate subsequent radiotherapy, says Barbara Smith, MD, PhD.
Barbara Smith, MD, PhD, spoke about the potential use of pegulicianine-guided breast cancer surgery based on reports from the phase 3 INSITE trial.
Carey Anders, MD, an expert on breast cancer
Carey Anders, MD, an expert on breast cancer
Carey Anders, MD, an expert on breast cancer
Carey K. Anders, MD, an expert on breast cancer
A panel of 4 experts on breast cancer seated at a long table
A panel of 4 experts on breast cancer seated at a long table
Related Content