Bias in Choice Architecture in Genetic Counseling for Breast Cancer Patients

Genetic Testing Discrepancies Among Breast Surgeons and Genetic Counselors

The American Society of Breast Surgeons (ASBrS) recommends that all patients with a personal history of breast cancer should have access to genetic testing. The National Comprehensive Cancer Network also supports multigene panel testing for breast cancer, beyond the most common pathogenic variants. Typically, genetic counseling is offered by breast surgeons or genetic counselors, but there are no official guidelines on the number of genes that should be tested.

According to ASBrS, genetic testing should be conducted with informed consent, allowing patients to decide on the scope of genetic testing after receiving pretest counseling. However, a study revealed that the decision-making process might be influenced by the bias of the healthcare provider administering the test.

A recent audit of four breast surgeons and five genetic counselors, who collectively ordered 3,912 genetic tests for breast cancer patients within a 7-hospital system over a 3-year period, highlighted significant differences in the number of genes tested. The median number of genes tested was found to be 48, with variations in the proportion of orders above the median among the clinicians. While there was no significant difference between breast surgeons and genetic counselors in terms of the number of genes tested, the study suggests a wide disparity in pretest counseling provided by both groups.

The findings indicate a need for further research and guidelines in the evolving landscape of genetic testing for breast cancer patients. These discrepancies emphasize the importance of standardized protocols to ensure consistent and comprehensive care for individuals undergoing genetic testing in the context of breast cancer diagnosis and treatment.