肿瘤内科和外科医师对于乳腺癌易感基因和乳腺癌二十一基因检测的认可情况

　　基因组检测的推广，对于精准医学的成功至关重要，但是肿瘤专科医师对于基因技术的认可情况尚不明确。

　　2018年5月8日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表哈佛大学麻省总医院、宾夕法尼亚大学佩雷尔曼医学院和艾布拉姆森癌症中心的研究报告，调查了肿瘤内科医师与外科医师对乳腺癌患者进行乳腺癌易感基因（BRCA1/2）和乳腺癌21基因（Oncotype DX）检测的认可情况。

　　该研究对佛罗里达州、纽约州、新泽西州、宾夕法尼亚州被列入2010年美国医学会医师数据库或根据患者确认从事乳腺癌患者治疗的732位肿瘤内科医师和外科医师进行了问卷调查。

　　结果发现，BRCA、21基因检测率分别为80.6%、85.4%（P=0.01）。

　　BRCA基因检测率较高的显著相关因素包括：

• 对基因创新态度较积极（比值比：1.14，P=0.001）

• 认为患者保险可能报销（比值比：2.84，P<0.001）

• 21基因检测率较高（比值比：8.69，P<0.001）

　　21基因检测率较高的显著相关因素包括：

• 认为患者保险可能报销（比值比：7.33，P<0.001）

• BRCA基因检测率较高（比值比：9.48，P<0.001）

　　因此，分别将近20%、15%的肿瘤专科医师从未或很少对乳腺癌患者进行的BRCA、21基因检测。较少进行BRCA基因检测与较少进行21基因检测相关，反之亦然。那些不进行BRCA基因检测的肿瘤专科医师对于基因创新技术态度不太积极。对这些肿瘤专科医师进行精准医学益处的继续教育，可能较快推广基因技术。

Breast Cancer Res Treat. 2018 May 8. [Epub ahead of print]

Uptake of BRCA 1/2 and oncotype DX testing by medical and surgical oncologists.

Yonina R. Murciano-Goroff, Anne Marie McCarthy, Mirar N. Bristol, Peter Groeneveld, Susan M. Domchek, U. Nkiru Motanya, Katrina Armstrong.

Massachusetts General Hospital, Boston, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, USA; University of Pennsylvania Abramson Cancer Center, Philadelphia, USA.

PURPOSE: The diffusion of genomic testing is critical to the success of precision medicine, but there is limited information on oncologists' uptake of genetic technology. We aimed to assess the frequency with which medical oncologists and surgeons order BRCA 1/2 and Oncotype DX testing for breast cancer patients.

METHODS: We surveyed 732 oncologists and surgeons treating breast cancer patients. Physicians were from Florida, New York, New Jersey, and Pennsylvania, and were listed in the 2010 AMA Masterfile or identified by patients.

RESULTS: 80.6% of providers ordered BRCA 1/2 testing at least sometimes and 85.4% ordered Oncotype DX (p = 0.01). More frequent ordering of BRCA 1/2 was associated with more positive attitudes toward genetic innovation (OR 1.14, p = 0.001), a belief that testing was likely to be covered by patients' insurance (OR 2.84, p < 0.001), and more frequent ordering of Oncotype DX testing (OR 8.69, p < 0.001). More frequent use of Oncotype DX was associated with a belief that testing was likely to be covered by insurance (OR 7.33, p < 0.001), as well as with more frequent ordering of BRCA 1/2 testing (OR 9.48, p < 0.001).

CONCLUSIONS: Nearly one in five providers never or rarely ever ordered BRCA 1/2 testing for their breast cancer patients, and nearly 15% never or rarely ever ordered Oncotype DX. Less frequent ordering of BRCA 1/2 is associated with less frequent use of Oncotype DX testing, and vice versa. Those who do not order BRCA 1/2 testing report less positive attitudes toward genetic innovation. Further education of this subset of providers regarding the benefits of precision medicine may enable more rapid diffusion of genetic technology.

KEYWORDS: Breast cancer; BRCA1/2 testing; Oncotype DX; Precision medicine

DOI: 10.1007/s10549-018-4810-2

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