Phone counseling for BRCA1/2 gene tests 'non-inferior' to in-person

NEW YORK - Telephone counseling prior to BRCA1/2 gene testing for breast and ovarian cancer risk may be as safe and effective as in-person counseling - although women who received phone counseling were less likely to undergo testing, new findings show.

Telephone counseling could help address the shortage of trained counselors, as well as cost, geographic, and structural barriers to genetic counseling, the researchers add.

Women who receive a breast cancer diagnosis before age 50 should have genetic counseling, according to guidelines for hereditary breast and ovarian cancer (HBOC) risk assessment and testing. However, fewer than half actually do, Dr. Anita Kinney of the University of New Mexico Cancer Center in Albuquerque and her colleagues note.

While guidelines say that women with breast cancer before age 50 should have genetic counseling, fewer than half actually do, Dr. Anita Kinney of the University of New Mexico Cancer Center in Albuquerque and her colleagues note.

"Although requested and preferred by many patients, telephone counseling is not frequently offered because consensus-approved guidelines suggest that in-person counseling is better than telephone counseling, and there is a lack of evidence supporting telephone counseling as an alternative genetic service delivery model," Dr. Kinney and her team write.

One study did show that telephone counseling was "non-inferior" to in-person counseling, but it involved women "who sought clinical genetic services at academic medical centers in primarily urban areas in the northeastern United States," Dr. Kinney and her team note. "These women had already overcome both structural and geographic barriers to access counseling."

In the new study, the researchers recruited 988 women, ages 25 to 74, with a personal or family history of breast or ovarian cancer from14 genetic counseling sites across Utah.

They randomized the women to receive either in-person or telephone counseling, delivered by the same five board-certified genetic counselors. Nine hundred and one women completed follow-up assessment six months after receiving their post-test counseling.

The researchers found that psychosocial and informed decision-making outcomes for patients who received telephone pre-test counseling were non-inferior to those who received in-person counseling. However, 21.8% of the women who received telephone counseling actually underwent genetic testing, versus 31.8% of those who received in-person counseling.

The study also revealed a non-significant difference in testing uptake rate between rural and urban women, at 35.1% versus 25.2%, which the authors say "suggests that the genetic screening interests of rural populations may be underserved by existing health care systems, perhaps because rural providers are less confident or equipped to provide genetic counseling or because of more barriers faced by rural populations."

"Because the goal of genetic counseling is informed decision-making, our findings suggest that HBOC can be added to the list of conditions for which telephone counseling can be safely and effectively delivered," Dr. Kinney and colleagues write.

Why the uptake of testing was higher with in-person counseling is not clear, the authors write, although the overall low uptake rate found in the study could have been due to the fact that the cost of the subsequent testing was not covered as part of the study.

They conclude: "BRCA1/2 telephone counseling, although leading to lower testing uptake, appears to be safe and as effective as in-person counseling with regard to minimizing adverse psychological reactions, promoting informed decision making, and delivering patient-centered communication for both rural and urban women."

Dr. Kinney was not able to comment by deadline.


J Natl Cancer Inst 2014.

References: Reuters Health
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