Assessing personal and family history characteristics of patients seeking cancer risk assessment due to direct-to-consumer marketing in a high risk clinic.
Authors: Legare RD , Kent JL , Wilbur JS 
Published: December 2010

Abstract
Abstract #1100
BACKGROUND: The use of Direct-to-Consumer Marketing(DTC) for cancer genetic testing may result in more patients seeking genetic counseling and risk assessment who may not otherwise have been referred to a High Risk Clinic. In the Fall of 2007 a DTC marketing campaign was launched in the Eastern United States regarding genetic testing for Hereditary Breast and Ovarian Cancer Susceptibility syndrome (HBOCS). Our objective was to assess the impact this campaign process has had on the type of patient seen in our High-Risk Clinic. METHODS: Patients seen for initial consultation between November of 2007 and April of 2008 were queried regarding exposure to advertisements regarding HBOC gene testing and whether it had been a motivating factor in the referral. Demographic and family history data was collected and pre-test probabilities calculated using the BRCAPRO (v.5) and Myriad models for those citing exposure to advertisement. Categorical data was compared using Fisher's Exact Test for those citing the marketing campaign as a motivating factor versus those who did not. RESULTS: Ninety patients were counseled regarding hereditary breast and ovarian cancer risk and were queried about their exposure to the marketing campaign. Fifty-seven (63.3%) reported exposure to advertisements with 17 (29.8%) citing it as a motivating factor for the referral. The average age of patients was 48 years and differed little between the groups (48.6 vs. 49.2). Those citing marketing influence were slightly more likely to be married (64.7% vs. 60.0%) or have children (82.4% vs.75.0%) P=.73. A personal cancer diagnosis was slightly more common in those influenced by the campaign (47.1% vs. 40.0%) P=.77. Influenced patients more often presented without additional cancer family history then non-influenced patients (18.8% vs. 5%) P=.13. In 44 patients (77.2%) genetic testing was preformed either directly or in a family member with 29.5% of those tested reporting marketing influence. BRCA deleterious mutations were identified in 8 patients (8.9%) with only 2 out of the 6 exposed reporting marketing influence. The average pre-test probability for the influenced and non-influenced groups as calculated by the BRCAPRO and Myriad Models were (8.0% vs. 14.76%) and (10.86% vs. 16.87%), respectively. CONCLUSION: Though not statistically significant, the data revealed interesting outcome trends. Over half of patients seen for consultation reported exposure to DTC marketing for BRCA gene testing. The majority of patients did not cite this as a motivating factor in seeking referral and this group differed little demographically from those who were influenced. The campaign appeared to influence those without cancer family history which resulted in a lower pre-test probability for this group. This trend raises concern that the advertisements may be unnecessarily influencing low-risk women to pursue cancer genetic testing, highlighting the need for continued educational interventions on both the level of the public and community practitioners.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1100.