Tuesday, April 14, 2009

Death Knell to Cancer Genetic Counseling?

ACOG has finally come around. They are now beginning to realize that it IS the responsibility of the OB/GYN to evaluate cancer risks. In this case BRCA1/2. Soon I imagine they will learn to appreciate the risk of Lynch Syndrome with their Endometrial cases.

All of this could spell trouble for the cancer genetic counselors in this country. OR it could mean a bunch of referrals. It all depends........

ACOG practice bulletin 103 recently published says

"Women may wish to discuss their personal and family history of breast and ovarian cancer with their physician in order to determine whether any further genetic assessment is warranted."

Well, with Myriad in your office saying, "Doc, you can do this test. And SHOULD do this test" It is going to be hard not too. Especially with ACOG now saying that OB/GYNs should do some evaluation.

So my question is "Now that their are guidelines, who is going to teach the OB/Gyns to do this work?"

My initial guess is the genetic counselors. Predominantly a female field it has done a great job of counseling these patients. But OB too is filled with women and they also have done a great job with other counseling. They do order genetic tests. So is this a big jump for them?

Probably not. In fact, I just spoke with a GYN who routinely orders the test and calls us for back up when the tests are positive or are variants.

Is that what will happen to CGCs in cancer genetics? Will they serve as "back up?"

If that happens, we may see a huge drop in referrals. Or we may see a busy OB not want to do this despite pressure from their patient AND the Myriad rep.

My guess, the cancer genetics programs who bill for physician consultation with a physician will likely suffer. So will those who bill appropriately for genetic counselor services. But this puts even further pressure on clinics to bill illegally, have no physician in the building with the counselors and then do a "quick" chart review on 40 patients in 30 minutes. With a flurry of signed notes.....you know who you are.

So, my guess, the "bread and butter" of Cancer genetics the BRCA evaluation will begin to fall further in the la of physicians who have had little training in genetics. Which scares me a little, but it should scare the hell out of the Genetic Counselors......What is their practice made up of? 75% BRCA? Probably.

The Sherpa Says: While community physicians are incorporating this ok, the mandate is now placed on the OB/GYNs. And when they have a mandate, you can sure as hell be certain that they will follow it. Hell, maybe they'll order the 23andME "Clinical Test".


Sandi Pniauskas said...

Note the rise in Myriad shares after the ACOG announcement.

Anonymous said...

At the very end of the guideline, it posts this "proposed performance measure" which (if followed) should increase referrals for cancer genetic counseling:

Percentage of patients identified as having greater than a
20–25% risk of having a BRCA mutation (high risk) who
are referred for genetic counseling

Though the rest of the guideline almost reads as a "how to" guide for Ob/Gyns....