ASPO Abstracts
Association of Provider Type and Receipt of Preventive Health Services Among Women Who Received Genetic Testing for Breast Cancer Risk Assessment in The Health of Women (HOW) Study®
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2020
Abstract Body:
Purpose: To examine the association between the type of provider (genetic counselor (GC) vs. primary care (PCP)
vs. others) who reported genetic test results related to hereditary breast and ovarian cancer and the uptake of
related preventive health services.
Methods: The Health of Women (HOW) Study® is an online study of ~55,000 individuals that aims to better
understand the causes of breast cancer. 4585 women from this study, who had received a genetic test for breast
cancer risk assessment, and had completed baseline and family history questionnaires were included in our study
sample. Logistic regression was used to examine the association of provider type with receipt of prophylactic (1)
mastectomy, (2) oophorectomy, and (3) guideline-concordant mammography for high-risk women, defined
according to 2015 NCCN guidelines. Ordered logistic regression was used to examine the association of provider
type with (1) age at initiation, and (2) frequency of mammography.
Results: The rate of guideline-concordant mammography in the high-risk sample was 68.62% (n=3426), and
receiving test results from a PCP was associated with higher odds of receiving guideline-concordant
mammography than receiving results from a GC (OR 1.46, 95% CI 0.90-2.43); however, this finding was not
statistically significant. Similarly, receiving genetic test results from a PCP was not significantly associated with
receiving a mastectomy (OR 0.84, 95% CI 0.53-1.28) or initiating mammography at an earlier age (OR 0.87, 95%
CI 0.61-1.25). Finally, receiving genetic test results from a PCP was not significantly associated with receiving
oophorectomy (OR 1.32, 95% CI 0.81-2.08) or of receiving routine mammography at a greater frequency (OR
1.18, 95% CI 0.77-1.84).
Conclusions: We found no statistically significant association between provider type and uptake of preventive
health services, including receipt of prophylactic surgery and dimensions of routine mammography, suggesting
that providers may be equally able to able to connect patients to preventive health services. However, about one
third of women with a high risk of breast cancer did not receive guideline-concordant mammography, suggesting a
need for future work to optimize the uptake of guideline-concordant screening among high-risk wom
Keywords: preventive health services use, genetic risk assessment