Assessing controversial direct-to-consumer advertising for hereditary breast cancer testing: reactions from women and their physicians in a managed care organization

Am J Manag Care. 2005 Oct;11(10):601-8.


Objective: To describe the impact on patients and physicians at a managed care organization (MCO) of a direct-to-consumer advertising (DTC-ad) campaign concerning testing for the BRCA1 and BRCA2 genes.

Study design: Observational study.

Methods: In 2003, we mailed a 30-item questionnaire to 750 randomly chosen female members of Kaiser Permanente Colorado (KPCO) aged 25 to 54 years, and 100 female KPCO members with a history of breast cancer genetic referral. We mailed a 7-item questionnaire to 180 randomly chosen KPCO primary care providers.

Results: Of 394 patient respondents, 245 (62%) reported exposure to the DTC-ad of whom 63% reported that the DTC-ad caused no anxiety at all. A high level of perceived breast cancer risk and being of Hispanic ethnicity each were independently associated with reported anxiety due to the DTC-ad (adjusted odds ratio [OR] = 3.23, 95% confidence interval [CI] = 1.35, 7.73, and adjusted OR = 4.19, 95% CI = 1.48, 11.83, respectively). Greater knowledge was seen among respondents exposed to the DTC-ad than among those reporting no exposure (P = .015). Of the physician respondents, 84% reported that the DTC-ad caused no strain on the doctor-patient relationship, and nearly 80% reported no effect on daily clinical practice. Genetic referrals soared more than 200% compared with the prior year, when there was no advertising.

Conclusion: The DTC-ad had a marked impact on genetic services, but little apparent negative impact on patients or primary care providers at an MCO.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Advertising*
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / genetics
  • Colorado
  • Female
  • Genes, BRCA1
  • Genes, BRCA2
  • Genetic Predisposition to Disease
  • Genetic Testing*
  • Humans
  • Managed Care Programs*
  • Middle Aged
  • Physicians / psychology*
  • Surveys and Questionnaires