Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Filters applied. Clear all
. 2016 Mar 11;4(1):19.
doi: 10.3390/healthcare4010019.

Public Health Approaches and Barriers to Educating Providers About Hereditary Breast and Ovarian Cancer Syndrome

Free PMC article

Public Health Approaches and Barriers to Educating Providers About Hereditary Breast and Ovarian Cancer Syndrome

Angela M Trepanier et al. Healthcare (Basel). .
Free PMC article


The Michigan Department of Health and Human Services implemented and evaluated two initiatives designed to enhance provider knowledge of patients appropriate for breast and/or ovarian cancer genetic risk assessment and hereditary breast and ovarian cancer (HBOC) syndrome testing. The first initiative targeted select providers who had diagnosed patients meeting HBOC risk criteria. Specifically, the initiative used 2008-2009 state cancer registry data to identify all providers who had diagnosed breast cancers in women ≤50 years of age, male breast cancers, and ovarian cancers in four health systems with newly established cancer genetics clinics. Using a method coined bidirectional reporting (BDR), reports highlighting how many of these cases each provider had seen were generated and mailed. Reports on 475 cancers (9.5% of the 5005 cases statewide meeting criteria) were sent to 69 providers with information about how and why to refer such patients for genetic counseling. Providers who received a report were contacted to assess whether the reports increased awareness or resulted in action (genetic counseling/referral). Based on the few responses received, despite multiple attempts to contact, and attrition rate, it is not possible to ascertain the impact of this initiative on providers. However the project resulted in the MDHHS identifying which providers see the largest proportion of at-risk patients, creating an opportunity to target those providers with HBOC education efforts. The second initiative involved creating and broadly disseminating an online, interactive case-based educational module to increase awareness and referral decisions for HBOC using high- and low-risk patient scenarios. A total of 1835 unique users accessed the module in a one year. Collectively the users viewed topic pages 2724 times and the interactive case studies 1369 times. Point of care tools (fact sheets) were viewed 1624 times and downloaded 764 times. Satisfaction among the subset of users applying for continuing medical education credit was high. The online educational module had a much broader reach than the bidirectional reporting initiative but to a self-selected audience. Combining targeted and broad-based provider education efforts may be a better way to increase HBOC awareness in the target audience, starting with those providers seeing the largest proportion of patients at risk.

Keywords: genetic counseling; hereditary breast and ovarian cancer syndrome (HBOC); provider education; public health initiative.

Similar articles

See all similar articles


    1. Healthy People 2020: Summary of objectives. [(accessed on 23 February 2016)]; Available online:
    1. Petrucelli N., Daly M.B., Feldman G.L. Hereditary breast and ovarian cancer due to mutations in BRCA1 and BRCA2. Genet. Med. 2010;12:245–259. doi: 10.1097/GIM.0b013e3181d38f2f. - DOI - PubMed
    1. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology Genetic/Familial High-Risk Assessment: Breast and Ovarian. Version 1.2016. [(accessed on 23 February 2016)]. Available online:
    1. Pruthi S., Gostout B.S., Lindor N.M. Identification and management of women with BRCA mutations or hereditary predisposition for breast and ovarian cancer. Mayo Clin. Proc. 2011;85:1111–1120. doi: 10.4065/mcp.2010.0414. - DOI - PMC - PubMed
    1. Nelson H.D., Fu R., Goddard K., Mitchell J.P., Okinaka-Hu L., Pappas M., Zakher B. Agency for Healthcare Research and Quality; Rockville, MD, USA: 2013. [(accessed on 23 February 2016)]. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer: Systematic review to update the U.S. Preventive Services Task Force recommendation. Evidence Synthesis No. 101. AHRQ Publication No. 12-05164-EF-1. Available online: