Calling on Primary Care to Prevent BRCA-Related Cancers

With the USPSTF reaffirming the importance of screening, counseling, and testing appropriate women for BRCA1/2 mutations, primary care has both an opportunity and a responsibility to lead in the implementation of these recommendations. Since the last UPSTF recommendations about preventing BRCA-related cancers in 2013, progress in incorporating risk assessment, counseling, and testing into primary care has been slow. There are multiple barriers to implementation outside of primary care, including limitations of the electronic medical record, availability of genetic counseling, and the administrative burden associated with obtaining insurance coverage. However, the early imbalance between hype and evidence in genomics led to a general skepticism among primary care providers about the importance of genomic medicine-a sharp contrast with many other areas of internal medicine. As a growing number of companies offer genetic testing directly to consumers and new models of genetic counseling are developed, primary care should capitalize on the opportunity to lead in the prevention of BRCA-related cancers-both to ensure that these services are delivered appropriately and in coordination with ongoing primary care and that primary care is not left behind as genomic medicine becomes a reality across internal medicine.