Variations in Practice and Geographic Disparities Between Dedicated Multidisciplinary Clinics for BRCA1/BRCA2...

Area of Science:

• Genetics and Genomics
• Oncology
• Public Health

Background:

• Population screening for BRCA mutations in Ashkenazi Jewish women is increasing in Israel.
• This rise necessitates dedicated multidisciplinary clinics for early detection and risk reduction in asymptomatic carriers.
• Current infrastructure for BRCA carrier follow-up requires evaluation.

Purpose of the Study:

• To assess the availability, capacity, and current practices of dedicated screening clinics for BRCA carriers in Israel.
• To identify geographical disparities and service variations among existing clinics.
• To inform future planning and resource allocation for BRCA carrier management.

Main Methods:

• A nationwide telephone survey of public hospitals in Israel was conducted between October 2020 and August 2021.
• Dedicated clinics were defined as multidisciplinary centers offering breast, gynecological screening, and risk-reducing services.
• Data were collected via questionnaires and semi-structured interviews with clinic directors or nurse navigators.

Main Results:

• Ten dedicated BRCA clinics were identified, with nine participating in the study.
• Approximately 4500 BRCA carriers are currently followed across these clinics.
• A significant disparity exists between central and peripheral areas, with no specialized clinics in the southern district or northernmost northern district. Screening practices, including initiation age, imaging, and follow-up protocols, varied among clinics despite adherence to international guidelines.

Conclusions:

• The distribution of dedicated BRCA carrier clinics in Israel is suboptimal, with notable geographical inequities.
• A centralized national effort to standardize screening guidelines is warranted to address variations in practice.
• Proactive planning is essential to meet the anticipated increase in demand for BRCA carrier services.