Importance Genetic testing after diagnosis of breast cancer is common, but little is known about the influence of the surgeon on the variation in testing.

Objectives To quantify and explain the association of attending surgeon with rates of genetic testing after diagnosis of breast cancer.

Design, Setting, and Participants This population-based study identified 7810 women with stages 0 to II breast cancer treated between July 1, 2013, and August 31, 2015, through the Surveillance, Epidemiology, and End Results registries for the state of Georgia, as well as Los Angeles County, California. Surveys were sent approximately 2 months after surgery. Also surveyed were 488 attending surgeons identified by the patients.

Main Outcomes and Measures The study examined the association of surgeon with variation in the receipt of genetic testing using information from patient and surgeon surveys merged to Surveillance, Epidemiology, and End Results and genetic testing data obtained from 4 laboratories.

Results In total, 5080 women (69.6%) of 7303 who were eligible (mean [SD] age, 61.4 [0.8] years) and 377 surgeons (77.3%) of 488 (mean [SD] age, 53.8 [10.7] years) responded to the survey. Approximately one-third (34.5% [1350 of 3910] of patients had an elevated risk of mutation carriage, and 27.0% (1056 of 3910) overall had genetic testing. Surgeons had practiced a mean (SE) of 20.9 (0.6) years, and 28.9% (107 of 370) treated more than 50 cases of new breast cancer per year. The odds of a patient receiving genetic testing increased more than 2-fold (odds ratio, 2.48; 95% CI, 1.85-3.31) if she saw a surgeon with an approach 1 SD above that of a surgeon with the mean test rate. Approximately one-third (34.1%) of the surgeon variation was explained by patient volume and surgeon attitudes about genetic testing and counseling. If a patient with higher pretest risk saw a surgeon at the 5th percentile of the surgeon distribution, she would have a 26.3% (95% CI, 21.9%-31.2%) probability of testing compared with 72.3% (95% CI, 66.7%-77.2%) if she saw a surgeon at the 95th percentile.

Conclusions and Relevance In this study, the attending surgeon was associated with the receipt of genetic testing after a breast cancer diagnosis. Variation in surgeon attitudes about genetic testing and counseling may explain a substantial amount of this association.

重要性 乳腺癌诊断后的基因检测很普遍，但是关于外科医生对检测变异的影响知之甚少。

目的 量化和解释乳腺癌诊断后主治医师与基因检测率之间的关系。

设计，背景和参与者 这项基于人群的研究通过格鲁吉亚州的监测，流行病学和最终结果登记册，确定了7810名在2013年7月1日至2015年8月31日期间接受治疗的0至II期乳腺癌女性。以及加利福尼亚的洛杉矶县。手术后约2个月发送了调查问卷。还对患者确定的488位主治外科医生进行了调查。

主要结果和措施 本研究使用合并了监视，流行病学和最终结果的患者和外科医生调查的信息以及从4个实验室获得的基因测试数据，研究了外科医生与基因测试接收变异的关系。

结果 共有7303名合格的女性（80岁，平均年龄61.4 [0.8]岁）中有5080名女性（69.6％），而488名（SD的平均年龄，53.8 [10.7]岁）中的377名外科医生（77.3％）做出了回应进行调查。大约有三分之一（34.5％[3950，在1310中的患者]有突变携带的风险较高，总体而言，有27.0％（3910在1056中的患者）进行了基因检测，外科医生的平均（SE）为20.9（0.6）年，每年有28.9％（370名患者中的107名）每年治疗50例以上的新发乳腺癌，接受基因检测的患者的机率增加了2倍以上（优势比为2.48； 95％CI为1.85-3.31）看到外科医生的平均检查率比外科医生高出1 SD，约有三分之一（34.1％）的外科医生变异是由患者数量以及外科医生对基因检测和咨询的态度所解释的。

结论与相关性 在这项研究中，主治医师与乳腺癌诊断后接受基因检测有关。外科医生对基因检测和咨询态度的差异可能解释了这种关联的很大一部分。