Abstract
BackgroundTesting for BRCA variants can impact treatment decisions for breast cancer patients and affect surveillance and prevention strategies for both patients and their relatives. National Comprehensive Cancer Network (NCCN) guidelines recommend testing for patients at heightened risk of BRCA pathogenic variant. We examined the BRCA testing rate among high risk breast cancer patients treated in community oncology practices.MethodsWe conducted a retrospective medical chart review among community-based US oncologists using a physician panel approach. High risk breast cancer patients with a known family history of cancer and diagnosis with breast cancer at age ≥ 18 years between January 2013–October 2017 were included. We assessed the proportions of patients tested for BRCA variants in accordance with NCCN guidelines.ResultsCharts from 63 physicians, averaging 16 years of practice, were included; 97% were medical oncologists and 66.7% had a genetic counselor in their practice. We analyzed data for 410 randomly-selected patients with mean age of 52 years; 95% were female, 74% were White, and 19% had Ashkenazi Jewish ancestry. Among all patients, 94% were tested for BRCA variants. The testing rate ranged from 78 to 100% in various high risk groups; lower rates were observed among Black patients (91%), men (92%), and patients meeting NCCN criteria based on family history of male breast cancer (78%) and prostate cancer (87%). We observed a higher testing rate in patients treated by physicians with a genetic counselor in their practice (95% versus 91%).ConclusionsAdherence to NCCN BRCA testing guidelines is high in this group of predominantly medical oncologists with extensive experience, with a high proportion having a genetic counselor in practice. Testing rates can be improved in patients with risk factors related to male relatives. High level of compliance to guidelines in a community setting is possible with a delivery model for genetic counseling and testing.
Highlights
Testing for BReast CAncer gene (BRCA) variants can impact treatment decisions for breast cancer patients and affect surveillance and prevention strategies for both patients and their relatives
This study demonstrates high rates of BRCA testing among recently diagnosed breast cancer patients at high risk of hereditary disease, treated by community-based oncologists who elected to participate in this study
Certain risk groups, such as female patients with malerelative related risk factors, had a lower testing rate compared to others, such as patients with a family history of BRCA pathogenic variants
Summary
Testing for BRCA variants can impact treatment decisions for breast cancer patients and affect surveillance and prevention strategies for both patients and their relatives. National Comprehensive Cancer Network (NCCN) guidelines recommend testing for patients at heightened risk of BRCA pathogenic variant. Pathogenic variants in the tumor suppressor breast cancer genes BRCA1 and BRCA2 increase the risk of female breast and ovarian cancers. Testing for BRCA variants may impact cancer prevention or treatment decisions in patients at heightened risk of hereditary breast cancer [3]. One study assessing 220 breast cancer patients reported a significantly higher proportion of contralateral prophylactic mastectomy, which may positively impact survival, in patients who were aware of their BRCA variant status compared to patients who were not aware (76.4% vs 14.7%) [4]. As new, targeted therapies for breast cancer such as poly (ADP-ribose) polymerase (PARP) inhibitors are approved for use, knowledge of BRCA status is essential for understanding optimal treatment options for breast cancer patients
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