Abstract
Introduction: The National Comprehensive Cancer Network (NCCN) has outlined guidelines for criteria regarding genetic testing for high-penetrance breast and/or ovarian cancer susceptibility genes. Due to the lack of availability of genetic counseling services in Northern Michigan prior to COVID-19, the utilization of genetic testing falls well below recommended guidelines.Methods: Patients diagnosed with breast cancer in 2019 were randomly selected from Ascension Michigan's Northern Ministries Tumor Registry. A retrospective chart review was conducted. For patients who met NCCN criteria, their medical records were used to determine if genetic testing was recommended and if genetic testing was completed. Univariate (Crosstabs and t-tests) and multivariate tests with logistic regression were used to identify significant associations between the variables of interest.Results: One hundred and two (102) patient charts were reviewed in this group; 55 (52.4%) were eligible by the NCCN guidelines for genetic testing. From this eligible subset of patients, only 29 were offered genetic testing, and only 21 were tested. The mean age of the patients offered genetic counseling was 56.2 years compared and 67.6 years in the group not offered counseling (p < 0.001). The patient's insurance type was an independent factor for obtaining genetic testing, specifically, the subgroup who had Medicare (OR = 0.73, CI = 0.01-0.54; p = 0.02). Patients insured through Medicare were less likely to obtain genetic testing after referral to a genetic counselor (p = 0.01).Conclusion: Genetic counseling for high-risk breast cancer patients is below average in Northern Michigan, likely related to lack of physician referral, poor availability of counseling services, low socioeconomic status as well as a lower level of concern in older ages.
Highlights
The National Comprehensive Cancer Network (NCCN) has outlined guidelines for criteria regarding genetic testing for high-penetrance breast and/or ovarian cancer susceptibility genes
The purpose of this study is to identify barriers to genetic counseling for patients in the Northern Michigan region to begin recognizing ways to overcome genetic counseling discrepancies
Genetic counseling should be offered to all patients who fulfill NCCN criteria regardless of their socioeconomic status, race, and geographic location
Summary
The National Comprehensive Cancer Network (NCCN) has outlined guidelines for criteria regarding genetic testing for high-penetrance breast and/or ovarian cancer susceptibility genes. Due to the high prevalence of breast cancer worldwide and the significant hereditary component, the National Comprehensive Cancer Network (NCCN) has outlined specific criteria for genetic counseling for patients with or at considerable risk for breast cancer. The NCCN clinical practice guidelines in oncology for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic make recommendations for patients based on several factors, including age at diagnosis, sex, personal and family history of cancer (NCCN version 1.2020) [3]. The American Society of Breast Surgeons supported the need for genetic counseling in hereditary breast cancer in patients with and without a personal history of breast cancer who meet NCCN criteria in their February 2019 consensus guidelines [4]. Numerous professional societies support genetic counseling for patients who meet criteria as results may alter the frequency of surveillance and treatment protocol and have implications for future generations
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