Patients with pathogenic variants for breast cancer other than BRCA1 and BRCA2: qualitative interviews about health care experiences

Kristin E Clift,Stephanie L Hines,Sarah K Macklin

doi:10.1186/s13053-019-0132-6

Kristin E Clift, Stephanie L Hines + Show 1 more

Open Access

https://doi.org/10.1186/s13053-019-0132-6

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Abstract

BackgroundGenetic testing for hereditary cancer syndromes has been revolutionized by next-generation sequencing, which allows for simultaneous review of numerous genes. Multigene panels are regularly offered to patients because of their scope and decreased cost and turnaround time. However, many genes included on larger panels have not been studied as extensively as BRCA1 and BRCA2 (BRCA1/2), and their clinical effects are often not as well established.MethodsWe identified patients who received positive test results for pathogenic variants of breast cancer genes from January 2012 through May 2018. We mailed a survey and conducted qualitative interviews to explore the personal and health care experiences of patients with pathogenic variants of BRCA1/2 and patients with “other” (ie, non-BRCA1/2 or PALB2; PTEN; ATM; TP53; NBM, RAD51C; MSH6) variants. We compared the experiences of these patients.ResultsFifty-nine out of 128 individuals responded to the survey (46%). Thirty-two patients had BRCA1/2 variants, and 27 had other variants. (49 women and 10 men; median [range] age, 63 [34–87] years). We interviewed 21 patients (17 women and 4 men; median [range] age, 59.6 [34–82] years). Of the interview participants, ten patients had BRCA1/2 variants, and 11 had non-BRCA1/2 variants. Patients reported receiving poor information about their genetic test results, and they often educated their physicians about their results. Some patients believed that they had been ignored or “brushed off” by health care professionals because non-BRCA1/2 genes are less understood outside the genetics research community. Patients with BRCA1/2 variants had similar problems with health care providers, despite increased awareness and established guidelines about BRCA1/2.ConclusionsResearch is required to understand the clinical significance and proper management of diseases attributable to newly characterized hereditary cancer genes. Additional evaluation of patient and provider education should be at the forefront of efforts to improve patient care.

Highlights

Genetic testing for hereditary cancer syndromes has been revolutionized by next-generation sequencing, which allows for simultaneous review of numerous genes
Since the 1990s, genetic testing has been offered to patients at high risk for pathogenic variants of the BRCA1 and BRCA2 (BRCA1/2) genes [1, 2]
Pathogenic changes in BRCA1/2 do not account for all cases of hereditary breast cancer, and additional genes are associated with an increased cancer risk [7,8,9]

Summary

Introduction

Genetic testing for hereditary cancer syndromes has been revolutionized by next-generation sequencing, which allows for simultaneous review of numerous genes. Since the 1990s, genetic testing has been offered to patients at high risk for pathogenic variants of the BRCA1 and BRCA2 (BRCA1/2) genes [1, 2]. Pathogenic changes in BRCA1/2 do not account for all cases of hereditary breast cancer, and additional genes are associated with an increased cancer risk [7,8,9]. Many newly discovered genes are included on panels for hereditary cancer gene testing These larger panels have become widely available because of the development of next-generation sequencing, a technology that allows for simultaneous assessment of multiple genes. Physicians do not have clear guidance to help counsel patients about the risks or management of pathogenic variants of other genes [14]. Despite growth in the consumer genetic testing industry, general public knowledge about genetics is limited [18]

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