MAY 07, 2019 2:15 PM PDT

Why Breast Surgeons Are Calling for Wider Genetic Testing

WRITTEN BY: Julia Travers

In early 2019, the American Society of Breast Surgeons (ASBrS) released new recommendations on genetic testing for people with breast cancer, widening the scope to include all such patients. This statement contrasts with the National Comprehensive Cancer Network’s (NCCN) more restrictive guidelines. ASBrS president and Texas Health Dallas surgeon Walton A. Taylor, M.D., says the NCCN guidelines are “fairly complicated” and hail from an era when testing was much more expensive.

“We are seeing more data that suggests the current NCCN guidelines miss a fair number of patients with genetic mutations: pathogenic variants that would change how we would manage their cancer, follow or screen them for future cancers, and what might happen to their children or siblings,” Taylor told Clinical Oncology.

credit: collage, public domain images

The new ASBrS recommendations were developed by breast surgeons and medical oncologists with experience in genetics, risk assessment, health care policy and care management. The panel reviewed contemporary literature on genetic testing and concluded the NCCN guidelines were too limited.

In order to analyze the new guidelines, Dr. Peter Beitsch of the TME Breast Cancer Network in Dallas and his colleagues looked into the results of an 80-gene testing panel that was taken by breast cancer patients who had not previously received genetic testing. About half of the patients met NCCN criteria for the testing, and the other half didn’t. Beitsch and his team ran a broad panel test, looking not just for the about 30 genes associated with breast cancer, but the full 80 genes associated with cancers.

“[Not] surprisingly, the pathogenic variant rate is not statistically different between the two groups,” Beitsch said. Pathogenic or likely pathogenic variants were found in more than 9 percent of those who fell within NCCN guidelines, and almost 8 percent of those who did not. “With the current lower cost of testing, it doesn’t make sense for us to miss half the women who have a pathogenic variant,” he said, and his team concluded that all patients with breast cancer should have expanded panel testing.

Cost is one of the main concerns that arises with the potential expansion of testing. Most insurance only covers testing for patients who meet the NCCN guidelines. While the genetic test cost has now fallen to a few hundred dollars, it will still be a prohibitive amount to many patients.

“We’re hoping that by trying to move the needle we might persuade [insurers] to cover testing in an expanded fashion,” Taylor said.

Dr. Roshni Rao, chief of the breast surgery program and associate professor of surgery at New York-Presbyterian Hospital/Columbia University Medical Center, supports the new recommendations with some reservations, such as cost. She also points out the discovery of genetic abnormalities like variants of uncertain significance (VUS) can potentially cause overscreening and distress.

credit: CQUniversity Australia

Establishing and maintaining a high-quality, transparently priced, connected and communicative network of genetic testing labs is another potential challenge related to expanded screening.

 

 

Sources: Clinical Oncology, American Society of Breast Surgeons

About the Author
  • Julia Travers is a writer, artist and teacher. She frequently covers science, tech, conservation and the arts. She enjoys solutions journalism. Find more of her work at jtravers.journoportfolio.com.
You May Also Like
FEB 10, 2021
Drug Discovery & Development
Black Men Respond Best to Immunotherapy for Prostate Cancer
FEB 10, 2021
Black Men Respond Best to Immunotherapy for Prostate Cancer
Researchers from Northwestern University have found that Black men and men of African ancestry respond better than men f ...
APR 12, 2021
Cancer
Using antibodies to treat melanoma
APR 12, 2021
Using antibodies to treat melanoma
New research presented at the American Association of Cancer Research (AACR) virtual annual meeting this week from the Y ...
APR 13, 2021
Cancer
New efforts to predict which patients will suffer from side effects from immunotherapy
APR 13, 2021
New efforts to predict which patients will suffer from side effects from immunotherapy
The findings from a study published in the Journal for ImmunoTherapy of Cancer give medical professionals a way to predi ...
APR 14, 2021
Cancer
Fighting back against medulloblastoma with naturally-occurring compound
APR 14, 2021
Fighting back against medulloblastoma with naturally-occurring compound
Renewed hope for young children with medulloblastoma comes in the form of a research paper published from the Queen Mary ...
APR 15, 2021
Cancer
What should breast cancer treatment in older women look like?
APR 15, 2021
What should breast cancer treatment in older women look like?
A new study published in JAMA Network Open by researchers at UPMC Hillman Cancer Center and the University of Pittsburgh ...
MAY 03, 2021
Cardiology
Task Force IDs 7 Costly Medical Procedures With No Benefit
MAY 03, 2021
Task Force IDs 7 Costly Medical Procedures With No Benefit
Researchers have identified a surprising number of health screens that are given to patients who may not need them. Thes ...
Loading Comments...