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
MAY 30, 2020
Cancer
Linking an Aggressive Tumor Factor to the Innate Immune Response
MAY 30, 2020
Linking an Aggressive Tumor Factor to the Innate Immune Response
Epithelial Ovarian Cancer (EOC) is a cancer of the fallopian tubes with a low five-year survival rate with a tendency to ...
JUN 06, 2020
Immunology
Cancer Cell Clusters Better At Resisting the Immune System
JUN 06, 2020
Cancer Cell Clusters Better At Resisting the Immune System
For cancerous cells in the body, it seems there is safety in numbers. Researchers from a newly published study investiga ...
JUN 28, 2020
Cell & Molecular Biology
Insight Into How Dietary Changes Could Affect Cancer Therapies
JUN 28, 2020
Insight Into How Dietary Changes Could Affect Cancer Therapies
Researchers are investigating the complex relationship between cancer, diet, and metabolism in cells, and are attempting ...
JUL 11, 2020
Cancer
New drug combo could improve immunotherapy for SCCOHT ovarian cancer
JUL 11, 2020
New drug combo could improve immunotherapy for SCCOHT ovarian cancer
Research published recently in PLOS ONE reports on SP-2577, a drug that could help girls and young women plagued with a ...
JUL 30, 2020
Cancer
Researchers say DBT doesn't serve women with "extremely dense" breasts
JUL 30, 2020
Researchers say DBT doesn't serve women with "extremely dense" breasts
When you undergo screening for breast cancer, you usually have to have a mammogram, an x-ray that looks for abnormal mas ...
AUG 03, 2020
Cancer
New research on fusion proteins that may help young patients with synovial sarcoma
AUG 03, 2020
New research on fusion proteins that may help young patients with synovial sarcoma
New research is published by scientists at Dana-Farber Cancer Institute have discovered new information that may help pa ...
Loading Comments...