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All Breast Cancer Patients Should Receive Multigene Panel Tests, Surgeon Group Says

NEW YORK (GenomeWeb) – The American Society of Breast Surgeons recommended that individuals with breast cancer receive testing on multigene panels to assess their hereditary risk for cancer.

"Genetic testing should be made available to all patients with a personal history of breast cancer," the ASBrS stated in an updated consensus statement. "If genetic testing is performed, such testing should include BRCA1/BRCA2 and PALB2, with other genes as appropriate for the clinical scenario and family history."

The society noted that for newly diagnosed patients, panel testing could identify a mutation that impacts decisions about preventive surgery, radiation, and systemic therapy. Patients' knowledge that they have a mutation could also help relatives understand their genetic risks for cancer and help initiate cascade testing.

Patients who had testing many years ago could also benefit from testing on multigene panels, the group added, because they may not have been assessed for large rearrangements in BRCA1 and BRCA2, or been tested for mutations in other, more recently discovered cancer-associated genes. "Every patient being seen by a breast surgeon, who had genetic testing in the past and no pathogenic variant was identified, should be re-evaluated and updated testing considered," the ASBrS wrote.

The group also outlined how testing should be offered to those who have never had breast cancer, but who meet National Comprehensive Cancer Network's guidelines. In such cases, the ASBrS noted that it's more informative to test an affected relative first before testing the unaffected individual. When this isn't possible, the unaffected individual can be offered testing but should receive counseling first to explain the limitations of negative results. 

ASBrS also emphasized the important role breast surgeons, genetic counselors, and other medical professionals can play in helping patients navigate their test results and treatment choices. Such expertise may be particularly helpful in navigating a test landscape crowded with multigene panels. "There are a wide variety of panels available with different genes on different panels. There is a lack of consensus among experts regarding which genes should be tested in different clinical scenarios," the society noted. "There is also variation in the degree of consensus regarding the understanding of risk and appropriate clinical management of mutations in some genes."

The group also warned against making clinical decisions based on variants-of-uncertain-significance results. "This type of result needs to be considered as inconclusive, and the patient should be managed based on their risk factors and not influenced by this result," the group wrote.