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Pensabene M, Calabrese A, von Arx C, Caputo R, De Laurentiis M. Cancer genetic counselling for hereditary breast cancer in the era of precision oncology. Cancer Treat Rev 2024; 125:102702. [PMID: 38452709 DOI: 10.1016/j.ctrv.2024.102702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
A relevant percentage of breast cancers (BCs) are tied to pathogenetic (P)/likely pathogenetic (LP) variants in predisposing genes. The knowledge of P/LP variants is an essential element in the management of BC patients since the first diagnosis because it influences surgery and subsequent oncological treatments and follow-up. Moreover, patients with metastatic BCs can benefit from personalized treatment if carriers of P/LP in BRCA1/2 genes. Multigene panels allow the identification of other predisposing genes with an impact on management. Cascade genetic testing for healthy family members allows personalized preventive strategies. Here, we review the advances and the challenges of Cancer Genetic Counseling (CGC). We focus on the area of oncology directed to hereditary BC management describing the peculiar way to lead CGC and how CGC changes over time. The authors describe the impact of genetic testing by targeted approach or universal approach on the management of BC according to the stage at diagnosis. Moreover, they describe the burden of CGC and testing and future perspectives to widely offer testing. A new perspective is needed for models of service delivery of CGC and testing, beyond formal genetic counselling. A broader genetic test can be quickly usable in clinical practice for comprehensive BC management and personalized prevention in the era of precision oncology.
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Affiliation(s)
- M Pensabene
- Clinical and Experimental Unit of Breast Cancer, National Cancer Institute, IRCCS "Fondazione G. Pascale", Naples, Italy.
| | - A Calabrese
- Clinical and Experimental Unit of Breast Cancer, National Cancer Institute, IRCCS "Fondazione G. Pascale", Naples, Italy.
| | - C von Arx
- Clinical and Experimental Unit of Breast Cancer, National Cancer Institute, IRCCS "Fondazione G. Pascale", Naples, Italy.
| | - R Caputo
- Clinical and Experimental Unit of Breast Cancer, National Cancer Institute, IRCCS "Fondazione G. Pascale", Naples, Italy.
| | - M De Laurentiis
- Clinical and Experimental Unit of Breast Cancer, National Cancer Institute, IRCCS "Fondazione G. Pascale", Naples, Italy.
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Marjon N, Guerra R, Freeman A, Mak J, Cheung S, Gordon K, Blanco A, Ueda S, Chen LM. Same day service: A genetic testing station model to improve germline genetic testing in patients with ovarian cancer. Gynecol Oncol 2023; 177:53-59. [PMID: 37639903 DOI: 10.1016/j.ygyno.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Genetic testing for ovarian cancer (OC) patients is essential to consideration of PARP inhibitor therapy. To improve access, we piloted a Genetic Testing Station (GTS) allowing patients to have a same-day genetic testing visit facilitated by Genetic Counselor Assistants (GCAs) under the supervision of Genetic Counselors (GCs). METHODS The GTS was implemented December 2018 and operated through February 2020. Gynecologic Oncologists offered ovarian cancer patients a same-day GTS visit with a GCA. The patient received education via videos designed by GCs and then provided consent, a brief family history, and a sample for a standardized 133-gene panel. Results were provided by a GC. Patients were retrospectively identified by querying the medical record for OC patients seen 12 months prior to and 18 months after GTS implementation. RESULTS A total of 482 patients pre-GTS were compared to 625 patients post-GTS. Genetic testing increased from 68.5% to 75.4% (p = 0.012) after implementation, primarily in patients with epithelial histologies (80% vs 89% in pre-GTS vs post-GTS, p = 0.005). Time from referral for genetic testing to obtaining results was evaluated in the post-GTS cohort, comparing patients who had traditional counseling to those who utilized the GTS. Time to obtaining results was 21 days in the GTS group (95% CI [10, 34]) compared to 56 days (95% CI [41,76]) in the traditional genetic counseling group. CONCLUSIONS The GTS reduces barriers to care and facilitates discussion of precision treatment within a timely fashion while optimizing GC clinic time. Access improvement remains integral to improving uptake of genetic testing.
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Affiliation(s)
- Nicole Marjon
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecoloigc Oncology, University of California San Francisco, San Francisco, CA 94143, USA.
| | - Rosa Guerra
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecoloigc Oncology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Alexandra Freeman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecoloigc Oncology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Julie Mak
- Department Cancer Genetics and Prevention, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94115, USA
| | - Stephanie Cheung
- Department Cancer Genetics and Prevention, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94115, USA
| | - Kelly Gordon
- Department Cancer Genetics and Prevention, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94115, USA
| | - Amie Blanco
- Department Cancer Genetics and Prevention, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94115, USA
| | - Stefanie Ueda
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecoloigc Oncology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Lee-May Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecoloigc Oncology, University of California San Francisco, San Francisco, CA 94143, USA
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