The ASBrS and NCCN provide recommendations on how to manage patients with hereditary breast and ovarian cancer genetic mutations
Published: Thursday, September 29, 2016
The American Society of Breast Surgeons (ASBrS) issued a consensus guideline for hereditary genetic testing for patients with and without breast cancer on September 13.
The purpose of this guideline was to inform breast surgeons how to approach genetic testing for patients with or without breast cancer, and to guide them on what to do with the genetic testing results.
The consensus guideline says, “Identifying patients who are mutation carriers may reduce the risk of future cancer and may prevent death from cancer through risk-reducing interventions.” The guideline also provides a table of genes associated with breast and ovarian cancer, along with the cancer risk percentages and the recommended surveillance and management guidelines for each gene. The most well-known genes associated with hereditary breast and ovarian cancer are BRCA1 and BRCA2, but others exist as well.
In response, Courtney M. Cook, MS, LCGC, Oncology Genetic Counselor at The University of Tennessee Medical Center Cancer Institute states, “Ideally, cancer genetic testing should be ordered by a genetic counselor after appropriate pre-test counseling. When a genetic counselor is unavailable, physicians who have experience with, and an appropriate understanding of, the genetic testing process may order genetic testing. Since genetic counselors are not always geographically available, the document issued by the ASBrS is a great way to educate breast surgeons on appropriate genetic testing practices.”
Courtney also highlighted one difference between the National Comprehensive Cancer Network (NCCN) guidelines for genetic/familial high-risk assessment for breast and ovarian cancer, versus the guidelines issued by ASBrS. She notes, “While the ASBrS recommends risk-reducing mastectomy (removal of unaffected breast tissue) for patients with CHEK2 mutations, the NCCN guidelines say that there is not enough evidence to support this surgery. Instead, NCCN recommends that patients with CHEK2 mutations should be monitored based on their family history. Similarly, NCCN states that the type of mutation in the CHEK2 gene may determine what type of management is appropriate for the patient. A discussion between the patient, the genetic counselor, and the surgeon is the best way to determine how to monitor the patient.”
For more information about genetic counseling and testing at the University Genetics Oncology Clinic, visit their website.
To make a referral to Oncology Genetic Counseling, call (865) 305-2DNA, or complete the Physician Referral Form.