Researchers have found that many eligible breast cancer survivors may not be receiving genetic counseling and testing, according to a recent study published by Katz et al in the Journal of Clinical Oncology.
Background
A growing proportion of cancer treatment and survivorship care relies on understanding the genetic makeup of a patient’s tumor. Clinical guidelines are currently changing to include more patients eligible for genetic testing. The tests themselves now include more genes that could help guide cancer treatment, follow-up care, and screening. The results of these tests may impact family members of patients with cancer, who may also be at an increased risk of the disease.
“Genetic risk evaluation and testing can fall through the cracks during survivorship as patients’ needs for ongoing treatments, managing the side-effects of treatments, and monitoring for recurrence or [disease] progression grow,” explained senior study author Lauren Wallner, PhD, MPH, Associate Professor of Internal Medicine and Epidemiology at the University of Michigan and Co-Leader of the Cancer Control and Population Sciences program at the University of Michigan Health Rogel Cancer Center.
Study Methods and Results
In the recent study, the researchers used the Georgia and Los Angeles County Surveillance Epidemiology and End Results registries to identify 1,412 female patients with breast cancer. Through a survey delivered at 7 months and 6 years following their diagnosis with early-stage breast cancer, the patients were asked whether they had received genetic counseling or testing and, if so, whether they spoke with their relatives about the results.
The researchers discovered that nearly 75% of the patients who were eligible for genetic testing at diagnosis received the services during the study period. Additionally, just over 50% and about 33% of the patients who had or did not have indications for genetic testing during follow-up care received the services.
The researchers revealed that nearly 67% of the patients who underwent genetic testing and had a genetic variant communicated their results to family members. Those who had a genetic variant seemed to be more likely to talk with their family members than those who did not have a genetic variant.
Further, few patients expressed interest in direct-to-consumer genetic tests—which are not as sophisticated as clinical-based genetic testing and counseling.
Conclusions
“Our findings support a rapidly growing movement to simplify clinical guidelines to increase access to genetic testing and clinical impact of the results after diagnosis and into survivorship,” highlighted lead study author Steven J. Katz, MD, MPH, Professor of Internal Medicine and Health Management and Policy at the University of Michigan.
“[The results of the study] reinforce the need for novel approaches to genetic risk evaluation and testing in practice to target prevention and early detection strategies for … patients and their families,” underscored co–senior study author Allison Kurian, MD, MSc, Professor of Medicine and Epidemiology and Population Health at Stanford Medicine.
The researchers plan to conduct further studies examining how cancer survivorship care is coordinated between oncologists and primary care providers with the goal of improving survivorship care.
Disclosure: The research in this study was funded by the American Cancer Society and the National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
