The National Comprehensive Cancer Network (NCCN) introduced expanded NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) to account for the advanced understanding of hereditary cancer risk in breast, ovarian, pancreatic, and prostate cancers. The new guidelines followed the recent publication of the NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal, Endometrial, and Gastric.
Background
The NCCN Guidelines are the recognized standard for clinical recommendations and policy in cancer care and the most frequently updated clinical practice guidelines available in any area of medicine. There are 88 separate subject-specific guidelines, which are maintained by more than 1,900 subject matter experts from across the 33 NCCN Member Institutions. Panels may also include primary care physicians and patient advocates.
“The recently updated NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal, Endometrial, and Gastric takes into account the latest published research and expert opinions from more than 30 experts on caring for [patients] with risk for hereditary cancer,” detailed Samir Gupta, MD, of the University of California, San Diego Moores Cancer Center and Chair of the NCCN Guidelines Panel for Genetic/Familial High-Risk Assessment: Colorectal, Endometrial, and Gastric. “For the first time, we feature enhanced recommendations for evaluation for endometrial and gastric cancer risk, including new recommendations for consideration for hereditary cancer screening for all individuals with newly diagnosed endometrial cancer, new recommendations for evaluation and management of CDH1-associated gastric cancer risk, de-implementation of intense colorectal cancer screening for [patients] with CHEK2 pathogenic variants, an enhanced recommendations for managing gastric cancer risk in patients with APC pathogenic variants,” he noted.
Overview of Expanded Guidelines
Additional cancer types were added to the title and content for both guidelines. These updates were necessitated by the growing use of genetic testing in cancer prevention, screening, and treatment.
The NCCN Guidelines included information on when genetic testing is recommended, and which type of testing may be the most effective. They detailed which hereditary conditions and genetic mutations may be associated with an elevated cancer risk and included follow-up on how to manage patients who have the conditions. The guidelines indicated that next steps could include instructions for increased screening, even preventive surgeries, or other interventions.
“NCCN has played a major role in the field by creating guideline panels specifically devoted to the genetics of major cancers, and by developing scientifically based guidelines to help providers offer the best genetic-based care to their patients,” emphasized Mary B. Daly, MD, PhD, FACP, of the Fox Chase Cancer Center and Chair of the NCCN Guidelines Panel for Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate. “These guideline panels are continuously active and engaged, constantly responding to new evidence as it becomes available to provide the most up-to-date information to NCCN Guidelines users. These updates include the spectrum of genes associated with genetic syndromes, the range of risk associated with each pathogenic variant, the improvements in screening and prevention strategies, the role of genetic data to inform cancer treatment, and the expansion of the role of genetic counseling as this field moves forward,” she highlighted.
Conclusions
“These expanded guidelines reflect the recommendations from leading experts on genetic testing based on the latest scientific research across the cancer spectrum, consolidated into two convenient resources,” explained Crystal S. Denlinger, MD, Chief Executive Officer of the NCCN. “This information is critical for guiding shared decision-making between health-care providers and their patients, enhancing screening practices as appropriate, and potentially choosing options for prevention and targeted treatment choices. Genetic testing guidelines enable us to better care for [patients] with cancer and their family members,” she concluded.
