Clinical and Translational Oncology

, Volume 18, Issue 10, pp 981–987

Germline BRCA testing is moving from cancer risk assessment to a predictive biomarker for targeting cancer therapeutics

  • L. Moreno
  • C. Linossi
  • I. Esteban
  • N. Gadea
  • E. Carrasco
  • S. Bonache
  • S. Gutiérrez-Enríquez
  • C. Cruz
  • O. Díez
  • J. Balmaña
Research Article

DOI: 10.1007/s12094-015-1470-0

Cite this article as:
Moreno, L., Linossi, C., Esteban, I. et al. Clin Transl Oncol (2016) 18: 981. doi:10.1007/s12094-015-1470-0

Abstract

Purpose

Originally, BRCA testing was used for risk assessment and prevention strategies for breast and ovarian cancer. Nowadays, BRCA status may influence therapeutic decision making at cancer diagnosis. Our objective was to analyze whether the medical advances have changed the burden and pattern of referral, and the pathogenic mutation detection rate.

Methods

We included 969 probands from our hereditary cancer registry who undertook a full BRCA analysis between 2006 and 2014. Chi-square tests were used to compare categorical variables.

Results

The number of genetic tests have raised from 28 to 170, representing a sixfold increase. In 2006, we tested 1.6 relatives/proband while this proportion was four in 2014. Overall, 20 % harbored a deleterious mutation and 11 % had a variant of unknown significance (VUS). There has been a downward trend in the detection rate of VUS. Testing patients with breast cancer during neoadjuvancy has raised from 4 to 25 % (p = 0.002), while testing them during remission has decreased from 79 to 29 % (p < 0.001). The proportion of patients assessed during the first 6 months after their cancer diagnosis has increased from 3 to 34 % (p = 0.001). Risk reducing mastectomy and salpingoophorectomy have raised from 0 to 24 %, and from 36 to 65 %, respectively.

Conclusions

BRCA testing has experienced a sixfold increase, the number of relatives being tested has doubled, and the test is being performed at earlier phases of the disease. It is necessary to adequate the health resources to preserve the BRCA genetic counseling quality while incorporating BRCA testing for therapeutic decision making.

Keywords

BRCA Genetic testing Genetic counseling Risk assessment Therapeutic decision making 

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2015

Authors and Affiliations

  • L. Moreno
    • 1
  • C. Linossi
    • 1
  • I. Esteban
    • 1
  • N. Gadea
    • 1
  • E. Carrasco
    • 1
  • S. Bonache
    • 2
  • S. Gutiérrez-Enríquez
    • 2
  • C. Cruz
    • 1
  • O. Díez
    • 2
    • 3
  • J. Balmaña
    • 1
  1. 1.High Risk and Cancer Prevention Unit, Medical Oncology DepartmentUniversity Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, and Vall d’Hebron Institute of Oncology (VHIO)BarcelonaSpain
  2. 2.Oncogenetics GroupVall d’Hebron Institute of Oncology (VHIO) and Universitat Autònoma de BarcelonaBarcelonaSpain
  3. 3.Clinical and Molecular Genetics AreaUniversity Hospital Vall d’HebronBarcelonaSpain

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