Impact of an embedded genetic counselor on breast cancer treatment
- 351 Downloads
We predicted that embedding a genetic counselor within our breast practice would improve identification of high-risk individuals, timeliness of care, and appropriateness of surgical decision making. The aim of this study is to compare cancer care between 2012 and 2014, prior to embedding a genetic counselor in the breast center and following the intervention, respectively.
A retrospective review of patients diagnosed with breast cancer in 2012 (n = 471) and 2014 (n = 440) was performed to assess patterns of medical genetics referral, compliance with referral, genetic testing findings, and impact on treatment.
Between 2012 and 2014, patients were 49% more likely to be referred to genetics, 66% more likely to follow through with their genetic counseling appointment, experienced a 73% reduction in wait times to genetic counseling visits and 69% more likely to have genetic testing results prior to surgery. Notably, while the number of genetic mutations identified was in the expected range over both time periods (9% of those tested in 2012 vs. 6.6% of those tested in 2014), there was a 31% reduction in time to treatment in 2014 vs. 2012.
Awareness of germline genetic mutations is critical in surgical decision making for newly diagnosed breast cancer patients. Having an experienced genetics specialist on site in a busy surgical breast clinic allows for timely access to genetic counseling and testing, and may have influenced time to treatment in our institution.
KeywordsBRCA Surgery Mastectomy Lumpectomy Time to treatment Breast cancer Genetic testing Panel testing Genetic counseling
Dr. Holly Pederson serves as a consultant to Myraid Genetics. Dr. Charis Eng serves as a consultant/advisor to N-of-One and holds stock ownership in Family Care Path, Inc. All other authors have no relevant disclosures to report.
- 6.Yurgelun MB, Allen B, Kaldate RR et al (2015) Identification of a variety of mutations in cancer predisposition genes in patients with suspected lynch syndrome. Gastroenterology 149(604–13):e20Google Scholar
- 7.NCCN Guidelines 1. 2018 genetic/familial risk assessment: breast and ovarian. 2017Google Scholar
- 13.Weitzel JN, McCaffrey SM, Nedelcu R, MacDonald DJ, Blazer KR, Cullinane CA (2003) Effect of genetic cancer risk assessment on surgical decisions at breast cancer diagnosis. Arch Surg 138:1323–1328; discussion 9Google Scholar
- 18.Surgeons ACo. (2014) NAPBC standards manual, pp 1–78Google Scholar