Universal genetic testing for women with newly diagnosed breast cancer in the context of multidisciplinary team care

De Silva, DL; Stafford, L; Skandarajah, AR; Sinclair, M; Devereux, L; Hogg, K; Kentwell, M; Park, A; Lal, L; Zethoven, M; Jayawardana, MW; Chan, F; Butow, PN; James, PA; Mann, GB; Campbell, IG; Lindeman, GJ

Author(s): De Silva, DL; Stafford, L; Skandarajah, AR; Sinclair, M; Devereux, L; Hogg, K; Kentwell, M; Park, A; Lal, L; Zethoven, M; Jayawardana, MW; Chan, F; Butow, PN; James, PA; Mann, GB; Campbell, IG; Lindeman, GJ;
Details: Publication Year 2023-05-01,Volume 218,Issue #8,Page 368-373
Journal Title: Medical Journal of Australia
Abstract: OBJECTIVE: To determine the feasibility of universal genetic testing of women with newly diagnosed breast cancer, to estimate the incidence of pathogenic gene variants and their impact on patient management, and to evaluate patient and clinician acceptance of universal testing. DESIGN, SETTING, PARTICIPANTS: Prospective study of women with invasive or high grade in situ breast cancer and unknown germline status discussed at the Parkville Breast Service (Melbourne) multidisciplinary team meeting. Women were recruited to the pilot (12 June 2020 - 22 March 2021) and expansion phases (17 October 2021 - 8 November 2022) of the Mutational Assessment of newly diagnosed breast cancer using Germline and tumour genomICs (MAGIC) study. MAIN OUTCOME MEASURES: Germline testing by DNA sequencing, filtered for nineteen hereditary breast and ovarian cancer genes that could be classified as actionable; only pathogenic variants were reported. Surveys before and after genetic testing assessed pilot phase participants' perceptions of genetic testing, and psychological distress and cancer-specific worry. A separate survey assessed clinicians' views on universal testing. RESULTS: Pathogenic germline variants were identified in 31 of 474 expanded study phase participants (6.5%), including 28 of 429 women with invasive breast cancer (6.5%). Eighteen of the 31 did not meet current genetic testing eligibility guidelines (probability of a germline pathogenic variant >/= 10%, based on CanRisk, or Manchester score >/= 15). Clinical management was changed for 24 of 31 women after identification of a pathogenic variant. Including 68 further women who underwent genetic testing outside the study, 44 of 542 women carried pathogenic variants (8.1%). Acceptance of universal testing was high among both patients (90 of 103, 87%) and clinicians; no decision regret or adverse impact on psychological distress or cancer-specific worry were reported. CONCLUSION: Universal genetic testing following the diagnosis of breast cancer detects clinically significant germline pathogenic variants that might otherwise be missed because of testing guidelines. Routine testing and reporting of pathogenic variants is feasible and acceptable for both patients and clinicians.
Publisher: Wiley
Keywords: Humans; Female; Breast Neoplasms/diagnosis/genetics; Prospective Studies; Genetic Predisposition to Disease; Genetic Testing; Patient Care Team; Breast neoplasms; Cancer; Cancer genes; Genetic counselling; Pathology, molecular; Sequence analysis
Research Division(s): Cancer Biology And Stem Cells
PubMed ID: 37005005
Publisher's Version: https://doi.org/10.5694/mja2.51906
Open Access at Publisher's Site: https://doi.org/10.5694/mja2.51906
Terms of Use/Rights Notice: Refer to copyright notice on published article.
Documents: Medical Journal of Australia - 2023 - De Silva - Universal genetic testing for women with newly diagnosed breast cancer in.pdf - (0.55MB, application/pdf)

Creation Date: 2023-04-18 01:58:44

Last Modified: 2023-06-05 10:14:50