Title

Impact of national comprehensive cancer network (NCCN) genetic testing guidelines on genetic counseling referral patterns for triple negative breast cancer (TNBC) patients

Document Type

Conference Proceeding

Publication Date

2018

Publication Title

Ann Surg Oncol

Abstract

INTRODUCTION: In 2011 the NCCN revised the clinical practice guideline regarding identification of breast cancer pts that should be referred for genetic counseling/testing, to include any woman diagnosed with triple negative breast cancer (TNBC) ≤60 years, regardless of family history. Little is known regarding the impact of this revision on referral patterns and testing results among African American (AA) women, who face an increased risk of TNBC compared to White Americans (WAs). Methods: We queried a prospectively-maintained, IRB-approved breast cancer database linked to a genetic counseling program in a diverse metropolitan multi-hospital health system. Genetic counseling referrals prior to 2011 versus after 2011 were evaluated and stratified by AA versus WA. Results: Of 2984 pts with invasive breast cancer (57% WA; 32% AA) seen 05/1997 to 01/2017, 12% had TNBC. Frequency of TNBC was 16% for AA and 10% for WA pts (p<0.05). Median age was 62 years for WA versus 60 for AA TNBC pts. Of the 1288 pts ages ≤60 years, 495 (38%) were AA. Prior to 2011, 52% of WA pts were referred for genetic counseling and 54% of the 24 pts that completed testing were found to harbor a genetic mutation; 26% of the AA pts were referred for genetic counseling and 0% of the 4 pts that completed testing were found to harbor a genetic mutation. From 2011 onward, 53% of the WA pts ≤60 were referred for genetic counseling and 15% of the 13 pts that completed testing were found to harbor a genetic mutation; 50% of the AA pts were referred for genetic counseling and 17% of the 12 pts that completed testing were found to harbor a genetic mutation. The increase in genetic counseling referrals for AA TNBC pts <60yrs pre-2011 versus 2011 and later was statistically significant (p<0.05). Conclusion: The NCCN guidelines resulted in modest increases in genetic counseling referrals among WA TNBC cases but significant increases for AA pts. The revised guidelines will likely result in improved knowledge about hereditary susceptibility for breast cancer among AA women.

Volume

25

Issue

1 Suppl

First Page

S43

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