Regardless of family history, the National Comprehensive Cancer Network guidelines recommend genetic testing for highly penetrant breast and ovarian cancer in women with metastatic human epidermal growth factor receptor 2 (HER2)-negative breast cancer or early-onset breast cancer occurring at ≤45 years. In 2018, a survey of 95 patients conducted by the Association of Community Cancer Centers (ACCC) demonstrated that >80% of respondents reported testing >50% of patients with breast cancer who met these guidelines. Therefore, to support site-directed quality improvement interventions the ACCC partnered with 15 community cancer programs to expand and increase genetic counseling and testing rates.
An analysis of data from 9 of these 15 partner programs focused on women who are genetically at risk for early-onset or HER2-negative metastatic breast cancer (MBC). Pre-intervention data were collected between January 1, 2017, and June 30, 2019, and post-intervention data were collected between July 1, 2019, and October 1, 2020. Education focused on “testing eligibility” and the creation of a “virtual genetic counseling clinic” were among the quality improvement measures. Family history documentation, genetic counseling appointment, test results, and timing of results relative to surgical date were all included in deidentified data that were collected and analyzed.
A total of 2691 women were included in the pre-intervention cohort, and 3104 women were included in the post-intervention cohort, which included women who were eligible for genetic counseling. In the post-intervention group, early-onset patients attended a genetic counseling appointment in most cases (83%) and nearly three-quarters (74%) had genetic test results, with 92% of these receiving results before surgery. Among women with HER2-negative MBC in the post-intervention group, 61% received genetic counseling, compared with 36% in the pre-intervention group. Overall, the number of MBC patients with documented test results increased following genetic counseling in the post-intervention cohort (55% compared with 15%; P <.0001).
Rates of genetic counseling appointments improved overall, regardless of documented family history. Following quality improvement interventions, among those with a documented high-risk family history, rates increased from 57% to 85% (P <.0001). Among women in the post-intervention group without family histories, there was also a significantly higher rate of genetic counseling provided (40% vs 23%; P <.0001). In the post-intervention cohort, there was an increase in genetic counseling rates from 6% to 45% of women with no documentation of family history (P <.0001).
In women with breast cancer, genetic testing is suboptimally utilized. For readily identified populations with targeted quality improvement initiatives, significant improvement was achieved while meeting guidelines for genetic counseling and testing. Practice-directed strategies aimed at improving risk identification highlight the interest in genetic counseling and testing. In women with breast cancer, genetic testing is underemployed. With quality improvement initiatives, significant improvement was realized by focusing on clearly recognized populations meeting guidelines for genetic counseling and testing. This study establishes the value of practice-directed strategies that target risk detection and promote increased use of genetic counseling and testing.
Source:
Boehmer L, Shivakumar L, Weldon CB, et al. Genetic counseling and testing rates among community cancer programs for patients with breast cancer following site-directed quality improvement. Presented at: American Society of Clinical Oncology 2021 Annual Meeting, June 4-8. Abstract 10529.
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