An interesting paper in JAMA this week revealed that many breast cancer patients in the US want a genetic test, but don’t always get one. If you don’t have access to the original paper, NPR has a good summary.
The study, led by Allison Kurian at Stanford University, noted that many breast cancer patients that met the criteria for testing were never informed about the possibility of a genetic test.
The article also suggests that one of the reasons for this lack of testing is that there is a lack of access to genetic counsellors to support genetic testing of all breast cancer patients, and that cancer clinicians themselves don’t always have the skills and knowledge to be able to direct their patients toward genetic testing.
This is a problem that we have addressed in the UK through our mainstreaming cancer genetics programme. We developed and validated a system whereby members of the cancer team take a short training which then allows them to offer genetic testing to their patients during one of their regular clinic appointments. If the test shows that they have a BRCA mutation, the patient then gets an appointment with a geneticist. The patient can also ask for a genetics consultation at any other point, if they want to.
Our system gives the cancer team the ability to offer genetic testing to their patients directly, and gives simplified access to genetic testing to cancer patients. It also allows the genetics department to focus their expertise where it is most needed. We published the results of the pilot study last year.
At the Royal Marsden Hospital, BRCA testing is now routinely offered to eligible breast and ovarian cancer patients directly by the cancer team. This means that all eligible women that want testing, get testing. Over 1000 patients have had testing through the new system. Patient feedback of the system has been extremely positive.
Several groups around the world are now offering BRCA gene testing to cancer patients as part of routine cancer clinic appointments. We are in the process of connecting these groups, so please drop us a line if you are involved with a similar testing pathway, or would like to know more.