Breast Cancer Coverage from Every Angle

Are Long-Term Survivors of Triple-Negative Breast Cancer Being Referred for Genetic Counseling?

By: Kayci Reyer
Posted: Thursday, July 26, 2018

A study published in the JNCCN–Journal of the National Comprehensive Cancer Network has found that genetic counseling referral rates for patients with triple-negative breast cancer have improved over time, from 15% before 2010 to 100% after 2014. The single-institution retrospective analysis, performed by Carlos H. Barcenas, MD, MS, of The University of Texas MD Anderson Cancer Center, and colleagues, looked at the patterns of genetic counseling referrals for long-term survivors of triple-negative breast cancer younger than age 60.

The analysis included 646 patients with triple-negative breast cancer who were diagnosed at younger than age 60 between 1992 and 2008 and who have been disease-free for at least 5 years. For patients whose last follow-up visit was between 2011 and 2013, 25% received a referral for genetic counseling. In comparison, patients whose last follow-up visit was during or after 2014 experienced a 100% referral rate for genetic testing. Researchers found that premenopausal age at diagnosis and family history of breast cancer were associated with the increase in referral rates.

Overall, 38% of the participants received a referral for genetic counseling following their diagnosis. Of those referred, 64% underwent the recommended genetic testing, and 35% of those tested showed BRCA pathogenic variants. A total of 20% of patients who received a referral for genetic counseling declined to undergo testing.

The authors proposed two possible reasons for the increase in referral for genetic counseling in this patient population over time. First, clear criteria for genetic counseling referral in patients with breast cancer appeared in the 2010 NCCN Clinical Practice Guidelines in Oncology. Second, improved insurance coverage after the publication of the Genetic Information Nondiscrimination Act of 2008 may also have played a role.

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