The University of Texas MD Anderson Cancer Center, Houston, TX
David Luis Ramirez, Jessica Corredor, Igryl Cordero-Hernandez, Banu Arun
Background: Genetic testing for BRCA 1/2 in breast cancer patients can have important impacts on patients’ systemic therapy options. NCCN recommendations for genetic testing include all patients with metastatic breast cancer or triple negative breast cancer to determine qualification of PARP inhibitor therapy. New guidelines recommend testing high risk, her2-negative breast cancer patients who would qualify for olaparib adjuvant therapy. It is vital that these breast cancer patients be offered genetic testing early in their cancer diagnosis journey so appropriate therapies can be provided. Due to the limited access to genetic counselors, provider ordered testing can help provide genetic testing in an expedited manner. Methods: A retrospective review of metastatic breast cancer patients who were seen at our institution between 01/01/2021 and 12/31/2021 was performed to determine if they met with genetic counselors at our institution. Based on this data, a new protocol was established guiding providers on ordering genetic testing for patients by their primary team. Additionally, a best practice advisory was designed and input into the electronic medical record to alert providers to patients who should be tested. Results: A review of patients with metastatic breast cancer seen at our institution in 2021 showed that only 29.6% of them had met with genetic counselors at our institution. Based on this finding, we created a provider initiated genetic testing process, where providers order genetic testing at the initial appointment to expedite genetic testing results. Due to an initial low uptake of this process (less than 10 tests ordered in the first three months), we also implemented a best practice advisory (BPA) within our electronic medical records (EMR). This BPA flags patients with stage IV breast cancer, that have not seen genetic counselors at our institution, and guides providers to either order genetic testing, place a referral for genetic counseling, or dismiss the BPA due to reasons. Conclusions: With the expansion of genetic testing recommendations for patients with metastatic breast cancer our institution is moving to oncologist ordered testing to increase the access to genetic testing. We hope to expand this best practice alert to other subgroups of breast cancer who would qualify for adjuvant PARP therapy. Additionally, expanding provider-initiated testing to other providers such as breast surgeons, or oncologists in our regional care centers can help increase the overall yield.
Disclaimer
This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org
Abstract Disclosures
2023 ASCO Annual Meeting
First Author: Katrin Marie Sjoquist
2023 ASCO Annual Meeting
First Author: Helen Mackay
2023 ASCO Annual Meeting
First Author: Jose Alejandro Perez-Fidalgo
2020 ASCO Virtual Scientific Program
First Author: Nadine M. Tung