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Many patients with bad cancer may miss genetic tests that could help determine the ideal treatment regimen at least in part because their surgeons are uncomfortable discussing the benefits and disadvantages of these tests. One-third of patients receive genetic testing after bad cancer diagnosis, and multigene panel testing quickly replaces two BRCA1 and BRCA2-based tests, which have long been badociated with aggressive tumors, say researchers in JAMA Surgery . Current guidelines recommend genetic testing for bad cancer patients who are at high risk for genetic mutations based on age, family history, and tumor characteristics.
Although most patients see a surgeon while they determine their ideal regimen, little research to date has examined variation in surgeons over the frequency at which genetic tests are ordered, researchers note. women treated for bad cancer at an early stage by 377 surgeons in the state of Georgia and the city of Los Angeles between 2013 and 2015.
Overall, about 35 percent of patients had a high risk of carrying a genetic mutation. "Breast cancer treatments are now very effective and tumor tests are becoming more and more accurate in informing clinicians about treatment recommendations for patients," said the head of the clinic. study. Steven Katz, a researcher in health policy and management at the University of Michigan at Ann Arbor
"Really important advances are saving lives," Katz said by e-mail. "But the clinical utility of germ-line genetic testing – the badysis of inherited gene mutations in normal tissues – after diagnosis is less certain and surgeons and other oncologists agree less on the approach of counseling and screening uncertainty. "
Even among women at higher risk of carrying genetic mutations, only 52 percent have obtained genetic testing, the study found. About 14% of women at average risk of genetic mutations were tested.
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About one-third of surgeons reported that they often or always delayed surgery to obtain genetic testing, and just over half of surgeons said that they were either very or very confident about discussing genetic testing with their patients
. In total, about 17 percent of the variation in genetic test rates could be explained by surgeons' practice patterns, the study found.
Women at highest risk of carrying genetic mutations had about 26 percent The probability of obtaining genetic testing was less than 95% of the surgeons in the study.
Those same women with the highest genetic risk had a 72% chance of having genetic tests they saw a surgeon who ordered these tests more often than 95% of other surgeons in the study .
The study was not designed to prove whether or how surgeons' decisions had an impact on the rates of genetic testing or cancer treatment outcomes in women. And researchers lacked data to determine whether genetic testing or counseling was appropriate in cases where surgeons recommended it.
Still, the results suggest that to avoid missing the necessary tests, it would make sense to order genetic testing for all women. Newman of the Henry Ford Health System in Detroit writes in an accompanying editorial.
"Genetic testing to badess the risk of bad and / or ovarian cancer is generally considered optional, but for some women these findings may influence their decisions." In other women, BRCA tests can influence options regarding how they treat their ovaries, either as a component of their bad cancer treatment or to prevent ovarian cancer, "added Newman." Patients may also use this information to help family members make decisions about genetic counseling and testing. "
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