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Multigene testing ‘not leading to more worry’ for patients with breast cancer
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Multigene panel genetic testing did not increase worry among patients with breast cancer compared with BRCA1/BRCA2 testing alone, according to study results published in JCO Precision Oncology.
“Genetic testing is becoming increasingly more complex but increasingly more precise,” Steven J. Katz, MD, MPH, professor in the departments of medicine, and health management and policy at University of Michigan, said in a press release. “This has led to some ambiguity in test results. The challenge is incorporating this information into the treatment decision without causing unnecessary worry.”
Katz and colleagues merged survey responses with SEER data and germline genetic testing results from 1,063 women with breast cancer diagnosed between 2013 and 2015.
Approximately 60% of the women underwent BRCA1/BRCA2 testing alone, and nearly 40% underwent multigene panel testing.
According to study results, the impact of cancer worry did not differ significantly by test type, test results, or clinical or treatment factors. Researchers calculated an OR of 0.81 (95% CI, 0.51-1.28) for higher impact of cancer worry for multigene panel testing compared with BRCA1/BRCA2 testing.
HemOnc Today spoke with Katz about the benefits of multigene panel testing, why these study results are reassuring to the clinical community, and what needs to be done to help refine test results.
Question: Can you describe the study rationale?
Answer: We wanted to produce information on the growth of genetic testing and the consequences and impact on patient experiences and outcomes.
Q: How did you conduct the study?
A: This study is a part of the largest survey of a cohort of patients with breast cancer that had occurred to date in the United States — more than 5,000 patients were enrolled between 2013 and 2015. Because of the work that we have been doing with cancer registries in California and Georgia, we were able to gather a large sample of patients and survey them on a monthly basis. We were able to merge their medical and genetic testing information and produce information on the growth of testing as well as the consequences and impact on patient experiences and outcomes.
Q: What did you find and what are the implications of the findings?
A: The role of genetic testing in decision-making after cancer diagnosis is complicated. We have shown that extensive testing does not result in patients getting more or less worried about their future. We also showed in previous work that more extensive testing does not appear to be leading to overtreatment.
Q: Why are these results reassuring to the clinical community?
A: There is concern that more extensive testing could lead to uncertainty in how those results are interpreted and the consequences for patients. However, we did not find this to be true, so there is a bit of reassurance that multigene panel testing is not leading to more worry among patients or potential overtreatment.
Q: What conversations should clinicians have with patients before and after multigene panel testing to help them understand the po tential benefits and minimize worry?
A: We as clinicians need to explain to patients what types of testing are needed so we can bring the results to the patient for discussion. We do not want to ‘get lost in the weeds’ with regard to how to talk to patients about testing. Not only does genetic testing have value in deciding how we are going to treat the current cancer, it also has implications for prevention of the next cancer and implications for the family.
Q: What needs to be done to help ensure continued improvement of multigene panel testing so the variation or uncertainty is not as great as it is now?
A: Clinicians should only use tests that have important implications for decision-making. Also, we need to ensure that the clinician informs the patient of the plan for testing and what happens after results are in. Clinicians and surgeons are ultimately charged with treatment planning, because every patient with breast cancer sees a surgeon. I would, therefore, argue that surgeons are charged with ensuring that an initial genetic testing plan is in place. – by Jennifer Southall
Reference:
Katz SJ, et al. JCO Precis Oncol. 2018;doi:10.1200/PO.18.00225.
For more information:
Steven J. Katz MD, MPH, can be reached at Michigan Medicine, North Campus Research Complex, 2800 Plymouth Road, Building 16, 4th Floor, 410E, Ann Arbor, MI 48109; email: skatz@umich.edu.
Disclosure: Katz reports no relevant financial disclosures.