Holly J Pederson1,2,3,4,5, Najaah Hussain6,7, Ryan Noss8,9,7, Courtney Yanda10,7, Colin O'Rourke11,12,7, Charis Eng8,13,9,6,7, Stephen R Grobmyer10,13,14,9,6,7. 1. Division of Breast Services, Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave./A80, Cleveland, OH, 44195, USA. pedersh@ccf.org. 2. Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA. pedersh@ccf.org. 3. Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA. pedersh@ccf.org. 4. Department of Genetics and Genome Sciences, Cleveland Clinic, Cleveland, OH, USA. pedersh@ccf.org. 5. CASE Comprehensive Cancer Center, Cleveland Clinic, Cleveland, OH, USA. pedersh@ccf.org. 6. CASE Comprehensive Cancer Center, Cleveland Clinic, Cleveland, OH, USA. 7. Case Western Reserve University School of Medicine, Cleveland Clinic, Cleveland, OH, USA. 8. Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA. 9. Department of Genetics and Genome Sciences, Cleveland Clinic, Cleveland, OH, USA. 10. Division of Breast Services, Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave./A80, Cleveland, OH, 44195, USA. 11. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA. 12. Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 13. Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA. 14. Department of Surgery, Cleveland Clinic, Cleveland, OH, USA.
Abstract
BACKGROUND: We predicted that embedding a genetic counselor within our breast practice would improve identification of high-risk individuals, timeliness of care, and appropriateness of surgical decision making. The aim of this study is to compare cancer care between 2012 and 2014, prior to embedding a genetic counselor in the breast center and following the intervention, respectively. METHODS: A retrospective review of patients diagnosed with breast cancer in 2012 (n = 471) and 2014 (n = 440) was performed to assess patterns of medical genetics referral, compliance with referral, genetic testing findings, and impact on treatment. RESULTS: Between 2012 and 2014, patients were 49% more likely to be referred to genetics, 66% more likely to follow through with their genetic counseling appointment, experienced a 73% reduction in wait times to genetic counseling visits and 69% more likely to have genetic testing results prior to surgery. Notably, while the number of genetic mutations identified was in the expected range over both time periods (9% of those tested in 2012 vs. 6.6% of those tested in 2014), there was a 31% reduction in time to treatment in 2014 vs. 2012. CONCLUSION: Awareness of germline genetic mutations is critical in surgical decision making for newly diagnosed breast cancer patients. Having an experienced genetics specialist on site in a busy surgical breast clinic allows for timely access to genetic counseling and testing, and may have influenced time to treatment in our institution.
BACKGROUND: We predicted that embedding a genetic counselor within our breast practice would improve identification of high-risk individuals, timeliness of care, and appropriateness of surgical decision making. The aim of this study is to compare cancer care between 2012 and 2014, prior to embedding a genetic counselor in the breast center and following the intervention, respectively. METHODS: A retrospective review of patients diagnosed with breast cancer in 2012 (n = 471) and 2014 (n = 440) was performed to assess patterns of medical genetics referral, compliance with referral, genetic testing findings, and impact on treatment. RESULTS: Between 2012 and 2014, patients were 49% more likely to be referred to genetics, 66% more likely to follow through with their genetic counseling appointment, experienced a 73% reduction in wait times to genetic counseling visits and 69% more likely to have genetic testing results prior to surgery. Notably, while the number of genetic mutations identified was in the expected range over both time periods (9% of those tested in 2012 vs. 6.6% of those tested in 2014), there was a 31% reduction in time to treatment in 2014 vs. 2012. CONCLUSION: Awareness of germline genetic mutations is critical in surgical decision making for newly diagnosed breast cancerpatients. Having an experienced genetics specialist on site in a busy surgical breast clinic allows for timely access to genetic counseling and testing, and may have influenced time to treatment in our institution.
Entities:
Keywords:
BRCA; Breast cancer; Genetic counseling; Genetic testing; Lumpectomy; Mastectomy; Panel testing; Surgery; Time to treatment
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