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Apostolova C, Ferroum A, Alhassan B, Prakash I, Basik M, Boileau JF, Martel K, Meterissian S, Villareal Corpuz V, Wong N, Foulkes WD, Wong SM. Timing of genetic testing in BRCA1/2 and PALB2-Associated breast cancer: Preoperative result disclosure increases uptake of risk-reducing mastectomy and reduces unnecessary exposure to radiotherapy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108324. [PMID: 38636249 DOI: 10.1016/j.ejso.2024.108324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/25/2024] [Accepted: 04/06/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION The impact of timing of genetic testing on uptake of risk reducing mastectomy (RRM) in affected female BRCA1/2 or PALB2 carriers remains an area of evolving interest, particularly with the introduction of mainstream genetic testing initiatives. METHODS Women with stage I-III breast cancer and a confirmed germline pathogenic variant in BRCA1/2 or PALB2 between 2000 and 2023 were identified from an institutional genetics database. Uptake of RRM was evaluated according to disclosure of genetic testing results before or after index surgery for a first diagnosis of breast cancer. RESULTS The cohort included 287 female BRCA1/2 or PALB2 carriers with a median age of 44 years (IQR, 36-52). Overall, 155 (54 %) carriers received genetic testing results before and 132 (46 %) after index breast surgery. Receipt of genetic testing results before surgery was associated with a higher rate of index bilateral mastectomy (58.7 % vs. 7.6 %, p < 0.001) and a commensurate decrease in adjuvant radiation (41.9 % vs. 74.2 %, p < 0.001). At a median follow up of 4.4 years after genetic testing, 219 (76.3 %) affected carriers had undergone bilateral RRM, including 83.9 % with preoperative knowledge and 67.4 % of patients with postoperative knowledge of their germline pathogenic variant (log rank, p < 0.001). On multivariate regression, disclosure of genetic testing results before index breast surgery was independently associated with long-term uptake of bilateral mastectomy (HR 1.69, 95 % CI 1.21-2.38). CONCLUSION Genetic testing results delivered prior to index breast surgery increase uptake of bilateral RRM in affected BRCA1/2 and PALB2 carriers. Efforts to mainstream genetic testing would help optimize surgical decision-making.
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Affiliation(s)
- Carla Apostolova
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Stroll Cancer Prevention Centre, Jewish General Hospital, Montreal, QC, Canada
| | - Amina Ferroum
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Stroll Cancer Prevention Centre, Jewish General Hospital, Montreal, QC, Canada
| | - Basmah Alhassan
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Ipshita Prakash
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Stroll Cancer Prevention Centre, Jewish General Hospital, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | - Mark Basik
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | | | - Karyne Martel
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada
| | - Sarkis Meterissian
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada
| | | | - Nora Wong
- Stroll Cancer Prevention Centre, Jewish General Hospital, Montreal, QC, Canada; Department of Human Genetics, McGill University Medical School, Montreal, QC, Canada
| | - William D Foulkes
- Stroll Cancer Prevention Centre, Jewish General Hospital, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada; Department of Human Genetics, McGill University Medical School, Montreal, QC, Canada
| | - Stephanie M Wong
- Department of Surgery, McGill University Medical School, Montreal, QC, Canada; Stroll Cancer Prevention Centre, Jewish General Hospital, Montreal, QC, Canada; Department of Oncology, McGill University Medical School, Montreal, QC, Canada.
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