Dr Lee Schwartzberg on Genetic Testing for All Patients Diagnosed With Breast Cancer

Lee Schwartzberg, MD, FACP, executive director, West Cancer Center, discusses his thoughts on calls for every person diagnosed with breast cancer to receive a multigene panel.

Transcript

New guidelines from the American Society of Breast Surgeons called for every person diagnosed with breast cancer to receive a multigene panel. Do you agree with this?

It’s a very complicated area who should be tested for a hereditary breast cancer gene. Today, we use panels, anywhere from 25 to 50 gene panels, which look at all the common and uncommon genes that have been identified that increase susceptibility to breast cancer. Of course, number 1 and 2 of those are BRCA1 & 2. Now we know that if you look for more genes and if you expand the criteria for looking at these genes that we’re going to find more people that have the potential for hereditary breast cancer and they can be offered prophylactic options, whether that’s surgery or increased surveillance or chemo prevention.

So, I think the American Society of Breast Surgeons took a very provocative stand because right now, if you look at the guidelines, they’re very confusing, and they’re kind of arbitrary, like NCCN [National Comprehensive Cancer Institute] says any patient under 45 should be tested but only patients between 45 and 50 who have certain family history and triple-negative patients under 60, so it’s very complicated and it probably doesn’t need to be that complicated. I definitely advocate for a broader testing.

However, we have to use our clinical judgment on whether or not we should test every 80-year-old diagnosed with breast cancer with zero family history. I think we can leave that up to the doctors, but I strongly agree with expanding the indications for comprehensive genetic testing in patients with breast cancer.