Abstract
The increase in genetic testing availability, coupled with the increase in demand for genetic counselors has led some groups to evaluate who is offered genetic testing and genetic counseling, and how those services are provided. Hereditary breast cancer risk assessment is one of the fields currently undergoing re-evaluation of services. In February of 2019, the American Society of Breast Surgeons (ASBrS) released a consensus statement calling for all breast cancer patients to be offered genetic testing, which is a departure from the widely accepted National Comprehensive Cancer Network (NCCN) guidelines that recommend genetic testing based on a combination of certain cancer diagnoses, age of cancer diagnosis, as well as family history. It is the aim of this study to understand the impact of the ASBrS guidelines on the very group who stands to be most impacted by them: genetic counselors. A survey of 73 current cancer genetic counselors in the United States sought to understand the clinical practice of genetic counselors both before and after the announcement of the ASBrS guidelines. Additionally, we sought to understand both the personal and professional opinions of genetic counselors in regard to the ASBrS guidelines. Overall, participants were neutral on whether they personally supported testing all breast cancer patients, however those who were not part of a NCCN institution were more likely to personally support testing than those who were part of a NCCN institution (p = .001, χ2 = 18.2). Additionally, participants who were not part of a NCCN institution were more likely to believe the ASBrS guidelines have clinical utility compared to participants who were part of a NCCN institution (p = .003, χ2 = 16.3). Over 70% of participants stated they were concerned about following the ASBrS guidelines due to billing and/or insurance coverage as well as the burden on genetic counselors. At least 50% of participants stated they would be comfortable if a non-genetics provider performed pre-test counseling, risk assessment or ordered a breast STAT panel. Thematic analysis of open-ended responses revealed 20.8% and 29.2% of participants were actively considering insurance and testing criteria, respectively, and 33.3% of respondents were considering alternative delivery methods in response to the ASBrS guidelines and an increase in referrals. As genetic testing availability continues to increase, there is a need for concordance among both genetics and non-genetics providers on how to best provide testing, and for whom it should be offered. The views of the genetic counselors who participated in this study emphasized the need for further discussion and examination of the impacts of the ASBrS guidelines on the hereditary breast cancer field.