Are patients with triple-negative breast cancer screened for BRCA mutations according to NCCN guidelines?

7 Background: Ten to 25 percent of patients diagnosed with breast cancer have triple negative breast cancer (TNBC), defined as tumors negative for estrogen, progesterone, and Her2-neu receptors. TNBC is more aggressive than receptor positive cancer. The National Comprehensive Cancer Network (NCCN) recommends BRCA genetic testing for women less than age 60 when diagnosed with TNBC. Methods: The Commission on Cancer registry tumor database was queried for TNBC from 2006 to 2013. Patient demographics were analyzed. Data regarding pathologic details and BRCA testing was collected. Analyses using the Fisher's exact test were conducted. Results: TNBC tumors were identified in the database (n = 173). Sixty-one percent (105/173) of patients were less than 60 years of age, therefore BRCA testing was indicated. Fifteen patients were BRCA positive. Eighty-three percent (87/105) of patients underwent BRCA testing. Seventeen percent (18/105) of patients did not receive BRCA testing that should have under the current guidelines. Patients that did not undergo recommended BRCA testing were more likely to be greater than or equal to 55 years of age (p = 0.002), African-American (p = 0.001), have Medicaid listed as a primary payer (p = 0.021), and have American Joint Commission on Cancer (AJCC) stage 3 disease (p = 0.014). Conclusions: Risk factors for not completing BRCA testing include older age, African-American race, Medicaid insurance status, and stage 3 disease. Health provider awareness of this opportunity for improvement is important to decrease these health disparities. [Table: see text]

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Prospective Evaluation of Universal BRCA Testing for Women With Triple-Negative Breast Cancer

JNCI Cancer Spectrum ◽

10.1093/jncics/pkaa002 ◽

2020 ◽

Vol 4 (2) ◽

Cited By ~ 1

Author(s):

Trisha S Emborgo ◽

Donika Saporito ◽

Kimberly I Muse ◽

Angelica M Gutierrez Barrera ◽

Jennifer K Litton ◽

...

Keyword(s):

Breast Cancer ◽

National Comprehensive Cancer Network ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Cancer Center ◽

Brca Testing ◽

Clinical Genetic ◽

Large Rearrangement ◽

Pathogenic Variants ◽

Cancer Network

Abstract Background Limited published literature exists on women with triple-negative breast cancer (TNBC) diagnosed over the age of 60 years with breast cancer gene (BRCA) pathogenic variants. Our study determined whether the rate of BRCA pathogenic variants in a prospective cohort of TNBC patients outside the definition of current clinical genetic testing (GT) guidelines warrants a change in recommendations. Methods A prospective study of 395 women with TNBC underwent genetic counseling and 380 (96.2%) underwent clinical BRCA GT regardless of age of diagnosis beginning January 2014 to October 2015 at The University of Texas MD Anderson Cancer Center, Houston. TNBC patients older than 60 years who did not meet clinical GT guidelines had comprehensive sequencing and large rearrangement GT as part of the research protocol. Results Fifty-one of 380 (13.4%) women with TNBC who underwent clinical BRCA GT were BRCA positive. Of the 86 patients diagnosed at age over 60 years and underwent GT, only two (2.3%) were positive for BRCA. These two patients would have met clinical testing criteria due to family or ancestral history. Conclusions Our study does not support universal BRCA testing for TNBC patients diagnosed older than 60 years as their only risk factor for a BRCA pathogenic variant. Both of the positive BRCA patients older than 60 years identified would have met current National Comprehensive Cancer Network criteria for testing. Therefore, our study demonstrates that the National Comprehensive Cancer Network guidelines provide sufficient criteria for identifying BRCA pathogenic variants in women with TNBC at 60 years or younger.

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