Impact of an embedded genetic counselor on breast cancer treatment

Breast Cancer Res Treat. 2018 May;169(1):43-46. doi: 10.1007/s10549-017-4643-4. Epub 2018 Jan 18.


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.

Keywords: BRCA; Breast cancer; Genetic counseling; Genetic testing; Lumpectomy; Mastectomy; Panel testing; Surgery; Time to treatment.

MeSH terms

  • Adult
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / genetics*
  • Breast Neoplasms / pathology
  • Decision Making
  • Female
  • Genetic Counseling*
  • Genetic Predisposition to Disease*
  • Genetic Testing
  • Germ-Line Mutation / genetics
  • Humans
  • Referral and Consultation