This grid can give a quick breakdown of the different societies and their recommendations for genetic testing in women with a personal or family history of breast cancer:

GroupRecommend Genetic Testing for all people?Recommend genetic testing for all women with breast cancer?Recommend genetic testing for people who met personal or family history criteria?Type of testing recommended: BRCA1/2Type of testing recommended: Bigger gene panelIf bigger gene panel, guidelines on which genes to include?Recommend genetic counseling?
National Comprehensive Cancer Network (NCCN)NoNoYesYesDependsYes, BRCA1, BRCA2, CDH1, PTEN, and TP53 mentioned, guidelines for othersYes, can be GC, medical geneticist, oncologist, surgeon, oncology nurse, or other health professional with expertise
American Society of Breast SurgeonsNoYesYes, follows NCCN criteriaYesAt least PALB2, other genes as appropriate*No, lack of consensusYes, by breast surgeons, GCs, or other HCPs
USPSTFNoNoYes *women onlyYesNon/aYes, by any trained providers including PCPs
American College of Medical Genetics (ACMG)NoNoYesYesNo (made before panels were commonplace)n/aYes, by any trained providers who have adequate time
American Society of Clinical Oncology (ASCO)NoNoYesYesYesNoYes, they include their own standards for training, prefer multidisciplinary team
American College of Obstetricians and Gynecologists (ACOG)NoNoYesYesYesNoYes
Society for Gynecologic OncologyNoNoYesYesDependsYes, includes Lynch for gyn malignanciesYes, GCs preferred, but can be performed by others with appropriate training when needed
National Institute for Health and Care ExcellenceNoNoYes, if risk of testing positive is over 10%YesYesYes, TP53 for breast cancer patientsYes, but only if patient voices concern
European Society for Medical OncologyNoNoYes, follows NCCN and NICE criteriaYesDependsNoYes

*also updated testing for anyone prior to 2014

ALL guidelines advocate the following:

  • Patients should have the opportunity to make an informed choice to decline or accept testing
  • Pre- and post-test counseling regarding the overall benefits, risks, and limitations is essential
  • Post-test counseling should include risk reduction strategies

Other important guideline information:

  • Genetic testing should first be performed in an affected family member whenever possible
  • Following testing, it is also important to have experts available to interpret results and recommend treatment planning, ideally as part of a multidisciplinary team of providers
  • Treatment should not be based on variants of uncertain significance
  • Family histories change over time and should be reassessed periodically
  • Patients tested before 2014 should be considered for updated testing
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