Recommendations for breast cancer patients and genetic testing

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:

Group	Recommend 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: BRCA1/2	Type of testing recommended: Bigger gene panel	If bigger gene panel, guidelines on which genes to include?	Recommend genetic counseling?
National Comprehensive Cancer Network (NCCN)	No	No	Yes	Yes	Depends	Yes, BRCA1, BRCA2, CDH1, PTEN, and TP53 mentioned, guidelines for others	Yes, can be GC, medical geneticist, oncologist, surgeon, oncology nurse, or other health professional with expertise
American Society of Breast Surgeons	No	Yes	Yes, follows NCCN criteria	Yes	At least PALB2, other genes as appropriate*	No, lack of consensus	Yes, by breast surgeons, GCs, or other HCPs
USPSTF	No	No	Yes *women only	Yes	No	n/a	Yes, by any trained providers including PCPs
American College of Medical Genetics (ACMG)	No	No	Yes	Yes	No (made before panels were commonplace)	n/a	Yes, by any trained providers who have adequate time
American Society of Clinical Oncology (ASCO)	No	No	Yes	Yes	Yes	No	Yes, they include their own standards for training, prefer multidisciplinary team
American College of Obstetricians and Gynecologists (ACOG)	No	No	Yes	Yes	Yes	No	Yes
Society for Gynecologic Oncology	No	No	Yes	Yes	Depends	Yes, includes Lynch for gyn malignancies	Yes, GCs preferred, but can be performed by others with appropriate training when needed
National Institute for Health and Care Excellence	No	No	Yes, if risk of testing positive is over 10%	Yes	Yes	Yes, TP53 for breast cancer patients	Yes, but only if patient voices concern
European Society for Medical Oncology	No	No	Yes, follows NCCN and NICE criteria	Yes	Depends	No	Yes

*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