Developing an Alternative Model for Pre-Test Genetic Counseling for Women Diagnosed with Breast Cancer

Abstract

We offer a pilot model of genetic counseling patient care. Breast cancer (BC) patients when diagnosed at age 45 and under meet National Comprehensive Cancer Network (NCCN) criteria for a genetics evaluation and testing for BRCA1/2 and other high-risk genes to guide surgical and other risk management decisions. Currently, the standard of care is for all of these women to receive genetics education and counseling, ideally from a cancer genetic counselor (GC). However, given the limited number of cancer GCs available to support the growing number of cancer patients that need such services, seeing a cancer GC for pre-testing counseling is not always feasible. To decrease the burden currently placed on cancer GCs throughout the United States, we propose a novel alternative model of care for these patients in which pre-test genetic counseling is performed by a breast surgeon rather than a cancer GC. We created resources to support future studies of this proposed model, including a patient satisfaction and comprehension survey to follow pre-test counseling by breast surgeons versus cancer GCs. To ensure patients receive proper care, we also developed and provide the following: a proposed informational sheet for breast surgeons that highlights topics which should be covered in a pre-test counseling session and a proposed informational sheet to be offered to participating patients that highlights the main points about genetic testing to ensure they have all of the necessary information following the pre-testing session. We hope the proposed model for cancer genetic counseling for a targeted population of patients will be useful as a starting point for hospitals and clinics experiencing a shortage of GCs to gain further insight into how well a breast surgeon, under the guidance of NCCN guidelines for adequate cancer risk assessment and genetic testing, is able to provide pre-testing genetic counseling to breast cancer patients.