A pilot program that includes genetic counseling for all newly diagnosed breast cancer patients leads to more testing for inherited cancer-related genes, a new Kaiser Permanente study finds. A positive test for a genetic mutation can guide treatment and inform family members of important health information.
In December 2020, the pilot launched at 4 of the 14 breast care centers at Kaiser Permanente in Northern California. It expanded genetic testing to more patients by having breast care coordinators provide all newly diagnosed patients ages 65 and under with pre-test counseling and the option of genetic testing. The patients who received a positive test for a genetic mutation were seen by a genetic counselor for post-test counseling.
The new Kaiser Permanente study published in September in the “Annals of Surgical Oncology” compared the 4 centers that started the pilot with the 10 centers that provided routine care. At these centers, breast care coordinators referred patients only considered to be at increased risk for an inherited cancer genetic mutation for genetic testing.
The study’s findings highlight the pilot project’s success and support its expansion.
The benefits of genetic testing
“Knowing a patient newly diagnosed with breast cancer has an inherited mutation that increases cancer risk helps us tailor treatment options to that patient,” said study lead author Veronica Shim, MD, a breast cancer surgeon in Oakland. “But having this information doesn’t only affect the patient. If they have an inherited mutation, it affects their family members as well. So, the more people we can test, the better our ability to help patients and their families.”
The most common hereditary genetic mutations tied to breast cancer are on the genes known as BRCA1 and BRCA2. Inherited genetic mutations that increase cancer risk can be passed down from a mother or father to their children. If a newly diagnosed breast cancer patient has a mutation, the genetic counselor will recommend that certain family members also get tested.
The study included nearly 2,300 Kaiser Permanente members in Northern California who were newly diagnosed with breast cancer between December 2020 and June 2021.
At the 4 pilot sites, 62% of the patients chose genetic testing, compared with 32% of the patients at the 10 routine care sites. Ultimately, close to 4% of the pilot site patients and close to 2% of the routine care site patients learned they likely had a breast cancer-related genetic mutation.
“Our study shows that trained breast care coordinators, who at Kaiser Permanente in Northern California are nurses and nurse practitioners, can allow more patients to get tested without a significant impact on genetics departments,” said senior author Laurel A. Habel, PhD, a research scientist at the Kaiser Permanente Division of Research.
Study co-author Audrey Karlea, MS, LCGC, is a genetic counselor at Kaiser Permanente in Oakland. She has been providing genetic counseling to breast cancer patients for 16 years. “The difference between what it was like when I first started and now is like night and day,” she said. “We can test for more genes, the cost has come down, and the results play a larger role in how we treat patients. With all these things going on, it made sense to look at new ways to provide pre-test counseling.”
The pilot sites in Modesto, Oakland, Sacramento, and San Rafael continue to offer the program. The region aims to have breast care coordinators offer expanded testing at all its breast centers.
“Having been part of this pilot, I can’t stress enough the benefits it brings to our patients,” said study co-author Poline Engeman, NP, a breast care coordinator at South Sacramento. “It’s another way of providing top-of-the-line care.”
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