Germline BRCA1 and BRCA2 testing for breast cancer survivors

BackgroundFor patients with early breast cancer, knowledge of germlineBRCA1/2status increasingly influences management as well as informing future cancer risk for patients and their families. As access to germline testing expands, it is important that this benefit is extended to survivors as well as to the newly diagnosed. MethodsIn collaboration with our breast unit colleagues and by embedding a Senior Genetic Counsellor in the virtual multidisciplinary meeting, we identified patients suitable for genetics review 5 years after their breast cancer diagnosis. ResultsBetween May 2015 and December 2018, 2044 patients were discussed, of whom 769 patients were identified for notes review by Genetics. Of these, 275 had already undergone testing and 47 had confirmed germline pathogenic variants inBRCA1/2. A further 463 were recommended for referral. One hundred and eighty patients were subsequently offered testing with 161 accepting (161/180, 89%). Nine patients were found to harbour pathogenic variants in eitherBRCA1orBRCA2(9/161, 6%). Of the initial 2044 patients reviewed, 2.7% (56/2044) are now known to carry germline pathogenic variants. ConclusionThe survivorship setting provides an opportunity for genetic review underpinned by collaborative working between cancer specialists and the genetics team.