Ausems, Margreet G E M

Bokkers, Kyra

Utrecht University Repository

ASO AUTHOR REFLECTIONSASO Author Reflections: The Role of Surgeons and NurseSpecialists in the Mainstreaming of Genetic Testing for BreastCancer PatientsKyra Bokkers, MD , and Margreet G. E. M. Ausems, MD, PhDDivision Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht,Utrecht, The NetherlandsPASTGermline genetic testing of patients with breast cancerprovides valuable information for patients and familymembers; however, currently not all patients eligible forgenetic testing are being tested.1 Mainstream genetic test-ing is one initiative to address the imbalance between needand supply of genetic testing. In a mainstreaming pathway,nongenetic healthcare professionals, such as surgeons andnurses, provide pre-test genetic counseling.2 For a pathwayto be sustainable, it is important that these nongenetichealthcare professionals feel confident and capable toprovide pre-test genetic counseling themselves. Thus far,experiences have been evaluated primarily for healthcareprofessionals working in ovarian cancer care.PRESENTWe implemented a mainstream genetic testing pathwayfor breast cancer, including online training for healthcareprofessionals, and evaluated the attitudes and experiencesof 70 surgical oncologists, nurse specialists, and nursesboth before and after implementation.3 The results of thisstudy show that these healthcare professionals have apositive attitude, and feel confident and capable to providepre-test genetic counseling themselves with an accept-able time investment (\ 15 min per patient). Moreover,they appreciated the online training. Thus, this study showsthat healthcare professionals, working in a surgicaldepartment in particular, are well suited to provide pre-testgenetic counseling themselves after completing concisetraining.FUTUREThis study shows that mainstream genetic testing can besuccessfully implemented in breast cancer care and espe-cially in surgical departments. As poly(ADP-ribose)polymerase (PARP) inhibitors are expected to be usedmore frequently in the future,4 the need for genetic testingby medical oncologists is also expected to increase andfuture studies should focus on their experiences. Takinginto account the various barriers and facilitators,5 main-streaming initiatives may be a valuable adaptation inmaking germline genetic testing accessible to all eligiblebreast cancer patients. In addition, the experiences fromthese healthcare professionals provide valuable insights formainstream genetic testing for other types of cancer. Futureresearch should investigate whether mainstream genetictesting leads to higher testing rates.FUNDING AstraZeneca (Grant Number AZNL201900216) andPfizer (Grant Number 54265341) partly funded the appointment ofKB and thereby facilitated the implementation of the mainstreamgenetic testing pathway. They had no involvement in the studydesign, collection of data, analyses, or writing of the manuscript.OPEN ACCESS This article is licensed under a Creative CommonsAttribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in any medium or format, aslong as you give appropriate credit to the original author(s) and thesource, provide a link to the Creative Commons licence, and indicateif changes were made. The images or other third party material in this The Author(s) 2023First Received: 7 February 2023Accepted: 9 February 2023Published Online: 24 February 2023M. G. E. M. Ausems, MD, PhDe-mail: m.g.e.m.ausems@umcutrecht.nlAnn Surg Oncol (2023) 30:3259–3260https://doi.org/10.1245/s10434-023-13269-xarticle are included in the article’s Creative Commons licence, unlessindicated otherwise in a credit line to the material. If material is notincluded in the article’s Creative Commons licence and your intendeduse is not permitted by statutory regulation or exceeds the permitteduse, you will need to obtain permission directly from the copyrightholder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.REFERENCES1. Alberty-Oller JJ, Weltz S, Santos A, et al. Adherence to NCCNguidelines for genetic testing in breast cancer patients: Who are wemissing? Ann Surg Oncol. 2021;28(1):281–6.2. Kemp Z, Turnbull A, Yost S, et al. Evaluation of cancer-basedcriteria for use in mainstream BRCA1 and BRCA2 genetic testingin patients with breast cancer. JAMA Netw Open.2019;2(5):e194428.3. Bokkers K, Bleiker EMA, Aalfs CM, et al. Surgical oncologistsand nurses in breast cancer care are ready to provide pre-testgenetic counseling. Ann Surg Oncol. 2023. https://doi.org/10.1245/s10434-023-13229-5.4. Tutt ANJ, Garber JE, Kaufman B, et al. Adjuvant olaparib forpatients with BRCA1- or BRCA2-mutated breast cancer. N Engl JMed. 2021;384(25):2394–405.5. Bokkers K, Vlaming M, Engelhardt EG, et al. The feasibility ofimplementing mainstream germline genetic testing in routinecancer care-a systematic review. Cancers (Basel).2022;14(4):1059.Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.3260 K. Bokkers, M. G. E. M. Ausems

ASO Author Reflections: The Role of Surgeons and Nurse Specialists in the Mainstreaming of Genetic Testing for Breast Cancer Patients

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ASO Author Reflections: The Role of Surgeons and Nurse Specialists in the Mainstreaming of Genetic Testing for Breast Cancer Patients

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