Dr Lee Schwartzberg Reacts to USPSTF's BRCA Screening Recommendation Update

September 25, 2019

Lee Schwartzberg, MD, FACP, executive director, West Cancer Center, offers his view on the US Preventive Services Task Force's (USPSTF's) updated recommendation for risk assessment, genetic counseling, and genetic testing for BRCA-related cancer.

Lee Schwartzberg, MD, FACP, executive director, West Cancer Center, offers his view on the US Preventive Services Task Force's (USPSTF's) updated recommendation for risk assessment, genetic counseling, and genetic testing for BRCA-related cancer.

Transcript

USPSTF recently updated its recommendations for BRCA1/2 screening and testing and included women with a history of several cancers and women with ancestry associated with the mutations. What are your thoughts on this?

Who should be screened for genetic testing for cancers is an ever-evolving issue and we recently saw the United States Preventive Services Task Force come out with a new recommendation. To me, this was very interesting because they tend to be a very conservative group and they actually got ahead of some of the other guideline committees by mentioning that all women who have a personal history of breast, ovarian, or other cancers should be tested. So, we’re starting to see this movement towards universal testing. We’re not quite there yet but this is a broadening of who should be tested.

Testing for germline mutations for hereditary cancers is getting cheaper all the time. It’s getting easier to talk about, although we still need our genetic counselors and we need a workflow that works with this because genetic testing doesn’t just affect our patient, it affects the whole family. So, it’s a little different concept from the way we take care of patients. I think there’s more and more comfort with disseminating this information. So, I strongly endorse that recommendation. Not every payer has agreed to that yet but it’s definitely moving in that direction.

And the reason this is important is that up to 5% to 10% of women who have cancer, one of the female cancers, will have a mutation, and that’s a pretty substantial number when you’re dealing with a quart of a million breast cancer diagnoses per year. So, this old sort of arbitrary do triple-negative breast cancer if they’re under 60—there’s a lot of arbitrariness in who we’re defining should be tested. The broader we make it the better it is.