Background Testing for BRCA variants can impact treatment decisions for breast cancer patients and affect surveillance and prevention strategies for both patients and their relatives. National Comprehensive Cancer Network (NCCN) guidelines recommend testing for patients at heightened risk of BRCA pathogenic variant. We examined the BRCA testing rate among high risk breast cancer patients treated in community oncology practices. Methods We conducted a retrospective medical chart review among community-based US oncologists using a physician panel approach. High risk breast cancer patients with a known family history of cancer and diagnosis with breast cancer at age ≥ 18 years between January 2013–October 2017 were included. We assessed the proportions of patients tested for BRCA variants in accordance with NCCN guidelines. Results Charts from 63 physicians, averaging 16 years of practice, were included; 97% were medical oncologists and 66.7% had a genetic counselor in their practice. We analyzed data for 410 randomly-selected patients with mean age of 52 years; 95% were female, 74% were White, and 19% had Ashkenazi Jewish ancestry. Among all patients, 94% were tested for BRCA variants. The testing rate ranged from 78 to 100% in various high risk groups; lower rates were observed among Black patients (91%), men (92%), and patients meeting NCCN criteria based on family history of male breast cancer (78%) and prostate cancer (87%). We observed a higher testing rate in patients treated by physicians with a genetic counselor in their practice (95% versus 91%). Conclusions Adherence to NCCN BRCA testing guidelines is high in this group of predominantly medical oncologists with extensive experience, with a high proportion having a genetic counselor in practice. Testing rates can be improved in patients with risk factors related to male relatives. High level of compliance to guidelines in a community setting is possible with a delivery model for genetic counseling and testing.

中文翻译：

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遵守国家综合癌症网络指南对高危乳腺癌患者进行 BRCA 检测：一项回顾性图表回顾研究

背景 BRCA 变异检测会影响乳腺癌患者的治疗决策，并影响患者及其亲属的监测和预防策略。国家综合癌症网络 (NCCN) 指南建议对 BRCA 致病性变异风险较高的患者进行检测。我们检查了在社区肿瘤学实践中接受治疗的高危乳腺癌患者的 BRCA 检测率。方法 我们使用医师小组的方法对美国社区肿瘤学家进行回顾性病历审查。纳入 2013 年 1 月至 2017 年 10 月期间具有已知癌症家族史且年龄 ≥ 18 岁诊断为乳腺癌的高危乳腺癌患者。我们根据 NCCN 指南评估了接受 BRCA 变异检测的患者比例。结果 包括来自 63 名医生的图表，平均从业 16 年；97% 是医学肿瘤学家，66.7% 在他们的实践中有遗传咨询师。我们分析了 410 名随机选择的平均年龄为 52 岁的患者的数据；95% 是女性，74% 是白人，19% 有德系犹太人血统。在所有患者中，94% 的患者接受了 BRCA 变异检测。各种高危人群的检测率从78%到100%不等；在黑人患者 (91%)、男性 (92%) 和根据男性乳腺癌 (78%) 和前列腺癌 (87%) 家族史符合 NCCN 标准的患者中观察到较低的发病率。我们观察到在实践中由有遗传咨询师的医生治疗的患者的检测率更高（95% 对 91%）。结论 NCCN BRCA 检测指南的依从性在这组主要是具有丰富经验的肿瘤内科医师中很高，并且在实践中拥有遗传咨询师的比例很高。具有与男性亲属相关的危险因素的患者的检测率可以提高。遗传咨询和检测的交付模式可以在社区环境中高度遵守指南。