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August 20, 2019

USPSTF Recommendations for BRCA1 and BRCA2 Testing in the Context of a Transformative National Cancer Control Plan

Author Affiliations
  • 1Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
  • 2Center for Clinical Cancer Genetics, The University of Chicago, Chicago, Illinois
  • 3Center for Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
JAMA Netw Open. 2019;2(8):e1910142. doi:10.1001/jamanetworkopen.2019.10142

In the August 20, 2019, issue of JAMA, the US Preventive Services Task Force (USPSTF)1 offers updated recommendations for risk assessment, counseling, and genetic testing for the BRCA1 and BRCA2 genes. As in 2013, the USPSTF recommends risk assessment for women with family histories of breast, ovarian, tubal, or peritoneal cancers using risk stratification tools and offering those with positive results genetic counseling and possible testing (Grade B recommendation). The USPSTF continues to recommend against large-scale population risk assessment (Grade D recommendation). The 2019 recommendations explicitly add ethnicities and ancestries associated with pathogenic BRCA1 or BRCA2 gene variants (eg, Ashkenazi Jewish) as an indicator for risk assessment, dramatically expanding the number of testable patients in the primary care setting from the 2013 recommendations. Importantly, the USPSTF emphasizes that “Genetic counseling…should be done by trained health professionals, including trained primary care providers.” With the increase in women eligible for genetic counseling and testing under these recommendations and the explicit directive for primary care practitioners (PCPs) to consider clinical genetics training per the 2019 USPSTF recommendations, the oncology community should welcome the opportunity to better integrate comprehensive cancer risk assessment and genetic testing for BRCA1 and BRCA2 into routine preventive medicine.

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