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Comment & Response
December 12, 2018

Guidelines Do Not Proscribe Surgeons Performing Genetic Testing—Reply

Author Affiliations
  • 1Department of Medicine, University of Michigan, Ann Arbor
  • 2Department of Health Management and Policy, University of Michigan, Ann Arbor
  • 3Breast Service, Department of Surgery, Memorial Sloan Kettering Comprehensive Cancer Center, New York, New York
  • 4Department of Medicine, Stanford University, Stanford, California
  • 5Department of Health Research and Policy, Stanford University, Stanford, California
JAMA Surg. Published online December 12, 2018. doi:10.1001/jamasurg.2018.4885

In Reply The clinical guidelines promulgated at the time of diagnosis of our study cohort (2013-2015) did not reflect a consensus about who should initiate genetic risk evaluation after diagnosis of breast cancer. However, the American Society of Clinical Oncology guideline1 is clear that pretest genetic counseling is a cornerstone recommendation and that the complexities in interpretation of modern panel testing require that physicians with particular expertise in cancer risk assessment be involved in their ordering and interpretation. The National Comprehensive Cancer Network guidelines2 similarly advise that genetic testing, and specifically multigene panel testing—which has rapidly become the norm3—should be conducted in the context of professional genetic counseling.

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