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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Katz SJ, Morrow M, Kurian AW. Guidelines Do Not Proscribe Surgeons Performing Genetic Testing—Reply. JAMA Surg. Published online December 12, 2018. doi:10.1001/jamasurg.2018.4885
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