Implications of Following the Guidelines for Genetic Testing And MRI Use for
Breast Cancer
Polubriaginof F, Drohan B, Bosinoff P, Semine A, Claire Cronin C, Millham F, Rourke T, Block C, Hughes KS
Introduction
• Breast Cancer Genetic Testing is indicated for:
• Mutation risk ≥ 10%
• Meets NCCN Guidelines
• Screening Breast MRI is indicated for:
• Lifetime risk ≥ 20%
• NCCN
• American Cancer Society
Objective
• Evaluate the impact of following the guidelines in light of a new
version of Tyrer Cuzick.
Methods
• Retrospective analysis of 10,600 consecutive women presenting
for breast imaging at the Newton Wellesley Hospital Breast
Imaging Center September 3, 2013 to December 31, 2013
Results
Genetic Testing Eligibility by ≥10%
Genetic Testing ELIGIBILITY
MRI Eligibility
Genetic Testing COST
Percent of Patients at Lifetime Risk ≥20% by Decade
• Demographic characteristics and breast cancer risk factors were
entered into software to evaluate risk (Hughes RiskApps, LLC)
• Risk of mutation determined by:
• Tyrer Cuzick Versions 6 & 7, BRCAPRO and Myriad
Model
• Genetic testing eligibility determined by:
• Risk of mutation ≥ 10% of carrying a mutation
• Meets the NCCN Guidelines
• Lifetime risk of breast cancer determined by:
• Tyrer Cuzick Versions 6 & 7, BRCAPRO and Claus
Conclusion
• NCCN guidelines increase the number eligible for genetic testing
• Tyrer Cuzick 7 increases the number eligible for MRI
• The outcomes for this additional cost need to be evaluated