Are Current Genetic Testing Guidelines Outdated?
A Game-Changing Study Proves the Need to Expand Breast Cancer
NCCN testing guidelines have long been a key tool that payers use to decide which cancer patients will be covered for genetic testing. Now, with the rapid growth of precision medicine, it has become more important than ever to ensure every patient that should be tested is tested, raising new questions about how effectively and consistently current guidelines are applied.
Dr. Peter Beitsch, Chief Physician of the Dallas Surgical Group and an executive with the TME Breast Cancer Network, answers some of those questions in his study published by the Journal of Clinical Oncology titled, Underdiagnosis of Hereditary Breast Cancer: Are Genetic Testing Guidelines a Tool or an Obstacle? We spoke with Dr. Beitsch about the results of that study and the implications for the future of precision medicine in cancer care. In his words “all breast cancer patients should be tested, and the results of this study should have a major impact on women with breast cancer in the future.”
Listen to the full episode above and download the full PDF transcript here.
The episode begins with Dr. Beitsch explaining how the study came about and why he and his research team focused on NCCN guidelines. Dr. Beitsch clarifies that he thinks the NCCN is a tremendous group and was not necessarily targeting them specifically, but that the NCCN is so well-known and represents restrictive guidelines in general.
We asked Dr. Beitsch about the danger of providing genetic testing to everyone: Could it add to ambiguity for physicians and cancer patients? Beitsch responds that out of the 80 genes he and his team tested, at least half of the patients had a variant of unknown significance or VUS. He goes on to say that the vast majority of VUSs—95+ percent of them—end up being benign. In short, they are minor variations that could easily be managed by physicians with a small amount of education, because they do not have to act on VUSs.
As for patients, he believes that most can understand their own healthcare when they are properly educated. In fact, Beitsch believes that soon many people will have their entire genome sequenced, and he is confident they will be able to handle what they learn, just as they handle information about which antibiotics they can take now.
We wondered what Dr. Beitsch would say to physicians who want to “pump the brakes” before moving ahead on considering all cancer patients for genetic testing.
He said that genomics is critically important for the future of medicine, and understanding not just a patient’s predispositions for disease, but which drugs will be effective for those patients is invaluable. He notes that products like Trapelo™ that ensure the right patients get the right tests without coming up against insurance companies will be a big part of the new world of precision medicine.
Listen to the full episode above.
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About Our Guest
Dr. Beitsch went to medical school at University of Texas Southwestern Medical School in Dallas and finished his general surgery residency at Parkland Hospital in Dallas in 1993. He had a National Cancer Institute fellowship at M.D. Anderson Cancer Center from 1988-90. He completed his training with a surgical oncology fellowship at the John Wayne Cancer Institute in Santa Monica, California, where he trained with the fathers of sentinel lymph node biopsy, Donald Morton,MD and Armando Giuliano, MD. In 1994, he returned to private practice in Dallas where his practice is focused on melanoma and breast cancer.
He has held numerous positions in national surgical societies including at the American Society of Breast Surgeons. At the ASBrS, he was the first Chairman of the Membership Committee 2001-4, Program Director for the 2005 Annual Meeting in Los Angeles, Board of Directors Member from 2006-9 and 2012-15 as well as President of the Society 2013-14.
Dr. Beitsch has given numerous national and international presentations and is actively involved in breast cancer and melanoma research. He has major articles in peer-reviewed medical journals including the New England Journal of Medicine, the Journal of the American Medical Association, the Proceedings of the National Academy of Science, Journal of Clinical Oncology, and the Annals of Surgical Oncology.
TME Breast Cancer Network: https://www.breastcarenetwork.com/