WTF? Bad idea. It strikes me as @ASBrS overreaching. I mean seriously: Are we going to offer an 85 year old woman with a well-differentiated hormone receptor(+) cancer and no family history genetic testing? Why? It makes no sense. What will it accomplish for the patient?https://twitter.com/ESchattner/status/1096400867358593025 …
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What's the downside? Draw the prep creatinine, INR, Brca1/2. It's time to stop viewing these simple and cheap tests as privileged or special.
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Shouldnt we avoid paying for tests that likely wont influence treatment decison-making?
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Preoperative brca1/2 would profoundly influence treatment decisions... risk reducing mastectomy, more intensive screening, oophorectomy, e.g.
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For an 85 yr old with ER+?
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Maybe, depends. But her brca+ daughter yes.
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An 85 year old with HR(+) disease would be INCREDIBLY unlikely to be BRCA+. A BRCA carrier would likely have gotten her cancer decades earlier, and it likely would have been HR(-). A blanket recommendation to consider genetic testing for ALL breast cancer patients is unjustified.
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Sure, this example is extreme. However current status is the rules for who gets tested is complicated and changes every year. As a public health measure, testing all BrCa would identify families with major cancer risk, save lives.
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No, you ASSUME that testing all families would save lives. As we've found from so many other studies is screening, realizing decreases in mortality from such measures is by no means a given. There's no evidence.
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What kind of evidence would you require?
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