title: A targeted approach to genetic counseling in breast cancer patients: the experience of an Italian local project.
abstract: OBJECTIVE
  Patients with hereditary breast cancer (BC) may benefit from genetic counseling and testing for detection of causative mutations, definition of therapeutic and preventive strategies, and identification of at-risk relatives. Italy has few oncogenetic centers and genetic evaluation of all patients with BC is not feasible. Moreover, lack of uniformity in the selection of patients generates inappropriate referral to the geneticist. We designed a model that may represent a reproducible way to select patients at risk for hereditary BC, with the aims of rationalizing access to genetic centers and improving clinical management and surveillance.
  
  
  METHODS
  The genetic unit of a Cancer Center and the Departments of Oncology from 2 public Hospitals in Milan were involved in the project. After training sessions at the genetic unit, operators from the 2 hospitals evaluated all patients with BC attending a first oncologic visit, through a specific interview. Patients considered at risk of hereditary BC attended counseling at the genetic unit.
  
  
  RESULTS
  Of 419 patients, 61 (14.5%) were eligible for genetic counseling after the interview. Of these, 46 (10.9%) strictly met testing criteria. Overall, 52 (12.4%) patients underwent genetic counseling and 47 were tested for BRCA1/BRCA2 mutation. After genetic test results, the available options for treatment/surveillance were discussed by a multidisciplinary team, according to the level of genetic risk.
  
  
  CONCLUSIONS
  It is possible to improve the process of referring patients with suspected hereditary BC for genetic risk assessment. The application of clinical screening reduced the genetics unit's workload and enabled optimization of time and resources.
authors.affiliation: Department of Oncology, AO Fatebenefratelli & Oftalmico, Milan - Italy.
authors.forename: Nicla
authors.initials: N
authors.lastname: La Verde
authors.affiliation: Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan - Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Corsi
authors.affiliation: Department of Oncology, AO Fatebenefratelli & Oftalmico, Milan - Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Moretti
authors.affiliation: Unit of Medical Genetics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Bernard
authors.initials: B
authors.lastname: Peissel
authors.affiliation: Department of Oncology, Luigi Sacco Hospital, Milan - Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Dalu
authors.affiliation: Department of Oncology, AO Fatebenefratelli & Oftalmico, Milan - Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Girelli
authors.affiliation: Department of Oncology, Luigi Sacco Hospital, Milan - Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Fasola
authors.affiliation: Department of Oncology, Luigi Sacco Hospital, Milan - Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Gambaro
authors.affiliation: Department of Oncology, Luigi Sacco Hospital, Milan - Italy.|Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan - Italy.
authors.forename: Gaia
authors.initials: G
authors.lastname: Roversi
authors.affiliation: Unit of Medical Genetics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Azzollini
authors.affiliation: Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Radice
authors.affiliation: IFOM, Fondazione Istituto FIRC di Oncologia Molecolare and Cogentech Cancer Genetics Test Laboratory, Milan - Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Pensotti
authors.affiliation: Department of Oncology, AO Fatebenefratelli & Oftalmico, Milan - Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Farina
authors.affiliation: Unit of Medical Genetics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
authors.forename: Siranoush
authors.initials: S
authors.lastname: Manoukian
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control / Q000628:therapy*; D037001:Directive Counseling; D019468:Disease Management; D005190:Family; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006779:Hospitals, Public; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011159:Population Surveillance / Q000379:methods; D015397:Program Evaluation; D012017:Referral and Consultation / Q000592:standards