Streamlined genetic education is effective in preparing women newly diagnosed with breast cancer for decision making about treatment-focused genetic testing: a randomized controlled noninferiority trial.
Increasingly, women newly diagnosed with breast cancer are being offered treatment-focused genetic testing (TFGT). As the demand for TFGT increases, streamlined methods of genetic education are needed.



In this noninferiority trial, women aged <50 years with either a strong family history (FH+) or other features suggestive of a germ-line mutation (FH-) were randomized before definitive breast cancer surgery to receive TFGT education either as brief written materials (intervention group (IG)) or during a genetic counseling session at a familial cancer clinic (usual-care group (UCG)). Women completed self-report questionnaires at four time points over 12 months.



A total of 135 women were included in the analysis, all of whom opted for TFGT. Decisional conflict about TFGT choice (primary outcome) was not inferior in the IG compared with the UCG (noninferiority margin of -10; mean difference = 2.45; 95% confidence interval -2.87-7.76; P = 0.36). Costs per woman counseled in the IG were significantly lower (AUD$89) compared with the UCG (AUD$173; t(115) = 6.02; P < 0.001).



A streamlined model of educating women newly diagnosed with breast cancer about TFGT seems to be a cost-effective way of delivering education while ensuring that women feel informed and supported in their decision making, thus freeing resources for other women to access TFGT.Genet Med 19 4, 448-456.
Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Veronica F
VF
Quinn
Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Bettina
0000-0003-0390-2467
B
Meiser
Familial Cancer Service, Westmead Hospital, Westmead, Australia.|Centre for Cancer Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, Australia.
Judy
0000-0002-6452-9427
J
Kirk
Department of Medical Oncology, Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, Australia.
Kathy M
0000-0002-0915-8395
KM
Tucker
Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Kaaren J
0000-0001-7318-4152
KJ
Watts
Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Belinda
B
Rahman
Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.|Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Australia.
Michelle
0000-0003-2903-4688
M
Peate
School of Surgery, University of Western Australia, Crawley, Australia.
Christobel
0000-0003-2281-9829
C
Saunders
School of Population Health, University of Western Australia, Crawley, Australia.
Elizabeth
E
Geelhoed
Hunter Family Cancer Service, Waratah, Australia.
Margaret
M
Gleeson
Sydney Medical School-Northern, University of Sydney, Sydney, Australia.
Kristine
0000-0003-1831-9944
K
Barlow-Stewart
Royal North Shore Hospital, St Leonards, Australia.
Michael
M
Field
Monash Health, Melbourne, Australia.
Marion
M
Harris
Monash Health, Melbourne, Australia.|Familial Cancer Centre, Cabrini Health, Melbourne, Australia.
Yoland C
0000-0002-6366-5523
YC
Antill
Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia.
Linda
L
Cicciarelli
Genetic Health Queensland, Nambour General Hospital, Queensland, Australia.
Karen
K
Crowe
School of Psychology, University of Sydney, Sydney, Australia.
Michael T
MT
Bowen
Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia.|Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
Gillian
G
Mitchell
D000293:Adolescent; D000328:Adult; D019313:BRCA1 Protein / Q000235:genetics; D024682:BRCA2 Protein / Q000235:genetics; D001943:Breast Neoplasms / Q000235:genetics* / Q000628:therapy; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D005817:Genetic Counseling / Q000191:economics* / Q000379:methods; D005820:Genetic Testing; D018095:Germ-Line Mutation; D006801:Humans; D008875:Middle Aged; D057566:Self Report; D055815:Young Adult
D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human