title: Efficacy versus effectiveness of clinical genetic testing criteria for BRCA1 and BRCA2 hereditary mutations in incident breast cancer.
abstract: Increasing evidence supports the benefit of identifying BRCA1 and BRCA2 germline mutations in early breast cancer. Selection of patients for genetic testing is based on defined criteria taking individual and family history related factors into account. It is important to make a distinction between efficacy and effectiveness of BRCA testing criteria. Efficacy can be defined as the performance under ideal circumstances, whereas effectiveness refers to its real life performance. To allow for an unbiased and detailed evaluation of efficacy and effectiveness of the Swedish BRCA testing criteria, we retrospectively analyzed a prospectively collected cohort of 273 breast cancer patients from the well-characterized, population-based, single-site All Breast Cancer in Malmö (ABiM) study. The patients were diagnosed with breast cancer during the years 2007 through 2009. Out of 20 mutation carriers identified, 13 fulfilled Swedish criteria at time of diagnosis. Thus, the efficacy of these criteria was 65%. Excluding three patients in whom a mutation was already known at time of diagnosis, only 3/17 had been identified in the clinical routine, corresponding to an effectiveness of 18%. Here we detail the reasons why mutation carriers in our cohort were not detected though routine health care. In conclusion, effectiveness of BRCA testing criteria was much lower than efficacy. Our results indicate that current testing criteria and procedures associated with BRCA1 and BRCA2 testing are insufficient. There is room for improvement of their efficacy, but even more so regarding effectiveness. Clinical BRCA testing routines need to be critically revised.
authors.affiliation: Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.|Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Nilsson
authors.affiliation: Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.|Institute of Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Winter
authors.affiliation: Department of Clinical Genetics, Laboratory Medicine Region Skåne, Lund, Sweden.|Department of Clinical Genetics, Lund University, Lund, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Kristoffersson
authors.affiliation: Department of Surgery, Skåne University Hospital, Malmö, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Rehn
authors.affiliation: Department of Translational Cancer Research, Lund University, Lund, Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Larsson
authors.affiliation: Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.|CREATE Health Strategic Centre for Translational Cancer Research, Lund University, Lund, Sweden.
authors.forename: Lao H
authors.initials: LH
authors.lastname: Saal
authors.affiliation: Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden. niklas.loman@med.lu.se.|Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden. niklas.loman@med.lu.se.
authors.forename: Niklas
authors.initials: N
authors.lastname: Loman
mesh_terms: D019313:BRCA1 Protein / Q000235:genetics*; D024682:BRCA2 Protein / Q000235:genetics*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics; D057186:Comparative Effectiveness Research; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D018095:Germ-Line Mutation; D006801:Humans; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human
keywords: BRCA1; BRCA2; Breast cancer; Effectiveness; Genetic testing; Testing criteria