To evaluate the utilization of genetic testing after the implementation of a comprehensive multidisciplinary breast cancer care (cMDC) program: ALL breast cancer cases undergo a mandated, standardized/structured review of treatment options and ongoing care (including clinical trial opportunities).METHODS:
A retrospective chart review of 542 patients newly diagnosed with invasive breast cancer one year prior to and after the incorporation of a cMDC program was performed for primary outcome: rate of overall appropriate genetic referrals as defined by age, family history, triple negative status, and personal history. Secondary outcomes: compliance and equity in genetic referrals across demographics (race, insurance type and hospital site). SPSS was used for multivariate analysis, (P<.05).RESULTS:
There were 123 pre-cMDC and 419 cMDC patients. A positive pathologic genetic mutation was seen in 2.2% of patients. Comparison of pre-cMDC and cMDC patients yielded a significant increase in appropriate genetic referrals (34.1%–41.8%), a decrease in withholding genetic referral when indicated (59.3%–21.7%) and an increase in inappropriate referrals (1.9%–11.7%) respectively (P=.001). Amongst both study arms Caucasians were more compliant genetic appointment compared to their African American counterparts (pre-cMDC P=.011, cMDC P=.016). African Americans in the cMDC group demonstrated an 11% increase in attendance compared to a 1% decrease noted among Caucasians in the cMDC group. Genetic referrals were equally offered appropriately before and after the implementation of the MDC across race, insurance type and location.CONCLUSION:
Utilizing a cMDC approach to breast cancer care may help increase appropriate utilization of genetics, reach more African-Americans and identify those with pathologic mutations.