Evidence map›Paper›PMID 28402748›Full record

ArticleJournal of clinical oncology : official journal of the American Society of Clinical Oncology2017

Gaps in Incorporating Germline Genetic Testing Into Treatment Decision-Making for Early-Stage Breast Cancer.

Allison W Kurian, Yun Li, Ann S Hamilton, Kevin C Ward, Sarah T Hawley, Monica Morrow, M Chandler McLeod, Reshma Jagsi, Steven J Katz

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04533555 (Randomized Trial of Universal vs. Guideline-directed Germline Testing Among Young Adults With Cancer), which is not on this map. Cited by 140 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
140citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04533555 nacompletednot on this mapstarted 2020, after this paper: background citation

Randomized Trial of Universal vs. Guideline-directed Germline Testing Among Young Adults With Cancer

TypeinterventionalSponsorUniversity of PennsylvaniaRan2020 to 2025Enrolled749ConditionsCancerArmsBroad gene panel for young adult cancers, Standard
3 · Its place in the literature

Who cites it

140 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. How variants of uncertain significance affect clinical decisions: A systematic review.Genetics in medicine : official journal of the American College of Medical Genetics · 2026
    Pooled it
  2. Pooled it
  3. Systematic evidence review and meta-analysis of outcomes associated with cancer genetic counseling.Genetics in medicine : official journal of the American College of Medical Genetics · 2024
    Pooled it
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  18. Frontiers in oncology · 2026
    Review
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80 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Allison W KurianAllison W. Kurian, Stanford University, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Yun Li, M. Chandler McLeod, and Steven J. Katz, University of Michigan, School of Public Health; Sarah T. Hawley, University of Michigan, Veterans Administration Center for Clinical Management Research, Ann Arbor Veterans Affairs Health Care System; Reshma Jagsi, University of Michigan, Center for Bioethics and Social Science in Medicine, Ann Arbor, MI; Kevin C. Ward, Emory University, Rollins School of Public Health, Atlanta, GA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY.
Yun LiAllison W. Kurian, Stanford University, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Yun Li, M. Chandler McLeod, and Steven J. Katz, University of Michigan, School of Public Health; Sarah T. Hawley, University of Michigan, Veterans Administration Center for Clinical Management Research, Ann Arbor Veterans Affairs Health Care System; Reshma Jagsi, University of Michigan, Center for Bioethics and Social Science in Medicine, Ann Arbor, MI; Kevin C. Ward, Emory University, Rollins School of Public Health, Atlanta, GA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY.
Ann S HamiltonAllison W. Kurian, Stanford University, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Yun Li, M. Chandler McLeod, and Steven J. Katz, University of Michigan, School of Public Health; Sarah T. Hawley, University of Michigan, Veterans Administration Center for Clinical Management Research, Ann Arbor Veterans Affairs Health Care System; Reshma Jagsi, University of Michigan, Center for Bioethics and Social Science in Medicine, Ann Arbor, MI; Kevin C. Ward, Emory University, Rollins School of Public Health, Atlanta, GA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY.
Kevin C WardAllison W. Kurian, Stanford University, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Yun Li, M. Chandler McLeod, and Steven J. Katz, University of Michigan, School of Public Health; Sarah T. Hawley, University of Michigan, Veterans Administration Center for Clinical Management Research, Ann Arbor Veterans Affairs Health Care System; Reshma Jagsi, University of Michigan, Center for Bioethics and Social Science in Medicine, Ann Arbor, MI; Kevin C. Ward, Emory University, Rollins School of Public Health, Atlanta, GA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY.
Sarah T HawleyAllison W. Kurian, Stanford University, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Yun Li, M. Chandler McLeod, and Steven J. Katz, University of Michigan, School of Public Health; Sarah T. Hawley, University of Michigan, Veterans Administration Center for Clinical Management Research, Ann Arbor Veterans Affairs Health Care System; Reshma Jagsi, University of Michigan, Center for Bioethics and Social Science in Medicine, Ann Arbor, MI; Kevin C. Ward, Emory University, Rollins School of Public Health, Atlanta, GA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY.
Monica MorrowAllison W. Kurian, Stanford University, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Yun Li, M. Chandler McLeod, and Steven J. Katz, University of Michigan, School of Public Health; Sarah T. Hawley, University of Michigan, Veterans Administration Center for Clinical Management Research, Ann Arbor Veterans Affairs Health Care System; Reshma Jagsi, University of Michigan, Center for Bioethics and Social Science in Medicine, Ann Arbor, MI; Kevin C. Ward, Emory University, Rollins School of Public Health, Atlanta, GA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY.
M Chandler McLeodAllison W. Kurian, Stanford University, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Yun Li, M. Chandler McLeod, and Steven J. Katz, University of Michigan, School of Public Health; Sarah T. Hawley, University of Michigan, Veterans Administration Center for Clinical Management Research, Ann Arbor Veterans Affairs Health Care System; Reshma Jagsi, University of Michigan, Center for Bioethics and Social Science in Medicine, Ann Arbor, MI; Kevin C. Ward, Emory University, Rollins School of Public Health, Atlanta, GA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY.
Reshma JagsiAllison W. Kurian, Stanford University, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Yun Li, M. Chandler McLeod, and Steven J. Katz, University of Michigan, School of Public Health; Sarah T. Hawley, University of Michigan, Veterans Administration Center for Clinical Management Research, Ann Arbor Veterans Affairs Health Care System; Reshma Jagsi, University of Michigan, Center for Bioethics and Social Science in Medicine, Ann Arbor, MI; Kevin C. Ward, Emory University, Rollins School of Public Health, Atlanta, GA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY.
Steven J KatzAllison W. Kurian, Stanford University, Stanford; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Yun Li, M. Chandler McLeod, and Steven J. Katz, University of Michigan, School of Public Health; Sarah T. Hawley, University of Michigan, Veterans Administration Center for Clinical Management Research, Ann Arbor Veterans Affairs Health Care System; Reshma Jagsi, University of Michigan, Center for Bioethics and Social Science in Medicine, Ann Arbor, MI; Kevin C. Ward, Emory University, Rollins School of Public Health, Atlanta, GA; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY.

Funding

XenograftP30CA046592 · NCI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI THEODORE S LAWRENCE · 1988 to 2026
$178.2M
CALIFORNIA COORDINATED CANCER PREVENTION & CONTROL PROGRAMU58DP003862 · DP · CALIFORNIA STATE DEPT OF PUBLIC HEALTH · PI SNIPES, KURT P · 2012 to 2014
$31.5M
GEORGIA COMPREHENSIVE CANCER CONTROL PROGRAMU58DP003875 · DP · GEORGIA DIVISION OF PUBLIC HEALTH · PI O'CONNOR, JEAN CATHERINE · 2012 to 2014
$15.9M
The Challenge of Individualizing Treatments for Patients with Breast CancerP01CA163233 · NCI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI HOFER, TIMOTHY P. · 2012 to 2016
$13.4M
Impact of Affect Reactivity and Regulation on Breast Cancer Treatment DecisionsU01CA197282 · NCI · STANFORD UNIVERSITY · PI GROSS, JAMES J, SPIEGEL, DAVID · 2015 to 2019
$3.1M
CCR NIH HHS HHSN261201300015CNCCDPHP CDC HHS U58 DP003862NCCDPHP CDC HHS U58 DP003875NCI NIH HHS HHSN261201000034CNCI NIH HHS HHSN261201000035CNCI NIH HHS HHSN261201000035INCI NIH HHS HHSN261201000140CNCI NIH HHS P01 CA163233NCI NIH HHS P30 CA046592NCI NIH HHS U01 CA197282
6 · The paper itself

Abstract

Purpose Genetic testing for breast cancer risk is evolving rapidly, with growing use of multiple-gene panels that can yield uncertain results. However, little is known about the context of such testing or its impact on treatment. Methods A population-based sample of patients with breast cancer diagnosed in 2014 to 2015 and identified by two SEER registries (Georgia and Los Angeles) were surveyed about genetic testing experiences (N = 3,672; response rate, 68%). Responses were merged with SEER data. A patient subgroup at higher pretest risk of pathogenic mutation carriage was defined according to genetic testing guidelines. Patients' attending surgeons were surveyed about genetic testing and results management. We examined patterns and correlates of genetic counseling and testing and the impact of results on bilateral mastectomy (BLM) use. Results Six hundred sixty-six patients reported genetic testing. Although two thirds of patients were tested before surgical treatment, patients without private insurance more often experienced delays. Approximately half of patients (57% at higher pretest risk, 42% at average risk) discussed results with a genetic counselor. Patients with pathogenic mutations in BRCA1/2 or another gene had the highest rates of BLM (higher risk, 80%; average risk, 85%); however, BLM was also common among patients with genetic variants of uncertain significance (VUS; higher risk, 43%; average risk, 51%). Surgeons' confidence in discussing testing increased with volume of patients with breast cancer, but many surgeons (higher volume, 24%; lower volume, 50%) managed patients with BRCA1/2 VUS the same as patients with BRCA1/2 pathogenic mutations. Conclusion Many patients with breast cancer are tested without ever seeing a genetic counselor. Half of average-risk patients with VUS undergo BLM, suggesting a limited understanding of results that some surgeons share. These findings emphasize the need to address challenges in personalized communication about genetic testing.

Indexed as

Clinical Decision-MakingGenetic TestingGerm-Line MutationAttitude of Health PersonnelBreast NeoplasmsCommunicationFemaleGenes, BRCA1Genes, BRCA2Genetic CounselingGeorgiaHumansInsurance, HealthLos AngelesMedical OncologyMiddle Aged

Identifiers

PMID28402748
PMCPMC5501363

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.