New research underscores the high implementation rate and significant impact of universal germline genetic testing (GGT) for breast cancer (BC) in rural medical practices on shared treatment decision-making. The study has significant implications for standardized health care practice, especially in resource-constrained rural communities.

The research team led this study with the objective of bridging knowledge gaps in BC genetic testing implementation in a rural setup. Data collection involved conducting a comprehensive GGT on BC patients from 2019 to 2022 at a small rural community hospital. Demographics, clinical features, and GGT results of patients, along with clinical recommendations from physicians based on GGT results, were collected and analyzed.

Participants were primarily non-Hispanic white females with a mean age of 62 years, with most being diagnosed with stage 1 BC. Interestingly, while 54% of patients met conventional criteria for GGT, a significant percentage of them were out of criteria but were found to have actionable pathogenic germline variants (PGVs).
The study revealed that one in four patients profoundly altered their medical management based on the GGT results, with surgical decisions and surveillance measures shifting significantly for those with PGVs as compared to those without it. Researchers found that even among patients who tested negative, GGT results aided in 53% of breast conserving therapy decisions and in radiation strategy for 54% of patients.

Applying this to the world of medical practice, particularly in rural health systems, the results offer hope and perspective. A universal GGT approach for BC patients, as demonstrated by this study, can bypass conventional categorization restrictions, capturing more people with actionable PGVs and enabling a more individualized and optimized treatment approach. As the authors suggest, this can reduce unnecessary health care resource utilization, offering a more streamlined and effective model of care.

“Universal GGT for patients with BC was successfully implemented in a rural community practice with >90% uptake. . . . Universal GGT for patients with BC is feasible to implement as the standard of practice within rural populations, enabling optimization of clinical care to patients’ genetic profile and may reduce unnecessary healthcare resource utilization,” the authors concluded.

Shelton C, Nielsen S, Ruiz A, et al. Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making. Presented at: the 2023 San Antonio Breast Cancer Symposium; December 5-9, 2023; San Antonio, TX, and virtual; Abstract P01-08-04.