Abstract PS3-03-03: Evaluating the recommendations of community-based surgeons for germline genetic testing in patients with newly diagnosed localized breast cancer

Abstract BACKGROUND: Germline genetic testing has important implications for both the patient with breast cancer and family members. The first physician with the opportunity to consider this option is usually the surgeon. Current practice guidelines commonly consulted on this issue from the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN) and the American Society of Breast Surgeons (ASBrS) provide differing recommendations regarding which patients should be tested. We sought to determine how age, ER/PR and HER2 status and other variables factor into surgeons’ recommendations for testing. METHODS: From February to March 2025, 50 US-based surgeons in community practice were recruited to complete a survey designed to identify clinical situations when germline genetic testing is recommended. For each case-based question, a number of factors (age, ER/PR and HER2 status, family history, gender) were varied. Ten surgeons at academic centers were also recruited to complete the survey. A modest honorarium was provided. RESULTS: For a 30-year-old patient without a family history (all 3 guidelines recommend testing), almost all respondents recommend testing regardless of ER/PR/HER2 status (Table). For a similar 55-year-old patient, almost all participants recommended testing in patients with TNBC (as is consistent with guidelines), but less than half would test patients with ER/PR-positive tumors regardless of HER2 status (testing recommended by ASCO and ASBrS and a consideration per NCCN). For a 70-year-old patient (only ASBrS recommending testing), again almost all respondents recommended testing for patients with TNBC, but far fewer respondents would test patients with ER/PR-positive tumors regardless of HER2 status. There was also agreement that all men with localized breast cancer should be tested. Interestingly, the responses from the community-based cohort largely aligned with those of their academic counterparts. CONCLUSION: The findings from this survey demonstrate that whether a patient with newly diagnosed localized breast cancer receives a recommendation for germline genetic testing depends largely on the practice pattern of the surgeon initially managing the case as many do not initiate testing for patients 55 years and older with ER/PR-positive tumors. While other physicians, including medical oncologists, may seek out this information at a later time as they weigh adjuvant therapy options, it is important to consider that the main downside of genetic testing is financial. Given the important implications for family members and the overall survival benefit associated with olaparib in the OlympiA trial, perhaps in the future genetic testing will join ER and HER2 assessment as a standard for all patients with localized disease. Citation Format: N. Love, K. S. Hughes, M. Robson, G. Kelly, T. Wallace, T. Cruse, K. Miller, K. A. Ziel, K. H. Pang, D. Paley. Evaluating the recommendations of community-based surgeons for germline genetic testing in patients with newly diagnosed localized breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-03-03.