Family history.

It’s a thing of the past. Relying on complicated family medical trees to decipher who should and shouldn’t be tested for BRCA-mutations has led to some serious undertesting of people at risk. This is due to a couple of reasons: (1) it’s complicated, and (2) patients don’t know their family medical trees. The UK Mainstreaming Cancer Genetics (MCG) Programme was developed to bring simplified BRCA-testing criteria into the mainstream, including only an individual’s cancer history. These five criteria were prospectively validated in a UK cancer population with a goal BRCA-mutation detection rate of at least 10%, a threshold most cost-effective policies embrace. For patients meeting criteria,BRCA-mutation testing was streamlined such that it was automatically approved based on criteria alone with no middle man appointments. Among nearly 1200 patients tested, 117 (9.9%) were found to have BRCA-mutations and 115 of those (98%) showed up for subsequent genetic counseling. TBL: Five simple cancer criteria can be used to identify patients with 10% risk of harboring aBRCA-mutation, making way for a streamlined and cost-effective testing approach with no middle man. | Kemp, JAMA Netw Open 2019