BRCA testing delay during the COVID-19 pandemic: How to act?
Angelo Minucci1, Giovanni Scambia2,3, Maria De Bonis4
1Molecular and Genomic Diagnostics Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. angelo.minucci@policlinicogemelli.it.
Insights
The COVID-19 pandemic significantly reduced germline BRCA1/2 (gBRCA) testing, with no recovery post-lockdown. This delay impacts cancer patient management and questions the future of oncogenetic testing.
Area of Science:
- Oncology
- Genetics
- Epidemiology
Background:
- The COVID-19 pandemic caused widespread disruption to healthcare services globally.
- Germline BRCA1/2 (gBRCA) testing is crucial for managing hereditary cancers, including ovarian, breast, pancreas, and prostate cancers.
- Initial reports indicated a significant drop in gBRCA testing during the early COVID-19 lockdown in Italy.
Purpose of the Study:
- To evaluate the ongoing impact of the COVID-19 pandemic on gBRCA testing rates.
- To analyze gBRCA testing trends post-lockdown and compare them with pre-pandemic years.
- To assess the long-term implications of pandemic-related testing delays on cancer patient care.
Main Methods:
- Retrospective analysis of gBRCA testing data from a referral center in Italy.
- Comparison of testing volumes during lockdown (March-April 2020) and post-lockdown (May-October 2020).
- Trend analysis of annual gBRCA testing data from 2017 to 2020.
Main Results:
- gBRCA testing rates did not significantly increase after the initial lockdown period.
- Testing volumes in May-October 2020 remained low, similar to the lockdown phase.
- Overall gBRCA testing in 2020 (January-October) showed a significant decline compared to previous years, mirroring 2017 trends.
- The pandemic has caused a notable delay in oncogenetic testing for both cancer patients and healthy individuals.
Conclusions:
- The COVID-19 pandemic has severely impacted gBRCA testing, leading to significant delays in diagnosis and management.
- The observed trends question the sustainability of advancements in hereditary cancer management.
- Urgent measures are needed to ensure the continuity of oncogenetic testing services and integrate them into new diagnostic and clinical strategies.
Abstract:
Recently, our lab, part of a referral center in Italy, reported its experience regarding the execution of germline BRCA1/2 (gBRCA) testing during the first months of the coronavirus disease-2019 (COVID-19) pandemic, which highlights a substantial reduction (about 60%) compared with the first 2 months of the current year. This evidence appeared to be a lockdown effect due to extraordinary restriction measures to slow down the spread of SARS-CoV-2. In this study, we aimed to evaluate the overall effects of the ongoing pandemic on gBRCA testing in our institution and to understand how COVID-19 has influenced testing after the complete lockdown (March 8-May 5, 2020). Additionally, we compared this year's trend with trends of the last 3 years to better monitor gBRCA testing progress. This detailed analysis highlights two important findings: (1) gBRCA testing did not increase significantly after the lockdown period (May-October 2020) compared with the lockdown period (March-April 2020), emphasizing that even after the lockdown period testing remained low. (2) Comparing the total tests per year (January-October 2017, 2018, 2019, with 2020), the impact of COVID-19 on gBRCA testing is apparent, with similarities of trends registered in 2017. These evidences reveal a gBRCA testing delay for cancer patients and healthy patients at this moment, and the new era of gBRCA testing in the management of ovarian, breast, pancreas and prostate cancer patients has been seriously questioned due to the COVID-19 pandemic. As consequence, we underline that measures to guarantee oncogenetic testing (e.g., gBRCA testing) along with new diagnostic/clinic strategies are mandatory. For these reasons, several proposals are presented in this study.
