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Implementing National Comprehensive Cancer Network (NCCN) guidelines and electronic health record (EHR) improvements significantly increased homologous recombination deficiency (HRD)/BRCA testing rates in breast cancer patients. This initiative enhanced genetic screening adherence and referrals within community oncology practices.

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Area of Science:

  • Oncology
  • Genetics
  • Healthcare Informatics

Background:

  • Significant nonadherence to genetic screening and testing for breast cancer patients persists despite established guidelines.
  • Only 35% of breast cancer patients eligible for homologous recombination deficiency (HRD)/BRCA testing are referred for genetic counseling.
  • Over 300,000 breast cancer cases are diagnosed annually, with one-third meeting NCCN criteria for genetic testing.

Purpose of the Study:

  • To enhance HRD/BRCA testing rates by applying NCCN guidelines to new breast cancer patients in a community oncology setting.
  • To improve adherence to germline genetic testing protocols for breast cancer patients.
  • To streamline the referral process for genetic counseling and testing.

Main Methods:

  • Utilized Plan-Do-Study-Act methodology to implement NCCN guidelines for germline genetic testing.
  • Integrated provider education and electronic health record (EHR) templates for initial diagnosis and treatment planning.
  • Developed discreet data fields in the EHR to automate and streamline patient screening and referrals.

Main Results:

  • 99% of eligible breast cancer patients (1,200/1,203) were screened according to NCCN guidelines.
  • 52.5% of screened patients (631/1,200) met referral/testing criteria, with 92.7% (585/631) referred to a genetic specialist.
  • 71% of eligible patients (449/631) accepted genetic referral, demonstrating improved engagement.

Conclusions:

  • Provider education, EHR integration, and guideline implementation effectively increased patient screening and genetic referrals.
  • The study demonstrates a successful model for improving adherence to genetic testing in community oncology.
  • Systematic application of guidelines and technological enhancements can overcome barriers to genetic testing in breast cancer care.