Expanding Germline Genetic Testing in Breast Cancer: Universal versus ASCO-Guided Approaches

A notable fraction of breast cancer occurrences stems from hereditary pathogenic mutations. Germline genetic testing (GGT), especially focused on BRCA1 and BRCA2, is an indispensable component of precision oncology, enabling tailored risk classification and the formulation of individualized treatment plans. Within this report, we investigate the practicality of performing blanket testing on all freshly diagnosed breast cancer patients, without regard for age, personal or familial cancer background, in a setting marked by resource constraints. Consecutive patients newly presenting with breast cancer who satisfied the criteria for GGT under the most current American Society of Clinical Oncology (ASCO) recommendations were included. Across the study timeframe, 1,570 individuals were recruited, with a median age of 51 (range 22-96) years, of whom 1,352 (86.1%) were of Jordanian nationality. According to age-related benchmarks, 1,346 (85.7%) patients qualified for testing. A further 134 (8.5%) were deemed eligible owing to other indications, such as a personal or familial background of breast and other malignancies (n = 121, 7.7%), triple-negative pathology (n = 9, 0.57%), and male sex (n = 4, 0.25%). Cumulatively, 1,480 (94.3%) patients met the GGT eligibility requirements set by ASCO recommendations, resulting in merely 90 (5.7%) patients who were not candidates. Pathogenic or likely pathogenic alterations were uncovered in 23 (7.8%) patients. Adopting a universal GGT policy for every newly diagnosed breast cancer case, without consideration of age or risk determinants, would marginally broaden the pool of qualifying patients. This added load is warranted by its potential to boost referral completion rates.