Hot Topic: Should all Women with Breast Cancer Undergo Genetic Testing?

Purpose of Review: Panel testing for germline mutations in cancer patients has advanced rapidly in recent years. In breast cancer, these advances have raised questions about the indications for testing, with some groups advocating testing of all patients with breast cancer. Recent Findings: Studies uniformly demonstrate that expanded scope of genetic testing will result in identification of more women with germline mutations. However, many challenges remain in interpretation of such broad panel testing, including limited information about the risks of second cancers conferred by most of these germline mutations and the high rates of VUS that risk causing anxiety and driving decisions towards unwarranted CPM. These challenges limit the utility of panel testing and are further compounded by lack of sufficient genetic counseling support to facilitate discussion with patients around these complex issues. Summary: For most women, the benefits of broad panel testing are limited. A tailored approach to genetic testing, based on detailed family history and tumor phenotype, remains the preferred approach.