{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T22:10:26Z","timestamp":1789596626061,"version":"build-2803163510"},"reference-count":20,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Increasing germline genetic testing rates may impact contralateral prophylactic mastectomy (CPM) rates in patients with newly diagnosed breast cancer.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To quantify the impact of a personalized contralateral breast cancer (CBC) risk counseling tool that incorporates genetic testing results.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This randomized clinical trial recruited participants from a single tertiary referral center between June 8, 2020, and December 31, 2022. Patients aged 18 to 80 years with unilateral breast cancer who underwent genetic counseling and surgery were eligible. Exclusion criteria were prior or metastatic breast cancer or prior multigene panel testing. Follow-up was completed June 30, 2023.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Personalized age-specific CBC risks were estimated based on the presence or absence of pathogenic variants associated with breast cancer and were incorporated into a visual decision support tool. Patients were randomized 1:1 to quantitative counseling via the tool vs standard counseling without personalized CBC risk estimates.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n Co\u2013primary end points included patients\u2019 personal CBC risk knowledge and propensity to undergo CPM, before and after counseling, by randomization arm. The secondary end point was CPM rate. Sample size calculations assumed postcounseling CBC risk self-assessments would be 5% different from baseline (SD, 20%). A total of 199 patients in each arm would achieve 80% power and 5% type I error (based on a 2-sample\n t<\/jats:italic>\n test). Univariate and multivariate analyses were performed for each end point.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 400 patients were randomized (mean [SD] age, 54 [11] years), and 54 were excluded after randomization, leaving 346 patients. Among 341 patients with data available, 21 (6.2%) were Asian or Pacific Islander, 18 (5.3%) were Black, 295 (86.5%) were White, and 7 (2.1%) were of other race; 33 of 330 patients with available data (10.0%) were of Ashkenazi Jewish ancestry. Seventy-five of 346 patients (21.7%) had a first-degree relative with breast cancer. Patients who received quantitative counseling more accurately reported their CBC risk estimates than those who received standard counseling by univariate (coefficient, \u22129.39; 95% CI, \u221214.86 to \u22123.93;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and multivariate (coefficient, \u22129.52; 95% CI, \u221216.50 to \u22122.51;\n P<\/jats:italic>\n \u2009=\u2009.008) analyses. The type of counseling did not significantly impact perception of risk, self-reported propensity to undergo CPM, or CPM rates.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial, patients more accurately described their calculated CBC risk after quantitative counseling. This improved knowledge did not impact decisions to undergo CPM. The CBC risk assessment tool is publicly available and can be used for preoperative discussions.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04245176<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.51553","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T16:00:39Z","timestamp":1768233639000},"page":"e2551553","source":"Crossref","is-referenced-by-count":2,"title":["Genetic Testing for All Breast Cancer Patients"],"prefix":"10.1001","volume":"9","author":[{"given":"Anna","family":"Weiss","sequence":"first","affiliation":[{"name":"Division of Breast Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"now with Division of Surgical Oncology, Department of Surgery, University of Rochester, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Braun","sequence":"additional","affiliation":[{"name":"Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts"},{"name":"Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"Stopfer","sequence":"additional","affiliation":[{"name":"Division of Cancer Genetics and Prevention, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jintong","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts"},{"name":"Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"McGrath","sequence":"additional","affiliation":[{"name":"Division of Breast Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn R.","family":"Bradshaw","sequence":"additional","affiliation":[{"name":"Division of Breast Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Sol","family":"Rosito","sequence":"additional","affiliation":[{"name":"Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts"},{"name":"Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dillon","family":"Davis","sequence":"additional","affiliation":[{"name":"Division of Cancer Genetics and Prevention, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy E.","family":"Garber","sequence":"additional","affiliation":[{"name":"Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Division of Cancer Genetics and Prevention, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"},{"name":"Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tari A.","family":"King","sequence":"additional","affiliation":[{"name":"Division of Breast Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"now with Winship Cancer Institute of Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"issue":"1","key":"zoi251370r1","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1186\/s12885-017-3422-2","article-title":"Current guidelines for BRCA testing of breast cancer patients are insufficient to detect all mutation carriers.","volume":"17","author":"Grindedal","year":"2017","journal-title":"BMC Cancer"},{"issue":"10","key":"zoi251370r2","doi-asserted-by":"crossref","first-page":"2925","DOI":"10.1245\/s10434-018-6621-4","article-title":"Underdiagnosis of hereditary breast and ovarian cancer in Medicare Patients: genetic testing criteria miss the mark.","volume":"25","author":"Yang","year":"2018","journal-title":"Ann Surg Oncol"},{"issue":"6","key":"zoi251370r3","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1200\/JCO.18.01631","article-title":"Underdiagnosis of hereditary breast cancer: are genetic testing guidelines a tool or an obstacle?","volume":"37","author":"Beitsch","year":"2019","journal-title":"J Clin Oncol"},{"issue":"10","key":"zoi251370r4","doi-asserted-by":"crossref","first-page":"3025","DOI":"10.1245\/s10434-019-07549-8","article-title":"Consensus guidelines on genetic\u2019 testing for hereditary breast cancer from the American Society of Breast Surgeons.","volume":"26","author":"Manahan","year":"2019","journal-title":"Ann Surg Oncol"},{"issue":"12","key":"zoi251370r5","doi-asserted-by":"crossref","first-page":"4613","DOI":"10.1245\/s10434-020-08889-6","article-title":"Contralateral risk-reducing mastectomy in breast cancer patients who undergo multigene panel 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exam.","volume":"35","author":"Abittan","year":"2020","journal-title":"J Cancer Educ"},{"key":"zoi251370r14","article-title":"The accuracy of breast cancer risk self-assessment does not correlate with knowledge about breast cancer and knowledge and attitudes towards primary chemoprevention.","volume":"20","author":"Bojanic","year":"2020","journal-title":"Prev Med Rep"},{"issue":"4","key":"zoi251370r15","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1038\/bjc.2013.805","article-title":"Impact of rapid genetic counselling and testing on the decision to undergo immediate or delayed prophylactic mastectomy in newly diagnosed breast cancer patients: findings from a randomised controlled trial.","volume":"110","author":"Wevers","year":"2014","journal-title":"Br J Cancer"},{"issue":"20","key":"zoi251370r16","doi-asserted-by":"crossref","first-page":"2232","DOI":"10.1200\/JCO.2016.71.6480","article-title":"Gaps in Incorporating germline genetic testing into treatment decision-making for early-stage breast cancer.","volume":"35","author":"Kurian","year":"2017","journal-title":"J Clin Oncol"},{"issue":"6","key":"zoi251370r17","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/S1470-2045(25)00152-4","article-title":"Association between risk-reducing surgeries and survival in young BRCA carriers with breast cancer: an international cohort study.","volume":"26","author":"Blondeaux","year":"2025","journal-title":"Lancet Oncol"},{"issue":"23","key":"zoi251370r18","doi-asserted-by":"crossref","first-page":"2402","DOI":"10.1001\/jama.2017.7112","article-title":"Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers.","volume":"317","author":"Kuchenbaecker","year":"2017","journal-title":"JAMA"},{"key":"zoi251370r19","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.breast.2016.11.025","article-title":"Women\u2019s preferences for contralateral prophylactic mastectomy following unilateral 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Accessed July 21, 2023. https:\/\/hereditarycancer.dfci.harvard.edu\/CBCApp\/"},{"key":"zoi251370r11","unstructured":"CBCRisk: contralateral breast cancer (CBC) risk predictor. Accessed January 12, 2019. https:\/\/cbc-predictor-utd.shinyapps.io\/CBCRisk\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2843734\/weiss_2026_oi_251370_1767643164.13969.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T16:00:46Z","timestamp":1768233646000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2843734"}},"subtitle":["The GET FACTS Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.51553","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]}}}