{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T02:02:05Z","timestamp":1784512925456,"version":"3.55.0"},"reference-count":46,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Over recent decades, germline genetic testing has become increasingly integrated into breast cancer care, yet its precise effect on the timing of surgical workflows remains incompletely defined. This study investigates the implementation of nationally reimbursed genetic testing programs and examines how the scheduling of multigene germline testing relates to surgical timing. Materials and Methods: In this retrospective cohort analysis, we examined 502 breast cancer cases from the institutional registry of the \u201cIon Chiricu\u021b\u0103\u201d Oncology Institute (IOCN), with a mean age of 52 years, a high rate of neoadjuvant therapy (82.3%) and a majority of them in T2 (52%) and N1 (43%), N2 (29%) clinical stage: 263 patients from an earlier private-practice pay testing era (pre-reimbursement) as a comparison sample and 239 patients from the period when reimbursement programs were in operation. We then evaluated the benefits of state-funded genetic testing initiatives, computing three intervals: diagnosis to genetic test, genetic test to surgery, and diagnosis to surgery. Patients were categorized by timing of multigene testing (preoperative vs. postoperative), receipt of neoadjuvant systemic therapy (NACT), mutation status, and funding source for testing (national PNS program funded by the Romanian Ministry of Health; PNRR European Recovery and Resilience Facility funds; or self-funded private testing). Nonparametric statistics (Mann\u2013Whitney U, Spearman correlation) and effect-size metrics (Cliff\u2019s delta, Theil\u2013Sen slope) were employed. Results: The median diagnosis-to-surgery interval was 203 days (IQR 179\u2013230). Patients tested preoperatively had longer intervals than those tested postoperatively (216 vs. 182.5 days; p = 0.000153; Cliff\u2019s \u03b4 = \u22120.486), a pattern driven by shared pathways involving NACT rather than by testing-induced delays. NACT was the principal determinant of surgical timing (211 vs. 43 days; p = 302.55 \u00d7 10\u221211). Within the preoperative subgroup, time to multigene testing correlated strongly with time to surgery (Spearman \u03c1 = 0.54; p = 4.75 \u00d7 10\u22127; Theil\u2013Sen slope = 0.37, 95% CI = 0.22\u20130.53). However, the no-NACT group included only four patients. The presence of a pathogenic variant did not significantly change surgical timing (p = 0.982). The PNS national reimbursement program achieved the highest preoperative integration rate for multigene genetic testing after adjustment for NACT confounder (76.7%), outperforming PNRR (61%) and private practice (56%). Conclusions: While genetic testing timing correlates with surgical workflow, neoadjuvant systemic therapy pathways and program structure exert greater influence than testing per se. Structured national programs enhance preoperative testing uptake without causing delays beyond those inherent to NACT pathways.<\/jats:p>","DOI":"10.3390\/medicina62071397","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:47:32Z","timestamp":1784508452000},"page":"1397","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Germline Genetic Testing and Surgical Timing in Breast Cancer: Implementation of National Reimbursement Programs: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"62","author":[{"given":"Ioan-Catalin","family":"Vlad","sequence":"first","affiliation":[{"name":"Department of Oncology, University of Medicine and Pharmacy \u201cIuliu Ha\u021bieganu\u201d, 400347 Cluj-Napoca, Romania"},{"name":"Department of Surgical Oncology, The Oncology Institute \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin-Iulian","family":"Vlad","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The Oncology Institute \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0253-7103","authenticated-orcid":false,"given":"Ovidiu","family":"Balacescu","sequence":"additional","affiliation":[{"name":"Department of Genetics, Genomics and Experimental Pathology, The Oncology Institute \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7373-6877","authenticated-orcid":false,"given":"Vlad-Alexandru","family":"Gata","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Medicine and Pharmacy \u201cIuliu Ha\u021bieganu\u201d, 400347 Cluj-Napoca, Romania"},{"name":"Department of Surgical Oncology, The Oncology Institute \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragos-Stefan","family":"Morariu","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The Oncology Institute \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Miclaus","sequence":"additional","affiliation":[{"name":"Department of Oncogenetics, The Oncology Institute \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8057-9168","authenticated-orcid":false,"given":"Ana Lucia","family":"Muntean","sequence":"additional","affiliation":[{"name":"Department of Medical Education, University of Medicine and Pharmacy \u201cIuliu Ha\u021bieganu\u201d, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9340-348X","authenticated-orcid":false,"given":"Andreea","family":"Catana","sequence":"additional","affiliation":[{"name":"Department of Oncogenetics, The Oncology Institute \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d, 400015 Cluj-Napoca, Romania"},{"name":"Department of Molecular Sciences, University of Medicine and Pharmacy \u201cIuliu Ha\u021bieganu\u201d, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7497-5578","authenticated-orcid":false,"given":"Nicoleta","family":"Antone","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, The Oncology Institute \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9928-5883","authenticated-orcid":false,"given":"Patriciu","family":"Achimas-Cadariu","sequence":"additional","affiliation":[{"name":"Department of Oncology, University of Medicine and Pharmacy \u201cIuliu Ha\u021bieganu\u201d, 400347 Cluj-Napoca, Romania"},{"name":"Department of Surgical Oncology, The Oncology Institute \u201cProf. Dr. Ion Chiricu\u021b\u0103\u201d, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.annonc.2023.11.016","article-title":"Early Breast Cancer: ESMO Clinical Practice Guideline for Diagnosis, Treatment and Follow-Up","volume":"35","author":"Loibl","year":"2024","journal-title":"Ann. 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