{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:27:17Z","timestamp":1786973237406,"version":"build-2736575974"},"reference-count":21,"publisher":"Harborside Press, LLC","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    The demand for germline genetic testing in oncology is outpacing traditional genetics service capacity. Mainstream genetic testing, where oncologists initiate testing with structured support, may expand access while maintaining quality.\n                    <jats:bold>Patients and Methods:<\/jats:bold>\n                    We performed a retrospective chart review of patients with breast cancer who underwent germline genetic testing at Massachusetts General Hospital from March 2021 to July 2022. Patients were managed via either a traditional model (genetics professional\u2013led) or a genetics supported mainstream model (oncologist-led, with genetic counseling assistant support). Outcomes included test volume, turnaround times, documentation of consent and results disclosure, and follow-up for pathogenic variant (PV) carriers.\n                    <jats:bold>Results:<\/jats:bold>\n                    Among 805 patients (traditional: n=305; mainstream: n=500), the mainstream model significantly shortened the interval from diagnosis to consent (22.4 vs 59.5 days;\n                    <jats:italic>P<\/jats:italic>\n                    &lt;.0001) and from consent to final report (28.2 vs 35.2 days;\n                    <jats:italic>P<\/jats:italic>\n                    =.039). Documentation of informed consent was &gt;99% in both models. However, documentation of final result disclosure was significantly lower in the mainstream model (82.4% vs 100%;\n                    <jats:italic>P<\/jats:italic>\n                    &lt;.0001). All PV carriers were successfully referred to genetic counseling. The mainstream model substantially increased test volume without compromising compliance or follow-up care.\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    A structured mainstream genetic testing model, supported by trained assistants and robust workflows, improves access and test turnaround time for patients with breast cancer while maintaining quality standards, including documentation of consent and test ordering. This study did not evaluate whether surgical decisions were affected; however, timely results may support care planning in select cases. Continued efforts are needed to improve documentation of result disclosure by ordering providers.\n                  <\/jats:p>","DOI":"10.6004\/jnccn.2026.7020","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:16:18Z","timestamp":1783430178000},"source":"Crossref","is-referenced-by-count":0,"title":["Genetics-Supported Mainstream Testing Improves Access and Efficiency for Patients With Breast Cancer"],"prefix":"10.6004","volume":"24","author":[{"given":"Kristen M.","family":"Shannon","sequence":"first","affiliation":[{"name":"Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA"},{"name":"Department of Medicine, Massachusetts General Hospital, Boston, MA"},{"name":"Genetic Counseling Department, MGH Institute for Health Professions, Charlestown, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mackenzie","family":"Wooters","sequence":"additional","affiliation":[{"name":"Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey G.","family":"Fell","sequence":"additional","affiliation":[{"name":"Department of Data Science, Dana-Farber Cancer Institute, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Kelly","sequence":"additional","affiliation":[{"name":"Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devanshi","family":"Patel","sequence":"additional","affiliation":[{"name":"Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor X.","family":"Urban","sequence":"additional","affiliation":[{"name":"Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda M.","family":"Nieters","sequence":"additional","affiliation":[{"name":"Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas S.","family":"Micalizzi","sequence":"additional","affiliation":[{"name":"Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA"},{"name":"Department of Medicine, Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4047","reference":[{"key":"B1","article-title":"NCCN Clinical Practice Guidelines in Oncology: Genetic\/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate. Version 3.2026","author":"Daly MB","unstructured":"Daly MB, Pal T, AlHilli Z,  NCCN Clinical Practice Guidelines in Oncology: Genetic\/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate. Version 3.2026. Accessed May 7, 2026. To view the most recent version, visit https:\/\/www.nccn.org"},{"key":"B2","series-title":"J Clin Oncol","first-page":"1409","article-title":"Evaluation of germline genetic testing criteria in a hospital-based series of women with breast cancer","volume":"38","author":"Yadav S","year":"2020","unstructured":"Yadav S, Hu C, Hart SN,  Evaluation of germline genetic testing criteria in a hospital-based series of women with breast cancer. J Clin Oncol 2020;38:1409\u20131418."},{"key":"B3","series-title":"Curr Oncol","first-page":"7241","article-title":"Workforce implications of increased referrals to hereditary cancer services in Canada: a scenario-based analysis","volume":"30","author":"Dragojlovic N","year":"2023","unstructured":"Dragojlovic N, Borle K, Kopac N,  Workforce implications of increased referrals to hereditary cancer services in Canada: a scenario-based analysis. Curr Oncol 2023;30:7241\u20137251."},{"key":"B4","series-title":"N Engl J Med","first-page":"2091","article-title":"Olaparib for metastatic castration-resistant prostate cancer","volume":"382","author":"deBono J","year":"2020","unstructured":"deBono J, Mateo J, Fizazi K,  Olaparib for metastatic castration-resistant prostate cancer. N Engl J Med 2020;382:2091\u20132102."},{"key":"B5","series-title":"N Engl J Med","first-page":"2394","article-title":"Adjuvant olaparib for patients with BRCA1- or BRCA2- mutated breast cancer","volume":"384","author":"Tutt ANJ","year":"2021","unstructured":"Tutt ANJ, Garber JE, Kaufman G,  Adjuvant olaparib for patients with BRCA1- or BRCA2- mutated breast cancer. N Engl J Med 2021;384:2394\u20132405."},{"key":"B6","series-title":"Br J Nurs","first-page":"690","article-title":"The integration of BRCA testing into oncology clinics","volume":"25","author":"Percival N","year":"2016","unstructured":"Percival N, George A, Gyertson J,  The integration of BRCA testing into oncology clinics. Br J Nurs 2016;25:690\u2013694."},{"key":"B7","series-title":"Sci Rep","first-page":"3390","article-title":"Oncologist-led BRCA \u2018mainstreaming\u2019 in the ovarian cancer clinic: a study of 255 patients and its impact on their management","volume":"10","author":"Rumford M","year":"2020","unstructured":"Rumford M, Lythgoe M, McNeish I,  Oncologist-led BRCA \u2018mainstreaming\u2019 in the ovarian cancer clinic: a study of 255 patients and its impact on their management. Sci Rep 2020;10:3390."},{"key":"B8","series-title":"Sci Rep","first-page":"29506","article-title":"Implementing rapid, robust, cost effective, patient-centered, routine genetic testing in ovarian cancer patients","volume":"6","author":"George A","year":"2016","unstructured":"George A, Riddell D, Seal S,  Implementing rapid, robust, cost effective, patient-centered, routine genetic testing in ovarian cancer patients. Sci Rep 2016;6:29506."},{"key":"B9","series-title":"Hered Cancer Clin Pract","first-page":"33","article-title":"Mainstream genetic testing for women with ovarian cancer provides a solid basis for patients to make a well-informed decision about genetic testing","volume":"20","author":"Bokkers K","year":"2022","unstructured":"Bokkers K, Bleiker EMA, Hoogendam JP,  Mainstream genetic testing for women with ovarian cancer provides a solid basis for patients to make a well-informed decision about genetic testing. Hered Cancer Clin Pract 2022;20:33."},{"key":"B10","series-title":"Cancers (Basel)","first-page":"1059","article-title":"The feasibility of implementing mainstream germline genetic testing in routine cancer care \u2013 a systematic review","volume":"14","author":"Bokkers K","year":"2022","unstructured":"Bokkers K, Vlaming M, Engelhardt EG,  The feasibility of implementing mainstream germline genetic testing in routine cancer care \u2013 a systematic review. Cancers (Basel) 2022;14:1059."},{"key":"B11","series-title":"Fam Cancer","first-page":"295","article-title":"Positive experiences of healthcare professionals with a mainstreaming approach of germline genetic testing for women with ovarian cancer","volume":"21","author":"Bokkers K","year":"2022","unstructured":"Bokkers K, Zweemer RP, Koudijs MJ,  Positive experiences of healthcare professionals with a mainstreaming approach of germline genetic testing for women with ovarian cancer. Fam Cancer 2022;21:295\u2013304."},{"key":"B12","series-title":"Int J Gynecol Cancer","first-page":"221","article-title":"Mainstreamed genetic testing in ovarian cancer: patient experience of the testing process","volume":"30","author":"McLeavy L","year":"2020","unstructured":"McLeavy L, Rahman B, Kristeleit R,  Mainstreamed genetic testing in ovarian cancer: patient experience of the testing process. Int J Gynecol Cancer 2020;30:221\u2013226."},{"key":"B13","series-title":"Molec Bio Reports","first-page":"10023","article-title":"Breast cancer in the era of precision medicine","volume":"49","author":"Sarangi N","year":"2022","unstructured":"Sarangi N, Hajari S, Heydari SF,  Breast cancer in the era of precision medicine. Molec Bio Reports 2022;49:10023\u201310037."},{"key":"B14","series-title":"Pain Res Treat","first-page":"851276","article-title":"Depression and anxiety symptoms relate to distinct components of pain experience among patients with breast cancer","volume":"2012","author":"Galloway SK","year":"2012","unstructured":"Galloway SK, Baker M, Giglio P,  Depression and anxiety symptoms relate to distinct components of pain experience among patients with breast cancer. Pain Res Treat 2012;2012:851276."},{"key":"B15","series-title":"J Clin Oncol","first-page":"2232","article-title":"Gaps in incorporating germline genetic testing into treatment decision-making for early-stage breast cancer","volume":"35","author":"Kurian AW","year":"2017","unstructured":"Kurian AW, Li Y, Hamilton AS,  Gaps in incorporating germline genetic testing into treatment decision-making for early-stage breast cancer. J Clin Oncol 2017;35:2232\u20132239."},{"key":"B16","series-title":"J Genet Couns","first-page":"974","article-title":"The impact of genetic counseling on patient engagement in a specialty cancer clinic","volume":"28","author":"Zakas AL","year":"2019","unstructured":"Zakas AL, Leifeste C, Dudley B,  The impact of genetic counseling on patient engagement in a specialty cancer clinic. J Genet Couns 2019;28:974\u2013981."},{"key":"B17","series-title":"J Pers Med","first-page":"1511","article-title":"Understanding the patient experience of receiving clinically actionable genetic results from the MyCode community health initiative, a population-based genomic screening initiative","volume":"12","author":"Baker A","year":"2022","unstructured":"Baker A, Tolwinski K, Atondo J,  Understanding the patient experience of receiving clinically actionable genetic results from the MyCode community health initiative, a population-based genomic screening initiative. J Pers Med 2022;12:1511."},{"key":"B18","article-title":"Crossing the Quality Chasm: A New Health System for the 21st Century","unstructured":"Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Accessed March 10, 2026. Available at: https:\/\/www.nationalacademies.org\/projects\/HMD-HCS-18-P-114\/publication\/10027"},{"key":"B19","series-title":"Am J Obstet Gynecol","first-page":"276","article-title":"Uptake and patient-related outcomes of mainstreaming genetic testing: a systematic review and meta-analysis","volume":"233","author":"Kalra A","year":"2025","unstructured":"Kalra A, Ganesan S, Sia JJY,  Uptake and patient-related outcomes of mainstreaming genetic testing: a systematic review and meta-analysis. Am J Obstet Gynecol 2025;233:276\u2013291."},{"key":"B20","series-title":"Hered Cancer Clin Pract","first-page":"6","article-title":"\u201cIt was an important part of my treatment\u201d: a qualitative study of Norwegian breast cancer patients\u2019 experiences with mainstreamed genetic testing","volume":"20","author":"Str\u00f8msvik N","year":"2022","unstructured":"Str\u00f8msvik N, Olsson P, Gravdehaug B,  \u201cIt was an important part of my treatment\u201d: a qualitative study of Norwegian breast cancer patients\u2019 experiences with mainstreamed genetic testing. Hered Cancer Clin Pract 2022;20:6."},{"key":"B21","series-title":"Genet Test Mol Biomarkers","first-page":"152","article-title":"Patient-reported outcomes and experiences with population genetic testing offered through a primary care network","volume":"25","author":"Lemke A","year":"2021","unstructured":"Lemke A, Amendola L, Thompson J,  Patient-reported outcomes and experiences with population genetic testing offered through a primary care network. Genet Test Mol Biomarkers 2021;25:152\u2013160."}],"container-title":["Journal of the National Comprehensive Cancer Network"],"original-title":[],"link":[{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/24\/8\/article-e267020.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jnccn.org\/downloadpdf\/journals\/jnccn\/24\/8\/article-e267020.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jnccn.org\/downloadpdf\/journals\/jnccn\/24\/8\/article-e267020.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:55:33Z","timestamp":1786971333000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/24\/8\/article-e267020.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":21,"journal-issue":{"issue":"8"},"URL":"https:\/\/doi.org\/10.6004\/jnccn.2026.7020","relation":{},"ISSN":["1540-1405","1540-1413"],"issn-type":[{"value":"1540-1405","type":"print"},{"value":"1540-1413","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}