Management of breast cancer patients with BRCA gene mutations in Jordan: perspectives and challenges

ABSTRACT

Background

This paper explores and discusses local challenges oncologists face for diagnosing and managing breast cancer patients with BRCA gene mutations in Jordan.

Methods

A task force involving key opinion leaders, experts in the management of breast cancer, and stakeholders in healthcare systems where genetic testing is available in Jordan discussed current evidence and local real-life practice. The task force then formulated recommendations to achieve better patient outcomes and satisfaction based on evidence-based medicine and their clinical experience in BRCA-mutated breast cancer management.

Results and conclusion

Eligibility of patients for genetic testing, physician acceptance and willingness to integrate genetic testing into routine practice is encouraging but remains restricted by testing availability and financial coverage. Until more data is available, genetic testing should be targeted for breast cancer patients based on tumor subtypes, as well as family and personal history of cancer, as per international guidelines. Whenever possible, genetic testing should aim to detect all actionable genes through a multigene panel including BRCA1/2. Major challenges faced in clinical practice in Jordan include fear of genetic discrimination and social stigmatization, as well as hesitancy toward risk-reducing surgery. Pre-testing counseling is therefore critical to promote acceptance of genetic testing. Since geneticists are in short supply in Jordan, genetic counseling can be offered through a specially trained genetic counselor or through a hybrid system that includes oncologist-based counselling. In addition to cancer prevention, germline genetic testing may assist in the selection of specific anti-cancer therapy, such as PARP inhibitors, in patients with BRCA1/2 mutation. Nationwide initiatives are also needed to ensure access to PARP inhibition therapy and provide financial coverage for genetic screening, mastectomies and reconstructive surgery across Jordan.

KEYWORDS:

• Breast cancer
• HER2-negative
• germline BRCA mutation
• BRCA1
• BRCA2
• genetic testing

Declaration of financial/other relationships

H Abdel-Razeq has received an institutional research grant from Pfizer. S Abbasi has given lectures for Pfizer, Roche and MSD. H Abduelah has given lectures for Novartis, Pfizer, Roche and Hikma; and has participated in clinical studies sponsored by Hikma. S Al-Masri and J Debs are paid employees at Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Medical writing and editorial support of the manuscript was provided by Nancy Al Akkary (MSc, BSc) and Racha Aaraj, Pharm D, MSc, MPH from Phoenix Clinical Research and was funded by Pfizer.

Author contributions

The primary author was responsible for the concept of the paper and led the project. All authors have written parts of and have reviewed the whole manuscript.

Additional information

Funding

This paper was funded by Pfizer. The authors retained the editorial process, including the discussion at all times. There was no financial reward associated with writing the paper. Phoenix Clinical Research provided editorial and medical writing assistance for the preparation of this manuscript based on the Good Publication Practice (GPP3) and the ICMJE requirements and was funder by Pfizer. The views and opinions expressed are those of the authors. Pfizer has had no influence over the content other than a review of the paper for medical accuracy.