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

Autor:	Abdel-Razeq H; Deputy Director General, Chief Medical Officer, King Hussein Cancer Center, Amman, Jordan., Abbasi S; Hematology and Medical Oncology; Associate Professor of Medicine, Hematology & Oncology, Private Sector, Jordan University, Amman, Jordan., Abdeen G; Consultant Internal Medicine and Medical Oncologist, King Hussein Cancer Center, Amman, Jordan., Abdulelah H; Consultant Internal Medicine and Medical Oncologist, King Hussein Cancer Center, Amman, Jordan., Debs J; Medical Affairs, Pfizer Inc., Beirut, Lebanon., Al Masri S; Medical Affairs, Pfizer Inc., Beirut, Lebanon., Aljadayeh MH; Head of Medical Oncology, Hematology and Stem Cell Transplant Unit, Military Cancer Center, Royal Medical Services, Amman, Jordan., Awidi A; Professor of Medicine, Hematology & Oncology, Director of cell therapy center, Chief of Hematology & Oncology, Cell Therapy center, The University of Jordan, Amman, Jordan.
Jazyk:	angličtina
Zdroj:	Hospital practice (1995) [Hosp Pract (1995)] 2023 Oct; Vol. 51 (4), pp. 184-191. Date of Electronic Publication: 2023 Nov 16.
DOI:	10.1080/21548331.2023.2266019
Abstrakt:	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.
Databáze:	MEDLINE
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