Treatment

Document Overview

Design and created by Guideline Central in participation with the American Society of Clinical Oncology and Society of Surgical Oncology.

Germline Testing in Patients with Breast Cancer

American Society of Clinical Oncology

Society of Surgical Oncology

Publication Date: Jan 3, 2024

Page Last Updated: May 5, 2026

Grading Table

Recommendation Grading

Type		Benefit/harm		Evidence Quality		Strength of Recommendation
EB	Evidence-based	B	Benefits outweigh harms	H	High	Strong
CB/ FC	Consensus-based/ Formal Consensus	H	Harms outweigh benefits	M	Moderate	Moderate
IC	Informal consensus	B / H	Relative balance of benefits and harms	I	Intermediate	Weak
		U	Benefits/harms ratio uncertain	L	Low
				VL	Very Low
				Ins	Insufficient

Recommendation Rating Definitions

Quality of Evidence

Term	Definitions
H = High	We are very confident that the true effect lies close to that of the estimate of the effect
M = Moderate	We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
L = Low	Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
VL = Very low	We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

Strength of Recommendation

Term	Definitions
S = Strong	In recommendations for an intervention, the desirable effects of an intervention outweigh its undesirable effects. In recommendations against an intervention, the undesirable effects of an intervention outweigh its desirable effects. All or almost all informed people would make the recommended choice for or against an intervention.
C = Conditional/ W = Weak	In recommendations for an intervention, the desirable effects probably outweigh the undesirable effects, but appreciable uncertainty exists. In recommendations against an intervention, the undesirable effects probably outweigh the desirable effects, but appreciable uncertainty exists. Most informed people would choose the recommended course of action, but a substantial number would not.

Brozek JL, Akl EA, Compalati E, et al: Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. The GRADE approach to developing recommendations. Allergy 66:588-95, 2011

Document Overview

Document Title: Germline Testing in Patients with Breast Cancer

Authoring Societies

American Society of Clinical Oncology

Society of Surgical Oncology

Document Publication Date: Jan 3, 2024

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: ascopubs.org/doi/10.1200/JCO.23.02225

Source Citation: Bedrosian I, et al. Germline Testing in Patients with Breast Cancer: ASCO-SSO Guideline. J Clin Oncol. 2024 Jan 04. doi: 10.1200/JCO.23.02225

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: To develop recommendations for germline mutation testing for patients with breast cancer.

Scope: Counseling, Treatment

Diseases/Conditions (MeSH)

D001943 - Breast Neoplasms

D005817 - Genetic Counseling

D006580 - Genetic Carrier Screening

D005816 - Genetic Complementation Test

D005819 - Genetic Markers

D020022 - Genetic Predisposition to Disease

D001943 - Breast Neoplasms

D005817 - Genetic Counseling

D006580 - Genetic Carrier Screening

D005816 - Genetic Complementation Test

D005819 - Genetic Markers

D020022 - Genetic Predisposition to Disease

Keywords: BRCA 1/2 testing, BRCA1, BRCA2, Germline Testing, breast cancer

Target Patient Population: Patients with breast cancer

Target Provider Population: Oncologists, surgeons, medical geneticists, and genetic counselors.

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory, Outpatient

Intended Users: Genetics, Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

Which patients with breast cancer should have germline genetic testing for pathogenic variants in cancer susceptibility genes?
Should clinicians offer BRCA1/2 testing to all patients with newly diagnosed breast cancer?
Should all people with recurrent disease, local or metastatic, or with second breast primary, be offered BRCA1/2 testing?
Should people with a personal history of breast cancer (and no active disease) be offered BRCA1/2 testing?
What is the value of testing patients with a diagnosis of breast cancer for breast cancer predisposition genes other than BRCA1/2?
How should patients with breast cancer considering genetic testing be counseled?

Supplemental Methodology Resource: Data Supplement

Number of Source Documents: 102

Literature Search Start Date: Wednesday, September 19, 2012

Literature Search End Date: Wednesday, January 11, 2023

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No

Germline Testing in Patients with Breast Cancer

Treatment

Recommendation 1.1

Recommendation 1.2

Recommendation 1.3

Recommendation 2.1

Recommendation 2.2

Recommendation 3.1

Recommendation 3.2

Recommendation 4.1

Recommendation 4.2

Recommendation 4.3

Recommendation 5.1

Recommendation 5.2

Recommendation 5.3

Recommendation 5.4

Grading Table

Recommendation Grading

Recommendation Rating Definitions

Quality of Evidence

Strength of Recommendation

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology