A patient diagnosed with metastatic, poorly differentiated, stage IIIB invasive ductal, triple-negative breast cancer was not given pre- or post-test genetic counseling before undergoing genetic testing. After seeing another surgeon for bilateral mastectomy, the patient was sent to a genetic counselor by her medical oncologist. However, she was unable to obtain her genetic test results from the first surgeon who conducted the test. After making several unsuccessful attempts to get her report, the patient consulted a genetic counselor for a second time, and the counselor was able to procure the results. The report indicated that the patient had a BRCA1 pathogenic variant that would have allowed her to be eligible for targeted treatment with PARP inhibitors. The pathogenic BRCA1 variant was also associated with increased risk for ovarian and other cancers. By withholding the results due to a billing dispute, the physician potentially delayed the patient’s access to precision medicine and other family members’ testing and screening.
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