Impact of updated NCCN guidelines on clinical management and risk communication for CHEK2 p.I157T carriers in breast cancer.

Abstract

In 2023, the National Comprehensive Cancer Network^® (NCCN^®) updated its guidelines for managing breast cancer risk in patients with a CHEK2 p.I157T variant, recommending de-escalation of enhanced screening based on this variant alone. This shift reflects evidence that some missense variants carry a lower cancer risk than CHEK2 loss-of-function variants. A reduced cancer risk is particularly well established for the CHEK2 p.I157T variant, prompting the updated guidelines. This study examines healthcare providers' understanding of these updated guidelines and explores how providers communicate these changes to patients affected by hereditary cancer risks. We conducted a survey targeting healthcare providers involved in hereditary cancer management, capturing their perceptions of the clinical implications of CHEK2 p.I157T and the approaches used to communicate de-escalated management recommendations. Additionally, a retrospective records review was performed to approximate the percentage of patients impacted by these de-escalation recommendations. This research aims to evaluate factors shaping provider recommendations and communication following guideline changes in hereditary cancer care. Results may inform best practice considerations for patient-provider communication in hereditary cancer care, particularly when new evidence leads to modified screening or management recommendations.