# Germline testing in patients with breast cancer: ASCO-Society of Surgical Oncology guideline

Source: https://onco.cc/key-papers/paper-bedrosian-asco-sso-germline-testing-breast-jco-2024/  
OnCo record `paper-bedrosian-asco-sso-germline-testing-breast-jco-2024` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2024 American guideline says every woman diagnosed with breast cancer at 65 or under should be offered BRCA1/2 testing, as should anyone who might be treated with a PARP inhibitor, whatever her family history.

## Summary

An ASCO-SSO panel developed recommendations from a systematic review (47 articles on testing, 18 on counselling) and formal consensus. BRCA1/2 testing should be offered to all newly diagnosed patients at 65 or under and to selected older patients based on personal or family history, ancestry or PARP inhibitor eligibility; to all patients with recurrent breast cancer who are PARP inhibitor candidates regardless of family history; to women with a second primary in either breast; and to previously treated patients diagnosed at 65 or under. Testing beyond BRCA1/2 for high-penetrance genes should follow supportive family history, and moderate-penetrance testing may be offered to inform risk. Variants of uncertain significance should not change management.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Journal: Journal of Clinical Oncology
- Year: 2024
- DOI: 10.1200/JCO.23.02225
- Authors: Bedrosian I, Somerfield MR, Achatz MI, et al.
- Findings: BRCA1/2 testing for all patients diagnosed at 65 or under, and for any PARP inhibitor candidate.; Testing for a second primary breast cancer and for previously treated patients diagnosed at 65 or under.; Variants of uncertain significance should not alter management.
- What it means: For TNBC, which is diagnosed young and is the PARP inhibitor-eligible subtype, the guideline makes germline testing part of the diagnostic workup rather than a referral decision.
- Caveats: United States guideline; NHS eligibility runs through the National Genomic Test Directory R208 criteria.; Population testing beyond age 65 was not endorsed.

## Sources

- Bedrosian et al., J Clin Oncol 2024: ASCO-SSO guideline on germline testing in breast cancer: https://doi.org/10.1200/JCO.23.02225
- PubMed: https://pubmed.ncbi.nlm.nih.gov/38175972/
- ASCO breast cancer guidelines: https://ascopubs.org/topics/asco-guidelines/breast-cancer

## Connected records

- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- technologies: [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/)
- targets: [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/)
- drugs: [Olaparib](https://onco.cc/drugs/olaparib/), [Talazoparib](https://onco.cc/drugs/talazoparib/)
- terms: [Germline BRCA mutation (gBRCA)](https://onco.cc/terms/gbrca-mutation/), [Germline vs somatic mutations](https://onco.cc/terms/germline-vs-somatic/), [Variant of uncertain significance (VUS)](https://onco.cc/terms/vus/)
- people: [Giuseppe Curigliano](https://onco.cc/people/giuseppe-curigliano/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)
- biomarkers: [Germline BRCA1/2 pathogenic variant (gBRCAm)](https://onco.cc/biomarkers/brca-germline/)

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