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Managing Breast Cancer in the Era of Genetic Testing

Guests: David R. Byrd, MD, professor of surgery, section chief of surgical oncology at the University of Washington; Rebecca Nagy, MS, CGC, president of the National Society of Genetic Counselors and clinical assistant professor of internal medicine at Ohio State University; and Lance Stell, PhD, Samuel E. and Mary West Thatcher Professor of Philosophy and director of medical humanities at Davidson College.

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Breast cancer treatment has evolved in recent decades into an increasingly multidisciplinary approach. Among the surgeons, medical oncologists, radiation oncologists, and others regularly involved in treatment, genetic counselors have more recently begun to play an important role for breast cancer patients with genetic abnormalities and in testing those who may have such genetic susceptibilities.

In this episode of The Recovery Room, host Dr. Rick Greene explores questions of mastectomy vs. lumpectomy, informed consent, and other issues related to breast cancer and genetic testing with his panel of experts consisting of David R. Byrd, MD, Rebecca Nagy, MS, CGC, and Lance Stell, PhD. The panelists  explore the surgical, ethical, and counseling aspects of genetic testing in breast cancer treatment.

“Even if they don’t have a family history, if a woman is under 45 at diagnosis, that’s a red flag…we also look at woman who have triple negative breast cancer…that’s a trigger for us as well,” said Ms. Nagy about the types of patients who are candidates for genetic testing.

Dr. Byrd noted that genetic counseling is intended to have a discussion about risk to determine whether genetic testing is appropriate for the patient. “Genetic counseling vs. genetic testing are two important but different terms,” he said.


Dr. Byrd is a professor of surgery, section chief of surgical oncology at the University of Washington in Seattle, Wash. He is also the director of the Pancreatic Cancer Specialty Clinic. He received his medical and Master of Science degrees from Tulane University and was the surgeon who first brought the sentinel lymph node biopsy technique to the northwestern United States.

Ms. Nagy is the current president of the National Society for Genetic Counselors and is a clinical assistant professor of internal medicine at the Wexner Medical Center at Ohio State University (OSU) in Columbus, Ohio. She is a member of the Thyroid Cancer Unit at OSU and is a member of the NCI PDQ Cancer Genetics Editorial Board.

Dr. Stell is the Samuel E. and Mary West Thatcher Professor of Philosophy and director of medical humanities at Davidson College. He received his PhD and Master of Arts degrees from the University of Michigan in Ann Arbor, Mich. He is also a Fellow and Diplomate of the American College of Forensic Examiners.