A randomised clinical trial published in JAMA Network Open has found that personalised genetic risk counselling improves patients’ understanding of their individual risk of contralateral breast cancer, but does not significantly influence surgical decision-making, including uptake of contralateral prophylactic mastectomy (CPM).
The study, known as the GET FACTS trial, enrolled 346 women aged 18 to 80 years with newly diagnosed unilateral breast cancer who underwent genetic testing at a single tertiary referral centre in the United States. Participants were randomised to receive either standard genetic counselling or quantitative counselling supported by a personalised contralateral breast cancer (CBC) risk assessment tool, which included visual displays of absolute risk.
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The primary outcomes were changes in patients’ numeric understanding of their personalised CBC risk and their propensity to consider CPM, measured before and after counselling. A secondary outcome was the actual rate of CPM performed.
Improved risk knowledge
Following counselling, women who received the personalised quantitative risk tool demonstrated a significantly greater improvement in numeric accuracy when estimating their own CBC risk compared with those who received standard counselling. This finding remained consistent after adjustment for age, genetic test results, education level and other clinical variables.
The authors note that overestimation of CBC risk is common among patients with breast cancer, and that improving risk comprehension is an important component of informed consent and shared decision-making.
No impact on surgical choice
Despite improved understanding of individual risk, the intervention did not lead to significant differences between the two groups in:
- Qualitative perception of CBC risk
- Self-reported propensity to undergo CPM
-
The proportion of patients who ultimately proceeded with CPM
On multivariable analysis, randomisation to personalised risk counselling was not associated with a statistically significant change in CPM rates, indicating that enhanced risk knowledge alone did not alter surgical decisions.
Clinical implications
The findings suggest that while personalised, genetics-based risk tools can enhance patient understanding, surgical decision-making in breast cancer is influenced by multiple factors beyond quantitative risk estimates. These may include emotional responses to diagnosis, family history, anxiety about recurrence, body image considerations and clinician recommendations.
The authors emphasise that personalised risk communication remains valuable in clinical practice, but should be integrated within broader shared decision-making frameworks that address both informational and psychosocial aspects of care.
Conclusion
The GET FACTS trial demonstrates that personalised genetic risk counselling can improve patients’ understanding of contralateral breast cancer risk, but does not appear to change decisions regarding contralateral prophylactic mastectomy. The results highlight the complexity of treatment decision-making in breast cancer and the need for multifaceted approaches to patient counselling.
Source: Weiss ABraun DStopfer J, et al. Genetic Testing for All Breast Cancer Patients: The GET FACTS Randomized Clinical Trial. JAMA Netw Open. 2026;9(1):e2551553. doi:10.1001/jamanetworkopen.2025.51553. Access online here.
