Bottom line on breast cancer genetic screening for the masses | New guidance on pneumonia | Lab tests spare thyroid, appendix surgeries

Dear LabPulse Member,

We've been covering the debate over genetic testing of breast cancer patients with great interest since our launch in April.

On one hand, the underuse of testing for BRCA mutations could mean that women miss out on lifesaving preventive measures and new drug treatment options. On the other hand, testing costs add up, and the use of panels that test for many genetic mutations can flag uncertain things that may lead to overtreatment.

Adding to the debate, a new study in JAMA Oncology models costs of testing for BRCA1/2 and PALB2 mutations based on current, standard criteria, which are centered on family history and other factors, versus a strategy where all women with breast cancer are tested. A broader system of testing would prevent cases of breast and ovarian cancer, save lives, and save money in the process, according to the researchers. In fact, they found that costs would be well below thresholds for cost-effectiveness in the U.S. and U.K. healthcare systems and called for a policy change. However, the authors of an editorial about the study suggested that broadening testing criteria opens a Pandora's box.

In other clinical news, we reported on new studies showing the potential of lab tests for avoiding unnecessary surgeries. Researchers from the University of Texas at Austin and other institutions shared promising results on the use of a metabolic mass spectrometry test for thyroid cancer. The test identifies metabolites produced by cancer cells, providing useful information for patients who have inconclusive results on fine-needle aspiration tests.

Separately, researchers in Germany reported on the use of an artificial intelligence (AI) algorithm in diagnosing appendicitis, based on signatures from a range of lab results, including C-reactive protein and leukocytes, and ultrasound. They found that the AI model was accurate for evaluating suspected appendicitis and could help avoid unnecessary surgeries if used in clinical practice.

Antibiotic stewardship is a perennial topic in healthcare systems. We recently reported on the importance of taking blood cultures in cases of suspected sepsis prior to starting antibiotic treatment. In a new article, we review updated joint guidance from the American Thoracic Society and the Infectious Diseases Society of America for community-acquired pneumonia. The guidance advises more microscopic studies of respiratory tract samples to reduce the risk of treating drug-resistant infections.

Finally, researchers concluded that certain microRNAs are associated with the development of sepsis and other serious complications in patients hospitalized with severe community-acquired pneumonia. These biomarkers can be evaluated with polymerase chain reaction tests quickly -- and cheaply, the group reported at the European Respiratory Society International Congress in Madrid.

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