Breast cancer germline multigene panel testing in mainstream oncology based on clinical-public health utility: ESMO Precision Oncology Working Group recommendations

BRCA1, BRCA2, PALB2, RAD51C, RAD51D, BRIP1, TP53 (breast mainstreaming panel)

ESMO Precision Oncology evaluation framework: cancer mortality impact as inclusion criterion; 7 genes selected (BRCA1/2, PALB2, RAD51C/D, BRIP1, TP53<40 yrs); ATM and CHEK2 explicitly excluded (equivocal mortality benefit)

The ESMO Precision Oncology Working Group recommends a 7-gene panel for germline testing in mainstream oncology (breast): BRCA1, BRCA2, PALB2, RAD51C, RAD51D, BRIP1 and TP53 (for breast cancers diagnosed before age 40). ATM and CHEK2 are explicitly excluded: their mortality benefit is deemed equivocal to justify mainstreaming. These recommendations establish a standardized framework for germline testing prescribed by the oncologist (without a clinical geneticist).

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

A turning point for the practice of genetic testing in mainstream oncology in Europe. The exclusion of ATM and CHEK2 is controversial: these genes are systematically tested in many current practices. In France, to be articulated with SFMPP/INCa guidelines. These recommendations apply primarily to the mainstreaming pathway (oncologist as prescriber).

new ESMO 2026 mainstreaming guidelines +3; direct clinical impact (panel composition) +2; Ann Oncol +1; controversial but documented ATM/CHEK2 exclusion +1