Advantages of germline testing |
 1. Germline testing is a more well established technique. |
  DNA extraction is easier. |
  The results are highly accurate and reproducible. |
 2. Germline mutations have prognostic and predictive value. |
  There is robust data supporting the prognostic and predictive value of germline BRCA1/2 mutations. |
  Such data is limited for somatic mutations. |
 3. Germline mutations can offer knowledge of risk for other associated cancers. |
  As germline mutations often increase the risk for multiple cancers, awareness of germline mutations allows patients to pursue risk-reducing interventions for other cancers. |
 4. Germline mutation identification is clinically relevant for family members and allows for cascade testing. |
Advantages of somatic testing |
 1. Somatic testing with NGS will identify a larger number of patients with HRD who can be therapeutically targeted. |
  Including patients with somatic (and not germline) mutations who would be missed with germline testing alone. |
 2. Somatic testing can help patients understand the magnitude of clinical benefit from targeted therapy in the context of risks and side effects of particular therapeutic agents. |
 3. Somatic testing does not require genetic counseling which is often a limited resource. |
 4. Somatic testing can serve as a triage for germline testing. |
  Patients found to have a somatic mutation can then be referred to clinical genetics for germline testing, allowing for better utilization of genetic counselors and geneticists. |