Cancer genetic counselling for hereditary breast cancer in the era of precision oncology

[Display omitted] •A relevant percentage of breast cancers are tied to pathogenetic (P)/likely pathogenetic (LP) variants in predisposing genes.•P/LP variants in predisposing genes influences surgery and subsequent oncological treatments and follow-up.•Patient with early or metastatic breast cancers can benefit from personalized treatment if carriers of P/LP in BRCA1/2 genes.•The delivery of Cancer Genetic Counseling reflects the technological advances in the era of precision medicine.•The universal testing allows personalized management of patients and preventive measure of healthy family members. A relevant percentage of breast cancers (BCs) are tied to pathogenetic (P)/likely pathogenetic (LP) variants in predisposing genes. The knowledge of P/LP variants is an essential element in the management of BC patients since the first diagnosis because it influences surgery and subsequent oncological treatments and follow-up. Moreover, patients with metastatic BCs can benefit from personalized treatment if carriers of P/LP in BRCA1/2 genes. Multigene panels allow the identification of other predisposing genes with an impact on management. Cascade genetic testing for healthy family members allows personalized preventive strategies. Here, we review the advances and the challenges of Cancer Genetic Counseling (CGC). We focus on the area of oncology directed to hereditary BC management describing the peculiar way to lead CGC and how CGC changes over time. The authors describe the impact of genetic testing by targeted approach or universal approach on the management of BC according to the stage at diagnosis. Moreover, they describe the burden of CGC and testing and future perspectives to widely offer testing. A new perspective is needed for models of service delivery of CGC and testing, beyond formal genetic counselling. A broader genetic test can be quickly usable in clinical practice for comprehensive BC management and personalized prevention in the era of precision oncology.