Medical Oncologist
CION Cancer Clinics
Why a VUS should not change your treatment | CION Cancer Clinics
A variant of uncertain significance is not evidence of anything yet, and professional genetics guidance is explicit that it should not be used to decide surgery, chemotherapy or screening. This page explains what should be guiding your treatment instead, and what to ask if a VUS is ever offered as the reason for a decision. At CION Cancer Clinics in Hyderabad, our oncologists review your family history with you and guide you to the right genetic counselling and testing.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
17+specialists on panel
15,000+patients treated
35+centres across Telangana & AP
4.8★ / 800+Google rating
On this page
- Why shouldn't a VUS change my treatment?
- Four things treatment decisions are built on
- What to do if surgery is proposed because of a VUS
- Terms behind this guidance
- What a VUS supports, and what it does not
- Why does this happen at all, if the guidance is so clear?
- Four things said about a VUS and treatment
- Common questions about VUS and treatment
The short answer
Why shouldn't a VUS change my treatment?
A variant of uncertain significance is not evidence of anything yet. Professional genetics bodies are explicit that a VUS must not be used to decide surgery, to change chemotherapy, or to alter screening. Doing so would mean acting on a finding the laboratory itself has not been able to classify as harmful.
Treating uncertainty as if it were certainty
Using a VUS to justify removing a healthy organ, or to switch a cancer drug, treats an open question as if it were an answer. The whole point of the classification is that the laboratory does not yet know which way the evidence points. Building an irreversible decision on top of that uncertainty is exactly what the classification exists to warn against.
What should be guiding the decision instead
Your treatment should rest on your tumour's own features, your personal and family history, and established treatment guidelines, the same foundation used for anyone without a VUS on their report at all. A VUS sits quietly on file, waiting for more evidence, while care continues on solid ground. This is not a special exception written for difficult cases. It is the ordinary, expected way an uncertain finding is meant to be handled everywhere it is reported.
If a treatment decision is being proposed because of a VUS, that is the moment to ask for a second opinion.What actually guides your care
Four things treatment decisions are built on
The tumour itself
Its size, type, grade and how far it has spread remain the main drivers of a treatment plan, VUS or no VUS.
Confirmed classifications only
Only pathogenic or likely pathogenic findings are built into surgical or drug decisions. A VUS does not belong in that category.
Your family history
The pattern of illness across your family carries weight on its own, independent of an unresolved variant.
National and international guidelines
Bodies that set treatment standards are explicit that uncertain findings should not be used to guide clinical decisions.
Not sure whether this applies to you?
Ask an oncologistIf it comes up
What to do if surgery is proposed because of a VUS
Ask which finding is driving the recommendation
Have the exact classification word read out to you. If it is uncertain significance, say so plainly and ask why it is being treated as a positive result.
Ask for a genetic counsellor to be involved
A counsellor is trained specifically to separate a confirmed finding from an uncertain one, and can speak directly to your surgical or oncology team.
Ask what the guidelines actually recommend
A reasonable clinician will be able to point to a guideline supporting their recommendation. If none exists for a VUS, that is worth naming out loud.
Get a second opinion before an irreversible step
Surgery cannot be undone. Taking the time for one more opinion before it, especially where a VUS is part of the reasoning, is a reasonable request, not a delay.
Worth knowing
Terms behind this guidance
- Standard of care
- The treatment approach an established guideline recommends for a given diagnosis, independent of an unresolved genetic finding.
- Overtreatment
- Giving treatment, including surgery, beyond what the evidence actually supports for that person.
- Informed consent
- Being told plainly what a finding does and does not support before agreeing to any procedure based on it.
- NCCN
- A body that publishes widely used cancer treatment guidelines, which are explicit that uncertain findings should not drive clinical decisions.
- Multidisciplinary tumour board
- A panel of specialists reviewing a case together, which reduces the chance of one clinician overreacting to an uncertain finding alone.
- Reclassification
- The formal process by which a VUS may later become pathogenic or benign, at which point, and only then, action may follow.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Side by side
What a VUS supports, and what it does not
A VUS supports
A VUS does not support
Noting the finding in your file for future review
Preventive removal of a healthy organ
Continuing screening based on your existing history
Starting screening earlier than your history already warrants
A conversation with a counsellor about what it means
A change to your current chemotherapy or drug plan
Being told if the classification changes later
Testing relatives for that exact variant now
Being straight with you
Why does this happen at all, if the guidance is so clear?
It is not common, but it does happen, usually from unfamiliarity with how classification works rather than from bad intent. A busy clinician who does not routinely read genetic reports can mistake the word "variant" attached to a well-known cancer gene for a positive finding, especially under pressure to decide quickly.
What this page cannot do for you
It cannot tell your surgeon or oncologist what to do, and it is not a substitute for a genetic counsellor reviewing your specific case. It can only tell you, clearly, that acting on a VUS is not supported by genetics guidance, so that you know to ask the question if it ever seems to be happening. Bring this page with you if it helps start that conversation; naming the concern plainly is often all it takes to have it addressed properly.
Who this reassurance is not for
If your report shows a pathogenic or likely pathogenic finding rather than a VUS, this page does not apply, and discussing treatment or preventive options with your team is entirely appropriate.
If you are ever unsure which classification is actually driving a recommendation, call the helpline and ask to speak to a genetic counsellor before deciding anything.Commonly believed
Four things said about a VUS and treatment
"It is better to be cautious and act on the VUS anyway."
Caution here means waiting for real evidence, not acting on none. An irreversible procedure carries its own real risks, which should not be taken on for an unresolved finding.
"Removing the organ removes the uncertainty."
It removes an organ, not the underlying question. The variant remains just as uncertain afterward, and the surgery cannot be reversed if later evidence shows it was harmless all along.
"Waiting for reclassification means waiting to be treated."
Waiting for reclassification of a VUS is not the same as waiting for cancer treatment. Standard treatment, where it is needed, goes ahead on its own timeline regardless of an unresolved variant.
"My oncologist knows best, so I should not question it."
A good oncologist welcomes a question about which finding is driving a recommendation. Asking for the reasoning behind a major decision is a normal, expected part of your own care.
Questions we are asked
Common questions about VUS and treatment
Can a VUS ever justify preventive surgery?
No. Genetics guidance is explicit that preventive surgery is reserved for confirmed pathogenic or likely pathogenic findings, not for an unresolved uncertain result.
My surgeon mentioned my VUS before recommending surgery. Is that wrong?
Mentioning it is fine. Basing the recommendation on it is not supported by guidance. Ask directly whether the surgery is being recommended because of the VUS or for other, standard reasons.
Should my chemotherapy plan change because of a VUS?
No. Drug choices are guided by the tumour's own features and established treatment guidelines, not by an unclassified genetic finding.
What should I say if I feel pressured to act on a VUS?
Ask plainly for a genetic counsellor to review the case, and request the specific guideline supporting the recommendation. A reasonable team will welcome the question.
Does this guidance apply everywhere, or just in India?
It reflects international genetics guidance, used by cancer centres worldwide, not a rule specific to any one country or hospital.
Can I get a second opinion without upsetting my care team?
Yes. A second opinion before an irreversible decision is a normal, accepted step in cancer care, and a professional team will not see it as a lack of trust.
What if my VUS is later reclassified as pathogenic?
At that point, and only then, it becomes appropriate to discuss the options that apply to a confirmed finding, with your counsellor guiding the conversation.
Who can confirm whether a decision is appropriate for my case?
A genetic counsellor or clinical geneticist, reviewing your full report alongside your treating oncologist or surgeon, is best placed to confirm this.
Your Specialists
Meet CION's oncologists. Bring your family history or genetic report to them.
Our medical oncologists see people with a strong family history of cancer, arrange genetic counselling and testing where it fits, and plan the checks that follow.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Sources
- National Cancer Institute — Genetic Testing for Inherited Cancer Susceptibility Syndromes
- MedlinePlus Genetics — What do the results of genetic tests mean?
- Cancer Research UK — Inherited cancer genes and increased cancer risk
- NHS — Predictive genetic tests for cancer risk genes
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
'Variant of uncertain significance' in a germline reportWhat a VUS is, before this page's guidance on treatmentThe five variant classifications explainedWhere uncertain significance sits among the other tiersWhat a genetic counsellor doesWho to bring into a decision like thisVariant reclassification: when a result changes years laterWhat changes if your VUS is ever resolved
Talk to us
Told a decision is based on your VUS result?
Tell us what has been recommended and why. We will help you get a genetic counsellor's view before anything irreversible happens. One helpline serves every CION centre.