Our recent study evaluated universal GGT in all patients diagnosed with breast cancer between 2019 and 2022 at The Outer Banks Hospital.2 Test uptake was high (> 90%) with test costs not a deterrent to GGT. Return of GGT results led to changes in clinical management in ~ 80% of patients, including more aggressive treatments in those with pathogenic germline variants (PGVs) in genes, such as BRCA1 and BRCA2, and de-escalation of treatment in those with PGVs in other cancer predisposition genes, variants of unknown significance and negative results. Importantly, GGT in this community did not lead to guideline-discordant treatment as has been previously reported.3 Thus, universal GGT for patients with breast cancer is feasible within rural populations, enabling optimization of clinical care to patients’ genetic profile and may reduce healthcare resource utilization.