Keeping it simple: Genetics referrals for all invasive serous ovarian cancers

Blogger's Note: in the absence of the full paper (subscriber-based $$) the disparities in genetic referrals is specific to invasive serous ovarian cancer which may preclude early and/or other cell types; it is known that serous cell types in ovarian cancer represent a higher % of ovarian cancer cases, however, the results may be even further understated as the focus is narrow

Abstract

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Highlights

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In Ontario, all women diagnosed with invasive serous ovarian cancer are eligible for genetic testing, irrespective of family history.

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Only 23% of women with invasive serous ovarian cancer at a large Canadian gynaecologic cancer program attended genetic counselling.

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99% of women who had genetic counseling pursued genetic testing; 16% of carriers had no family history of breast/ovarian cancer.

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Objective

In the province of Ontario, all women diagnosed with invasive serous ovarian cancer are eligible for genetic testing for mutations in the BRCA1 and BRCA2 genes. This study aimed to determine the proportion of these women who are seen for genetic counseling and to identify potential predictors and barriers to having genetic counseling.

Methods

All women who were diagnosed with invasive serous ovarian cancer and had genetic counseling at Princess Margaret Hospital (PMH) between 2002 and 2009 were identified. Logistic regressions and trend analyses explored age at diagnosis, year at diagnosis, and the time between diagnosis and genetic counseling. Genetic counseling outcomes were also examined.

Results

Of 623 women diagnosed with invasive serous ovarian cancer, 144 (23%) were seen for genetic counseling. As age at diagnosis increased, the likelihood of genetic counseling decreased (p=0.005). With a more recent date of diagnosis, the probability of having genetic counseling increased (p=0.032) while the time to genetic counseling decreased (p=0.001). Of women who pursued genetic testing, 31% were found to have a BRCA1 or BRCA2 mutation, 16% of whom had no family history of breast or ovarian cancer.

Conclusions

Despite the availability of genetic testing, only a small proportion of women with invasive serous ovarian cancer were seen for genetic counseling. Over time, an improvement in the proportion of women being seen for genetic counseling was noted; however barriers to seeing women with a later age at diagnosis or those with no family history of breast or ovarian cancer clearly exist.