OA: Genetics Consultation Rates Following a Diagnosis of High-Grade Serous Ovarian Carcinoma in the Canadian Province of Ontario

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 Analysis was limited up to 2011, because this represented a time point prior to the widespread launch of PARP inhibitor trials in our region. In the province of Ontario, Local Health Integration Networks are responsible for regional health care administration and funding; the province is divided into 14 such geographically defined administrative health regions.
Based on the 2011 census, Ontario has approximately 6.58 million female residents older than 18 years. All Ontario residents are eligible to receive universal access to hospital care and physician services

The low consultation rates, as ascertained in our restricted dataset, suggest that a large gap exists between Cancer Care Ontario’s intention with the expansion of genetic testing in 2001 and the practice patterns in the province of Ontario.

Objective: In 2001, the province of Ontario expanded cancer genetic testing eligibility to include all women with high-grade serous ovarian carcinoma (HGSC) of the ovary, fallopian tube, and peritoneum. The aim of this study was to determine the proportion of women who attended genetics counseling for consideration of BRCA1/2 gene analysis. We also sought to examine if regional differences in consultation rate exist across administrative health regions in the province of Ontario.

Methods: We identified all women with a pathological diagnosis of HGSC in the province of Ontario between 1997 until 2011. Our primary outcome was the 2-year rate of genetics consultation following a diagnosis of HGSC. We compared consultation rates over time and geographical regions and applied multiple logistic regression to identify predictors of genetics consultation.

Results: Of the 5412 women with a diagnosis of HGSC over the study period, 6.6% were seen for genetics consultation within 2 years of diagnosis. Factors predictive of genetics consultation included history of breast cancer (odds ratio [OR], 3.56; 95% confidence interval [CI], 1.87-6.78), era of diagnosis (2009-2011 vs 1997-2000; OR, 10.59; 95% CI, 5.02-22.33), and younger age at diagnosis (OR, 0.95; 95% CI, 0.94-0.97 for each additional year). No regional differences in consultation rate were seen.

Conclusions: Despite an increasing rate across eras, a small proportion of women with HGSC undergo genetics consultation. Efforts are required to increase cancer genetics consultation in patients with HGSC in the province of Ontario.