Genetic counseling referral for ovarian cancer patients: a call to action
The hereditary contribution to ovarian cancer has been increasingly recognized over the past decade, with a 2014 Society of Gynecologic Oncology (SGO) recommendation for all women with epithelial ovarian cancer to be considered for genetic testing. The objective of the study was to determine if disparities exist in genetic referrals and characterize referral patterns over time. A retrospective cohort study included all women diagnosed with invasive epithelial ovarian cancer at the University of Virginia from 2004 to 2015. Clinicopathologic data were abstracted from the electronic medical record and analyzed for association with genetic referral and testing. We identified 696 cases, with a median age of 62 years and a median follow up of 25.2 months (range 1–115). Thirty-four percent were referred for genetic counseling with an 80% genetic testing rate in those women. Referrals increased from a rate of 8% in 2004 to 68% in 2015. On multivariable analysis, papillary serous histology (OR 1.6, 95% CI 1.0–2.6), stage III disease (OR 3.4, 95% CI 1.6–7.5), ovarian cancer family history (OR 2.6, 95% CI 1.5–4.6), breast cancer family history (OR 1.7, 95% CI 1.1–2.5), and diagnosis after 2014 (OR 2.3, 95% CI 1.3–4.1) remained significantly associated with genetics referral. Older age and living > 100 miles away were associated with decreased referral (OR 0.97, 95% CI 0.95–0.99 per year and OR 0.49, 95% CI 0.28–0.86). As only 68% of women with epithelial ovarian cancer were referred in 2015 innovative strategies such as Medicare coverage for counseling are still needed to universalize testing.
KeywordsGenetic counseling Hereditary cancer syndrome Ovarian cancer Familial cancer
Funding for this study was provided by the Obstetrics and Gynecology Department at the University of Virginia.
Compliance with ethical standards
Conflict of interest
The authors declared that they have no conflict of interest.
- 2.Strattot M (1995) Identification of the breast cancer susceptibility gene BRCA2. Nature 378(21):789–791Google Scholar
- 3.National Comprehensive Cancer Network (2016) NCCN guidelines for detection, prevention, & risk reduction: genetic/familial high-risk assessment: breast and ovarian. http://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdf Accessed 13 Apr 2016
- 4.Ledermann JA, Harter P, Gourley C et al (2016) Overall Survival in patients with platinum-sensitive recurrent serous ovarian cancer receiving olaparib maintenance monotherapy: an updated analysis from a randomized, placebo-controlled, double-blind, phase 2 trial. Lancet Oncol 17:1579–1589CrossRefPubMedGoogle Scholar
- 5.Strickland KC, Howitt BE, Shukla SA et al (2016) Association and prognostic significance of BRCA1/2-mutation status with neoantigen load, number of tumor-infiltrating lymphocytes and expression of PD-1/PD-L1 in high grade serous ovarian cancer. Oncotarget 7(12):13587–13598CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Society for Gynecologic Oncology Clinical Practice Guidelines: Genetic Testing for Ovarian Cancer (2014) Retrieved from: https://www.sgo.org/clinical-practice/guidelines/genetic-testing-for-ovarian-cancer/
- 15.Kolor K, Chen Z, Grosse SD et al (2017) BRCA genetic testing and receipt of preventive interventions among women aged 18-64 years with employer-sponsored health insurance in nonmetropolitan and metropolitan areas – United States, 2009-2014. MMWR Surveill Summ 66(15):1–11CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Centers for Disease Control and Prevention: National Center for Health Statisitics Urban-Rural Classification Scheme for Counties. Available from: https://www.cdc.gov/nchs/data_access/urban_rural.htm Accessed 1 June 2018