Abstract
Objectives
Few studies have comprehensively tested all ovarian cancer patients for BRCA1 and BRCA2 (BRCA1/2) mutations. We sought to determine if clinically identified mutation carriers differed
in clinical characteristics and outcomes from mutation carriers not identified during
routine clinical care.
Methods
We included women with ovarian, tubal or peritoneal carcinoma. BROCA, an assay using
targeted capture and massively parallel sequencing was used to identify mutations
in BRCA1/2 and 19 other tumor suppressor genes. We identified subjects with BRCA1/2 mutations using BROCA that had not previously received standard genetic testing (BROCA,
n=37) and compared them to subjects with BRCA1/2 mutations identified during routine clinical care (known, n=70), and to those wildtype for 21 genes using BROCA (wildtype, n=291).
Results
BROCA mutation carriers were older than known carriers, median age of 58 (range 41–77),
vs. 51 (range 33-76, p=0.003, Mann–Whitney). 58/70 (82.9%) of known carriers had a strong family history,
compared with 15/37 (40.5%) of BROCA carriers, p<0.0001, (Fisher's Exact). Median overall survival was significantly worse for BROCA
mutation carriers compared to known mutation carriers, (45 vs. 93 months, p<0.0001, HR 3.47 (1.79–6.72), Log-rank test). The improved survival for BRCA1/2 mutation carriers (known and BROCA) compared with wildtype cases (69 vs. 44 months, p=0.0001, HR 0.58 (0.43–0.77), Log-rank test) was driven by known mutation carriers.
Conclusions
Older age, absence of a strong family history, and poor survival are all associated
with decreased clinical identification of inherited BRCA1/2 mutations in women with ovarian cancer. Using age and family history to direct genetic
testing will miss a significant percentage of mutation carriers. Testing should be
initiated at the time of diagnosis to maximize identification of mutations and minimize
survival bias.
Highlights
- Older age, lack of family history, and poor survival are associated with decreased clinical identification of BRCA1/2 mutations.
- Testing should be initiated at time of diagnosis to maximize identification and minimize survival bias.
Keywords
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Article info
Footnotes
☆Financial support: This work was supported by National Institutes of Health Grants RO1CA131965, RO1CA157744, and P50CA083636, the Breast Cancer Research Foundation, Susan G. Komen for the Cure, and Department of Defense Ovarian Cancer Research Program OC093285.
Identification
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Published by Elsevier Inc.
