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

  • R. Demsky
    Correspondence
    Corresponding author at: Familial Breast and Ovarian Cancer Clinic, Princess Margaret Hospital, M-712 610 University Avenue, Toronto, Ontario M5G 2M9, Canada. Fax: +1 416 946 6528.
    Affiliations
    Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada

    Department of Molecular Genetics, University of Toronto, Toronto, Canada
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  • J. McCuaig
    Affiliations
    Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada
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  • M. Maganti
    Affiliations
    Department of Biostatistics, Princess Margaret Hospital, University Health Network, Toronto, Canada
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  • K.J. Murphy
    Affiliations
    Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada

    Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
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  • B. Rosen
    Affiliations
    Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada

    Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
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  • S.R. Armel
    Affiliations
    Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada

    Department of Molecular Genetics, University of Toronto, Toronto, Canada
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      Highlights

      • In Ontario, all women diagnosed with invasive serous ovarian cancer are eligible for genetic testing, irrespective of family history.
      • Only 23% of women with invasive serous ovarian cancer at a large Canadian gynecologic cancer program attended genetic counseling.
      • 99% of women who had genetic counseling pursued genetic testing; 16% of carriers had no family history of breast/ovarian cancer.

      Abstract

      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.

      Keywords

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