Highlights
- •Fifty-three percent of ovarian cancer patients are being referred for genetic services.
- •Disparities exist for race/ethnicity and language in referral rates for genetic evaluation.
- •Inclusion of genetic counseling into surgical pathways may help expedite patient navigation.
Abstract
Objective
We sought to characterize referral patterns for genetic counseling for women with
ovarian cancer and hypothesized that differences in referral and testing rates are
shaped by socioeconomic factors.
Methods
Patients were identified by pathology reports from August 2012 to January 2016 containing
the words “serous” or “ovarian.” Patient information was obtained via electronic medical
record. Primary outcomes were placement of a genetics referral and completion of counseling.
A secondary outcome was completion of genetic testing.
Results
We identified 246 women with a diagnosis of ovarian cancer. Ten were previously counseled
and excluded. 53% of patients were referred for counseling with mean time from diagnosis
to counseling of 4.6 months. Age and family history were not associated with referral, however rates differed
by race with 61% of Caucasian and 40%, 38% and 33% of Asian, Latina and Black women,
respectively, referred (p = 0.035). Overall, 36% of patients diagnosed underwent counseling, and 33% were tested.
English language (p < 0.0001), high-grade serous histology (p = <0.0001) and private or Medicare insurance (p < 0.0001) were significantly associated with referral.
Conclusion
We have not yet reached the Society of Gynecologic Oncology recommendation for referral
to genetics. Women of color and those with public insurance have lower referral rates.
This disparity in care impacts cancer treatment options and prevents appropriate screening
for other hereditary malignancies. To provide comprehensive oncology care, including
genetic assessment, we recommend focusing on these barriers including improving outreach
and interpreter services.
Keywords
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References
- Cancer statistics, 2014.Cancer J. Clin. 2014; 64: 9
- BRCA1 and BRCA2 mutations account for a large proportion of ovarian carcinoma cases.Cancer. 2005 Dec 15; 104: 2807-2816
- The contribution of the hereditary nonpolyposis colorectal cancer syndrome to the development of ovarian cancer.Gynecol. Oncol. 2006; 101: 238-243
- Society of Gynecologic Oncology statement on risk assessment for inherited gynecologic cancer predispositions.Gynecol. Oncol. 2015; 136: 3-7
NCCN clinical practice guidelines in oncology: genetic/familial high-risk assessment: breast and ovarian. January 2017.
- Serous carcinogenesis in the fallopian tube: a descriptive classification.Int. J. Gynecol. Pathol. 2008; 27: 1-9
- Meta-analysis of BRCA1 and BRCA2 penetrance.J. Clin. Oncol. 2007; 25: 1329-1333
- Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: a combined analysis of 22 studies.Am. J. Hum. Genet. 2003; 72: 1117-1130
- Poly(ADP)-ribose polymerase inhibition: frequent durable responses in BRCA carrier ovarian cancer correlating with platinum-free interval.J. Clin. Oncol. 2010; 28: 2512-2519
- FDA approval summary: olaparib monotherapy in patients with deleterious germline BRCA-mutated advanced ovarian cancer treated with three or more lines of chemotherapy.Clin. Cancer Res. 2015; 21: 4257-4261
- Adherence patterns to National Comprehensive Cancer Network (NCCN) guidelines for referral to cancer genetic professionals.Gynecol. Oncol. 2015; 138: 109-114
- Evaluating women with ovarian cancer for BRCA1 and BRCA2 mutations: missed opportunities.Obstet. Gynecol. 2010; 115: 945-952
- R: A Language and Environment for Statistical Computing [Internet].R Foundation for Statistical Computing, Vienna, Austria2015 (Available from:)
- Cancer statistics, 2013.CA Cancer J. Clin. 2013; 63: 11
- Factors associated with genetic counseling and BRCA testing in a population-based sample of young Black women with breast cancer.Breast Cancer Res. Treat. 2015; 151: 169-176
- Survival of blacks and whites after a cancer diagnosis.JAMA. 2002; 287: 2106-2113
- Insurance status and the use for guideline therapy in the treatment of selected cancers.J. Clin. Oncol. 2005; 23: 9079-9088
- Disparities in the allocation of treatment in advanced ovarian cancer: are there certain patient characteristics associated with nonstandard therapy?.Obstet. Gynecol. 2012; 119: 68-77
- Disparities in ovarian cancer care quality and survival according to race and socioeconomic status.J. Natl. Cancer Inst. 2013; 105: 823-832
- Have racial disparities in ovarian cancer increased over time? An analysis of SEER data.Gynecol. Oncol. 2012; 125: 19-24
- Randomized noninferiority trial of telephone versus in-person genetic counseling for hereditary breast and ovarian cancer.J. Clin. Oncol. 2014; 32: 618-626
- The integration of BRCA testing into oncology clinics.Br. J. Nurs. 2016; 25: 690-694
- Rucaparib in relapsed, platinum-sensitive high-grade ovarian carcinoma (ARIEL2 part 1): an international, multicentre, open-label, phase 2 trial.Lancet Oncol. 2017 Jan; (pii: S1470-2045(16)30559-9): 75-87
- Mainstreaming cancer genetics: a model integrating germline BRCA testing into routine ovarian cancer clinics.Gynecol. Oncol. 2017 Apr; 145: 130-136
- Improving referral for genetic risk assessment in ovarian cancer using an electronic medical record system.Int. J. Gynecol. Cancer. 2014 Jul; 24: 1003-1009
- The value of a genetic counselor: improving identification of cancer genetic counseling patients with chart review.J. Genet. Couns. 2014 Jun; 23: 323-329
- Smedley B.D. Stith A.Y. Nelson A.R. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (with CD). The National Academies Press, Washington, DC2003: 432
- The effect of patient race and socio-economic status on physicians' perceptions of patients.Soc. Sci. Med. 2000; 50: 813-828
- Effects of racial and ethnic group and health literacy on responses to genomic risk information in a medically underserved population.Health Psychol. 2015 Feb; 34: 101-110
- The association between race and attitudes about predictive genetic testing.Cancer Epidemiol. Biomark. Prev. 2004; 13: 361-365
- The prevalence of BRCA1 and BRCA2 mutations among young Mexican women with triple-negative breast cancer.Breast Cancer Res. Treat. 2015; 150: 389-394
- BRCA1 and BRCA2 mutations in ovarian cancer patients from China: ethnic-related mutations in BRCA1 associated with an increased risk of ovarian cancer.Int. J. Cancer. 2017; May 1; 140: 2051-2059
Article info
Publication history
Accepted:
October 26,
2017
Received in revised form:
October 24,
2017
Received:
August 27,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
