Evaluating women with ovarian cancer for BRCA1 and BRCA2 mutations: Missed opportunities

Larissa A. Meyer, Meaghan E. Anderson, Robin A. Lacour, Anuj Suri, Molly S. Daniels, Diana L. Urbauer, Graciela M. Nogueras-Gonzalez, Kathleen M. Schmeler, David M. Gershenson, Karen H. Lu

Research output: Contribution to journalArticle

73 Scopus citations

Abstract

Objective: To estimate the incidence of genetic counseling referral for ovarian cancer patients who are at substantial risk for a BRCA1 or BRCA2 mutation. Methods: An analysis was performed of new ovarian cancer patients who were seen at a comprehensive cancer center from January 1, 1999, through December 31, 2007. Patients at substantial (more than 20-25%) risk for a BRCA1 or BRCA2 mutation were identified and records reviewed for referral to genetic counseling. Time to referral was estimated using the Kaplan-Meier method. Results: A total of 3,765 epithelial ovarian cancer patients were seen during the 9-year period. On average, 23.8% of patients met substantial-risk criteria for BRCA mutations. In 1999, only 12% of patients at substantial-risk were referred. Referral improved over time with 48% referred in 2007 (P<.001). Newly diagnosed patients were more often referred for genetic counseling than new patients with recurrent disease or those seen as second opinions. African-American women meeting substantial-risk criteria were less likely to be referred than were white or Hispanic women (P=.009). Conclusion: Although dictated family history was accurate, interpretation of risk for BRCA1 or BRCA2 mutations and subsequent referral to genetic counseling was poor. Although there was significant improvement over time, 50% of substantial-risk patients still were missed. Systematic efforts to identify those ovarian cancer patients at substantial risk for a BRCA1 or BRCA2 are necessary.

Original languageEnglish (US)
Pages (from-to)945-952
Number of pages8
JournalObstetrics and Gynecology
Volume115
Issue number5
DOIs
StatePublished - May 2010

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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