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Does the Diagnosis of Breast or Ovarian Cancer Trigger Referral to Genetic Counseling?

Powell, C. Bethan MD*; Littell, Ramey MD*; Hoodfar, Elizabeth MS; Sinclair, Fiona PA-C, MHS; Pressman, Alice PhD§

International Journal of Gynecological Cancer: March 2013 - Volume 23 - Issue 3 - p 431–436
doi: 10.1097/IGC.0b013e318280f2b4
Ovarian Cancer

Objective: Kaiser Permanente Northern California is a large integrated health care delivery system in the United States that has guidelines for referring women with newly diagnosed BRCA1-and BRCA2-associated cancers for genetic counseling. This study assesses adherence to genetic counseling referral guidelines within this health system.

Methods: Chart review was performed to identify patients with cancer who met the following pathology-based Kaiser Permanente Northern California guidelines for referral for genetic counseling: invasive breast cancer, younger than age 40; nonmucinous epithelial ovarian, fallopian tube, or peritoneal cancer, younger than age 60; women with synchronous or metachronous primary cancers of the breast and ovaries; and male breast cancer. We assessed compliance with referral guidelines. An electronic notice was sent to the managing physician of patients with newly diagnosed cancer to assess the feasibility of this intervention.

Results: A total of 340 patients were identified with breast cancer at younger than age 40 or with ovarian, peritoneal, or tubal cancer between January and June, 2008. Upon chart review, 105 of these patients met pathology-based criteria for referral to genetic counseling, of whom 47 (45%) were referred within the 2-year study period. Of the 67 subjects with breast cancer, 40 subjects (60%) were referred. In contrast, only 7 (21%) of 33 patients with ovarian cancer were referred (P < 0.001). A pilot study was performed to test the feasibility of notifying managing oncologists with an electronic letter alerting them of eligibility for genetic referral of patients with new diagnosis (n = 21). In the 3 to 6 months after this notification, 12 of these 21 patients were referred for counseling including 5 of 7 patients with a diagnosis of ovarian cancer.

Conclusion: There is a missed opportunity for referring patients to genetic counseling, especially among patients with ovarian cancer. A pilot study suggests that alerting treating physicians is a feasible strategy to increase appropriate referral.

*Division of Gynecologic Oncology, †Northern California Regional Genetics Program, ‡Women’s Health Research Institute, Division of Research, and §Division of Research, Northern California, Kaiser Permanente Northern California, Oakland, CA.

Address correspondence and reprint requests to C. Bethan Powell, MD, Division of Gynecologic Oncology, Kaiser Permanente, 2350 Geary Blvd, San Francisco, CA 94115. E-mail: Bethan.Powell@kp.org.

This work was supported by Community Benefit Grant, Kaiser Permanente Northern California 2010.

The authors declare no conflicts of interest.

Received September 27, 2012

Accepted December 2, 2012

Copyright © 2013 by IGCS and ESGO