ABSTRACT: The use of genetic counseling and subsequent testing in women with invasive serous ovarian cancer has the potential to prevent future cancers in both the patient and her biologic relatives. The aim of this present study was to determine the proportion of women diagnosed with invasive serous ovarian cancer who had genetic counseling and to define barriers to genetic counseling and testing in this patient population. All participants had been diagnosed with invasive serous ovarian cancer between 2002 and 2009 at a hospital cancer clinic in Toronto, Ontario, Canada. Multiple logistic regression and trend analyses were used to test the association between the proportion of patients who had genetic counseling and the age at diagnosis as well as the year at diagnosis; the time between diagnosis and first visit for counseling was also determined. Genetic counseling and testing outcomes were also examined.
Among the 623 women with a diagnosis of invasive serous ovarian cancer, 144 (23%) attended genetic counseling. The likelihood of genetic counseling decreased with increasing age at diagnosis (P = 0.005). Women with a more recent date of diagnosis were more likely to have genetic counseling (P = 0.032) and had a significantly shorter time to receiving genetic counseling (P = 0.001). Ninety-nine percent of women (142/144) who had had genetic counseling pursued genetic testing; 31% (44/142) of those tested were found to have a BRCA1 or BRCA2 mutation; 16% (7/44) who had a positive test had no family history of breast or ovarian cancer.
These data show that only a small proportion of women with invasive serous ovarian cancer had genetic counseling in 2002 despite recommendations for it and the availability of genetic testing. By 2009, there was a clear improvement in the proportion of women being referred for genetic counseling. However, substantial barriers still exist that limit the number of women having counseling; these include an older age at time of diagnosis or lack of a family history of breast or ovarian cancer.
Division of Gynecologic Oncology, Princess Margaret Hospital, University Health Network (R.D., J.M., K.J.M., B.R., R.A.); Department of Molecular Genetics, University of Toronto (R.D., R.A.); Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada (K.J.M., B.R.) and Department of Biostatistics, Princess Margaret Hospital, University Health Network (M.M.)