The ACOG clinical management guidelines for Hereditary Breast and Ovarian Cancer Syndrome endorse the strict surgical protocol recommended by the National Comprehensive Cancer Network at the time of risk reducing salpingo-oophorectomy (RRSO) for BRCA mutation carriers. The purpose of this study is to compare the rate of provider compliance to this protocol between gynecologic oncologists (GOs) and obstetrician gynecologists (OB/GYNs).
This multi-center retrospective cohort study included women with deleterious BRCA mutations who underwent RRSO between 2011 and 2017. Patients were identified using ICD 9/10 codes and a regional genetic counseling database. Compliance was measured by collection of washings, complete resection of the fallopian tube, and serial sectioning with microscopic examination (SEE-FIM protocol). Statistical analysis was performed.
Of the 290 patients who met inclusion criteria, 160 patients were treated by 18 GOs and 130 patients were treated by 75 OB/GYNs at 10 different hospitals within a large metropolitan area. Overall, 68.5% of cases were compliant. GOs were over twice as likely to fully comply with the surgical protocol as OB/GYNs (OR 2.2, 95% CI 1.7-3.0). Specifically, they were more likely to collect washings (94.3% vs 49.2%), resect the whole tube (99.3% vs 95.4%), and adhere to SEE-FIM protocol (97.5% vs 82.3%). Complication rates did not differ between groups.
Despite clear surgical guidelines, only 2/3 of patients received full guideline-based care. GOs were more likely to follow national guidelines compared to general OB/GYNs. Rates of risk reducing surgery will likely continue to increase as genetic testing becomes more widespread, highlighting the importance of provider education for this important procedure.
University of Minnesota, Department of Obstetrics, Gynecology, and Women's Health, Minneapolis, MN
Financial Disclosure: The authors did not report any potential conflicts of interest.