Referral patterns for genetic counseling for hereditary breast and ovarian cancer syndromes.
Hong L, Roberson J, and Sangha R. Referral patterns for genetic counseling for hereditary breast and ovarian cancer syndromes. Obstet Gynecol 2018; 131:52S.
Introduction: BRCA 1 or 2 mutation carriers have a 45-85% risk of developing breast cancer and a 39-46% risk of developing ovarian cancer by age 70. Methods: A retrospective electronic chart review was conducted to identify women who were referred to the Henry Ford Health System Genetics department for counseling, as new consultations between 01/01/16 to 12/31/16 with a diagnosis that contained "breast", "ovarian", "ovary", or "adnexa". Women with a known cancer diagnosis were excluded. Information on age, race, if genetic testing was collected including if testing was offered and/or accepted, results of genetic testing, insurance type and referring provider specialty. Results: A total of 184 women with an average age of 46 years was included. 93 (50.5%) referrals were from obstetricians/gynecologists, 44 (23.9%) from internal medicine, 23 (12.5%) from family medicine, 13 (7.1%) from surgery, and 11 (6%) self-referrals. Of the 20 women who were not offered genetic testing, 5 (25%) had federal assisted insurance. The reasons documented for lack of genetic testing was due to inability to meet Medicare criteria or lack of clinical indication. 164 women were offered genetic testing, of which 147 accepted. Of the 147/164 (89.6%) a total of 14/147 (9.5%) women identified with positive hereditary breast and ovarian cancer mutation. 10/147 (6.8%) women were noted to have a variant mutation. CONCLUSION/IMPLICATIONS: Patients at high risk for hereditary cancer syndromes should be provided with a referral for genetic counseling based on extensive review of family history on both sides, including the ages of onset of cancer.