Impact of a Structured Early Detection Program on Adherence to Guidelines for Risk-Reducing Surgery in BRCA1/2 Carriers

Xiaoyue M. Guo*, Matthew Cowan, Adam Pyrzak, Lee Shulman, Emma L. Barber

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To determine the proportion of women with BRCA1/BRCA2 mutations participating in an ovarian cancer screening program who adhere to National Comprehensive Cancer Network (NCCN) guidelines for risk-reducing bilateral salpingo-oophorectomy (BRCA1 = 40 years, BRCA2 = 45 years). Design: Retrospective cohort study. Materials and Methods: Records were reviewed of all patients with BRCA1/BRCA2 mutations who were screened in Northwestern University's Ovarian Cancer Early Detection and Protection Program from 2002 to 2016. Exclusion criteria included a prior ovarian cancer diagnosis, oophorectomy before screening, or if visits were not recorded in the prospectively collected database. The primary endpoint was age at ovarian removal. Results: Of 134 patients identified (BRCA1, n = 83; BRCA2, n = 51), 46 patients underwent risk-reducing salpingo-oophorectomy (RRSO). Most surgeries (38/46, 83%) were performed by the upper limit of the mutation-specific recommended age. Of the 86 patients who have not undergone surgery, 49 patients are not yet at the recommended age for RRSO, 4 chose to continue screening, and 33 transferred care or were lost to follow-up. Patients were more likely to have prophylactic surgery by guideline-recommended age if they identified racially as white compared with non-white (odds ratio 7.5, 95% confidence interval 1.5-36.2, p = 0.02). Conclusion: More than 80% of BRCA patients in our program who obtained RRSO did so by the NCCN recommended ages. Indeed, most patients with BRCA1/BRCA2 who have not undergone surgery are still participating in the program. As more malignancy-related genes are discovered and evolving technologies developed for both genetic testing and cancer detection, screening programs may yet find a place in the management of high-risk patients.

Original languageEnglish (US)
Pages (from-to)262-266
Number of pages5
JournalJournal of Gynecologic Surgery
Volume36
Issue number5
DOIs
StatePublished - Oct 2020

Keywords

  • cancer risk genes
  • cancer screening
  • genetic counseling
  • health disparities
  • hereditary breast and ovarian cancer
  • ovarian cancer screening
  • risk-reducing surgery

ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynecology

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