Preventing future cancers by testing women with ovarian cancer for BRCA mutations.
OBJECTIVE
Women with ovarian cancer have a 10% probability of carrying a BRCA mutation. If a mutation is identified, unaffected family members can undergo genetic testing and cancer risk-reducing strategies. We estimated the net health benefits and cost-effectiveness of different criteria for BRCA mutation testing in women with ovarian cancer, and the downstream benefits for their first-degree relatives (FDRs).


METHODS
We developed a Markov Monte Carlo simulation model to compare four criteria for BRCA testing in women with ovarian cancer: no testing (reference); only if personal history of breast cancer, family history of breast/ovarian cancer, or Ashkenazi Jewish ancestry; only if invasive serous cancer; any invasive nonmucinous epithelial cancer. Net health benefit was life expectancy for FDRs and primary outcome was the incremental cost-effectiveness ratio (ICER). The model estimated the number of future breast and ovarian cancer cases in FDRs.


RESULTS
BRCA testing based on personal/family history and ancestry could prevent future cases in FDRs with an ICER of $32,018 per year of life (LY) gained compared with the reference strategy. BRCA testing based on serous or any nonmucinous epithelial ovarian cancer could prevent more cancer cases, but at ICERs of $128,465 and $148,363 per LY gained, respectively.


CONCLUSIONS
BRCA testing of women with ovarian cancer based on personal/family history of cancer or Ashkenazi Jewish ancestry is a cost-effective strategy to prevent future breast and ovarian cancers among FDRs. More inclusive testing strategies prevent additional cancer cases but at significant cost.
Division of Gynecologic Oncology, University of British Columbia, British Columbia, Canada. jkwon@post.harvard.edu
Janice S
JS
Kwon
Molly S
MS
Daniels
Charlotte C
CC
Sun
Karen H
KH
Lu
D019313:BRCA1 Protein / Q000235:genetics*; D024682:BRCA2 Protein / Q000235:genetics*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D018284:Cystadenocarcinoma, Serous / Q000191:economics / Q000235:genetics* / Q000517:prevention & control*; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*; D009361:Neoplasm Invasiveness; D010051:Ovarian Neoplasms / Q000191:economics / Q000235:genetics* / Q000517:prevention & control*; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate
D019313:BRCA1 Protein; D024682:BRCA2 Protein