title: Evaluating women with ovarian cancer for BRCA1 and BRCA2 mutations: missed opportunities.
abstract: OBJECTIVE
  To estimate the incidence of genetic counseling referral for ovarian cancer patients who are at substantial risk for a BRCA1 or BRCA2 mutation.
  
  
  METHODS
  An analysis was performed of new ovarian cancer patients who were seen at a comprehensive cancer center from January 1, 1999, through December 31, 2007. Patients at substantial (more than 20-25%) risk for a BRCA1 or BRCA2 mutation were identified and records reviewed for referral to genetic counseling. Time to referral was estimated using the Kaplan-Meier method.
  
  
  RESULTS
  A total of 3,765 epithelial ovarian cancer patients were seen during the 9-year period. On average, 23.8% of patients met substantial-risk criteria for BRCA mutations. In 1999, only 12% of patients at substantial-risk were referred. Referral improved over time with 48% referred in 2007 (P<.001). Newly diagnosed patients were more often referred for genetic counseling than new patients with recurrent disease or those seen as second opinions. African-American women meeting substantial-risk criteria were less likely to be referred than were white or Hispanic women (P=.009).
  
  
  CONCLUSIONS
  Although dictated family history was accurate, interpretation of risk for BRCA1 or BRCA2 mutations and subsequent referral to genetic counseling was poor. Although there was significant improvement over time, 50% of substantial-risk patients still were missed. Systematic efforts to identify those ovarian cancer patients at substantial risk for a BRCA1 or BRCA2 are necessary.
authors.affiliation: From the University of Texas M.D. Anderson Cancer Center, Department of Gynecologic Oncology; University of Texas Memorial Hermann, Department of Obstetrics and Gynecology; and the University of Texas M.D. Anderson Cancer Center, Division of Quantitative Sciences, Houston, Texas.
authors.forename: Larissa A
authors.initials: LA
authors.lastname: Meyer
authors.forename: Meaghan E
authors.initials: ME
authors.lastname: Anderson
authors.forename: Robin A
authors.initials: RA
authors.lastname: Lacour
authors.forename: Anuj
authors.initials: A
authors.lastname: Suri
authors.forename: Molly S
authors.initials: MS
authors.lastname: Daniels
authors.forename: Diana L
authors.initials: DL
authors.lastname: Urbauer
authors.forename: Graciela M
authors.initials: GM
authors.lastname: Nogueras-Gonzalez
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.forename: David M
authors.initials: DM
authors.lastname: Gershenson
authors.forename: Karen H
authors.initials: KH
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D019398:Genes, BRCA1 / Q000502:physiology*; D024522:Genes, BRCA2 / Q000502:physiology*; D005817:Genetic Counseling / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000235:genetics*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018570:Risk Assessment
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