Adherence patterns to National Comprehensive Cancer Network (NCCN) guidelines for referral to cancer genetic professionals.
OBJECTIVE
Genetic predisposition is responsible for 5-10% of breast cancer, 10% of ovarian cancer and 2-5% of uterine cancer. The study objective was to compare genetic counseling and testing referral rates among women with breast cancer that met NCCN referral guidelines to the referral rates among women with gynecologic cancers and determine predictors of referral.


METHODS
Utilizing an institutional tumor registry database, patients from an academic women's oncology program were identified who met a subset of NCCN guidelines for genetic referral between 2004 and 2010. Patients diagnosed with ovarian cancer, breast cancer ≤50years of age, or uterine cancer <50years of age were included. A retrospective electronic chart review was conducted to evaluate for a genetic referral and uptake of genetic testing.


RESULTS
820 women were included (216 uterine, 314 breast, and 290 ovarian cancer). The overall genetic referral rate was 21.7%. 34% of eligible breast cancer patients were referred compared to 13.4% of uterine cancer and 14.5% of ovarian cancer patients (p<0.0001). Younger age, breast cancer diagnosis, family history and earlier stage were all significant referral predictors. The odds of being referred increased with the number of affected family members. 70.8% of referred patients, consulted with genetics. Among those who consulted with genetics, 95.2% underwent testing.


CONCLUSIONS
Although increasing, genetic counseling remains underutilized across cancer diagnosis. Women with breast cancer are more likely to be referred than women with gynecologic cancers. Younger age, earlier stage and positive family history appear to be predictive of referral for genetic evaluation.
Women and Infants, Warren Alpert Medical School of Brown University, Providence, RI, USA. Electronic address: Terri.Febbraro@uchospitals.edu.
Terri
T
Febbraro
Women and Infants, Warren Alpert Medical School of Brown University, Providence, RI, USA; Program in Women's Oncology, USA.
Katina
K
Robison
Women and Infants, Warren Alpert Medical School of Brown University, Providence, RI, USA; Program in Women's Oncology, USA.
Jennifer Scalia
JS
Wilbur
Women and Infants, Warren Alpert Medical School of Brown University, Providence, RI, USA; Program in Women's Oncology, USA.
Jessica
J
Laprise
Women and Infants, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Amy
A
Bregar
Women and Infants, Warren Alpert Medical School of Brown University, Providence, RI, USA; Division of Research, USA.
Vrishali
V
Lopes
Women and Infants, Warren Alpert Medical School of Brown University, Providence, RI, USA; Program in Women's Oncology, USA.
Robert
R
Legare
Women and Infants, Warren Alpert Medical School of Brown University, Providence, RI, USA; Program in Women's Oncology, USA.
Ashley
A
Stuckey
D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics*; D005185:Fallopian Tube Neoplasms / Q000175:diagnosis / Q000235:genetics; D005260:Female; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D005833:Genital Neoplasms, Female / Q000175:diagnosis* / Q000235:genetics*; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000235:genetics; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000235:genetics
Genetic counseling; Hereditary cancer; Practice patterns