title: Impact of Clinical Genetics Attendance at a Gynecologic Oncology Tumor Board on Referrals for Genetic Counseling and BRCA Mutation Testing.
abstract: The objectives of this work were to determine the proportion of eligible patients with ovarian cancer discussed at a gynecologic oncology tumor board who were referred for counseling and BRCA mutation testing; to compare referral rates before genetics attendance at the tumor board to referral rates after genetics attendance; and to ascertain the proportions of women with germline BRCA mutations.
  
  
  
  Eligible cases were identified from the minutes of the weekly Western Australian gynecologic oncology tumor board from July 1, 2013 to June 30, 2015.Patients with ovarian cancer who met eligibility criteria for genetics referral were identified and checked against the records of the genetic services database to ascertain whether a referral was received. Outcomes including attendance for counseling and results of mutation testing were analyzed.
  
  
  
  Two hundred sixty-one patients were eligible for referral during the 24-month study period. One hundred six patients (40.6%) were referred for counseling and germline mutation testing. Of the eligible patients, 26.7% were referred in the 12 months before genetics attendance at the tumor board compared to 51.7% of the eligible patients in the 12 months after genetics attendance (P ≤ 0.0001). Ninety-seven patients were offered BRCA mutation testing, and 73 underwent testing with 65 results reported to date. Twenty-two patients (33.8 %) tested positive for a germline BRCA mutation.
  
  
  
  Patients with ovarian cancer had a high rate of BRCA mutations. Attendance of a genetics service at a tumor board was associated with an improved rate of referral of patients for genetic counseling and BRCA mutation testing.
authors.affiliation: *St John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, Western Australia; †School of Women's and Infants' Health, University of Western Australia; ‡Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia; §Genetics Services of Western Australia, King Edward Memorial Hospital, Subiaco, Western Australia; ∥Inherited Cancer Connect Partnership (ICCon); ¶School of Paediatrics and Child Health, University of Western Australia; and #School of Medicine and Pharmacology, University of Western Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Cohen
authors.forename: Cassandra B
authors.initials: CB
authors.lastname: Nichols
authors.forename: Lyn
authors.initials: L
authors.lastname: Schofield
authors.forename: Steven
authors.initials: S
authors.lastname: Van Der Werf
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pachter
mesh_terms: D000368:Aged; D019313:BRCA1 Protein / Q000235:genetics; D024682:BRCA2 Protein / Q000235:genetics; D015331:Cohort Studies; D018284:Cystadenocarcinoma, Serous / Q000235:genetics / Q000473:pathology; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005817:Genetic Counseling / Q000379:methods*; D018095:Germ-Line Mutation; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D010051:Ovarian Neoplasms / Q000235:genetics* / Q000473:pathology / Q000628:therapy*; D012017:Referral and Consultation; D012189:Retrospective Studies
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human