title: The effect of referral for genetic counseling on genetic testing and surgical prevention in women at high risk for ovarian cancer: Results from a randomized controlled trial.
abstract: BACKGROUND
  Guidelines recommend genetic counseling and testing for women who have a pedigree suggestive of an inherited susceptibility for ovarian cancer. The authors evaluated the effect of referral to genetic counseling on genetic testing and prophylactic oophorectomy in a randomized controlled trial.
  
  
  METHODS
  Data from an electronic mammography reporting system identified 12,919 women with a pedigree that included breast cancer, of whom 625 were identified who had a high risk for inherited susceptibility to ovarian cancer using a risk-assessment questionnaire. Of these, 458 women provided informed consent and were randomized 1:1 to intervention consisting of a genetic counseling referral (n = 228) or standard clinical care (n = 230).
  
  
  RESULTS
  Participants were predominantly aged 45 to 65 years, and 30% and 20% reported a personal history of breast cancer or a family history of ovarian cancer, respectively. Eighty-five percent of women in the intervention group participated in a genetic counseling session. Genetic testing was reported by 74 (33%) and 20 (9%) women in the intervention and control arms (P < .005), respectively. Five women in the intervention arm and 2 in the control arm were identified as germline mutation carriers. Ten women in the intervention arm and 3 in the control arm underwent prophylactic bilateral salpingo-oophorectomy (P < .05).
  
  
  CONCLUSIONS
  Routine referral of women at high risk for ovarian cancer to genetic counseling promotes genetic testing and prophylactic surgery. The findings from the current randomized controlled trial demonstrate the value of implementing strategies that target women at high risk for ovarian cancer to ensure they are offered access to recommended care. CA Cancer J Clin 2016. © 2016 American Cancer Society, Inc. Cancer 2016;122:3509-3518. © 2016 American Cancer Society.
authors.affiliation: Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Drescher
authors.affiliation: Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.|Swedish Cancer Institute, Swedish Medical Center, Seattle, Washington.
authors.forename: J David
authors.initials: JD
authors.lastname: Beatty
authors.affiliation: Swedish Cancer Institute, Swedish Medical Center, Seattle, Washington.|Hereditary Cancer Clinic, Swedish Medical Center, Seattle, Washington.
authors.forename: Robert
authors.initials: R
authors.lastname: Resta
authors.affiliation: Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: M Robyn
authors.initials: MR
authors.lastname: Andersen
authors.affiliation: Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Kate
authors.initials: K
authors.lastname: Watabayashi
authors.affiliation: Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Jason
authors.initials: J
authors.lastname: Thorpe
authors.affiliation: Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hawley
authors.affiliation: Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Hannah
authors.initials: H
authors.lastname: Purkey
authors.affiliation: Group Health Research Institute, Seattle, Washington.|Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Jessica
authors.initials: J
authors.lastname: Chubak
authors.affiliation: Swedish Cancer Institute, Swedish Medical Center, Seattle, Washington.|Hereditary Cancer Clinic, Swedish Medical Center, Seattle, Washington.
authors.forename: Nancy
authors.initials: N
authors.lastname: Hanson
authors.affiliation: Group Health Research Institute, Seattle, Washington.|Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.|Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Diana S M
authors.initials: DSM
authors.lastname: Buist
authors.affiliation: Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.|Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Nicole
authors.initials: N
authors.lastname: Urban
keywords: genetic counseling; genetic testing; ovarian cancer; referral and consultation; risk assessment; surgical prevention