Introduction/Background (Encore-but-modified/new-data).Since 2015, BRCA1/2 pathogenic variant (PV) testing is recommended for all epithelial ovarian cancer (EOC) patients in the Netherlands. Recently, recommendations shifted from germline testing to universal tumor testing and subsequent germline testing in those with BRCA1/2 tumor PVs (TPVs). Data on testing rates of these approaches and on characteristics of patients missing out on testing remain scarce. Therefore, we evaluated BRCA1/2 testing rates in EOC patients and compared rates of germline testing (performed from 2015 until mid-2018) versus tumor testing with germline testing only in those with TPVs (implemented mid-2018). Additionally, we delineated characteristics of patients who were less likely to receive BRCA1/2 testing.
Methodology A consecutive series of 250 patients diagnosed with EOC between 2016 and 2019 was included from the OncoLifeS databiobank of the University Medical Center Groningen. Testing rates were analyzed for the overall study population and by period of diagnosis to evaluate rates of germline testing (period I) and tumor-first testing (period II) separately. Characteristics of tested and untested patients were compared using the appropriate statistical test.
Results Median age was 67.0 years (interquartile range: 59.0–73.0) and 69.2% was diagnosed with high-grade serous carcinoma (HGSC). Overall, 80.4% of all patients had a known germline PV (GPV) status. In period I, 80.1% of all patients had a known GPV status and in period II this was 81.0%. Overall, and in period I and II separately, a significantly greater proportion of patients with HGSC was tested, as compared to those with non-HGSC (74.6% versus 23.9%; P=0.001).
Conclusion The results show that BRCA1/2 testing rates are suboptimal and suggest that clinicians may not be choosing to test EOC patients with non-HGSC, although guidelines recommend BRCA1/2 testing in all EOC patients. Suboptimal testing rates limit the optimization of care for EOC patients and counseling of potentially affected relatives.
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