Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Int J Gynecol Cancer. 2020 Sep;30(9):1397-1403. doi: 10.1136/ijgc-2019-001168. Epub 2020 May 23.
The National Comprehensive Cancer Network recommends that all women diagnosed with epithelial ovarian cancer undergo genetic testing, as the diagnosis of pathogenic variants may inform cancer survival and impact treatment options. The objective of this study was to assess factors associated with referral to genetic counseling in women with epithelial ovarian cancer.
A retrospective cohort study identified women with epithelial ovarian cancer from 2012 to 2017 at Massachusetts General Hospital and North Shore Medical Center, a community hospital affiliated with Massachusetts General Hospital. Multivariate logistic regression evaluated how race, age, stage, year of diagnosis, insurance status, family history of breast or ovarian cancer, and language relates to the receipt of genetic counseling.
Of the total 276 women included, 73.9% were referred for genetic screening, of which 90.7% attended a genetic counseling visit. Older women were less likely to undergo genetic counseling (age ≥70 years: OR 0.26, 95% CI 0.07-0.94, p=0.04). Women who died within 365 days of initial oncology consult rarely reached a genetic counselor (OR 0.05, 95% CI 0.01-0.24, p<0.001). Women with a family history of breast or ovarian cancer were more likely to undergo counseling (OR 3.27, 95% CI 1.74-6.15, p<0.001). There was no difference in receipt of genetic counseling by race, stage, year of diagnosis, insurance status, or language.
Older women with epithelial ovarian cancer and those who died within 1 year of initiation of care were less likely to undergo recommended genetic counseling. Race, insurance status, and language were not identified as predictive factors, although we were limited in this assessment by small sample size.
美国国家综合癌症网络建议所有被诊断为上皮性卵巢癌的女性都接受基因检测，因为致病性变异的诊断可能会影响癌症的生存并影响治疗选择。本研究的目的是评估与上皮性卵巢癌女性转诊至遗传咨询相关的因素。
一项回顾性队列研究从 2012 年至 2017 年在马萨诸塞州综合医院和北岸医疗中心（一家与马萨诸塞州综合医院有关联的社区医院）中确定了上皮性卵巢癌患者。多变量逻辑回归评估了种族、年龄、分期、诊断年份、保险状况、乳腺癌或卵巢癌家族史以及语言如何与接受遗传咨询相关。
在总共 276 名女性中，73.9%被转介进行基因筛查，其中 90.7%接受了遗传咨询访问。年龄较大的女性接受遗传咨询的可能性较小（年龄≥70 岁：OR 0.26，95%CI 0.07-0.94，p=0.04）。在最初肿瘤学咨询后 365 天内死亡的女性很少能见到遗传咨询师（OR 0.05，95%CI 0.01-0.24，p<0.001）。有乳腺癌或卵巢癌家族史的女性更有可能接受咨询（OR 3.27，95%CI 1.74-6.15，p<0.001）。种族、分期、诊断年份、保险状况或语言对接受遗传咨询没有差异。
上皮性卵巢癌的老年女性和在开始治疗后 1 年内死亡的女性接受推荐的遗传咨询的可能性较小。种族、保险状况和语言不是预测因素，尽管我们因样本量小而限制了这一评估。
