Management of Breast Cancer Risk in Women with Ovarian Cancer and Deleterious BRCA1 or BRCA2 Mutations

Excerpt

Advances in genetic testing have led to a new clinical dilemma: the optimal management of the elevated risk of breast cancer in women with ovarian cancer found to have a deleterious mutation in BRCA1 or BRCA2. In October 2014, the Society of Gynecologic Oncology released a clinical practice statement recommending that all women diagnosed with epithelial ovarian/fallopian tube/peritoneal cancer should receive genetic counseling and be offered genetic testing for genes associated with hereditary breast and ovarian cancer syndrome, even in the absence of family history. The need for the statement was based on the knowledge that approximately 15% of ovarian cancer patients, irrespective of family history, have germline BRCA1 or BRCA2 mutations.1 The National Comprehensive Cancer Network has the same recommendation.2 Since the release of these guidelines, an increasing number of women with ovarian cancer are being referred for genetic counseling. Most women referred for genetic counseling complete the consultation and >90% opt for genetic testing.3,4 Given the clinical availability of PARP inhibitors for treatment of ovarian cancer and the importance of cascade testing in identifying family members eligible for cancer risk reduction strategies, efforts to improve rates of genetic counseling referral are needed. Early findings after implementing a bundled approach to enhance referral indicate that nearly 75% of women with a new ovarian cancer at Mayo Clinic Rochester are now referred for genetic counseling with a goal of universal referral.5 …