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. 2012 Aug;126(2):229-35.
doi: 10.1016/j.ygyno.2012.04.046. Epub 2012 May 4.

Prophylactic oophorectomy rates in relation to a guideline update on referral to genetic counseling

Gaia Pocobelli  1 , Jessica Chubak, Nancy Hanson, Charles Drescher, Robert Resta, Nicole Urban, Diana S M Buist
Affiliations

Prophylactic oophorectomy rates in relation to a guideline update on referral to genetic counseling

Gaia Pocobelli et al. Gynecol Oncol. 2012 Aug.

Abstract

Objective: We sought to determine whether prophylactic oophorectomy rates changed after the introduction of a 2007 health plan clinical guideline recommending systematic referral to a genetic counselor for women with a personal or family history suggestive of an inherited susceptibility to breast/ovarian cancer.

Methods: We conducted a retrospective cohort study of female members of Group Health, an integrated delivery system in Washington State. Subjects were women aged ≥ 35 years during 2004-2009 who reported a personal or family history consistent with an inherited susceptibility to breast/ovarian cancer. Personal and family history information was collected on a questionnaire completed when the women had a mammogram. We ascertained oophorectomies from automated claims data and determined whether surgeries were prophylactic by medical chart review. Rates were age-adjusted and age-adjusted incidence rate ratios (IRR) and 95% confidence intervals (CI) were computed using Poisson regression.

Results: Prophylactic oophorectomy rates were relatively unchanged after compared to before the guideline change, 1.0 versus 0.8/1000 person-years, (IRR=1.2; 95% CI: 0.7-2.0), whereas bilateral oophorectomy rates for other indications decreased. Genetic counseling receipt rates doubled after the guideline change (95% CI: 1.7-2.4) from 5.1 to 10.2/1000 person-years. During the study, bilateral oophorectomy rates were appreciably greater in women who saw a genetic counselor compared to those who did not regardless of whether they received genetic testing as part of their counseling.

Conclusion: A doubling in genetic counseling receipt rates lends support to the idea that the guideline issuance contributed to sustained rates of prophylactic oophorectomies in more recent years.

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Conflict of interest statement

Conflict of interest statement

None of the authors have any conflicts of interest.

Figures

Figure 1
Figure 1
Annual age-adjusted rates (per 1,000 person-years) of bilateral oophorectomy, by type, Group Health, 2004–2009.a a Total bilateral oophorectomies include all those identified from the administrative data, whether or not the surgical indication could be ascertained from the medical charts.
Figure 2
Figure 2
Annual age-adjusted and age-specific rates (per 1,000 person-years) of receipt of genetic counseling, Group Health, 2004–2009.
See this image and copyright information in PMC

References

    1. King MC, Marks JH, Mandell JB. Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science. 2003;302:643–646. - PubMed
    1. Antoniou A, Pharoah PD, Narod S, Risch HA, Eyfjord JE, Hopper JL, Loman N, Olsson H, Johannsson O, Borg A, Pasini B, Radice P, Manoukian S, Eccles DM, Tang N, Olah E, Anton-Culver H, Warner E, Lubinski J, Gronwald J, Gorski B, Tulinius H, Thorlacius S, Eerola H, Nevanlinna H, Syrjakoski K, Kallioniemi OP, Thompson D, Evans C, Peto J, Lalloo F, Evans DG, Easton DF. Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case Series unselected for family history: a combined analysis of 22 studies. Am J Hum Genet. 2003;72:1117–1130. - PMC - PubMed
    1. Brose MS, Rebbeck TR, Calzone KA, Stopfer JE, Nathanson KL, Weber BL. Cancer risk estimates for BRCA1 mutation carriers identified in a risk evaluation program. J Natl Cancer Inst. 2002;94:1365–1372. - PubMed
    1. Fast Stats: An interactive tool for access to SEER cancer statistics. Surveillance Research Program, National Cancer Institute; [Accessed on 4-16-2012]. Probability of developing cancer by cancer site aa, all races, female, 2007–2009. < http://seer.cancer.gov/faststats>.
    1. Howlader NNA, Krapcho M, Neyman N, Aminou R, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, editors. Bethesda, MD: National Cancer Institute; 2012. SEER Cancer Statistics Review, 1975–2009 (Vintage 2009 Populations) http://seer.cancer.gov/csr/1975_2009_pops09/, based on November 2011 SEER data submission, posted to the SEER web site.

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