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. 2019 Aug;154(2):379-382.
doi: 10.1016/j.ygyno.2019.05.031. Epub 2019 Jun 10.

Differences in referral patterns based on race for women at high-risk for ovarian cancer in the southeast: Results from a Gynecologic Cancer Risk Assessment Clinic

Teresa K L Boitano  1 , David A Barrington  1 , Sadhvi Batra  2 , Gerald McGwin Jr  3 , Taylor B Turner  4 , Meagan B Farmer  5 , Aimee M Brown  5 , Michael J Straughn Jr  4 , Charles A Leath 3rd  6
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Differences in referral patterns based on race for women at high-risk for ovarian cancer in the southeast: Results from a Gynecologic Cancer Risk Assessment Clinic

Teresa K L Boitano et al. Gynecol Oncol. 2019 Aug.

Abstract

Objective: To compare referral patterns, genetic testing and pathogenic variant rates in Black women (BW) and White women (WW) in a large academic Gynecologic Cancer Risk Assessment Clinic (GCRAC).

Methods: Cross sectional study of an IRB-approved prospective, cohort study from a GCRAC. Data evaluated included: age, race, referral provider specialty and indication, genetic testing frequency, as well as frequency and types of pathogenic variants.

Results: 588 WW and 57 BW were evaluated from 1/2010-12/2015. Although approximately one-third of BW and WW were referred for family history alone, referral indications varied. BW were more likely referred for a known pathogenic variant (20.0% vs. 6.2%) although less likely referred for a personal history of ovarian cancer (24.0% vs. 46.8%; p = 0.0023). While gynecologic oncologists referred most patients (BW 43.6% vs. WW 63.0%), BW were more likely to be referred by surgical oncologist (23.0% vs. 12.8%) or genetic counselor (12.8% vs. 5.9%) than WW (p = 0.0234). Referral from non-OBGYN primary care providers was <3% in both groups. Genetic testing rates were similar in both races (82.4% vs. 85.5%). Rates of BRCA1 mutations (12.7% vs. 11.5%) were similar; however, BW had more BRCA2 mutations (21.3% vs. 9.5%; p = 0.0194).

Conclusions: Since BW are more likely to be referred by surgical oncology or genetics counselor, breast clinics might be an entry point to ensure genetic counseling and testing. Continued efforts to increase awareness regarding the importance of patient referral at the primary care level may help identify the subset of women not currently undergoing counseling and testing.

Keywords: African Americans; Genetic predisposition; Genetic testing; Ovarian cancer.

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Conflict of interest statement

Conflict of Interest Report: None

Figures

Fig. 1.
Fig. 1.
Type of referring provider for women evaluated in GCRAC*. *GCRAC – Gynecologic Cancer Risk Assessment Clinic
Fig. 2.
Fig. 2.
Rates of BRCA mutations in women tested at GCRAC* *GCRAC – Gynecologic Cancer Risk Assessment Clinic
See this image and copyright information in PMC

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