- Email: [email protected]
Patient-directed screening for familial cancer risk: Results from a familial cancer registry
Abstracts / Gynecologic Oncology 125 (2012) S3–S167
MSH6 and PMS2) were included in data collection. Other variables included in subgroup analysis were personal and family history of malignancy, BMI, and EC stage, grade and histology. Results: Of 69 EC patients from the selected time period, IHC staining was performed on the tumors of 53 patients. Of the tested patients, 45 were 50–60 years and 8 were younger than 50 years. Among the patients b 50 years old, 1 (12.5%) had abnormal IHC testing and further gene sequencing revealed a mutation in the MSH6 gene. Among the patients ≥ 50 years old, 9 (20%) had abnormal IHC testing suggestive of Lynch syndrome. One patient had normal gene sequencing, 1 patient declined testing, and 2 patients were lost to follow-up. The 5 remaining patients are currently undergoing genetic counseling and testing; results will be available at the time of presentation. Conclusions: A high proportion of endometrial cancer patients from ages 50 to 60 in this cohort had abnormal IHC testing (20%). Of these, only 1 patient has a personal history of cancer and only 2 patients had a family history of Lynch-associated malignancies. IHC screening of all EC patients less than 60 years may be reasonable.
doi:10.1016/j.ygyno.2011.12.209
209 Patient-directed screening for familial cancer risk: Results from a familial cancer registry M. Geller, K. Niendorf, T. Church, R. Madoff. University of Minnesota, Minneapolis, MN. Objective: Cancer patients at increased familial risk of cancer are typically sub-optimally referred for genetic counseling. We describe a patient-directed model for screening cancer patients for hereditary cancer risk based on family history. Methods: Cancer patients from a University-based gynecologic oncology clinic and a colon cancer registry were screened for hereditary cancer risk using two-tiers: (1) a 7-item screening questionnaire and if screen positive (2) individuals at risk for familial cancer provide a detailed family history to specifically trained telephone interviewers and a 4-generation pedigree constructed. A risk assessment is then performed in accordance with published criteria. A satisfaction survey with the registry process is recorded after at least 3 months has elapsed following receipt of the recommendation letter. Inclusive of this survey is whether the participant shared the registry risk assessment information with providers and/or genetic counselors. Results: From April 2009 to August 2011, 1192 invitations were sent, 928 (46.6%) agreed to participate. Of those 89% were eligible for registry enrollment due to 1 or more high risk family history features. 448 consented to family history tabulation and pedigree analysis. Of those assessed, 6.7% had known syndromes/mutations, 67.4% were at high risk for a hereditary cancer syndrome, 20.1% at moderate familial cancer risk and 12.5% at average risk. Of those assessed, nearly all respondents found the process at least “somewhat helpful” but only 5.5% of high risk individuals shared the materials with a provider or genetic counselor after receiving the information. Conclusions: This study outlines a process for screening for hereditary cancer based on patient family history report and follows the compliance of these increased risk individuals in pursuit of genetic counseling. Participants were willing to provide family history information for the purposes of risk assessment and were satisfied with the process involved in registry participation. Despite this, few patients at increased risk for a hereditary cancer actually pursued genetic services. This suggests that receipt of a 4-generation family pedigree and a letter recommending genetic counseling
S87
follow-up is inadequate to encourage patients to pursue genetic services. doi:10.1016/j.ygyno.2011.12.210
210 Hereditary risk assessment for women with newly diagnosed epithelial ovarian cancer: Improving referral using an electronic medical record M. Geller, S. Petzel, R. Isaksson Vogel, J. Trask, A. Leininger, P. Argenta. University of Minnesota, Minneapolis, MN. Objective: The medical community plays an important role in referring cancer patients who might benefit the most from genetic assessment yet genetic services often are under-utilized by providers and patients. An electronic format to increase genetic counseling referral was evaluated in a university-based women's cancer clinic. Methods: From April 30, 2007 to April 30, 2009, seven gynecologic oncologists at a university based cancer center saw 495 patients with epithelial ovarian cancer, pathology reports verified 171 (34.5%) newly diagnosed patients during that time period who were included in the analysis. On April 30, 2008 a form summarizing SGO referral guidelines for BRCA1/2 and Lynch syndrome testing was introduced into the EMR allowing providers to electronically fax a request for genetic services. Analysis compared pre and post intervention characteristics. Results: The majority of patients lived within 60 miles of the clinic, had stage III–IV disease, had family history documented in their chart, and had a treating oncologist that was b10 years from fellowship. Referral rates increased from 17.4% before the intervention to 31.8% post-intervention (p = 0.0296). Factors best predicting referral were whether the patient was seen after the intervention (p = 0.0005), whether the patient resided within 60 miles of the clinic (p = 0.0039) and if designated to be at high hereditary risk (p b 0.0001). To assess the effectiveness of the intervention, we examined rates of referral among the three indicators for risk-referral as identified by intervention guidelines: 1) patients diagnosed at less than 50 years old; 2) previous cancer diagnosis; or 3) high-risk family cancer history. Prior to the intervention, 38% with high-risk family cancer history were referred for genetic counseling whereas 76% were referred after the intervention (p = 0.0092). Among patients with a previous cancer diagnosis, 29% were referred before the intervention and 62% were referred afterwards (p = 0.1283). There was an increase in the proportion of patients diagnosed at less than 50 years old being referred (23% vs. 53%; p = 0.1021). Conclusions: Our study suggests a referral system streamlined for providers can promote opportunities for women at increased hereditary cancer risk to be referred for genetic services. Addition of an electronic prompt to provide timely and pertinent hereditary risk information to clinicians as they are making patient-care decisions could promote both genetic counseling referral and uptake. doi:10.1016/j.ygyno.2011.12.211
Ovarian/FP/PPC 211 Should be para-aortic lymphadenectomy up to the level of the renal vein mandatory in ovarian cancer patients presenting ovarian cancer presumed to be confined to the ovary? S. Chang1, R. Bristow2, T. Kong1, J. Paek1, H. Ryu1, P. DiSaia2. 1Ajou University School of Medicine, Suwon, South Korea, 2University of California Irvine - Medical Center, Orange, CA.
MSH6 and PMS2) were included in data collection. Other variables included in subgroup analysis were personal and family history of malignancy, BMI, and EC stage, grade and histology. Results: Of 69 EC patients from the selected time period, IHC staining was performed on the tumors of 53 patients. Of the tested patients, 45 were 50–60 years and 8 were younger than 50 years. Among the patients b 50 years old, 1 (12.5%) had abnormal IHC testing and further gene sequencing revealed a mutation in the MSH6 gene. Among the patients ≥ 50 years old, 9 (20%) had abnormal IHC testing suggestive of Lynch syndrome. One patient had normal gene sequencing, 1 patient declined testing, and 2 patients were lost to follow-up. The 5 remaining patients are currently undergoing genetic counseling and testing; results will be available at the time of presentation. Conclusions: A high proportion of endometrial cancer patients from ages 50 to 60 in this cohort had abnormal IHC testing (20%). Of these, only 1 patient has a personal history of cancer and only 2 patients had a family history of Lynch-associated malignancies. IHC screening of all EC patients less than 60 years may be reasonable.
doi:10.1016/j.ygyno.2011.12.209
209 Patient-directed screening for familial cancer risk: Results from a familial cancer registry M. Geller, K. Niendorf, T. Church, R. Madoff. University of Minnesota, Minneapolis, MN. Objective: Cancer patients at increased familial risk of cancer are typically sub-optimally referred for genetic counseling. We describe a patient-directed model for screening cancer patients for hereditary cancer risk based on family history. Methods: Cancer patients from a University-based gynecologic oncology clinic and a colon cancer registry were screened for hereditary cancer risk using two-tiers: (1) a 7-item screening questionnaire and if screen positive (2) individuals at risk for familial cancer provide a detailed family history to specifically trained telephone interviewers and a 4-generation pedigree constructed. A risk assessment is then performed in accordance with published criteria. A satisfaction survey with the registry process is recorded after at least 3 months has elapsed following receipt of the recommendation letter. Inclusive of this survey is whether the participant shared the registry risk assessment information with providers and/or genetic counselors. Results: From April 2009 to August 2011, 1192 invitations were sent, 928 (46.6%) agreed to participate. Of those 89% were eligible for registry enrollment due to 1 or more high risk family history features. 448 consented to family history tabulation and pedigree analysis. Of those assessed, 6.7% had known syndromes/mutations, 67.4% were at high risk for a hereditary cancer syndrome, 20.1% at moderate familial cancer risk and 12.5% at average risk. Of those assessed, nearly all respondents found the process at least “somewhat helpful” but only 5.5% of high risk individuals shared the materials with a provider or genetic counselor after receiving the information. Conclusions: This study outlines a process for screening for hereditary cancer based on patient family history report and follows the compliance of these increased risk individuals in pursuit of genetic counseling. Participants were willing to provide family history information for the purposes of risk assessment and were satisfied with the process involved in registry participation. Despite this, few patients at increased risk for a hereditary cancer actually pursued genetic services. This suggests that receipt of a 4-generation family pedigree and a letter recommending genetic counseling
S87
follow-up is inadequate to encourage patients to pursue genetic services. doi:10.1016/j.ygyno.2011.12.210
210 Hereditary risk assessment for women with newly diagnosed epithelial ovarian cancer: Improving referral using an electronic medical record M. Geller, S. Petzel, R. Isaksson Vogel, J. Trask, A. Leininger, P. Argenta. University of Minnesota, Minneapolis, MN. Objective: The medical community plays an important role in referring cancer patients who might benefit the most from genetic assessment yet genetic services often are under-utilized by providers and patients. An electronic format to increase genetic counseling referral was evaluated in a university-based women's cancer clinic. Methods: From April 30, 2007 to April 30, 2009, seven gynecologic oncologists at a university based cancer center saw 495 patients with epithelial ovarian cancer, pathology reports verified 171 (34.5%) newly diagnosed patients during that time period who were included in the analysis. On April 30, 2008 a form summarizing SGO referral guidelines for BRCA1/2 and Lynch syndrome testing was introduced into the EMR allowing providers to electronically fax a request for genetic services. Analysis compared pre and post intervention characteristics. Results: The majority of patients lived within 60 miles of the clinic, had stage III–IV disease, had family history documented in their chart, and had a treating oncologist that was b10 years from fellowship. Referral rates increased from 17.4% before the intervention to 31.8% post-intervention (p = 0.0296). Factors best predicting referral were whether the patient was seen after the intervention (p = 0.0005), whether the patient resided within 60 miles of the clinic (p = 0.0039) and if designated to be at high hereditary risk (p b 0.0001). To assess the effectiveness of the intervention, we examined rates of referral among the three indicators for risk-referral as identified by intervention guidelines: 1) patients diagnosed at less than 50 years old; 2) previous cancer diagnosis; or 3) high-risk family cancer history. Prior to the intervention, 38% with high-risk family cancer history were referred for genetic counseling whereas 76% were referred after the intervention (p = 0.0092). Among patients with a previous cancer diagnosis, 29% were referred before the intervention and 62% were referred afterwards (p = 0.1283). There was an increase in the proportion of patients diagnosed at less than 50 years old being referred (23% vs. 53%; p = 0.1021). Conclusions: Our study suggests a referral system streamlined for providers can promote opportunities for women at increased hereditary cancer risk to be referred for genetic services. Addition of an electronic prompt to provide timely and pertinent hereditary risk information to clinicians as they are making patient-care decisions could promote both genetic counseling referral and uptake. doi:10.1016/j.ygyno.2011.12.211
Ovarian/FP/PPC 211 Should be para-aortic lymphadenectomy up to the level of the renal vein mandatory in ovarian cancer patients presenting ovarian cancer presumed to be confined to the ovary? S. Chang1, R. Bristow2, T. Kong1, J. Paek1, H. Ryu1, P. DiSaia2. 1Ajou University School of Medicine, Suwon, South Korea, 2University of California Irvine - Medical Center, Orange, CA.