User login
AUSTIN, TEX. – Universal BRCA mutation testing for first-degree relatives of women with high-grade serous ovarian cancer could prevent significantly more cases, according to a study presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.
Women with high-grade serous ovarian cancer have a 20% chance of having a BRCA mutation; however, the risk is 50% for first degree relatives of someone with that mutation.
“Until we find an effective screening test for ovarian cancer, which can identify women at an early stage for which there is curative treatment, we need to maximize opportunities for prevention,” said Janice S. Kwon, MD, the gynecologic oncology fellowship program director at the University of British Columbia, Vancouver. “An obvious target group,” she added, are women “at highest risk of developing ovarian cancers, specifically those who inherit mutations in BRCA1 or BRCA2.”
First-degree relatives of ovarian cancer patients have three conceivable options if their BRCA status is unknown, and have no other risk factor for BRCA testing: To not undergo testing; to get tested and, if found to have the mutation, undergo risk-reducing surgery (bilateral salpingo-oophorectomy); or to undergo surgery without testing.
To estimate the efficiency and cost effectiveness of universal BRCA testing of female first-degree relatives of women with high-grade serous ovarian cancer, Dr. Kwon and her colleagues used the “Markov Monte Carlo” simulation model, with a time horizon of 50 years, evaluating the costs and benefits of those three strategies.
They acknowledged that testing excluded women with a personal history of breast cancer and did not include nonhormonal interventions in their analysis.
They found that the average quality-adjusted life year (QUALY) gain of universal BRCA testing was 19.20 years, compared with 18.99 years for no BRCA testing, and 18.48 years for universal surgery with no BRCA testing.
The reason universal surgery was the lowest is because most of these women will be premenopausal at the time of surgery, according to Dr. Kwon. A procedure like a premenopausal oophorectomy has been associated with a 40% increase in all-cause mortality, putting the patient at unnecessary risk, she noted.
Financially, no BRCA testing cost the least, an average of $8,524 Canadian dollars (about US$6,648) followed by universal BRCA at CA$10,103 (about US$7,880) . Universal surgery, with no BRCA testing, cost CA$13,959 (about US$10,888).
Despite the increased cost, the chance to give patients who may be at risk for ovarian cancer a better chance is a good investment, according to Dr. Kwon.
“Any opportunity to prevent ovarian cancer is worthwhile,” Dr. Kwon commented. “If an ovarian cancer patient cannot be tested because she declines testing or, more commonly, because she is deceased, her first-degree relative should have BRCA mutation testing, regardless of other personal or family history or ethnicity.”
She and her coinvestigators reported no relevant financial disclosures.
AUSTIN, TEX. – Universal BRCA mutation testing for first-degree relatives of women with high-grade serous ovarian cancer could prevent significantly more cases, according to a study presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.
Women with high-grade serous ovarian cancer have a 20% chance of having a BRCA mutation; however, the risk is 50% for first degree relatives of someone with that mutation.
“Until we find an effective screening test for ovarian cancer, which can identify women at an early stage for which there is curative treatment, we need to maximize opportunities for prevention,” said Janice S. Kwon, MD, the gynecologic oncology fellowship program director at the University of British Columbia, Vancouver. “An obvious target group,” she added, are women “at highest risk of developing ovarian cancers, specifically those who inherit mutations in BRCA1 or BRCA2.”
First-degree relatives of ovarian cancer patients have three conceivable options if their BRCA status is unknown, and have no other risk factor for BRCA testing: To not undergo testing; to get tested and, if found to have the mutation, undergo risk-reducing surgery (bilateral salpingo-oophorectomy); or to undergo surgery without testing.
To estimate the efficiency and cost effectiveness of universal BRCA testing of female first-degree relatives of women with high-grade serous ovarian cancer, Dr. Kwon and her colleagues used the “Markov Monte Carlo” simulation model, with a time horizon of 50 years, evaluating the costs and benefits of those three strategies.
They acknowledged that testing excluded women with a personal history of breast cancer and did not include nonhormonal interventions in their analysis.
They found that the average quality-adjusted life year (QUALY) gain of universal BRCA testing was 19.20 years, compared with 18.99 years for no BRCA testing, and 18.48 years for universal surgery with no BRCA testing.
The reason universal surgery was the lowest is because most of these women will be premenopausal at the time of surgery, according to Dr. Kwon. A procedure like a premenopausal oophorectomy has been associated with a 40% increase in all-cause mortality, putting the patient at unnecessary risk, she noted.
Financially, no BRCA testing cost the least, an average of $8,524 Canadian dollars (about US$6,648) followed by universal BRCA at CA$10,103 (about US$7,880) . Universal surgery, with no BRCA testing, cost CA$13,959 (about US$10,888).
Despite the increased cost, the chance to give patients who may be at risk for ovarian cancer a better chance is a good investment, according to Dr. Kwon.
“Any opportunity to prevent ovarian cancer is worthwhile,” Dr. Kwon commented. “If an ovarian cancer patient cannot be tested because she declines testing or, more commonly, because she is deceased, her first-degree relative should have BRCA mutation testing, regardless of other personal or family history or ethnicity.”
She and her coinvestigators reported no relevant financial disclosures.
AUSTIN, TEX. – Universal BRCA mutation testing for first-degree relatives of women with high-grade serous ovarian cancer could prevent significantly more cases, according to a study presented at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.
Women with high-grade serous ovarian cancer have a 20% chance of having a BRCA mutation; however, the risk is 50% for first degree relatives of someone with that mutation.
“Until we find an effective screening test for ovarian cancer, which can identify women at an early stage for which there is curative treatment, we need to maximize opportunities for prevention,” said Janice S. Kwon, MD, the gynecologic oncology fellowship program director at the University of British Columbia, Vancouver. “An obvious target group,” she added, are women “at highest risk of developing ovarian cancers, specifically those who inherit mutations in BRCA1 or BRCA2.”
First-degree relatives of ovarian cancer patients have three conceivable options if their BRCA status is unknown, and have no other risk factor for BRCA testing: To not undergo testing; to get tested and, if found to have the mutation, undergo risk-reducing surgery (bilateral salpingo-oophorectomy); or to undergo surgery without testing.
To estimate the efficiency and cost effectiveness of universal BRCA testing of female first-degree relatives of women with high-grade serous ovarian cancer, Dr. Kwon and her colleagues used the “Markov Monte Carlo” simulation model, with a time horizon of 50 years, evaluating the costs and benefits of those three strategies.
They acknowledged that testing excluded women with a personal history of breast cancer and did not include nonhormonal interventions in their analysis.
They found that the average quality-adjusted life year (QUALY) gain of universal BRCA testing was 19.20 years, compared with 18.99 years for no BRCA testing, and 18.48 years for universal surgery with no BRCA testing.
The reason universal surgery was the lowest is because most of these women will be premenopausal at the time of surgery, according to Dr. Kwon. A procedure like a premenopausal oophorectomy has been associated with a 40% increase in all-cause mortality, putting the patient at unnecessary risk, she noted.
Financially, no BRCA testing cost the least, an average of $8,524 Canadian dollars (about US$6,648) followed by universal BRCA at CA$10,103 (about US$7,880) . Universal surgery, with no BRCA testing, cost CA$13,959 (about US$10,888).
Despite the increased cost, the chance to give patients who may be at risk for ovarian cancer a better chance is a good investment, according to Dr. Kwon.
“Any opportunity to prevent ovarian cancer is worthwhile,” Dr. Kwon commented. “If an ovarian cancer patient cannot be tested because she declines testing or, more commonly, because she is deceased, her first-degree relative should have BRCA mutation testing, regardless of other personal or family history or ethnicity.”
She and her coinvestigators reported no relevant financial disclosures.
REPORTING FROM ACOG 2018
Key clinical point: BCRA testing should be extended to all first degree family members of ovarian cancer patients.
Major finding: Quality-adjusted life year gain was higher in patients given universal BRCA testing (an average of 19.20 years) compared with universal surgery (18.48 years) and no BRCA testing (18.99 years).
Study details: A simulation model, was used to evaluate the costs and benefits of three possible approaches for female first-degree relatives of women with high-grade serous ovarian cancer.
Disclosures: The authors had no disclosures.