BRCA testing and genetic counseling was highly recommended for women who had strong family history among ovarian cancer. There are some barriers for offering genetic counseling and acceptance according to disease severity. We undertook this study to investigate whether advanced staging can be a barrier in BRCA testing and genetic counseling.
A case control study was done between early (I-II) and advanced (III-IV) ovary carcinoma patients Total 34 patients were evenly divided between them. After complete surgical staging and pathology result, single gynecologic oncologist offered genetic counseling about risk assessment based on pathology, family history and immunohistochemistry. BRCA1/2 gene sequencing were done for approved patient. Among BRCA positive patients, second genetic counseling for risk management options (family counseling, risk reducing surgery, surveillance for BRCA associated cancer and chemoprevention) was done.
Total 34 patients were divided by early stage (n = 17) and advanced stage (n = 17) respectively. Advanced stage group was older than early stage group, median age of 52.53(19 ∼ 73) vs 57.77(45 ∼ 75). In contrast to early stage group, advanced stage group had high proportion of serous carcinoma (6/17 (35.3%) vs 15/17 (88.2%) and short DFS (22.27 months vs 10.87 months). Among 34 patients, only 2 patients refused BRCA testing and gene counseling at each group. In early stage group, BRCA testing period after the diagnosis and total genetic counseling time was longer than advanced group. BRCA1 was found by three patients in advanced stage group only and BRCA2 was not detected in all groups. Ten patients were found VUS (Variation of Unknown Significance) in early stage group and four patients were found VUS in advanced stage group.
Early genetic counseling even at advanced stage of ovary cancer by gynecologic oncologist is feasible. Comprehensive cancer care including treatment, prevention and early detection of BRCA mutation of ovary carcinoma is equally important. Therefore, advanced staging patient may not be an obstacle for early counseling by surgeon about BRCA mutation.
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All authors have declared no conflicts of interest.