Prophylactic oophorectomy rates in relation to a guideline update on referral to genetic counseling
Published Date:May 04 2012
Source:Gynecol Oncol. 2012; 126(2):229-235.
Pubmed Central ID:PMC3383401
Funding:CA63731/CA/NCI NIH HHS/United States
N01 PC035142/PC/NCI NIH HHS/United States
N01-CN-67009/CN/NCI NIH HHS/United States
N01-PC-35142/PC/NCI NIH HHS/United States
P01 CA154292/CA/NCI NIH HHS/United States
R18DP001142/DP/NCCDPHP CDC HHS/United States
U01 CA063731/CA/NCI NIH HHS/United States
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.
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.
Prophylactic oophorectomy rates were relatively unchanged after compared to before the guideline change, 1.0 versus 0.8/1,000 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 10.2/1,000 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.
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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