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Prophylactic oophorectomy rates in relation to a guideline update on referral to genetic counseling
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Details:
  • Pubmed ID:
    22564716
  • 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
  • Document Type:
  • Collection(s):
  • Description:
    Objective

    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.

    Methods

    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.

    Results

    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.

    Conclusion

    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.