Prophylactic oophorectomy rates in relation to a guideline update on referral to genetic counseling

Details

• Alternative Title:
  Gynecol Oncol
• Personal Author:
  Pocobelli, Gaia ; Chubak, Jessica ; Hanson, Nancy ; Drescher, Charles ; Resta, Robert ; Urban, Nicole ; Buist, Diana S.M.
• 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.
  
  
• Subjects:
  Adult Aged Aged, 80 And Over Cohort Studies Female Genetic Counseling Genetic Predisposition To Disease Humans Middle Aged Ovarian Neoplasms Ovariectomy Retrospective Studies Risk Factors

  More +
• Source:
  Gynecol Oncol. 2012; 126(2):229-235.
• Pubmed ID:
  22564716
• Pubmed Central ID:
  PMC3383401
• Document Type:
  Journal Article
• Funding:
  N01-PC-35142/PC/NCI NIH HHS/United States ; N01 CN067009/CN/NCI NIH HHS/United States ; R18DP001142/DP/NCCDPHP CDC HHS/United States ; U01 CA063731/CA/NCI NIH HHS/United States ; N01 PC035142/PC/NCI NIH HHS/United States ; P01 CA154292/CA/NCI NIH HHS/United States ; CA63731/CA/NCI NIH HHS/United States ; R18 DP001142/DP/NCCDPHP CDC HHS/United States ; N01PC35142/CA/NCI NIH HHS/United States
• Volume:
  126
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:4189c23c066968c441e12fde84e125b8cc5c9e5c1c9b8dcda3c745c9eedb94c0
• Download URL:
  https://stacks.cdc.gov/view/cdc/33394/cdc_33394_DS1.pdf
• File Type:
  [PDF - 919.50 KB ]