Impact of a Structured Early Detection Program on Adherence to Guidelines for Risk-Reducing Surgery in BRCA1/2 Carriers

Objective: To determine the proportion of women with BRCA1/BRCA2 mutations participating in an ovarian cancer screening program who adhere to National Comprehensive Cancer Network (NCCN) guidelines for risk-reducing bilateral salpingo-oophorectomy (BRCA1 = 40 years, BRCA2 = 45 years). Design: Retrospective cohort study. Materials and Methods: Records were reviewed of all patients with BRCA1/BRCA2 mutations who were screened in Northwestern University's Ovarian Cancer Early Detection and Protection Program from 2002 to 2016. Exclusion criteria included a prior ovarian cancer diagnosis, oophorectomy before screening, or if visits were not recorded in the prospectively collected database. The primary endpoint was age at ovarian removal. Results: Of 134 patients identified (BRCA1, n = 83; BRCA2, n = 51), 46 patients underwent risk-reducing salpingo-oophorectomy (RRSO). Most surgeries (38/46, 83%) were performed by the upper limit of the mutation-specific recommended age. Of the 86 patients who have not undergone surgery, 49 patients are not yet at the recommended age for RRSO, 4 chose to continue screening, and 33 transferred care or were lost to follow-up. Patients were more likely to have prophylactic surgery by guideline-recommended age if they identified racially as white compared with non-white (odds ratio 7.5, 95% confidence interval 1.5-36.2, p = 0.02). Conclusion: More than 80% of BRCA patients in our program who obtained RRSO did so by the NCCN recommended ages. Indeed, most patients with BRCA1/BRCA2 who have not undergone surgery are still participating in the program. As more malignancy-related genes are discovered and evolving technologies developed for both genetic testing and cancer detection, screening programs may yet find a place in the management of high-risk patients.