Genetic testing is an increasingly important component of cancer care, particularly for women with breast or ovarian cancers. Identifying the mutations present in a patient's tumor can guide treatment decisions and give hints about a patient's prognosis. But it's been difficult to determine exactly when and how genetic testing is carried out day-to-day in clinics across the country, and whether ethnic or income disparities may affect a woman's access to such testing.
Now Allison Kurian, MD, a Stanford breast and gynecologic cancer specialist, together with colleagues Kevin Ward,
From our release:
National guidelines recommend that all women with the most common type of ovarian cancer be tested for the presence of cancer-associated mutations; guidelines for testing breast cancer patients have been less expansive. Although the guidelines for genetic testing have expanded to include more patients diagnosed with breast or ovarian cancer and the more extensive multigene panel tests, it's not been clear to what degree these guidelines are followed in real-world clinical settings. Furthermore, the prevalence of known cancer-associated mutations in breast and ovarian cancer patients who are racial or ethnic minorities, as well as in the overall population, is unknown.
The researchers used the National Cancer Institute's Surveillance, Epidemiology and End Results Program to study women diagnosed with breast or ovarian cancer in California and Georgia from 2013 to 2014. They linked information from the database with the results from four laboratories that provided most of the cancer genetic testing in the nation during that time period.
Kurian and her colleagues found that only about one-third of women diagnosed with ovarian cancer during the study period underwent genetic testing. The prevalence of the testing was highest among non-Hispanic white women and lower among Hispanic and African American women, and women living in wealthier areas were more likely to have been tested than those living in poorer neighborhoods. Additionally, women with private insurance were more likely to have been tested than those on Medicare.
As Kurian explained in our release:
We initiated this study -- the largest population-based study of multigene testing in breast and ovarian cancer patients -- because we wanted to see what cancer genetic testing and results looked like in the real world. Now we can see that women with ovarian cancer are dramatically undertested. We also learned that between 8 and 15 percent of women with breast or ovarian cancer carry cancer-associated mutations that could be used to drive care decisions and influence family members' health care and screening choices.
Photo by Tom Woodward