Ursula A. Matulonis, MD: All patients with ovarian cancer, regardless of stage, regardless of histology, regardless of family history, should undergo genetic testing. And that genetic testing now should undergo at initial diagnosis. So it’s important to understand if that patient has an underlying BRCA mutation or one of a number of different other genetic mutations. It’s important to understand for the patient herself in thinking about risk-reducing surgeries in the future or screening tests, as well as letting her family members, direct blood relatives, know that she has this mutation, yes or no. And understanding someone’s BRCA status is also important for treatment planning because of the SOLO-1 results for patients who have advanced ovarian cancer and have an underlying BRCA mutation, using and thinking about olaparib as a maintenance strategy post-carboplatin/paclitaxel chemotherapy.
So genetic counseling, genetic testing, really has to happen for all of our patients and has to happen initially. At our institution, what I do is I’ll start with germline testing, get that genetic counselor in to see the patient very quickly during either cycle 1, 2, or 3 of her treatment, get the blood tested quickly, and then also test the tumor. For patients with high-grade serous carcinoma, about 6% of those patients will have a somatic or tumor BRCA mutation. And, for those patients who have somatic BRCA mutations, they can also benefit from upfront olaparib maintenance.
Kathleen Moore, MD: In my practice, there’s a definite blend for genetic counseling for our patients. We have genetic counselors at our cancer center, and they’re very good. They’re exceptional, in fact. But, for the most part, for the ovarian cancer patients, the providers are ordering the testing and doing the testing because we all shifted it very early on in the diagnosis. And then we are referring those patients who have a positive test or those patients who just want to speak with a genetic counselor if they have a very significant family history, for example; or even if they don’t and they want to see a genetic counselor, they go to genetic counseling. So that’s what we do at our institution.
We do not have the restrictions that some sites have, such that only a genetic counselor can order the genetic test. Were there enough genetic counselors that they could see patients right that day and we could get things done would be the best way to take care of patients because the services they provide are really essential. And I believe that we just don’t have enough, and so it’s several weeks to get a patient in and there’s the risk that they don’t go and then you forget about it, and then you haven’t tested somebody. And that’s just been a known roadblock and again, it’s just not an excuse anymore. And so we, the providers, test. We do a little bit of counseling, but I would never say honestly that we do as good a job as the counselors. So we do try to get them eventually to see the counselors so that everybody feels like they’ve had the opportunity to have their family pedigree evaluated if they so choose. But the initial testing is done by us.
Transcript Edited for Clarity