Abstract IA11: Women at high risk for ovarian cancer: Novel strategies for identification and prevention

Abstract

Abstract Most women carry a lifetime risk of 1.4% of ovarian cancer. However, certain women with germline mutations in BRCA1, BRCA2, or other hereditary cancer genes have elevated lifetime risks, some as high as 50%. Identification of these unaffected, high-risk women, followed by patient-centered prevention strategies, is key to decreasing overall mortality from ovarian cancer. A number of barriers exist for identification—including cost, patient preference, and availability of genetics services. In an effort to decrease these barriers, novel delivery systems of genetic testing have been developed. We are currently testing an on-line genetic counseling and testing strategy in a study called Making Genetic Testing Accessible (MAGENTA). We hypothesize that online genetic education and testing with access to board-certified genetic counselors could improve access to genetic testing while maintaining test quality and clinical utility. In this prospective, randomized, national clinical trial, over 3,000 women with a family history of breast or ovarian cancer will undergo genetic testing. We will compare the effectiveness of online genetic education with optional telephone counseling with three other strategies: online genetic education with required pretest telephone genetic counseling, online genetic education with required post-test telephone genetic counseling, and online genetic education with required pre- and post-test telephone genetic counseling. The primary outcome is cancer risk distress at 3 months post disclosure of genetic test results. Additional endpoints include testing completion rate (defined as receiving results), genetics knowledge, cognitive outcomes (i.e., decisional satisfaction, decisional regret), and behavioral outcomes. We currently have women enrolled from all 50 states in the United States. Preliminary data from this study will be presented. In addition, we will discuss our prospective, multicenter surgical prevention study that has enrolled over 200 women nationwide who have undergone either a salpingectomy or risk-reducing salpingo-oophorectomy (RRSO). The concept of salpingectomy with delayed oophorectomy as a cancer-prevention strategy for high-risk women is based on multiple studies implicating the fallopian tube epithelia as the cell of origin for BRCA-associated high-grade serous ovarian cancer. This information, coupled with high-risk women’s desire to minimize side effects associated with surgical menopause from RRSO, forms the rationale for the study. Finally, we will discuss plans for a prospective, international trial of salpingectomy in high-risk women that will be powered for a cancer efficacy endpoint. Citation Format: Karen H. Lu. Women at high risk for ovarian cancer: Novel strategies for identification and prevention [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research; 2019 Sep 13-16, 2019; Atlanta, GA. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(13_Suppl):Abstract nr IA11.