Guideline concordance for risk-reducing bilateral salpingo- oophorectomy in a cohort of reproductive age women with BRCA1/2 mutations (562)

Abstract

<b>Objectives:</b> Current guidelines recommend risk-reducing bilateral salpingo-oophorectomy (RRSO) for women diagnosed with <i>BRCA1</i> mutations by ages 35-40 and <i>BRCA2</i> mutations by ages 40-45. Our study aimed to examine guideline concordance for RRSO in a cohort of women with <i>BRCA1</i> and <i>BRCA2</i> mutations. <b>Methods:</b> We performed a retrospective cohort study of women aged 18-45 diagnosed with pathogenic <i>BRCA1</i> or <i>BRCA2</i> mutations seen by gynecologic oncologists at a single academic center between 2015 and 2019 and were eligible for RRSO per national guidelines. Our primary outcome was guideline concordance, defined as <i>1)</i> electing RRSO by age 35 for women with <i>BRCA1</i> and by age 40 for women with <i>BRCA2,</i> or <i>2)</i> if the patient was diagnosed after age 35 with <i>BRCA1</i> or after age 40 with <i>BRCA2,</i> electing RRSO within one year of diagnosis. Patients were monitored for electing RRSO by July 1^st, 2021. We excluded those previously diagnosed with gynecologic malignancies and those whose current age was less than 35 for <i>BRCA1</i> and less than 40 for <i>BRCA2</i>. We examined patient differences in guideline concordance using Fisher's exact and Pearson's Chisquare tests. We then identified relevant patient factors associated with guideline concordance using univariate log-binomial regression. <b>Results:</b> Of 62 total patients, 41 had a diagnosis of a suspected pathogenic or pathogenic <i>BRCA1</i> mutation (median age at diagnosis 34 y), and 21 had a diagnosis of suspected pathogenic or pathogenic <i>BRCA2</i> mutation (median age at diagnosis 41 y). Overall, 23% of patients (<i>n</i>=14/62) were guideline-concordant, or 27% of <i>BRCA1</i> patients (<i>n</i>=11/41) and 14% of <i>BRCA2</i> patients (<i>n</i>=3/21). In the descriptive analysis, guideline concordance was more common in non-White women compared to White women (<i>n</i>=7/18 vs <i>n</i>=7/44, p=0.09) and single women compared to partnered women (<i>n</i>=4/8 vs <i>n</i>=10/54, p=0.07). More women with a family history of both breast and ovarian cancer were guideline-concordant than women with a family history of breast cancer only (<i>n</i>=9/27 vs <i>n</i>=5/30, p=0.14). However, women with a personal history of breast cancer were less commonly guideline-concordant than women without a personal history (<i>n</i>=3/19 vs <i>n</i>=11/43, p=0.5). In univariate analysis, factors significantly associated with guideline concordance were non-White compared to White race (RR: 2.4, 95% CI: 1.00-5.97) and being single compared to being partnered (RR: 2.7, 95% CI: 1.11-6.58). There were no significant associations with guideline concordance by patient BMI, having children, having private insurance, income, type of <i>BRCA</i> diagnosis, past diagnosis of breast cancer, or family history of breast or ovarian cancer. Table 1 <b>Conclusions:</b> A minority of reproductive-age <i>BRCA1/2</i> patients met guideline concordance for electing RRSO. Being guideline-concordant was associated with non-White and single status. Further studies are needed to verify and identify disparities in meeting guideline- recommended timing of RRSO for the <i>BRCA1/BRCA2</i> population.