Patterns of genetic testing for women recently diagnosed with uterine cancer

Abstract

<h3>Objectives:</h3> Genetic profiling is rapidly emerging as standard of care for women diagnosed with uterine cancer. Optimal strategies for ensuring that genetic profiling is performed in a timely manner and that uterine cancer patients understand genetic implications of their disease remain unclear. The primary objective of this study was to profile patterns of genetic testing and counseling performed by gynecologic oncologists actively practicing in the United States and identify potential barriers for effectively incorporating genetic counseling into care of their uterine cancer patients. <h3>Methods:</h3> With institutional review board (IRB) permission, a 31-question survey was emailed to active Society of Gynecologic Oncology (SGO) members. The survey evaluated demographic characteristics, practice setting, and contained questions examining practice patterns for both somatic and germline testing in newly diagnosed uterine cancer patients. All responses were anonymous. Associations between categorical variables and endpoints were analyzed using Chi-square or Fisher's exact tests. <h3>Results:</h3> Responses were received from 184 of 2178 active SGO members. Of these, 146 were complete and included in subsequent analyses. Mean age of respondents was 41 years. 34.2% (50/146) reported practicing >10 years. 51.4% of respondents (75/146) reported practicing in university-based academic settings, while the remaining practitioners (71/146; 48.6%) see patients in community-based settings. Trainees comprised a significant proportion of survey respondents, especially in academic settings (28/75 academic [37.0%] vs 5/71 community [7.0%], p<0.0001). 138/146 respondents reported screening for Lynch syndrome, and most of these (119/138; 86.2%) reported screening all or almost all newly diagnosed endometrial cancer patients. Screening strategies included mismatch repair gene evaluation on endometrial biopsy or hysterectomy specimens. Over 90% reported that they screened all grades of endometrioid histologic subtypes. Carcinosarcoma, clear cell, and serous subtypes varied in frequency of screening (61.0% to 71.2%). Academic practices were more likely to review results of Lynch syndrome genetic screening at a tumor board (82.7% vs 67.6%, p=0.04), and report that they had a genetic tumor board (24.0% vs 8.4%, p=0.02). 53.3% of participants (65/122) indicated interest in a separate genetics tumor board if they did not have one. A significant proportion of trainees in academic settings (18.7% vs 1.4% community, p<0.01) reported that they directly conveyed genetic testing results to patients. <h3>Conclusions:</h3> Gynecologic oncologists are actively involved in genetically profiling and counseling uterine cancer patients. Clinical trainees are frequently involved in genetic counseling of recently diagnosed uterine cancer patients, particularly at academic medical centers. Both observations underscore the importance of incorporating adequate training in genetics and genetic counseling into postgraduate education of trainees in our field.