The impact of an educational and information systems initiative on somatic BRCA testing rates in patients with high grade serous tubo-ovarian cancer in Western Australia

Andrew Fantoni; Tarek Meniawy; Paul A Cohen; Michelle McMullen

doi:10.1016/j.gore.2023.101246

The impact of an educational and information systems initiative on somatic BRCA testing rates in patients with high grade serous tubo-ovarian cancer in Western Australia

Gynecol Oncol Rep. 2023 Jul 16:48:101246. doi: 10.1016/j.gore.2023.101246. eCollection 2023 Aug.

Authors

Andrew Fantoni¹, Tarek Meniawy^{1

2

3

4}, Paul A Cohen^{2

3

4}, Michelle McMullen^{1

2}

Affiliations

¹ Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia.
² St John of God Subiaco Hospital, Subiaco, Western Australia.
³ School of Medicine, The University of Western Australia, Western Australia.
⁴ Western Australia Gynaecological Cancer Service, King Edward Memorial Hospital, Western Australia.

Abstract

Objective: Poly-ADP ribose polymerase inhibitors (PARPi) have expanded the management armamentarium against high grade serous tubo-ovarian cancer (HGSOC) in patients with germline and somatic BRCA pathogenic variants (PVs). Germline testing has been available in Western Australia (WA) since July 2015, whilst somatic BRCA testing was previously only available through interstate laboratories. We hypothesized that due to complexity of referral, testing rates for somatic BRCA would be low. We aimed to demonstrate that improving education and information systems would improve testing rates in our service.

Methods: Retrospective data were collected for all patients with HGSOC reviewed between June - November 2021. BRCA testing for this period was discussed at multi-disciplinary tumor board. Patients eligible to commence PARPi that had not received somatic testing were referred. Changes were implemented to patient outcome reports, the results application was adjusted to flag clinicians, departmental guidelines were developed, and teaching sessions conducted. Testing rates from March - August 2022 were compared.

Results: From June - November 2021, 98% of patients had germline BRCA testing performed. PVs in BRCA1/2 were detected in 18% of patients. Of those without germline PVs, further somatic BRCA testing was referred in 42% of patients. One somatic PV was detected. From March - August 2022, 99% of patients had germline BRCA testing and 17% had PVs detected. Further somatic BRCA testing was referred in 72% of patients. No somatic PVs were detected.

Conclusion: Testing rates for germline BRCA variants in patients with HGSOC in WA are high. Focused education and information systems improved somatic BRCA testing rates.

Keywords: BRCA testing; Genetics; High grade serous ovarian cancer; Mainstreaming; PARP inhibitor.