Genetic testing uptake among ovarian cancer survivors in the Genetic Risk Analysis in Ovarian Cancer (GRACE) study

Abstract

Simple Summary The improvement in genetic testing uptake for ovarian cancer faces barriers, such as deficiency in access to genetic testing and counseling, lack of referral, and poor follow-up to completion. Genetic risk information can be utilized to guide risk reduction strategies and management during ovarian cancer treatment. The Genetic Risk Analysis in ovarian CancEr (GRACE) study aimed to evaluate the feasibility of retrospective identification ("Traceback") of both individuals diagnosed with ovarian cancer and their families who could benefit from genetic risk information. The GRACE study findings can assist health care systems to implement and increase genetic testing for survivors of ovarian cancer and other hereditary cancers.Abstract Background: Recommendations state all people with ovarian cancers (OCs) receive genetic counseling, but testing uptake is only between 15 and 31%. Those with a prior diagnosis of OC who have not received genetic testing represent a missed opportunity for life-saving genetic risk information. The Genetic Risk Analysis in ovarian CancEr (GRACE) study aimed to evaluate the feasibility of the retrospective identification ("Traceback") of individuals diagnosed with OC. Methods: This nonrandomized intervention study within two integrated health care systems identified participants with a history of OC between 1998 and 2020 who did not have genetic testing or testing limited to BRCA1/2. Participants received clinical genomic sequencing via a custom 60 gene panel. This study measured the feasibility of the Traceback methodology in OC survivors. Results: The initial cohort included 929 individuals, of which 57% had no prior genetic testing. Of the 302 eligible for recruitment, 88 consented to participate. We were able to outreach 97% of the eligible population using contact information from medical records. The stage at diagnosis was the only factor associated with consent. Of the 78 who returned their saliva sample, 21% had pathogenic/likely pathogenic variants, and 79% had negative results. Conclusion: The GRACE study resulted in a 29% uptake of genetic testing in OC survivors. The time since diagnosis did not have an impact on consent or ability to contact. GRACE can inform the implementation of future Traceback programs, providing guidance on how to prevent and mitigate the burden of OC and other hereditary cancers.