Emerging Role of Gynecologic Oncologist as BRCA Mutation Counselor for Breast Cancer Patients

Abstract

Background: BRCA mutations carry a lifetime risk of breast and ovarian cancer. Although breast cancer occurs more frequently than ovarian cancer, it has lower mortality in Korea and the United states. Providing genetic counseling for BRCA mutation carriers provides several advantages in the prevention and treatment of both cancers. The objective of this study was to investigate the role of gynecologic oncologists as genetic counselors for BRCA mutation in breast cancer. Material & Methods:We performed a retrospective review of patients diagnosed with breast cancer who had visited a gynecologic oncology clinic for a variety of reasons. Clinical information of age, family and personal history of cancer, and purpose of clinic visit was extracted from their medical records. Genetic counseling of BRCA1 and 2 mutations was offered to any patient who had not undergone counseling previously. Risk management and further counseling were offered to inform patients about risk-reducing surgery and cascade testing of family members after obtaining results of such mutations.Outcomes: A total of 33 breast cancer patients who had visited a gynecologic clinic were selected. The most common purpose of visit was routine gynecological exam (16/33) and the second most common was gynecologic problems with fibroids, ovarian cysts, and vaginal spotting (15/33). Two patients visited for risk-reducing surgery consultation. Median ages at clinic visit and diagnosis of breast cancer were 46 (range, 32-69) and 44 (range, 32-69) years, respectively. Fourteen (14/33, 42%) patients were stage IA and three patients were triple negative (ER/PR/HER2/neu). Eighteen (18/33, 55%) patients were taking tamoxifen. Five patients had a family history of BRCA-related cancer. Among 33 patients, only three with BRCA results had BRCA counseling by a breast cancer surgeon and 11 (11/33, 37%) patients accepted BRCA gene testing. Two patients had BRCA1 germline mutations and two had BRCA2 mutations. Three patients had VUS (Variation of Unknown Mutation). Information about risk-reducing surgery and family counseling were provided for all patients who were positive for mutation.Conclusions: Genetic counseling about BRCA mutations in breast cancer patient by experienced gynecologic oncologists is feasible. Breast cancer patients with gynecologic issues are encouraged to receive genetic counseling by gynecologic oncologists.