Abstract P4-11-06: Automatic referral to genetic counseling for identification of BRCA1/2 mutations: a pilot program at Norton Cancer Institute, Louisville, KY.
Authors: Lewis AL , Alabek ML , Dreher C , Goldberg JM , Brooks SE 
Published: August 2014

Abstract
BACKGROUND: Identifying a hereditary cancer syndrome has the potential to significantly impact a patient's treatment and long-term management, as well as prevent future malignancies among relatives. Therefore, referral of patients appropriate for genetic counseling and testing is critical. Providers traditionally initiate patient referral; however, this can lead to inconsistent referrals and results in failure to refer more than 50% of appropriate individuals, according to recent studies. In an attempt to address these quality issues, we developed an automatic referral program using the National Comprehensive Cancer Network guidelines, which was approved through our cancer committee and implemented 10/1/10. This pilot was conducted within a genetic counseling program staffed by board certified genetic counselors and associated with a private, multi-disciplinary oncology practice that is part of an American College of Surgeons accredited Network Cancer Center. Our Cancer Center is part of a five-hospital integrated healthcare system and a part of the National Cancer Institute Community Cancer Centers Program network.
METHODS: We conducted weekly reviews of oncology patients scheduled for upcoming appointments to identify individuals diagnosed with breast cancer before age 50 or with ovarian, fallopian, or primary peritoneal cancer at any age. Patients previously referred to our genetic counseling program were excluded. Providers were notified weekly of their patients identified via this program, with the option to decline referral. We undertook a retrospective review of the outcomes of individuals identified from 10/1/10 through 10/1/11, with follow up as of 6/1/12. IRB approval was obtained through the University of Louisville.
RESULTS: We identified 521 patients for referral, 24 (4.6%) of whom were declined by a provider, resulting in 497 referrals. Three hundred forty one (69%) referrals had breast cancer and 156 (31%) had other malignancies. Of referrals, 139 (28%) have been seen, 223 (45%) have declined, and 135 (27%) are in process. Testing was pursued by 108 (78%) of referrals seen, all of whom had BRCA1/2 testing and 5 (4.6%) of whom had additional testing. We identified 11 (10%) individuals with a BRCA1/2 mutation. An additional 17 (16%) individuals who completed testing were counseled to consider enhanced surveillance in the absence of a confirmed hereditary cancer syndrome. The total number of first degree relatives with potential to benefit from this program is 62 among individuals with a BRCA1/2 mutation and 86 among individuals without a confirmed hereditary cancer syndrome.
CONCLUSIONS: Initiation of an automatic genetic counseling referral program in the setting of a large oncology practice is feasible and has the potential to identify individuals with a BRCA1/2 mutation who might otherwise go undetected. Few providers object to referral, and the majority of patients are receptive to referral. The impact of this program extends beyond those identified with a BRCA1/2 mutation. This project was funded in part with federal funds: NCI, NIH Contract No. HHSN261200800001E.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-11-06.