Mainstreaming genetic counselling for ovarian cancer could support screening, in Malaysia and beyond

November 20, 2017, European Society for Medical Oncology
Credit: European Society for Medical Oncology

A study that looked at mainstreaming genetic counselling for ovarian cancer to support screening programmes in Malaysia was presented at the ESMO Asia 2017 Congress. The preliminary results of the MaGiC study show that most patients counselled by a well-trained but not necessarily an expert in genetics were satisfied or just as satisfied with their experience as compared to those being counselled by a genetic counsellor or clinical geneticist.

One in nine carries the BRCA1 or BRCA2 (breast gene 1 or 2) mutation and four in 10 carriers do not have a family history of breast or ovarian cancer. Knowing one's BRCA status may indicate how one may respond to certain therapies or the level of risk to develop certain cancers.

"In the past, genetic testing in ovarian cancer was limited to a small number of patients with the aim of identifying relatives at risk," said Dr Soo Chin Lee, Senior Consultant, National University Cancer Institute, Singapore, commenting on the study. "Now that there is a drug to treat cancer patients with BRCA mutations, genetic counselling and testing is recommended for all patients with epithelial ovarian cancer. This has increased the number of patients who qualify for testing and thus specialised centres have become overloaded."

The MaGiC study was designed to assess the prevalence of germline BRCA1 and BRCA2 mutations among ovarian cancer patients; determine the feasibility of mainstreaming genetic testing and counselling at local hospitals; examine the psychosocial impact of genetic testing in Malaysia.

800 ovarian cancer patients are to be recruited over a two-year period. Basic genetic counselling workshops have been held for 70 non-genetic clinicians from 29 hospitals across Malaysia. According to the study protocol, patients are allocated to counselling by a trained non-genetic clinician in their local hospital in a clinical programme led by Professor Yin Ling Woo, MaGiC's lead clinician, or to counselling by a genetic counsellor or clinical geneticist in a programme with Professor Meow Keong Thong, lead clinical geneticist at specialised centres in Kuala Lumpur.

All blood samples were analyzed for BRCA mutations by Cancer Research Malaysia, coordinated by diagnostic lead Dr Joanna Lim. Patients received pre- counselling, followed by test results and post-test counselling. After both pre- and post-test counselling, they are interviewed by a researcher over the telephone to assess the feasibility and the psychosocial impact of the experience.

One year into the study, 248 patients have been recruited, of whom 208 received genetic testing and 13% (27) had BRCA mutations, which is similar to that found in other populations.

"Screening for BRCA1 and BRCA2 mutations and providing genetic counselling in local hospitals could help identify mutation carriers who may benefit from risk management and targeted treatment," said lead author Ms Sook-Yee Yoon, genetic counsellor, Cancer Research Malaysia, Subang Jaya, Malaysia. (3,4) "In Malaysia, BRCA genetic testing and counselling is only available at specialised centres in Kuala Lumpur but most people live outside the capital: patients seem to prefer local appointments, so if they are referred to another centre for genetic counselling, they seem less likely to attend. "

Preliminary results show that the answers to the psychosocial surveys were similar between the two groups. Most patients were satisfied with their counselling experience, felt informed about their choices, and found it easy to decide to go ahead with genetic testing.

In terms of feasibility, patients in the local and specialised counselling arms were equally satisfied or very satisfied with the counselling they received. The local counselling arm has been recruiting patients more quickly than the specialised arm.

"Cancer is still a taboo subject in Malaysia and there is a fatalistic attitude to hereditary conditions," continued Yoon. "Genetic information can cause conflict in families and the data we are collecting on the psychosocial impact of genetic testing will provide insights into the psychosocial challenges. With this knowledge, we can focus on interventions to overcome these challenges."

"Mainstreaming and counselling to local hospitals is a strategy to cope with this increased volume of patients," continued Lee. "This is ideal for a large country like Malaysia where specialised centres are concentrated in the capital yet the majority of the population live elsewhere. Lee said: "The preliminary results of the study show that moving the process to the community is feasible and could be rolled out across Malaysia. It also is a model for other countries like Singapore to follow."

Explore further: Genetic predisposition to breast cancer due to non-brca mutations in ashkenazi Jewish women

More information: Abstract LBA4_PR 'Mainstreaming Genetic Counselling for Genetic Testing of BRCA1 and BRCA2 in Ovarian Cancer Patients in Malaysia (MaGiC Study)'

Related Stories

Genetic predisposition to breast cancer due to non-brca mutations in ashkenazi Jewish women

July 20, 2017
Genetic mutations in BRCA1 and BRCA2 increase the risk of breast and ovarian cancer in Ashkenazi Jewish women. A new article published by JAMA Oncology examines the likelihood of carrying another cancer-predisposing mutation ...

Open-access genetic screening for hereditary breast cancer is feasible and effective

May 27, 2017
Ashkenazi Jewish women are known to have a predisposition to the inherited breast cancers BRCA1 and BRCA2, but currently genetic testing in this group is limited to women affected by breast and ovarian cancers and those who ...

Number of cancer gene tests increases five-fold thanks to improved availability

September 28, 2015
Mutations in the BRCA 1 and BRCA 2 genes are very likely to lead to a form of cancer in people who have them. These mutations can be detected using a genetic test. The introduction of a new drug has improved treatment options ...

Family history and location of genetic fault affect risk for carriers of cancer genes

June 20, 2017
A large scale study of women carrying faults in important cancer genes should enable doctors to provide better advice and counselling for treatments and lifestyle changes aimed at reducing this risk.

Genetic testing rates for ovarian cancer low across Ontario

April 14, 2017
Nearly 3,000 Canadian women will be diagnosed with ovarian cancer this year. Often undetected, until it progresses to late stages, the disease is the fifth most common – and the most serious – cancer in women.

Recommended for you

Why some cancers affect only young women

October 19, 2018
Among several forms of pancreatic cancer, one of them specifically affects women, often young. How is this possible, even though the pancreas is an organ with little exposure to sex hormones? This pancreatic cancer, known ...

Scientists to improve cancer treatment effectiveness

October 19, 2018
Together with researchers from the University of Nantes and the University of Reims Champagne-Ardenne in France, experts from the National Research Nuclear University MEPhI have recently developed a quantum dot-based microarray ...

Mutant cells colonize our tissues over our lifetime

October 18, 2018
By the time we reach middle age, more than half of the oesophagus in healthy people has been taken over by cells carrying mutations in cancer genes, scientists have uncovered. By studying normal oesophagus tissue, scientists ...

Study involving hundreds of patient samples may reveal new treatment options of leukemia

October 17, 2018
After more than five years and 672 patient samples, an OHSU research team has published the largest cancer dataset of its kind for a form of leukemia. The study, "Functional Genomic Landscape of Acute Myeloid Leukemia", published ...

A 150-year-old drug might improve radiation therapy for cancer

October 17, 2018
A drug first identified 150 years ago and used as a smooth-muscle relaxant might make tumors more sensitive to radiation therapy, according to a recent study led by researchers at The Ohio State University Comprehensive Cancer ...

Loss of protein p53 helps cancer cells multiply in 'unfavourable' conditions

October 17, 2018
Researchers have discovered a novel consequence of loss of the tumour protein p53 that promotes cancer development, according to new findings in eLife.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.