Genetic counselling, testing feasible additions to national ovarian cancer treatment toolkit

Genetic counselling and testing can be feasibly included in frontline clinical treatment settings for ovarian cancer nationwide, according to a study by Cancer Research Malaysia (CRM).

The MaGiC* study found that oncologist-led and genetics-led counselling for patients with ovarian cancer resulted in similar patient uptake rates—80 and 79 percent, respectively—of testing for pathogenic BRCA1 and BRCA2 gene variants. The variants were identified in 13.5 percent of the 790 multiethnic patients enrolled in the prospective, 4-year observational study. [J Med Genet. 2021; doi:10.1136/jmedgenet-2020-107416]

“Identifying BRCA mutations in ovarian cancer patients is important for their medical management and preventative measures for their relatives,” said Yoon Sook-Yee, MaGiC study’s principal investigator and CRM’s genetic counsellor. “However, due to the lack of genetic counsellors, clinical geneticists and awareness among clinicians, there is inadequate genetic testing in most parts of Asia.”

Yoon added that mainstreaming genetic counselling would improve access to testing, allowing clinicians to identify more individuals at higher risk of ovarian cancer, and patients to access better treatment and risk management options.

Mainstreaming refers to the provision of training and resources for patients to access genetic counselling through ovarian cancer frontliner specialists eg, oncologists and gynae-oncologists, instead of dedicated genetic clinics.

Only 14 clinical geneticists and nine genetic counsellors at such clinics currently serve the national population of 32 million. In comparison, the US has more than 5,000 genetic counsellors for a population of 330 million, noted CRM’s representatives.

Conducted in collaboration between CRM and 70 clinicians from 29 sites nationwide, the MaGiC study also marks the first initiative in Asia to mainstream genetic counselling for ovarian cancer throughout an entire country. Genetic counselling services previously only available at four genetic clinics in Malaysia are now available in 23 hospitals, said representatives.

A reported 95 percent of oncologists engaged in the study also expressed interest in incorporating genetic testing into their continued clinical practice. Dato Dr Mohd Rushdan Md Noor, a gynaeoncologist at Hospital Sultanah Bahiyah, said that previously, clinicians had received little training on doing so.

“As a hospital situated outside of Klang Valley, it was a challenge for patients to have access to this kind of service,” said Rushdan. “Thanks to the MaGiC study, we are delighted to provide equitable access to precision medicine, and we hope that this will lead to an improvement in survival rates of ovarian cancer patients in Malaysia.”

Professor Dr Woo Yin Ling, MaGiC study’s lead clinician and consultant gynaeoncologist at University Malaya Medical Centre (UMMC), said that the study showed mainstreaming is feasible among oncologists and gynaeoncologists, adding that the MaGiC study had built a resource of trained clinicians nationwide to improve genetic counselling and testing access.

According to CRM’s prior research, one in nine Malaysian patients with ovarian cancer carry BRCA1 or BRCA2 gene alterations, as compared to one in 20 patients with breast cancer, and one in 1,000 healthy individuals.