Establishment and challenges of hereditary breast and ovarian cancer (HBOC) treatment system in northern Tochigi Prefecture: in the absence of a certified genetic counselor

Abstract

　The BRCA1/2 gene test has been covered by insurance since 2018 as a companion diagnosis for PARP inhibitors and the diagnosis of hereditary breast and ovarian cancer syndrome (HBOC) in Japan. In response to the insurance coverage of HBOC diagnosis and the coronavirus disease (COVID-19) pandemic in 2020, we opened an outpatient genetic counseling clinic in obstetrics and gynecology department to establish a genetic counseling system within the secondary medical care area. In collaboration with neighboring medical institutions, we conducted the BRCA1/2 gene test in 31 cases in the first two years, leading to surveillance and risk-reducing salpingo-oophorectomy (RRSO). On the other hand, we found the importance of multidisciplinary cooperation within the hospital and regional collaboration in order to establish a sustainable system. In Tochigi Prefecture, access to advanced medical institutions, which are unevenly distributed in the southern part of the prefecture, is still difficult in some areas. Therefore, it is important in each area to develop a solid system based on cooperation with related departments and the community to meet the increasing need for genetic testing.