International trends and determinants of homologous recombination deficiency and BRCA testing in ovarian cancer management: a cross-sectional study from the European network of young gynaecologic oncologists.

OBJECTIVE

The introduction of poly (adenosine diphosphate-ribose) polymerase inhibitors has made homologous recombination deficiency and BRCA testing essential for guiding personalized therapy in epithelial ovarian cancer, although implementation remains variable. We aimed to evaluate international patterns of BRCA and homologous recombination deficiency testing, identify factors associated with their use, and assess their impact on clinical decision-making.

METHODS

A cross-sectional survey was conducted among health care providers in gynecologic oncology. A 28-item questionnaire assessed demographics, testing practices, and perceived barriers related to homologous recombination deficiency and BRCA testing. The survey was distributed via the European Network of Young Gynecologic Oncologists mailing list and social media platforms. Descriptive statistics and comparative analyses were performed.

RESULTS

A total of 251 responses were analyzed. Most respondents worked in academic centers (80.1%) and were based in Western Europe (56.4%). Overall, 77.7% reported performing both BRCA and homologous recombination deficiency testing, while 17.2% performed BRCA testing alone. Testing rates were higher in advanced-stage disease (BRCA 90.2%, homologous recombination deficiency 80.0%) compared with early-stage disease (63.7% and 21.4%, respectively). Testing was more frequently performed in high-grade serous tumors (BRCA 96.7%, homologous recombination deficiency 90.0%) than in other histologic subtypes. Combined testing was associated with specialty (p =.027), geographic region (p <.001), institutional setting (p <.001), and reimbursement status (p <.001). Western European practice (odds ratio [OR] 5.95, 95% confidence interval [CI] 3.34-10.63, p <.001), academic setting (OR 3.49, 95% CI 1.81-6.71, p <.001), and European Society for Medical Oncology guideline adherence (OR 2.43, 95% CI 1.40-4.21, p =.002) were associated with higher likelihood of combined testing, whereas National Comprehensive Cancer Network adherence was associated with lower uptake (OR 0.37, 95% CI 0.21-0.67, p <.001). BRCA and homologous recombination deficiency testing were reported to influence treatment decisions in 91.4% and 79.2% of cases, respectively.

CONCLUSIONS

Although homologous recombination deficiency and BRCA testing are widely adopted in ovarian cancer care, substantial variability persists across regions and health care settings. Efforts to standardize testing pathways and improve global access are required to ensure the equitable delivery of biomarker-driven therapy.