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Publications

Journal Article Review Ahead of print

PubMed: 42817777 DOI: 10.1002/ijgo.71348

Global implementation of hereditary cancer care in gynecologic oncology: Development and evaluation of the Hereditary Cancer Care Implementation Index.

Int J Gynaecol Obstet

Authors: Mauricio A Cuello, Carolina Ibañez, Juan Sebastián Obando, Angélica Fletcher, Christina Fotopoulou, Joachim Sehouli, Alexander Olawaiye, Munachiso Ndukwe Iheme, Eva Chalas, David Mutch, Ka Yu Tse, Neerja Bhatla, Barbara Schmalfeldt

Affiliations

  • Department of Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
  • Gynecologic Oncology Unit, Hospital Clínico Universidad Católica, UC-Christus Health Network, Santiago, Chile.
  • Center for Cancer Prevention and Control, Santiago, Chile.
  • Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
  • Instituto Nacional De Cancerología, Bogotá, Colombia. Universidad Militar Nueva Granada, Bogotá, Colombia.
  • Instituto Nacional De Cancerología, Bogotá, Colombia.
  • Department of Gynecologic Oncology, Clínica Internacional de Alta Tecnología, Ibagué, Colombia.
  • Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
  • Department of Gynecology, Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
  • Department of Obstetrics and Gynecology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic.
  • Department of Gynecologic Oncology, New York University Grossman Long Island School of Medicine, Mineola, New York, USA.
  • Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA.
  • Division of Gynaecology Oncology, Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, Hong Kong.
  • All India Institute of Medical Sciences, New Delhi, India.
  • Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Abstract

This study develops and evaluates a pragmatic framework for benchmarking hereditary cancer care implementation in gynecologic oncology and identify gaps between testing access, policy adoption, and preventive care delivery to evaluate genetic counselor workforce capacity as an independent implementation correlate across different health system settings. We conducted an international implementation assessment across 36 countries representing eight geographic regions and diverse socioeconomic contexts. The Hereditary Cancer Care Implementation Index (HCCII) was developed using predefined implementation domains, including testing access, policy and guideline integration, preventive intervention uptake, and life-course care, while genetic counselor workforce capacity was assessed separately as an implementation determinant. Publicly available data, national guidelines, published reports, and professional society resources were systematically reviewed and scored using standardized criteria. Country-level performance was evaluated descriptively and explored in relation to implementation domains and structural health system characteristics. HCCII scores ranged from 0 to 12 across 36 countries. Ten countries (27.8%) achieved Tier I implementation (score 10-12), while 14 countries (38.9%) scored in the lowest tier (0-3) and 19 lacked nationally documented data on preventive intervention uptake. Testing infrastructure and policy readiness were more developed than preventive care delivery across all regions. A persistent Access-Delivery gap was identified even among high-income countries, indicating that implementation capacity does not reliably translate into delivery of risk-reducing interventions. Hereditary cancer care implementation remains highly variable worldwide. The HCCII provides a pragmatic benchmarking framework for evaluating implementation across health systems. Our findings highlight a persistent gap between genetic testing capacity and translation into preventive care, including in high-income settings, emphasizing the need for implementation strategies that prioritize delivery, equity, and sustainability alongside expansion of testing services.

MeSH

Research Design, Genetic Testing, Preventive Medicine, Neoplasms, Income, Obstetrics, Benchmarking, Implementation Science, Workforce