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 (ENYGO)

Background The introduction of Poly (ADP-ribose) Polymerase (PARP) inhibitors has made homologous recombination deficiency (HRD) and BRCA testing essential for guiding personalized therapy in epithelial ovarian cancer, but implementation remains variable. We aimed to evaluate international patterns of BRCA and HRD testing, identify factors associated with their use, and assess their impact on clinical decision-making. Methods A cross-sectional survey was conducted among healthcare providers in gynaecological oncology. A 28-item questionnaire assessed demographics, testing practices, and perceived barriers related to HRD and BRCA testing. The survey was distributed via the European Network of Young Gynaecologic Oncologists (ENYGO) mailing list and social media platforms. Descriptive statistics and comparative analyses were performed. Results A total of 251 responses were analysed. Most respondents worked in academic centres (80.1%) and were based in Western Europe (56.4%). Overall, 77.7% reported performing both BRCA and HRD testing, while 17.2% performed BRCA testing alone. Testing rates were higher in advanced-stage disease ( BRCA 90.2%, HRD 80.0%) compared with early-stage disease (63.7% and 21.4%, respectively). Testing was more frequently performed in high-grade serous tumours ( BRCA 96.7%, HRD 90.0%) than in other histological subtypes. Combined testing was associated with specialty ( p =0.027), geographic region ( p <0.001), institutional setting ( P <0.001), and reimbursement status ( p <0.001). Western European practice (OR 5.95, 95%CI 3.34-10.63; p <0.001), academic setting (OR 3.49, 95%CI 1.81-6.71; p <0.001), and ESMO guideline adherence (OR 2.43, 95%CI 1.40-4.21; p =0.002) were associated with higher likelihood of combined testing, whereas NCCN adherence was associated with lower uptake (OR 0.37, 95%CI 0.21-0.67; p <0.001). BRCA and HRD testing were reported to influence treatment decisions in 91.4% and 79.2% of cases, respectively. Conclusions Although HRD and BRCA testing are widely adopted in ovarian cancer care, substantial variability persists across regions and healthcare settings. Efforts to standardise testing pathways and improve global access are required to ensure equitable delivery of biomarker-driven therapy.