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Shelton C, Ruiz A, Shelton L, Montgomery H, Freas K, Ellsworth RE, Poll S, Pineda-Alvarez D, Heald B, Esplin ED, Nielsen SM. Universal Germline-Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision-Making. Ann Surg Oncol 2024; 31:325-334. [PMID: 37814187 PMCID: PMC10695880 DOI: 10.1245/s10434-023-14394-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Whereas the National Comprehensive Cancer Network (NCCN) criteria restrict germline-genetic testing (GGT) to a subset of breast cancer (BC) patients, the American Society of Breast Surgeons recommends universal GGT. Although the yield of pathogenic germline variants (PGV) in unselected BC patients has been studied, the practicality and utility of incorporating universal GGT into routine cancer care in community and rural settings is understudied. This study reports real-world implementation of universal GGT for patients with breast cancer and genetics-informed, treatment decision-making in a rural, community practice with limited resources. METHODS From 2019 to 2022, all patients with breast cancer at a small, rural hospital were offered GGT, using a genetics-extender model. Statistical analyses included Fisher's exact test, t-tests, and calculation of odds ratios. Significance was set at p < 0.05. RESULTS Of 210 patients with breast cancer who were offered GGT, 192 (91.4%) underwent testing with 104 (54.2%) in-criteria (IC) and 88 (45.8%) out-of-criteria (OOC) with NCCN guidelines. Pathogenic germline variants were identified in 25 patients (13.0%), with PGV frequencies of 15 of 104 (14.4%) in IC and ten of 88 (11.4%) in OOC patients (p = 0.495). GGT informed treatment for 129 of 185 (69.7%) patients. CONCLUSIONS Universal GGT was successfully implemented in a rural, community practice with > 90% uptake. Treatment was enhanced or de-escalated in those with and without clinically actionable PGVs, respectively. Universal GGT for patients with breast cancer is feasible within rural populations, enabling optimization of clinical care to patients' genetic profile, and may reduce unnecessary healthcare, resource utilization.
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Affiliation(s)
| | | | | | | | - Karen Freas
- The Outer Banks Hospital, Nags Head, NC, USA
| | | | - Sarah Poll
- Invitae Corporation, San Francisco, CA, USA
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Hongyan J, Pengcheng C, Chihong Z, Xiaoqian Q, Danying W, Jianguo F. Serum high-density lipoprotein level and prognosis of ovarian cancer. Medicine (Baltimore) 2023; 102:e35561. [PMID: 37832112 PMCID: PMC10578687 DOI: 10.1097/md.0000000000035561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
This study aimed to investigate the prognostic value of serum high-density lipoprotein (HDL) level in patients with ovarian cancer. This study enrolled 152 patients diagnosed with ovarian cancer and 119 patients with benign ovarian tumors. The associations of patient characteristics and disease with survival were determined using Cox regression analysis, t tests, analysis of variance for multiple-group comparisons, and chi-square tests. The potential association between HDL levels and the clinical characteristics of the disease was also analyzed. The diagnostic value of HDL was estimated using receiver operating characteristic curve analysis and calculation of the area under the curve. Progression-free survival and overall survival were determined using the Kaplan-Meier method, and their associations with patient and pathological variables, including HDL, were determined using the log-rank test. The median serum HDL was 1.15 mm measured in 152 patients with ovarian cancer and 1.30 mm in 119 patients with benign ovarian tumors (P = .000054). The receiver operating characteristic curve analysis yielded an area under the curve of 0.735 for serum HDL levels. Serum HDL levels were significantly associated with tumor pathological types (non-serous vs serous, P < .05). No association was observed between serum HDL levels and patient age, age at menarche or marriage, number of children, tumor grade, or clinical stage (P > .05). Patients with high serum HDL levels had a longer progression-free survival and overall survival than those with low serum HDL levels. Serum HDL levels are an independent prognostic factor for ovarian cancer.
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Affiliation(s)
- Jiang Hongyan
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chen Pengcheng
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Zhu Chihong
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Qian Xiaoqian
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Wan Danying
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Feng Jianguo
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
- Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Hangzhou, Zhejiang, China
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Sessa C, Balmaña J, Bober SL, Cardoso MJ, Colombo N, Curigliano G, Domchek SM, Evans DG, Fischerova D, Harbeck N, Kuhl C, Lemley B, Levy-Lahad E, Lambertini M, Ledermann JA, Loibl S, Phillips KA, Paluch-Shimon S. Risk reduction and screening of cancer in hereditary breast-ovarian cancer syndromes: ESMO Clinical Practice Guideline. Ann Oncol 2023; 34:33-47. [PMID: 36307055 DOI: 10.1016/j.annonc.2022.10.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- C Sessa
- Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - J Balmaña
- Medical Oncology Hospital Vall d'Hebron and Hereditary Cancer Genetics Group, Vall d'Hebron Institut of Oncology, Barcelona, Spain
| | - S L Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute/Harvard Medical School, Boston, USA
| | - M J Cardoso
- Champalimaud Foundation, Breast Unit and Faculdade de Medicina, Lisbon, Portugal
| | - N Colombo
- Department of Gynecologic Oncology, Istituto Europeo di Oncologia e IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - G Curigliano
- Early Drug Development for Innovative Therapies Division, Istituto Europeo di Oncologia, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - S M Domchek
- Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - D G Evans
- Manchester Centre for Genomic Medicine, Division of Evolution Infection and Genomic Sciences, University of Manchester, MAHSC, Manchester, UK; Manchester Centre for Genomic Medicine, MAHSC, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - D Fischerova
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - N Harbeck
- Breast Center, Department of Obstetrics & Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich, Germany
| | - C Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, University Hospital Aachen (UKA), RWTH Aachen, Germany
| | - B Lemley
- KIU - Patient Organisation for Women with Gynaecological Cancer, Copenhagen, Denmark; Clinical Trials Project, ESGO ENGAGe, Prague, Czech Republic
| | - E Levy-Lahad
- Medical Genetics Institute, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - J A Ledermann
- Department of Oncology, UCL Cancer Institute, University College London and UCL Hospitals, London, UK
| | - S Loibl
- GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - K-A Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre and The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - S Paluch-Shimon
- Sharett Institute of Oncology Department, Hadassah University Hospital & Faculty of Medicine Hebrew University, Jerusalem, Israel
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4
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Kumerow MT, Rodriguez JL, Dai S, Kolor K, Rotunno M, Peipins LA. Prevalence of Americans reporting a family history of cancer indicative of increased cancer risk: Estimates from the 2015 National Health Interview Survey. Prev Med 2022; 159:107062. [PMID: 35460723 PMCID: PMC9162122 DOI: 10.1016/j.ypmed.2022.107062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 11/27/2022]
Abstract
The collection and evaluation of family health history in a clinical setting presents an opportunity to discuss cancer risk, tailor cancer screening recommendations, and identify people with an increased risk of carrying a pathogenic variant who may benefit from referral to genetic counseling and testing. National recommendations for breast and colorectal cancer screening indicate that men and women who have a first-degree relative affected with these types of cancers may benefit from talking to a healthcare provider about starting screening at an earlier age and other options for cancer prevention. The prevalence of reporting a first-degree relative who had cancer was assessed among adult respondents of the 2015 National Health Interview Survey who had never had cancer themselves (n = 27,999). We found 35.6% of adults reported having at least one first-degree relative with cancer at any site. Significant differences in reporting a family history of cancer were observed by sex, age, race/ethnicity, educational attainment, and census region. Nearly 5% of women under age 50 and 2.5% of adults under age 50 had at least one first-degree relative with breast cancer or colorectal cancer, respectively. We estimated that 5.8% of women had a family history of breast or ovarian cancer that may indicate increased genetic risk. A third of U.S. adults who have never had cancer report a family history of cancer in a first-degree relative. This finding underscores the importance of using family history to inform discussions about cancer risk and screening options between healthcare providers and their patients.
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Affiliation(s)
- Marie T Kumerow
- Tanaq Support Services, LLC, 3201 C St Site 602, Anchorage, AK 99503, USA.
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-4, Atlanta, GA 30341, USA.
| | - Shifan Dai
- Cyberdata Technologies, Inc., 455 Springpark Pl # 300, Herndon, VA 20701, USA.
| | - Katherine Kolor
- Office of Genomics and Precision Public Health, Centers for Disease Control and Prevention, 2500 Century Parkway NE, MS V25-5, Atlanta, GA 30345, USA.
| | - Melissa Rotunno
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr RM 4E548, Bethesda, MD 20892, USA.
| | - Lucy A Peipins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-4, Atlanta, GA 30341, USA.
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5
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Le AL, Xie R, Liao Y, Chen I. Outcomes of Concurrent Prophylactic Mastectomy and Oophorectomy, Compared to Mastectomy and Hysterectomy, in Hereditary Breast and Gynecologic Cancer: A National Surgical Quality Improvement Program Database Analysis. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ai-Lien Le
- University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rihua Xie
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Nanhai Hospital, Foshan, Guangdong Province, China
| | - Yan Liao
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Innie Chen
- University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
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Muessig KR, Zepp JM, Keast E, Shuster EE, Reyes AA, Arnold B, Ingphakorn C, Gilmore MJ, Kauffman TL, Hunter JE, Knerr S, Feigelson HS, Goddard KAB. Retrospective assessment of barriers and access to genetic services for hereditary cancer syndromes in an integrated health care delivery system. Hered Cancer Clin Pract 2022; 20:7. [PMID: 35144679 PMCID: PMC8832647 DOI: 10.1186/s13053-022-00213-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/30/2022] [Indexed: 12/18/2022] Open
Abstract
Background A critical step in access to genetic testing for hereditary cancer syndromes is referral for genetic counseling to assess personal and family risk. Individuals meeting testing guidelines have the greatest need to be evaluated. However, referrals to genetics are underutilized in US patients with hereditary cancer syndromes, especially within traditionally underserved populations, including racial and ethnic minorities, low-income, and non-English speaking patients. Methods We studied existing processes for referral to genetic evaluation and testing for hereditary cancer risk to identify areas of potential improvement in delivering these services, especially for traditionally underserved patients. We conducted a retrospective review of 820 referrals to the Kaiser Permanente Northwest (KPNW) genetics department containing diagnosis codes for hereditary cancer risk. We classified referrals as high- or low-quality based on whether sufficient information was provided to determine if patients met national practice guidelines for testing. Through chart abstraction, we also assessed consistency with practice guidelines, whether the referral resulted in a visit to the genetics department for evaluation, and clinical characteristics of patients receiving genetic testing. Results Most referrals (n = 514, 63%) contained sufficient information to assess the appropriateness of referral; of those, 92% met practice guidelines for genetic testing. Half of referred patients (50%) were not offered genetic evaluation; only 31% received genetic testing. We identified several barriers to receiving genetic evaluation and testing, the biggest barrier being completion of a family history form sent to patients following the referral. Those with a referral consistent with testing guidelines, were more likely to receive genetic testing than those without (39% vs. 29%, respectively; p = 0.0058). Traditionally underserved patients were underrepresented in those receiving genetic evaluation and testing relative to the overall adult KPNW population. Conclusions Process improvements are needed to increase access to genetic services to diagnose hereditary cancer syndromes prior to development of cancer.
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Affiliation(s)
- Kristin R Muessig
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR, 97227, USA.
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR, 97227, USA
| | - Erin Keast
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR, 97227, USA
| | - Elizabeth E Shuster
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR, 97227, USA
| | - Ana A Reyes
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR, 97227, USA
| | - Briana Arnold
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR, 97227, USA
| | - Chalinya Ingphakorn
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR, 97227, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR, 97227, USA
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR, 97227, USA
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR, 97227, USA
| | - Sarah Knerr
- Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Heather S Feigelson
- Institute for Health Research Kaiser Permanente Colorado, 10065 E Harvard Avenue #300, Denver, CO, 80231, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Avenue, Portland, OR, 97227, USA
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7
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Kim S, Aceti M, Baroutsou V, Bürki N, Caiata-Zufferey M, Cattaneo M, Chappuis PO, Ciorba FM, Graffeo-Galbiati R, Heinzelmann-Schwarz V, Jeong J, Jung MM, Kim SW, Kim J, Lim MC, Ming C, Monnerat C, Park HS, Park SH, Pedrazzani CA, Rabaglio M, Ryu JM, Saccilotto R, Wieser S, Zürrer-Härdi U, Katapodi MC. Using a Tailored Digital Health Intervention for Family Communication and Cascade Genetic Testing in Swiss and Korean Families With Hereditary Breast and Ovarian Cancer: Protocol for the DIALOGUE Study. JMIR Res Protoc 2021; 10:e26264. [PMID: 34114954 PMCID: PMC8235289 DOI: 10.2196/26264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/09/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
Background In hereditary breast and ovarian cancer (HBOC), family communication of genetic test results is essential for cascade genetic screening, that is, identifying and testing blood relatives of known mutation carriers to determine whether they also carry the pathogenic variant, and to propose preventive and clinical management options. However, up to 50% of blood relatives are unaware of relevant genetic information, suggesting that potential benefits of genetic testing are not communicated effectively within family networks. Technology can facilitate communication and genetic education within HBOC families. Objective The aims of this study are to develop the K-CASCADE (Korean–Cancer Predisposition Cascade Genetic Testing) cohort in Korea by expanding an infrastructure developed by the CASCADE (Cancer Predisposition Cascade Genetic Testing) Consortium in Switzerland; develop a digital health intervention to support the communication of cancer predisposition for Swiss and Korean HBOC families, based on linguistic and cultural adaptation of the Family Gene Toolkit; evaluate its efficacy on primary (family communication of genetic results and cascade testing) and secondary (psychological distress, genetic literacy, active coping, and decision making) outcomes; and explore its translatability using the reach, effectiveness, adoption, implementation, and maintenance framework. Methods The digital health intervention will be available in French, German, Italian, Korean, and English and can be accessed via the web, mobile phone, or tablet (ie, device-agnostic). K-CASCADE cohort of Korean HBOC mutation carriers and relatives will be based on the CASCADE infrastructure. Narrative data collected through individual interviews or mini focus groups from 20 to 24 HBOC family members per linguistic region and 6-10 health care providers involved in genetic services will identify the local cultures and context, and inform the content of the tailored messages. The efficacy of the digital health intervention against a comparison website will be assessed in a randomized trial with 104 HBOC mutation carriers (52 in each study arm). The translatability of the digital health intervention will be assessed using survey data collected from HBOC families and health care providers. Results Funding was received in October 2019. It is projected that data collection will be completed by January 2023 and results will be published in fall 2023. Conclusions This study addresses the continuum of translational research, from developing an international research infrastructure and adapting an existing digital health intervention to testing its efficacy in a randomized controlled trial and exploring its translatability using an established framework. Adapting existing interventions, rather than developing new ones, takes advantage of previous valid experiences without duplicating efforts. Culturally sensitive web-based interventions that enhance family communication and understanding of genetic cancer risk are timely. This collaboration creates a research infrastructure between Switzerland and Korea that can be scaled up to cover other hereditary cancer syndromes. Trial Registration ClinicalTrials.gov NCT04214210; https://clinicaltrials.gov/ct2/show/NCT04214210 and CRiS KCT0005643; https://cris.nih.go.kr/cris/ International Registered Report Identifier (IRRID) PRR1-10.2196/26264
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Affiliation(s)
- Sue Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Monica Aceti
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Vasiliki Baroutsou
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Nicole Bürki
- Women's Clinic and Gynecological Oncology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Maria Caiata-Zufferey
- La Scuola Universitaria Professionale della Svizzera Italiana (SUPSI), Manno, Switzerland
| | - Marco Cattaneo
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Pierre O Chappuis
- Unit of Oncogenetics, Division of Oncology, Division of Genetic Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Florina M Ciorba
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | | | - Viola Heinzelmann-Schwarz
- Women's Clinic and Gynecological Oncology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - MiSook M Jung
- College of Nursing, Chungnam National University, Deajeon, Republic of Korea
| | - Sung-Won Kim
- Dairim St Mary's Hospital, Seoul, Republic of Korea
| | - Jisun Kim
- Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Myong Cheol Lim
- Division of Tumor Immunology, Center for Gynecologic Cancer Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Chang Ming
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | | | - Hyung Seok Park
- Department of Surgery, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Sang Hyung Park
- Department of Computer Science, Yonsei University, Seoul, Republic of Korea
| | - Carla A Pedrazzani
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Manuela Rabaglio
- University Clinic for Medical Oncology, Inselspital, Bern, Switzerland
| | - Jai Min Ryu
- Department of Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ramon Saccilotto
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Simon Wieser
- School of Management and Law, Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Ursina Zürrer-Härdi
- Medical Oncology and Hematology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Maria C Katapodi
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Identification of women at risk for hereditary breast and ovarian cancer in a sample of 1000 Slovenian women: a comparison of guidelines. BMC Cancer 2021; 21:665. [PMID: 34082720 PMCID: PMC8176743 DOI: 10.1186/s12885-021-08400-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background An important number of breast and ovarian cancer cases is due to a strong genetic predisposition. The main tool for identifying individuals at risk is recognizing a suggestive family history of cancer. We present a prospective study on applying three selected clinical guidelines to a cohort of 1000 Slovenian women to determine the prevalence of at-risk women according to each of the guidelines and analyze the differences amongst the guidelines. Methods Personal and family history of cancer was collected for 1000 Slovenian women. Guidelines by three organizations: National Comprehensive Cancer Network (NCCN), American College of Medical Genetics in cooperation with National Society of Genetic Counselors (ACMG/NSGC), and Society of Gynecologic Oncology (SGO) were applied to the cohort. The number of women identified, the characteristics of the high-risk population, and the agreement between the guidelines were explored. Results NCCN guidelines identify 13.2% of women, ACMG/NSGC guidelines identify 7.1% of women, and SGO guidelines identify 7.0% of women from the Slovenian population, while 6.2% of women are identified by all three guidelines as having high-risk for hereditary breast and ovarian cancer. Conclusions We identified 13.7% of women from the Slovenian population as being at an increased risk for breast and ovarian cancer based on their personal and family history of cancer using all of the guidelines. There are important differences between the guidelines. NCCN guidelines are the most inclusive, identifying nearly twice the amount of women as high-risk for hereditary breast and ovarian cancer as compared to the AGMG/NSCG and SGO guidelines in the Slovenian population. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08400-8.
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9
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Baroutsou V, Underhill-Blazey ML, Appenzeller-Herzog C, Katapodi MC. Interventions Facilitating Family Communication of Genetic Testing Results and Cascade Screening in Hereditary Breast/Ovarian Cancer or Lynch Syndrome: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13040925. [PMID: 33672149 PMCID: PMC7926393 DOI: 10.3390/cancers13040925] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 12/19/2022] Open
Abstract
Evidence-based guidelines recommend cascade genetic testing of blood relatives of known Hereditary Breast and Ovarian Cancer (HBOC) or Lynch Syndrome (LS) cases, to inform individualized cancer screening and prevention plans. The study identified interventions designed to facilitate family communication of genetic testing results and/or cancer predisposition cascade genetic testing for HBOC and LS. We conducted a systematic review and meta-analysis of randomized trials that assessed intervention efficacy for these two outcomes. Additional outcomes were also recorded and synthesized when possible. Fourteen articles met the inclusion criteria and were included in the narrative synthesis and 13 in the meta-analysis. Lack of participant blinding was the most common risk of bias. Interventions targeted HBOC (n = 5); both HBOC and LS (n = 4); LS (n = 3); or ovarian cancer (n = 2). All protocols (n = 14) included a psychoeducational and/or counseling component. Additional components were decision aids (n = 4), building communication skills (n = 4), or motivational interviewing (n = 1). The overall effect size for family communication was small (g = 0.085) and not significant (p = 0.344), while for cascade testing, it was small (g = 0.169) but significant (p = 0.014). Interventions show promise for improving cancer predisposition cascade genetic testing for HBOC and LS. Future studies should employ family-based approaches and include racially diverse samples.
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Affiliation(s)
- Vasiliki Baroutsou
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland;
| | - Meghan L. Underhill-Blazey
- School of Nursing, Wilmot Cancer Institute Hereditary Cancer Program, University of Rochester, Rochester, NY 14642, USA;
| | | | - Maria C. Katapodi
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland;
- Correspondence: ; Tel.: +41-61-207-04-30
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10
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Green RF, Kumerow MT, Rodriguez JL, Addie S, Beachy SH, Senier L. Implementing Cancer Genomics in State Health Agencies: Mapping Activities to an Implementation Science Outcome Framework. Public Health Genomics 2020; 23:218-229. [PMID: 32942283 DOI: 10.1159/000510336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To show how state health agencies can plan and evaluate activities to strengthen the evidence base for public health genomics, we mapped state cancer genomics activities to the Doyle et al. [Genet Med. 2018;20(9):995-1003] implementation science outcome framework. METHODS We identified state health agency activities addressing hereditary breast and ovarian cancer and Lynch syndrome by reviewing project narratives from Centers for Disease Control and Prevention Cancer Genomics Program funding recipients, leading discussions with state health agencies, and conducting an environmental scan. RESULTS State health agencies' cancer genomics activities included developing or adding to state surveillance systems, developing educational materials, bidirectional reporting, promoting health plan policy change, training providers, and promoting recommendations and standards. To address health disparities, programs have tracked group differences, developed culturally appropriate educational materials, and promoted access to services for underserved populations. CONCLUSION State health agencies can use the Doyle et al. [Genet Med. 2018;20(9):995-1003] performance objectives and outcome measures to evaluate proposed and ongoing activities. By demonstrating whether activities result in improved outcomes, state health agencies can build the evidence for the implementation of cancer genomics activities.
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Affiliation(s)
- Ridgely Fisk Green
- Carter Consulting, Inc. and Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,
| | - Marie T Kumerow
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Siobhan Addie
- National Academies of Sciences, Engineering, and Medicine, Washington, District of Columbia, USA
| | - Sarah H Beachy
- National Academies of Sciences, Engineering, and Medicine, Washington, District of Columbia, USA
| | - Laura Senier
- Department of Sociology & Anthropology and Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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Greenberg S, Buys SS, Edwards SL, Espinel W, Fraser A, Gammon A, Hafen B, Herget KA, Kohlmann W, Roundy C, Sweeney C. Population prevalence of individuals meeting criteria for hereditary breast and ovarian cancer testing. Cancer Med 2019; 8:6789-6798. [PMID: 31531966 PMCID: PMC6825998 DOI: 10.1002/cam4.2534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/21/2022] Open
Abstract
Background Personal cancer diagnosis and family cancer history factor into which individuals should undergo genetic testing for hereditary breast and ovarian cancer (HBOC) syndrome. Family history is often determined in the research setting through kindreds with disease clusters, or clinically from self‐report. The population prevalence of individuals with diagnostic characteristics and/or family cancer history meeting criteria for HBOC testing is unknown. Methods Utilizing Surveillance, Epidemiology, and End Results (SEER) cancer registry data and a research resource linking registry records to genealogies, the Utah Population Database, the population‐based prevalence of diagnostic and family history characteristics meeting National Comprehensive Cancer Network (NCCN) criteria for HBOC testing was objectively assessed. Results Among Utah residents with an incident breast cancer diagnosis 2010‐2015 and evaluable for family history, 21.6% met criteria for testing based on diagnostic characteristics, but the proportion increased to 62.9% when family history was evaluated. The proportion of cases meeting testing criteria at diagnosis was 94% for ovarian cancer, 23% for prostate cancer, and 51.1% for pancreatic cancer. Among an unaffected Utah population of approximately 1.7 million evaluable for family history, 197,601 or 11.6% met testing criteria based on family history. Conclusions This study quantifies the population‐based prevalence of HBOC criteria using objectively determined genealogy and cancer incidence data. Sporadic breast cancer likely represents a portion of the high prevalence of family cancer history seen in this study. These results underline the importance of establishing presence of a deleterious mutation in an affected family member, per NCCN guidelines, before testing unaffected relatives.
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Affiliation(s)
| | - Saundra S Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | | | - Whitney Espinel
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Alison Fraser
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Amanda Gammon
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Brent Hafen
- Intermountain Healthcare, Salt Lake City, Utah
| | | | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Carol Sweeney
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Utah Cancer Registry, University of Utah, Salt Lake City, Utah
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