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Hynes J, Dawson L, Seal M, Green J, Woods M, Etchegary H. "There should be one spot that you can go:" BRCA mutation carriers' perspectives on cancer risk management and a hereditary cancer registry. J Community Genet 2024; 15:49-58. [PMID: 37864742 PMCID: PMC10858006 DOI: 10.1007/s12687-023-00685-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/11/2023] [Indexed: 10/23/2023] Open
Abstract
Individuals who carry BRCA1 or BRCA2 pathogenic variants are recommended to have extensive cancer prevention screening and risk-reducing surgeries. Uptake of these recommendations is variable, and there remains room for improvement in the risk management of BRCA carriers. This paper explores female BRCA carriers' experiences with the current model of care and their perspectives on (and interest in) an inherited cancer registry. Findings can inform the development of a dedicated high-risk screening and management program for these patients. Quantitative and qualitative data were gathered through a provincial descriptive survey and semi-structured qualitative interviews to assess BRCA carriers' opinions toward risk management services in the province of Newfoundland and Labrador (NL), Canada. Survey (n = 69) and interview data (n = 15) revealed continuity and coordination challenges with the current system of care of high-risk individuals. Respondents suggested an inherited cancer registry would help identify high-risk individuals and provide a centralized system of risk management for identified carriers. Respondents identified concerns about the privacy of their registry data, including who could access it. Findings suggest BRCA carriers see great value in an inherited cancer registry. Specifically, participants noted it could provide a centralized system to help improve the coordination of burdensome, life-long risk management. Important patient concerns about protecting their privacy and their health data confidentiality must be addressed in patient and public information and informed consent documents about a registry.
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Affiliation(s)
- J Hynes
- Faculty of Medicine, Memorial University, Craig L. Dobbin Centre for Genetics, Rm 4M210, St. John's, NL, A1B 3V6, Canada
| | - L Dawson
- Department Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M Seal
- Cancer Care Program, Eastern Regional Health Authority, St. John's, NL, Canada
| | - J Green
- Faculty of Medicine, Memorial University, Craig L. Dobbin Centre for Genetics, Rm 4M210, St. John's, NL, A1B 3V6, Canada
| | - M Woods
- Faculty of Medicine, Memorial University, Craig L. Dobbin Centre for Genetics, Rm 4M210, St. John's, NL, A1B 3V6, Canada
| | - H Etchegary
- Faculty of Medicine, Memorial University, Craig L. Dobbin Centre for Genetics, Rm 4M210, St. John's, NL, A1B 3V6, Canada.
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Shamseddine A, Chehade L, Al Mahmasani L, Charafeddine M. Colorectal Cancer Screening in the Middle East: What, Why, Who, When, and How? Am Soc Clin Oncol Educ Book 2023; 43:e390520. [PMID: 37163709 DOI: 10.1200/edbk_390520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The incidence of colorectal cancer (CRC) in the Middle East is increasing, especially among those younger than 50 years. Risk factors including obesity, sedentary lifestyle, and dietary changes are associated with the epidemiologic shift and are a result of socioeconomic changes happening in the region. Worldwide, CRC screening is associated with decreased incidence and mortality of CRC, but screening uptake is still low in the Middle East because of cultural barriers and lack of awareness; in addition, most countries do not have national screening programs. Knowledge of CRC screening and participation rates vary among different countries, but overall they are low. Both primary and secondary prevention approaches are needed in the Middle East, and cost-effectiveness is important in choosing screening modalities. Although colonoscopy is considered the most robust screening method, stool-based testing may be an acceptable screening strategy in resource-limited settings, and focusing on high-risk individuals such as those with hereditary CRC might be the most cost-effective strategy. In addition to financial limitations in many countries in the Middle East, human displacement places an extra toll on cancer control strategies in the region.
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Affiliation(s)
- Ali Shamseddine
- Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - Laudy Chehade
- Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - Layal Al Mahmasani
- Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - Maya Charafeddine
- Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
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High prevalence of MUTYH associated polyposis among minority populations in Israel, due to rare founder pathogenic variants. Dig Liver Dis 2023:S1590-8658(23)00162-7. [PMID: 36740502 DOI: 10.1016/j.dld.2023.01.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Autosomal recessive conditions are common in consanguineous populations. Since consanguinity is common in the Israeli Arab population, we evaluated the rate of MUTYH polyposis (MAP) among polyposis patients in this population and studied Pathogenic Variants (PVs) spectrum. METHODS We reviewed health records of all Arab and Druze polyposis patients referred for counseling during 2013-2020 who fulfilled the Israeli Genetic Society criteria for MUTYH/APC testing, in a tertiary center in Northern Israel and four additional gastro-genetic clinics in Israel. RESULTS The Northern cohort included 37 patients from 30 unrelated families; 8(26.6%) carried bi-allelic MUTYH PVs. The major variant p.Glu452del was detected in 6/8 Druze and Muslim families who shared the same haplotype. Other PVs detected in both cohorts included p.Tyr56Ter, p.His57Arg, c.849+3A>C, p.Ala357fs, and p.Tyr151Cys. Among bi-allelic carriers, 88% reported consanguinity, and 100% had positive family history for polyposis or colorectal cancer (CRC). Generally, the age of CRC was 10 years younger than reported in the general MAP population. CONCLUSIONS MAP accounted for 27% of polyposis cases in the Arab population of Northern Israel. PVs spectrum is unique, with high frequency of the founder variant p.Glu452del. Our results may inform the genetic testing strategy in the Israeli Arab population.
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Georgiou D, Monje-Garcia L, Miles T, Monahan K, Ryan NAJ. A Focused Clinical Review of Lynch Syndrome. Cancer Manag Res 2023; 15:67-85. [PMID: 36699114 PMCID: PMC9868283 DOI: 10.2147/cmar.s283668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023] Open
Abstract
Lynch syndrome (LS) is an autosomal dominant condition that increases an individual's risk of a constellation of cancers. LS is defined when an individual has inherited pathogenic variants in the mismatch repair genes. Currently, most people with LS are undiagnosed. Early detection of LS is vital as those with LS can be enrolled in cancer reduction strategies through chemoprophylaxis, risk reducing surgery and cancer surveillance. However, these interventions are often invasive and require refinement. Furthermore, not all LS associated cancers are currently amenable to surveillance. Historically only those with a strong family history suggestive of LS were offered testing; this has proved far too restrictive. New criteria for testing have recently been introduced including the universal screening for LS in associated cancers. This has increased the number of people being diagnosed with LS but has also brought about unique challenges such as when to consent for germline testing and questions over how and who should carry out the consent. The results of germline testing for LS can be complicated and the diagnostic pathway is not always clear. Furthermore, by testing only those with cancer for LS we fail to identify these individuals before they develop potentially fatal pathology. This review will outline these challenges and explore solutions. Furthermore, we consider the potential future of LS care and the related treatments and interventions which are the current focus of research.
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Affiliation(s)
- Demetra Georgiou
- Genomics and Personalised Medicine Service, Charing Cross Hospital, London, UK
| | - Laura Monje-Garcia
- The St Mark's Centre for Familial Intestinal Cancer Polyposis, St Mark's Hospital, London, UK.,School of Public Health, Imperial College, London, UK
| | - Tracie Miles
- South West Genomics Medicine Service Alliance, Bristol, UK
| | - Kevin Monahan
- The St Mark's Centre for Familial Intestinal Cancer Polyposis, St Mark's Hospital, London, UK.,Department of Gastroenterology, Imperial College, London, UK
| | - Neil A J Ryan
- Department of Gynaecological Oncology, Royal Infirmary of Edinburgh, Edinburgh, UK.,The College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
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Li G, Ma J, Zhang N, Li X, Li F, Jiang Y. The associations between interleukin-17 single-nucleotide polymorphism and colorectal cancer susceptibility: a systematic review and meta-analysis. World J Surg Oncol 2022; 20:116. [PMID: 35410225 PMCID: PMC9004118 DOI: 10.1186/s12957-022-02586-2] [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: 12/08/2021] [Accepted: 04/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background Numerous case-control studies have reported associations between interleukin-17 (IL-17) polymorphisms and colorectal cancer; however, the results were inconsistent. The aim of this meta-analysis was to further clarify the effects of IL-17 polymorphisms on colorectal cancer susceptibility. Materials and method Relevant studies were extracted from the electronic databases PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and the Chinese Biomedical Literature Database (CMB) up to April 2021. The odds ratio and 95% confidence interval were used to estimate the strength of the associations. Results Ten articles including 2599 cases and 2845 controls were enrolled in our research after strict literature screening. Highly significant associations between the IL-17A rs2275913 polymorphism and increased colorectal cancer susceptibility were observed in all five gene models (allelic, dominant, recessive, homozygous, and heterozygous models), and subgroup analysis based on ethnicity revealed that these associations existed not only in the Asian population but also in the Caucasian population. However, the results showed no significantly elevated colorectal cancer risk correlated with the IL-17F rs763780 polymorphism, and a slightly lower colorectal cancer susceptibility for the Caucasian population was discovered in the recessive and homozygous models of this mutation. Conclusion The IL-17A rs2275913 polymorphism may be an independent risk factor contributing to colorectal cancer susceptibility, while the IL-17F rs763780 polymorphism may decrease susceptibility to colorectal cancer. Future studies with large-scale samples are warranted to identify these associations. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02586-2.
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Affiliation(s)
- Gaoming Li
- Center for Disease Control and Prevention of Central Theater Command, Shijingshan District, Beijing, China
| | - Jingfu Ma
- Department of Intensive Care Unit, The 305 Hospital of PLA, Beijing, China
| | - Ning Zhang
- Department of Intensive Care Unit, The 305 Hospital of PLA, Beijing, China
| | - Xiaogang Li
- Department of Intensive Care Unit, The 305 Hospital of PLA, Beijing, China
| | - Fangfang Li
- Department of Intensive Care Unit, The 305 Hospital of PLA, Beijing, China
| | - Yuxing Jiang
- Department of Intensive Care Unit, The 305 Hospital of PLA, Beijing, China. .,Department of General surgery, The 305 Hospital of PLA, Beijing, China.
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Sina M, Ghorbanoghli Z, Abedrabbo A, Al-Mulla F, Sghaier RB, Buisine MP, Cortas G, Goshayeshi L, Hadjisavvas A, Hammoudeh W, Hamoudi W, Jabari C, Loizidou MA, Majidzadeh-A K, Marafie MJ, Muslumov G, Rifai L, Seir RA, Talaat SM, Tunca B, Ziada-Bouchaar H, Velthuizen ME, Sharara AI, Ahadova A, Georgiou D, Vasen HFA. Identification and management of Lynch syndrome in the Middle East and North African countries: outcome of a survey in 12 countries. Fam Cancer 2020; 20:215-221. [PMID: 33098072 PMCID: PMC8214581 DOI: 10.1007/s10689-020-00211-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/06/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Lynch syndrome (LS), the most common inherited form of colorectal cancer (CRC), is responsible for 3% of all cases of CRC. LS is caused by a mismatch repair gene defect and is characterized by a high risk for CRC, endometrial cancer and several other cancers. Identification of LS is of utmost importance because colonoscopic surveillance substantially improves a patient's prognosis. Recently, a network of physicians in Middle Eastern and North African (ME/NA) countries was established to improve the identification and management of LS families. The aim of the present survey was to evaluate current healthcare for families with LS in this region. METHODS A questionnaire was developed that addressed the following issues: availability of clinical management guidelines for LS; attention paid to family history of cancer; availability of genetic services for identification and diagnosis of LS; and assessment of knowledge of LS surveillance. Members of the network and authors of recent papers on LS from ME/NA and neighbouring countries were invited to participate in the survey and complete the online questionnaire. RESULTS A total of 55 individuals were invited and 19 respondents from twelve countries including Algeria, Azerbaijan, Cyprus, Egypt, Iran, Jordan, Kuwait, Lebanon, Morocco, Palestine, Tunisia, and Turkey completed the questionnaire. The results showed that family history of CRC is considered in less than half of the surveyed countries. Guidelines for the management of LS are available in three out of twelve countries. The identification and selection of families for genetic testing were based on clinical criteria (Amsterdam criteria II or Revised Bethesda criteria) in most countries, and only one country performed universal screening. In most of the surveyed countries genetic services were available in few hospitals or only in a research setting. However, surveillance of LS families was offered in the majority of countries and most frequently consisted of regular colonoscopy. CONCLUSION The identification and management of LS in ME/NA countries are suboptimal and as a result most LS families in the region remain undetected. Future efforts should focus on increasing awareness of LS amongst both the general population and doctors, and on the improvement of the infrastructure in these countries.
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Affiliation(s)
- Mohammad Sina
- Genetics Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.,A. Nocivelli Institute for Molecular Medicine, Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy
| | - Zeinab Ghorbanoghli
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. .,Dutch Hereditary Cancer Registry, Leiden, The Netherlands.
| | - Amal Abedrabbo
- Department of Pediatrics, Makassed Islamic Charitable Hospital, Jerusalem, Palestine
| | - Fahd Al-Mulla
- Department of Genetics and Bioinformatics, Dasman Diabetes Institute, P.O. Box 1180, 15462, Dasman, Kuwait
| | - Rihab Ben Sghaier
- Cytogenetic, Molecular Genetics and Human Reproduction Biology - Farhat, HACHED Hospital, Sousse, Tunisia
| | - Marie-Pierre Buisine
- Unit of Molecular Oncology and Genetics, Institute of Biochemistry and Molecular Biology, Lille University Hospital, Lille, France
| | - George Cortas
- Department of Gastroenterology, St. George Hospital Medical Center, University of Balamand Medical School, Beirut, Lebanon
| | - Ladan Goshayeshi
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Andreas Hadjisavvas
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Wail Hammoudeh
- Department of Internal Medicine, Arabcare Hospital, Ramallah, Palestine
| | - Waseem Hamoudi
- Department of Gastroenterology, The Royal Hospital, Amman, Jordan
| | - Carol Jabari
- Patient's Friends Society, Jerusalem, Palestine.,Hebron University, Hebron, Palestine
| | - Maria A Loizidou
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Keivan Majidzadeh-A
- Genetics Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Makia J Marafie
- Kuwait Medical Genetics Centre, Maternity Hospital, 13059, Safat, Kuwait
| | - Gurbankhan Muslumov
- Colorectal Surgery Department, Scientific Center of Surgery, Baku, Azerbaijan
| | - Laila Rifai
- Centre Hospitalier Universitaire IBN SINA, Rabat Instituts, Institut National D'Oncologie Sidi Mohamed Ben Abdellah, BP 6213, Rabat, Maroc
| | | | | | - Berrin Tunca
- Department of Medical Biology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Hadia Ziada-Bouchaar
- Laboratory of Biology and Molecular Genetics, Faculty of Medicine, University 3, Rabah Bitat, Constantine, Algeria
| | - Mary E Velthuizen
- Department of Genetics, University Medical Center Utrecht (Location WKZ), Utrecht, the Netherlands
| | - Ala I Sharara
- Division of Gastroenterology, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Aysel Ahadova
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Cooperation Unit Applied Tumour Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Demetra Georgiou
- Department of Clinical Genetics, London North West University Healthcare, London, UK
| | - Hans F A Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Dutch Hereditary Cancer Registry, Leiden, The Netherlands
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