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Aslan K, Kabakçı M, Zengin Aksel T, Atalay F. Is It Possible to Prevent Nontherapeutic Laparotomies in Breast Cancer Patients With Isolated Adnexal Masses? Am Surg 2024:31348241265145. [PMID: 39033518 DOI: 10.1177/00031348241265145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Introduction: The risk of ovarian malignancy is increasing in patients with a history of breast cancer. Thus, well-defined predictors of ovarian malignancy should be identified to determine surgical or conservative management of adnexal masses in women with breast cancer. This study aimed to clarify the predictors of malignant ovarian tumors in patients with breast cancer with an isolated adnexal mass. Methods: Breast cancer patients diagnosed with an adnexal mass who underwent surgery between 2010 and 2021 at a tertiary cancer center were included in the study. Patients with suspected extra ovarian metastases were excluded. Results: A total of 40 breast cancer patients who underwent surgery for ovarian masses were identified. 23 (57.5%) women had benign ovarian tumors and 17 (42.5%) had malignant ovarian tumors. Among the malignant ovarian tumors, there were three (17.6%) metastatic breast cancers in the ovary and 14 (82.4%) primary ovarian cancers. In univariate analyses, the risk of malignant ovarian tumors increased in women with age >52 years (P = .012), postmenopausal status (P = .023), CA 125 ≥ 35 IU/ml (P = .001), CA 15-3 ≥ 32 IU/ml (P = .002), and complex ovarian masses (P < .001). Ovarian malignancies were observed in 82.4% of patients who had complex ovarian masses. Conclusion: Ovarian malignancies were diagnosed in 82.4% of the breast cancers who had complex ovarian mass on USG examination. Therefore, surgery is recommended in women with complex ovarian masses. Postmenopausal status, age >52 years, CA 125 ≥ 35 IU/ml, and CA 15-3 ≥ 32 were other risk factors for ovarian malignancy.
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Affiliation(s)
- Koray Aslan
- Department of Gynecologic Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Mükiye Kabakçı
- Department of Gynecologic Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Tuba Zengin Aksel
- Department of Gynecologic Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Funda Atalay
- Department of Gynecologic Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Shi J, Liu J, Tian G, Li D, Liang D, Wang J, He Y. Association of radiotherapy for stage I-III breast cancer survivors and second primary malignant cancers: a population-based study. Eur J Cancer Prev 2024; 33:115-128. [PMID: 37669169 DOI: 10.1097/cej.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE With life span extending, breast cancer survivors may face the possibility of developing second primary cancers (SPCs). The objective of this research is to investigate the risk factors, risk attribute to radiotherapy and the survivalship for SPCs. METHODS A total of 445 523 breast cancer patients were enrolled from Surveillance, Epidemiology, and End Results database in 2000-2018. The risk factors for SPCs development were confirmed by competing risk model, and then were integrated to the nomogram establishment. The cumulative incidence of SPCs including SBC (second breast cancer), SGC (second gynecological cancer), and SLC (second lung cancer) were estimated. The radiotherapy-associated risk for SPCs were evaluated by Poisson regression in radiotherapy and no-radiotherapy. Propensity score matching was used to reduce possible bias for survival comparison. RESULTS There were 57.63% patients in radiotherapy. The risk factors for developing SPCs were age, year, race, tumor size, stage, radiotherapy, grade, surgery, and histology. The cumulative incidence of SPCs was 7.75% in no-radiotherapy and 10.33% in radiotherapy. SLC, SBC, and SGC also appeared the similar results. The increased risk of developing SPCs were associated with radiotherapy in majority subgroups. The dynamic radiotherapy-associated risk for SPCs by age slightly increased risk was observed. Regardless radiotherapy or no-radiotherapy, the 10-year overall survival for SBC (radiotherapy: 59.41%; no-radiotherapy: 55.53%) and SGC (radiotherapy: 48.61%; no-radiotherapy: 35.53%) were worse than that among matched patients with only primary cancers. CONCLUSIONS Breast cancer survivors remained a high radiotherapy-associated risk for developing SPCs. The prognosis in radiotherapy was better than in no-radiotherapy for some specific SPCs. Largely attention should be paid to these patients.
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Affiliation(s)
- Jin Shi
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Jian Liu
- The Service Center of Comprehensive Supervision Health Commission of Hebei Province
| | - Guo Tian
- Department of Medical Records, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Daojuan Li
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Di Liang
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Jun Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province, Shijiazhuang, Hebei, China
| | - Yutong He
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
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Tavares V, Marques IS, Melo IGD, Assis J, Pereira D, Medeiros R. Paradigm Shift: A Comprehensive Review of Ovarian Cancer Management in an Era of Advancements. Int J Mol Sci 2024; 25:1845. [PMID: 38339123 PMCID: PMC10856127 DOI: 10.3390/ijms25031845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
Ovarian cancer (OC) is the female genital malignancy with the highest lethality. Patients present a poor prognosis mainly due to the late clinical presentation allied with the common acquisition of chemoresistance and a high rate of tumour recurrence. Effective screening, accurate diagnosis, and personalised multidisciplinary treatments are crucial for improving patients' survival and quality of life. This comprehensive narrative review aims to describe the current knowledge on the aetiology, prevention, diagnosis, and treatment of OC, highlighting the latest significant advancements and future directions. Traditionally, OC treatment involves the combination of cytoreductive surgery and platinum-based chemotherapy. Although more therapeutical approaches have been developed, the lack of established predictive biomarkers to guide disease management has led to only marginal improvements in progression-free survival (PFS) while patients face an increasing level of toxicity. Fortunately, because of a better overall understanding of ovarian tumourigenesis and advancements in the disease's (epi)genetic and molecular profiling, a paradigm shift has emerged with the identification of new disease biomarkers and the proposal of targeted therapeutic approaches to postpone disease recurrence and decrease side effects, while increasing patients' survival. Despite this progress, several challenges in disease management, including disease heterogeneity and drug resistance, still need to be overcome.
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Affiliation(s)
- Valéria Tavares
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP), Pathology and Laboratory Medicine Department, Clinical Pathology SV/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
| | - Inês Soares Marques
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP), Pathology and Laboratory Medicine Department, Clinical Pathology SV/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal
- Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal
| | - Inês Guerra de Melo
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP), Pathology and Laboratory Medicine Department, Clinical Pathology SV/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal
| | - Joana Assis
- Clinical Research Unit, Research Center of IPO Porto (CI-IPOP), RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Deolinda Pereira
- Oncology Department, Portuguese Institute of Oncology of Porto (IPOP), 4200-072 Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP), Pathology and Laboratory Medicine Department, Clinical Pathology SV/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-072 Porto, Portugal
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Faculty of Health Sciences, Fernando Pessoa University, 4200-150 Porto, Portugal
- Research Department, Portuguese League Against Cancer (NRNorte), 4200-172 Porto, Portugal
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Lertwilaiwittaya P, Tantai N, Maneeon S, Kongbunrak S, Nonpanya N, Hurst ACE, Srinonprasert V, Pithukpakorn M. A cost-utility analysis of BRCA1 and BRCA2 testing in high-risk breast cancer patients and family members in Thailand: a cost-effective policy in resource-limited settings. Front Public Health 2023; 11:1257668. [PMID: 38162618 PMCID: PMC10757601 DOI: 10.3389/fpubh.2023.1257668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/31/2023] [Indexed: 01/03/2024] Open
Abstract
Background Screening for germline pathogenic BRCA1 or BRCA2 variants (gBRCA) in high-risk breast cancer patients is known to be cost-effective in high-income countries. Nationwide adoption of genetics testing in high-risk breast cancer population remains poor. Our study aimed to assess gBRCA health economics data in the middle-income country setting of Thailand. Methods Decision tree and Markov model were utilized to assess cost-utility between the testing vs. no-testing groups from a societal and lifetime perspective and lifetime. We interviewed 264 patients with breast/ovarian cancer and their family members to assess relevant costs and quality of life using EQ-5D-5L. One-way sensitivity, probabilistic sensitivity (Monte Carlo simulation), and budget impact analyses were done to estimate the outcome under Thailand's Universal Health Coverage scheme. Results The predicted lifetime cost and Quality-adjusted Life Years (QALY) for those with breast cancer were $13,788 and 10.22 in the testing group and $13,702 and 10.07 in the no-testing group. The incremental cost-effectiveness ratio for gBRCA testing in high-risk breast cancer patients was $573/QALY. The lifetime cost for the family members of those with gBRCA was $14,035 (QALY 9.99), while the no-testing family members group was $14,077 (QALY 9.98). Performing gBRCA testing in family members was cost-saving. Conclusion Cost-utility analysis demonstrated a cost-effective result of gBRCA testing in high-risk breast cancer patients and cost-saving in familial cascade testing. The result was endorsed in the national health benefits package in 2022. Other middle-income countries may observe the cost-effective/cost-saving aspects in common genetic diseases under their national health schemes.
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Affiliation(s)
- Pongtawat Lertwilaiwittaya
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Genomics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narisa Tantai
- Department of Pharmacy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Satanun Maneeon
- Department of Pharmacy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sophittha Kongbunrak
- Department of Pharmacy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nongyao Nonpanya
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anna C. E. Hurst
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Varalak Srinonprasert
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Manop Pithukpakorn
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Genomics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Pozzati F, Sassu CM, Marini G, Mascilini F, Biscione A, Giannarelli D, Garganese G, Fragomeni SM, Scambia G, Testa AC, Moro F. Subjective assessment and IOTA ADNEX model in evaluation of adnexal masses in patients with history of breast cancer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:594-602. [PMID: 37204769 DOI: 10.1002/uog.26253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/14/2023] [Accepted: 04/18/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To evaluate the performance of subjective assessment and the Assessment of Different NEoplasias in the adneXa (ADNEX) model in discriminating between benign and malignant adnexal tumors and between metastatic and primary adnexal tumors in patients with a personal history of breast cancer. METHODS This was a retrospective single-center study including patients with a history of breast cancer who underwent surgery for an adnexal mass between 2013 and 2020. All patients had been examined with transvaginal or transrectal ultrasound using a standardized examination technique and all ultrasound reports had been stored and were retrieved for the purposes of this study. The specific diagnosis suggested by the original ultrasound examiner in the retrieved report was analyzed. For each mass, the ADNEX model risks were calculated prospectively and the highest relative risk was used to categorize each into one of five categories (benign, borderline, primary Stage I, primary Stages II-IV or metastatic ovarian cancer) for analysis of the ADNEX model in predicting the specific tumor type. The performance of subjective assessment and the ADNEX model in discriminating between benign and malignant adnexal tumors and between primary and metastatic adnexal tumors was evaluated, using final histology as the reference standard. RESULTS Included in the study were 202 women with a history of breast cancer who underwent surgery for an adnexal mass. At histology, 93/202 (46.0%) masses were benign, 76/202 (37.6%) were primary malignancies (four borderline and 72 invasive tumors) and 33/202 (16.3%) were metastases. The original ultrasound examiner classified correctly 79/93 (84.9%) benign adnexal masses, 72/76 (94.7%) primary adnexal malignancies and 30/33 (90.9%) metastatic tumors. Subjective ultrasound evaluation had a sensitivity of 93.6%, specificity of 84.9% and accuracy of 89.6%, while the ADNEX model had higher sensitivity (98.2%) but lower specificity (78.5%), with similar accuracy (89.1%), in discriminating between benign and malignant ovarian masses. Subjective evaluation had a sensitivity of 51.5%, specificity of 88.8% and accuracy of 82.7% in distinguishing metastatic and primary tumors (including benign, borderline and invasive tumors), and the ADNEX model had a sensitivity of 63.6%, specificity of 84.6% and similar accuracy (81.2%). CONCLUSIONS The performance of subjective assessment and the ADNEX model in discriminating between benign and malignant adnexal masses in this series of patients with history of breast cancer was relatively similar. Both subjective assessment and the ADNEX model demonstrated good accuracy and specificity in discriminating between metastatic and primary tumors, but the sensitivity was low. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F Pozzati
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - C M Sassu
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G Marini
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Mascilini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - A Biscione
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - D Giannarelli
- Facility of Epidemiology and Biostatistics, G-STEP Generator, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G Garganese
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S M Fragomeni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Ferris JS, Morgan DA, Tseng AS, Terry MB, Ottman R, Hur C, Wright JD, Genkinger JM. Risk factors for developing both primary breast and primary ovarian cancer: A systematic review. Crit Rev Oncol Hematol 2023; 190:104081. [PMID: 37541535 DOI: 10.1016/j.critrevonc.2023.104081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/11/2023] [Accepted: 07/30/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVE Women with breast cancer have an increased risk of primary ovarian cancer (BR→OV), and women with ovarian cancer have an increased risk of primary breast cancer (OV→BR). This systematic review summarizes risk factors for developing BR→OV and OV→BR. METHODS We searched PubMed and Embase until June 2022. RESULTS We identified 23 articles meeting our inclusion criteria. Studies observed a lower risk of BR→OV for Black versus White women, alcohol consumption, radiotherapy and hormone therapy, BRCA2 versus BRCA1, and ER/PR positive versus negative breast tumors, and a higher risk with family history of breast/ovarian cancer, triple negative versus luminal breast cancer, and higher grade breast tumors. There was an increased risk of OV→BR with family history of cancer. CONCLUSIONS Tumor characteristics, and genetic and familial factors are associated with risk of BR→OV and OV→BR. These results could aid clinicians in decision-making for breast and ovarian cancer patients, including risk-reducing strategies.
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Affiliation(s)
- Jennifer S Ferris
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA.
| | - Devon A Morgan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA
| | - Ashley S Tseng
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY 10032, USA
| | - Ruth Ottman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA; G. H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA; Division of Translational Epidemiology and Mental Health Equity, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Chin Hur
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY 10032, USA; Department of Medicine, Columbia University Irving Medical Center, 622 W 168th Street, PH9-105C, New York, NY 10032, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Jeanine M Genkinger
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY 10032, USA
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He XQ, Gao YT, Zhang X, Jiang H. Time Intervals between Double Primary Breast and Ovarian Cancers and Survival Outcomes of Patients with Both Cancers: A SEER Database Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4557346. [PMID: 35707375 PMCID: PMC9192218 DOI: 10.1155/2022/4557346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/27/2022] [Accepted: 05/06/2022] [Indexed: 12/24/2022]
Abstract
Background The time interval rules and survival outcomes of individuals with synchronous and metachronous breast cancer (BC) and ovarian cancer (OC) were examined in this retrospective population-based investigation. Methods The National Cancer Institute's Surveillance, Epidemiology, and End Results database was used to create a cohort of people diagnosed with BC and OC between 1973 and 2015. Patients were separated into three groups: those with main BC followed by primary OC (group 1), those with synchronous primary breast and ovarian cancer (group 2), and those with OC prior to BC (group 3). The Kaplan-Meier technique was used to assess overall survival (OS) and cancer-specific survival (CSS). Results A total of 4,975 patients were identified: 2,929 patients in group 1, 680 patients in group 2, and 1,366 patients in group 3. The average duration between these tumors was 60 months (range 0-499). Approximately 50% of second primary cancer cases occurred during the first 60 months of the first primary cancer diagnosis, and more than 70% occurred within the first 120 months. The median survival time for 4,975 individuals was 140 months. Group 2 had the smallest median OS (35 months), whereas group 3 had the longest (45 months) (239 months). Conclusions The majority of second primary cancer cases occurred during the first 120 months following the diagnosis of the first original malignancy. Individuals who had primary OC prior to BC had better prognoses, whereas patients who had synchronous BC and OC had worse prognoses.
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Affiliation(s)
- Xin-Qin He
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350000 Fujian, China
| | - Yu-Tao Gao
- Department of Gynecology, First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, Wuhua District, Kunming, Yunnan 650032, China
| | - Xia Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350000 Fujian, China
| | - Hong Jiang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350000 Fujian, China
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Diagnostic Accuracy of Whole-Body Computed Tomography for Incidental Ovarian Tumors in Patients with Prior Breast Cancer. Diagnostics (Basel) 2022; 12:diagnostics12020347. [PMID: 35204438 PMCID: PMC8870859 DOI: 10.3390/diagnostics12020347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 12/10/2022] Open
Abstract
Whole-body computed tomography (WBCT) serves as the first-line imaging modality for breast cancer follow-up. To investigate the imaging characteristics and diagnostic accuracy of WBCT for incidental ovarian tumors in patients with prior breast cancer, we retrospectively reviewed a consecutive cohort of 13,845 patients with breast cancer, of whom 149 had pathologically-proven ovarian lesions. We excluded patients with ovarian diagnosis before breast cancer, CT scan not including ovary, CT-pathology interval >30 days, and severe CT artifact. Among our 60 breast cancer patients (median age, 46 years) with pathologically proven ovarian lesions, 49 patients had benign diseases, seven had primary ovarian cancer and four had ovarian metastasis from breast cancer. The histologic types of breast cancer with ovarian metastases included invasive ductal carcinoma, lobular carcinoma and angiosarcoma. Cystic ovarian lesions identified on WBCT during the breast cancer follow-up are more likely to be benign, while solid-cystic lesions are likely to be primary ovarian cancers, and solid lesions may indicate ovarian metastasis. The diagnostic accuracy, sensitivity, specificity, and areas under the receiver operating characteristic curve of WBCT were 98.3%, 100.0%, 98.0%, and 0.99 (malignant vs. benign); 90.0%, 100.0%, 85.7%, and 0.93 (metastasis vs. primary ovarian cancer), respectively. The only false positive solid lesion was a Sertoli–Leydig tumor. In conclusion, WBCT may help diagnose incidental ovarian tumors in patients with prior breast cancers and guide disease management.
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Shakya P, Bajracharya A, Shrestha S, Kharel S, Maharjan R, Shrestha AK. Metastatic ovarian carcinoma in breast cancer patients during risk-reducing salpingo-oophorectomy: Report of two cases. Ann Med Surg (Lond) 2022; 73:103158. [PMID: 34976386 PMCID: PMC8685998 DOI: 10.1016/j.amsu.2021.103158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Metastatic ovarian cancer of breast carcinoma is rare and accounts for only 0.68%-2% of all ovarian tumors, the majority of which are diagnosed incidentally during follow-up or therapeutic oophorectomy. Risk-reducing salpingo-oophorectomy (RRSO) is a highly recommended prophylactic surgery associated with a significant decrease in ovarian cancer risk in both BRCA1 and BRCA2 mutation carriers, and in those with and without prior breast cancer. CASE PRESENTATION We present two cases who presented with a lump in the right axilla and left breast respectively and were subsequently diagnosed as invasive mammary carcinoma but later, diagnosed with metastatic ovarian carcinoma with breast primary after RRSO. The patients were treated with cycles of chemo-radiation. DISCUSSION Invasive lobular carcinoma, larger tumor size, advanced breast cancer increases the risk of developing ovarian metastases. Thorough macroscopic, microscopic, immunohistochemical, and molecular tests are considered the cornerstone in the diagnosis of metastatic breast cancer to the ovaries. Bilateral salpingo-oophorectomy, a risk-reducing surgery for the BRCA gene mutation, has been shown to reduce the risk of death from ovarian cancer. CONCLUSIONS Metastatic ovarian cancer in breast cancer is a rare possibility among patients undergoing RRSO for breast cancer. The importance of continued surveillance of ovaries rather than the delayed diagnosis of ovarian metastasis for patients with newly diagnosed breast cancer cannot be less emphasized.
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Affiliation(s)
- Prafulla Shakya
- Department of Surgery, Breast Unit, Nepal Cancer Hospital, and Research Center, Lalitpur, Nepal
| | - Anu Bajracharya
- Department of Gynecologic Oncology, Nepal Cancer Hospital, and Research Center, Lalitpur, Nepal
| | - Suraj Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Sanjeev Kharel
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Rubina Maharjan
- Department of Medical Oncology, Nepal Cancer Hospital, and Research Center, Lalitpur, Nepal
| | - Aagon Krishna Shrestha
- Department of Surgery, Breast Unit, Nepal Cancer Hospital, and Research Center, Lalitpur, Nepal
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10
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Bian X, Xia J, Wang K, Wang Q, Yang L, Wu W, Li L. The effects of a prior malignancy on the survival of patients with ovarian cancer: a population-based study. J Cancer 2020; 11:6178-6187. [PMID: 33033501 PMCID: PMC7532502 DOI: 10.7150/jca.46584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/13/2020] [Indexed: 12/20/2022] Open
Abstract
Background: With the improvement in the prognostic outcomes of multiple malignancies, the population of cancer survivors is growing rapidly and is at higher risk of developing secondary ovarian cancer. However, the prevalence and clinical outcomes of prior cancer among newly diagnosed ovarian cancer patients remain unknown. Methods: Patients diagnosed with ovarian cancer between 2004 and 2015 were identified using the Surveillance, Epidemiology, and End Results database. Patients were divided into two groups based on whether there was a prior malignancy. A multivariate Cox regression analysis was used to calculate all-cause and ovarian-specific survival. Furthermore, we conducted subgroup survival analyses of patients stratified by previous cancer site to explore the associations between prior cancer site and survival outcomes. Results: A total of 52,182 patients with primary ovarian cancer were identified, and 3.6% (n=1,860) had a documented prior malignancy. In multivariate analyses, patients with prior malignancies had a worse all-cause and ovarian cancer-specific prognosis than those without. In subset analyses, patients with a history of thyroid cancer had a better all-cause and ovarian cancer-specific prognosis, and patients with prior colorectal, urinary system, skin, lung, haematologic and stomach cancers were at risk of decreased survival compared to that of patients without a prior cancer. Conclusions: Prior malignancy has an adverse impact on the survival of patients with ovarian cancer, and the impact on prognostic outcomes varies by different prior cancer sites. The inconsistent survival effects of previous malignancies should be considered in clinical trial design and recruitment.
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Affiliation(s)
- Xiaoyuan Bian
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
| | - Jiafeng Xia
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
| | - Kaicen Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
| | - Qiangqiang Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
| | - Liya Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
| | - Wenrui Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
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11
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Chen C, Xu Y, Huang X, Mao F, Shen S, Xu Y, Sun Q. Clinical characteristics and survival outcomes of patients with both primary breast cancer and primary ovarian cancer. Medicine (Baltimore) 2020; 99:e21560. [PMID: 32769897 PMCID: PMC7593036 DOI: 10.1097/md.0000000000021560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Breast cancer and ovarian cancer are closely related. The major common risk factors of these 2 types of cancer are likely genetic factors. However, few studies have shown any common characteristics in patients who have both types of these 2 cancers. The purpose of this retrospective study is to explore the clinical characteristics and survival outcomes of patients with both primary breast cancer and primary ovarian cancer.A cohort of patients who had a history of both primary breast cancer and primary ovarian cancer were enrolled, and they received treatment in the Peking Union Medical College Hospital between January 1, 2010, and December 31, 2018. Both descriptive statistics analysis and survival analysis were performed for analysis.A total of 114 patients with both primary breast cancer and primary ovarian cancer were included in the study. The median (range) follow-up was 129.5 (20-492) months. The average interval time between the diagnosis of 2 types of cancer was 79.4 months in patients having ovarian cancer firstly and was 115.9 months in patients having breast cancer firstly. The 5- and 10-year overall survival (OS) rates were 91.5% and 81.7% for patients with ovarian cancer following breast cancer, respectively, and 90.6% and 87.5% for patients with breast cancer following ovarian cancer, respectively. Multivariate analysis revealed that independent predictors of OS were the age of diagnosis of the first tumor and the time interval between two types of tumor in patients with ovarian cancer following breast cancer.Most breast cancer or ovarian cancer occurred within 5 years after being diagnosed with the first tumor, and the interval time was significantly shorter in patients with previous ovarian cancer. The prognosis is likely positively correlated to the interval time between the occurrences of two types of cancer.
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12
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Niu Y, Sun W, Chen K, Fu Z, Chen Y, Zhu J, Chen H, Shi Y, Zhang H, Wang L, Shen HM, Xia D, Wu Y. A Novel Scoring System for Pivotal Autophagy-Related Genes Predicts Outcomes after Chemotherapy in Advanced Ovarian Cancer Patients. Cancer Epidemiol Biomarkers Prev 2019; 28:2106-2114. [PMID: 31533939 DOI: 10.1158/1055-9965.epi-19-0359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/30/2019] [Accepted: 09/12/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the clinical practice of ovarian cancer, the application of autophagy, an important regulator of carcinogenesis and chemoresistance, is still limited. This study aimed to establish a scoring system based on expression profiles of pivotal autophagy-related (ATG) genes in patients with stage III/IV ovarian cancer who received chemotherapy. METHODS Data of ovarian serous cystadenocarcinoma in The Cancer Genome Atlas (TCGA-OV) were used as training dataset. Two validation datasets comprised patients in a Chinese local database and a dataset from the Gene Expression Omnibus (GEO). ATG genes significantly (P < 0.1) associated with overall survival (OS) were selected and aggregated into an ATG scoring scale, of which the abilities to predict OS and recurrence-free survival (RFS) were examined. RESULTS Forty-three ATG genes were selected to develop the ATG score. In TCGA-OV, patients with lower ATG scores had better OS [HR = 0.41; 95% confidence interval (CI), 0.26-0.65; P < 0.001] and RFS [HR = 0.47; 95% CI, 0.27-0.82; P = 0.007]. After complete or partial remission to primary therapy, the rate of recurrence was 47.2% in the low-score group and 68.3% in the high-score group (odds ratio = 0.42; 95% CI, 0.18-0.92; P = 0.03). Such findings were verified in the two validation datasets. CONCLUSIONS We established a novel scoring system based on pivotal ATG genes, which accurately predicts the outcomes of patients with advanced ovarian cancer after chemotherapy. IMPACT The present ATG scoring system may provide a novel perspective and a promising tool for the development of personalized therapy in the future.
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Affiliation(s)
- Yuequn Niu
- Department of Toxicology of School of Public Health, and Department of Gynecologic Oncology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenjie Sun
- Department of Pathology, Zhejiang University School of Medicine, Hangzhou, China
| | - Kelie Chen
- Department of Toxicology of School of Public Health, and Department of Gynecologic Oncology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiqin Fu
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yaqing Chen
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jianqing Zhu
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Hanwen Chen
- Department of Toxicology of School of Public Health, and Department of Gynecologic Oncology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Gastroenterology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu Shi
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Honghe Zhang
- Department of Pathology, Zhejiang University School of Medicine, Hangzhou, China
| | - Liming Wang
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Han-Ming Shen
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Dajing Xia
- Department of Toxicology of School of Public Health, and Department of Gynecologic Oncology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Yihua Wu
- Department of Toxicology of School of Public Health, and Department of Gynecologic Oncology of Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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13
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Zhang W, Zhang W, Lin Z, Wang F, Li M, Zhu L, Yu Y, Gao Y. Survival Outcomes of Patients with Primary Breast Cancer Following Primary Ovarian Cancer. Med Sci Monit 2019; 25:3869-3879. [PMID: 31125329 PMCID: PMC6545065 DOI: 10.12659/msm.914163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Patients with primary breast cancer following primary ovarian cancer do not comprise a large clinical entity, and reports of the survival outcomes of this cohort are rare. The purpose of this retrospective population-based research was to investigate the survival outcomes of patients with primary breast cancer after primary ovarian cancer. Material/Methods A cohort of patients diagnosed with primary breast cancer following primary ovarian cancer between 1973 and 2014 was drawn from the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) database. Cox proportional hazards survival regression analysis and Kaplan-Meier were applied to calculate overall survival (OS), cancer-specific survival (CSS), and independent predictors of CSS. Results A total of 1455 patients with primary breast cancer following primary ovarian cancer were identified. The 5-year and 10-year OS rates for the entire cohort were 81.7% and 67.4%, respectively. The 5-year and 10-year CSS rates were 84.2% and 74.3% for ovarian cancer, and 76.0% and 67.8% for breast cancer, respectively. Multivariate analysis revealed that independent predictors of ovarian cancer CSS include age, cancer stage, diagnosis time, and histological subtype. Conclusions Patients diagnosed with breast cancer following ovarian cancer have better survival rates. Patients age, ovarian cancer stage, ovarian cancer histological type, and time of diagnose affect the survival rate.
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Affiliation(s)
- Wei Zhang
- Department of Gynaecology, The People's Hospital of Yuxi City, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China (mainland)
| | - Wenque Zhang
- Department of Gynaecology, The People's Hospital of Yuxi City, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China (mainland)
| | - Zhihong Lin
- Department of Gynaecology, The People's Hospital of Yuxi City, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China (mainland)
| | - Fang Wang
- Department of Gynaecology, The People's Hospital of Yuxi City, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China (mainland)
| | - Miaojie Li
- Department of Gynaecology, The People's Hospital of Yuxi City, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China (mainland)
| | - Libo Zhu
- Department of Gastroenterology, Dali Bai Autonomous Prefecture People's Hospital, Dali, Yunnan, China (mainland)
| | - Yixian Yu
- Department of Gynecology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Yutao Gao
- Department of Gynecology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
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14
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Tian W, Zhou Y, Wu M, Yao Y, Deng Y. Ovarian metastasis from breast cancer: a comprehensive review. Clin Transl Oncol 2018; 21:819-827. [DOI: 10.1007/s12094-018-02007-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/04/2018] [Indexed: 12/20/2022]
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15
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Reinert T, Nogueira-Rodrigues A, Kestelman FP, Ashton-Prolla P, Graudenz MS, Bines J. The Challenge of Evaluating Adnexal Masses in Patients With Breast Cancer. Clin Breast Cancer 2018; 18:e587-e594. [PMID: 29680194 DOI: 10.1016/j.clbc.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/26/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
This narrative literature review addresses the problem of an adnexal mass discovered during the course of breast cancer (BC) care, which may represent a benign condition, a metastatic process, or a primary ovarian cancer (OC), clinical scenarios associated with distinct physiopathology and prognosis. Furthermore, the coexistence of BC and OC in the same patient may be owing to a hereditary disorder, deserving specific management strategies and counseling. The initial detection and evaluation of an adnexal mass in a patient with BC requires a high index of suspicion, and the initial workup should include a thorough medical history and physical examination, measurement of tumor markers, complete blood count, and imaging tests. Transvaginal ultrasonography remains the standard tool, and findings suggestive of malignancy include bilateral tumors, thick septations, predominance of a solid component, Doppler flow to the solid component, and ascites. From the pathology point of view, features that are suggestive of metastatic disease include bilaterality, mild ovarian enlargement, vascular emboli, no omental deposits, and the absence of transition from benign to malignant epithelium. Although there is a considerable overlap in OC and BC immunohistochemical profiles, BC usually stain positive for GCDFP-15 and negative for vimentine, PAX8, and WT1, and OC often stain positive for CK7, PAX8, WT1, and to mesothelin. Genetic counselling should always be indicated in this clinical scenario. In conclusion, diagnostic spectrum of an ovarian mass in a patient with BC is broad, and a systematic multi-professional strategy is necessary to conduct these challenging cases.
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Affiliation(s)
- Tomás Reinert
- Hospital do Câncer Mãe de Deus, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Angélica Nogueira-Rodrigues
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil; Brazilian Group of Gynecologic Oncology (EVA), Belo Horizonte, Brazil; DOM Oncologia, Minas Gerais, Brazil
| | | | - Patricia Ashton-Prolla
- Departamento de Genética e Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratório de Medicina Genômica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Márcia Silveira Graudenz
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Departamento de Patologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Instituto de Patologia, Porto Alegre, Brazil
| | - José Bines
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil.
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16
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Ukawa S, Tamakoshi A, Mori M, Ikehara S, Shirakawa T, Yatsuya H, Iso H. Association between average daily television viewing time and the incidence of ovarian cancer: findings from the Japan Collaborative Cohort Study. Cancer Causes Control 2018; 29:213-219. [PMID: 29340890 DOI: 10.1007/s10552-018-1001-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/06/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Seventy-five percent of epidemiological studies have reported that sedentary behavior is associated with ovarian cancer incidence. Although Japan has one of the most sedentary populations, with median sitting times of 7 h/day, this association has not been investigated. This study aimed to elucidate the association between average daily television (TV) viewing time, which is a major sedentary behavior, and the incidence of ovarian cancer in a large-scale nationwide cohort study in Japan. METHODS A total of 34,758 female participants aged 40-79 years without a history of cancer at baseline were included in the study. The inverse probability weighted competing risk model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for the incidence of ovarian cancer. RESULTS During a median follow-up of 19.4 years, 59 participants developed ovarian cancer (ICD-10: C56), 2,706 participants developed other types of cancer, and 4,318 participants died. Participants who watched TV for ≥ 5 h/day were more likely to develop ovarian cancer than those who watched TV for < 2 h/day (HR 2.15; 95% CI 1.54-2.99). CONCLUSION Our findings suggest that reducing the amount of time spent sedentarily may be beneficial for preventing ovarian cancer.
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Affiliation(s)
- Shigekazu Ukawa
- Department of Public Health, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Mitsuru Mori
- Hokkaido Chitose College of Rehabilitation, Hokkaido, Japan
| | - Satoyo Ikehara
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Hygiene and Public Health, Osaka Medical College, Osaka, Japan
| | - Toru Shirakawa
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Yatsuya
- Department of Public Health, Fujita Health University School of Medicine, Aichi, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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18
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Heemskerk-Gerritsen BAM, Seynaeve C, van Asperen CJ, Ausems MGEM, Collée JM, van Doorn HC, Gomez Garcia EB, Kets CM, van Leeuwen FE, Meijers-Heijboer HEJ, Mourits MJE, van Os TAM, Vasen HFA, Verhoef S, Rookus MA, Hooning MJ. Breast cancer risk after salpingo-oophorectomy in healthy BRCA1/2 mutation carriers: revisiting the evidence for risk reduction. J Natl Cancer Inst 2015; 107:djv033. [PMID: 25788320 DOI: 10.1093/jnci/djv033] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous studies have reported a breast cancer (BC) risk reduction of approximately 50% after risk-reducing salpingo-oophorectomy (RRSO) in BRCA1/2 mutation carriers, but may have been subject to several types of bias. The purpose of this nationwide cohort study was to assess potential bias in the estimated BC risk reduction after RRSO. METHODS We selected BRCA1/2 mutation carriers from an ongoing nationwide cohort study on Hereditary Breast and Ovarian Cancer in the Netherlands (HEBON). First, we replicated the analytical methods as previously applied in four major studies on BC risk after RRSO. Cox proportional hazards models were used to calculate hazard ratios and conditional logistic regression to calculate odds ratios. Secondly, we analyzed the data in a revised design in order to further minimize bias using an extended Cox model with RRSO as a time-dependent variable to calculate the hazard ratio. The most important differences between our approach and those of previous studies were the requirement of no history of cancer at the date of DNA diagnosis and the inclusion of person-time preceding RRSO. RESULTS Applying the four previously described analytical methods and the data of 551 to 934 BRCA1/2 mutation carriers with a median follow-up of 2.7 to 4.6 years, the odds ratio was 0.61 (95% confidence interval [CI] = 0.35 to 1.08), and the hazard ratios were 0.36 (95% CI = 0.25 to 0.53), 0.62 (95% CI = 0.39 to 0.99), and 0.49 (95% CI = 0.33 to 0.71), being similar to earlier findings. For the revised analysis, we included 822 BRCA1/2 mutation carriers. After a median follow-up period of 3.2 years, we obtained a hazard ratio of 1.09 (95% CI = 0.67 to 1.77). CONCLUSION In previous studies, BC risk reduction after RRSO in BRCA1/2 mutation carriers may have been overestimated because of bias. Using a design that maximally eliminated bias, we found no evidence for a protective effect.
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Affiliation(s)
- B A M Heemskerk-Gerritsen
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - C Seynaeve
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - C J van Asperen
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - M G E M Ausems
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - J M Collée
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - H C van Doorn
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - E B Gomez Garcia
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - C M Kets
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - F E van Leeuwen
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - H E J Meijers-Heijboer
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - M J E Mourits
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - T A M van Os
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - H F A Vasen
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - S Verhoef
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - M A Rookus
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
| | - M J Hooning
- Department of Medical Oncology (BAMHG, CS, MJH), Department of Clinical Genetics (JMC), and Department of Gynecology (HCvD), Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Clinical Genetics, Leiden University MC, Leiden, the Netherlands (CJvA); Department of Clinical Genetics, University MC Utrecht, Utrecht, the Netherlands (MGEMA); Department of Clinical Genetics, Maastricht University MC, Maastricht, the Netherlands (EBGG); Department of Human Genetics, Radboud University Nijmegen MC, Nijmegen, the Netherlands (CMK); Department of Epidemiology (FEvL, MAR), and Department of Clinical Genetics (SV), Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Human Genetics, VU University MC, Amsterdam, the Netherlands (HEJMH); Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands (HEJMJ, TAMvO); Department of Gynecology, University MC Groningen, Groningen, the Netherlands (MJEM); Foundation for Detection of Hereditary Tumours, Leiden, the Netherlands (HFAV)
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Abstract
Epithelial ovarian cancer is the fifth commonest cancer among women and the leading cause of gynecological cancer death in the UK. Most women present with advanced disease, mainly because the nonspecific nature of the symptoms lead to diagnostic delays. Recent data have shown a fall in ovarian cancer mortality rates in the UK, but rates are still higher when compared to other European countries or the USA. In addition, surgeons in the UK achieve on average lower optimal surgical cytoreduction rates in patients with advanced ovarian cancer. Despite a wealth of information on epidemiological risk factors, the pathogenesis of epithelial ovarian cancer remains largely unknown. This review presents the most recent data on incidence, mortality, and survival for epithelial ovarian cancer in the UK. Time trends, trends by age, international comparisons, and regional variation in incidence, survival, and mortality are presented within the context of a major reorganization of cancer services that took place in the UK over 10 years ago. Centralization of cancer services has meant that women with ovarian cancer receive treatment in specialist Cancer Centers.
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Affiliation(s)
- Konstantinos Doufekas
- Department of Gynaecological Oncology, University College London Hospitals, London, UK
| | - Adeola Olaitan
- Department of Gynaecological Oncology, University College London Hospitals, London, UK
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20
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Abd El hafez A, Monir A. Diagnostic spectrum of ovarian masses in women with breast cancer; magnetic resonance imaging: histopathology correlation. Ann Diagn Pathol 2013; 17:441-7. [DOI: 10.1016/j.anndiagpath.2013.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 06/20/2013] [Indexed: 01/02/2023]
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Heemskerk-Gerritsen BAM, Menke-Pluijmers MBE, Jager A, Tilanus-Linthorst MMA, Koppert LB, Obdeijn IMA, van Deurzen CHM, Collée JM, Seynaeve C, Hooning MJ. Substantial breast cancer risk reduction and potential survival benefit after bilateral mastectomy when compared with surveillance in healthy BRCA1 and BRCA2 mutation carriers: a prospective analysis. Ann Oncol 2013; 24:2029-35. [PMID: 23576707 DOI: 10.1093/annonc/mdt134] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To prospectively assess the efficacy of bilateral risk-reducing mastectomy (BRRM) when compared with surveillance on breast cancer (BC) risk and mortality in healthy BRCA1 and BRCA2 mutation carriers. PATIENTS AND METHODS Five hundred and seventy healthy female mutation carriers (405 BRCA1, 165 BRCA2) were selected from the institutional Family Cancer Clinic database. Eventually, 156 BRCA1 and 56 BRCA2 mutation carriers underwent BRRM. The effect of BRRM versus surveillance was estimated using Cox models. RESULTS During 2037 person-years of observation (PYO), 57 BC cases occurred in the surveillance group versus zero cases during 1379 PYO in the BRRM group (incidence rates, 28 and 0 per 1000 PYO, respectively). In the surveillance group, four women died of BC, while one woman in the BRRM group presented with metastatic BC 3.5 years after BRRM (no primary BC), and died afterward, yielding a HR of 0.29 (95% CI 0.02-2.61) for BC-specific mortality. CONCLUSIONS In healthy BRCA1/2 mutation carriers, BRRM when compared with surveillance reduces BC risk substantially, while longer follow-up is warranted to confirm survival benefits.
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Affiliation(s)
- B A M Heemskerk-Gerritsen
- Department of Medical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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22
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Pennington KP, Swisher EM. Hereditary ovarian cancer: beyond the usual suspects. Gynecol Oncol 2012; 124:347-53. [PMID: 22264603 DOI: 10.1016/j.ygyno.2011.12.415] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 11/29/2011] [Indexed: 01/08/2023]
Abstract
In the past, hereditary ovarian carcinoma was attributed almost entirely to mutations in BRCA1 and BRCA2, with a much smaller contribution from mutations in DNA mismatch repair genes. Recently, three new ovarian cancer susceptibility genes have been identified: RAD51C, RAD51D, and BRIP1. In addition, germline mutations in women with ovarian carcinoma have been recently identified in many of the previously identified breast cancer genes in the Fanconi anemia (FA)-BRCA pathway. While mutations in genes other than BRCA1 and BRCA2 are each individually rare, together they make up a significant proportion of cases. With at least 16 genes implicated in hereditary ovarian cancer to date, comprehensive testing for ovarian cancer risk will require assessment of many genes. As the cost of genomic sequencing continues to fall, the practice of evaluating cancer susceptibility one gene at a time is rapidly becoming obsolete. New advances in genomic technologies will likely accelerate the discovery of additional cancer susceptibility genes and increase the feasibility of comprehensive evaluation of multiple genes simultaneously at low cost. Improved recognition of inherited risk will identify individuals who are candidates for targeted prevention. In addition, identifying inherited mutations in a variety of FA-BRCA pathway genes may aid in identifying individuals who will selectively benefit from PARP inhibitors.
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Affiliation(s)
- Kathryn P Pennington
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA 98195, USA
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23
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Hemminki K, Sundquist J, Brandt A. Incidence and mortality in epithelial ovarian cancer by family history of any cancer. Cancer 2011; 117:3972-80. [DOI: 10.1002/cncr.26016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 01/10/2011] [Accepted: 01/14/2011] [Indexed: 12/20/2022]
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Silver DF, Chi DS, Bou-Zgheib N. Clinical Approach to Diagnosis and Management of Ovarian, Fallopian Tube, and Peritoneal Carcinoma. Surg Pathol Clin 2011; 4:261-74. [PMID: 26837295 DOI: 10.1016/j.path.2010.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ovarian, fallopian tube and peritoneal carcinomas make up the deadliest group of malignancies of the female genital tract. Ovarian carcinoma is the second most common malignancy of the female reproductive tract in developed countries and the sixth most common cancer diagnosed in women in the United States. While signs and symptoms of ovarian carcinoma related to the mass-effect of advanced disease are relatively common, no reliable signs or symptoms are seen in patients with early ovarian carcinoma. The diagnosis can only be made by surgical removal and pathologic evaluation of a suspicious mass. The authors present an overview of the disease and discussions of genetic predisposition, prevention, screening, and diagnosis of ovarian, fallopian tube and primary peritoneal carcinomas. Details on staging procedures as well as surgical and chemotherapeutic techniques are outlined for the various stages of disease.
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Affiliation(s)
- David F Silver
- The Women's Institute for Gynecologic Cancer & Special Pelvic Surgery, 755 Memorial Parkway, Phillipsburg, NJ 08865, USA.
| | - Dennis S Chi
- Gynecologic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Nadim Bou-Zgheib
- The Women's Institute for Gynecologic Cancer & Special Pelvic Surgery, 755 Memorial Parkway, Phillipsburg, NJ 08865, USA
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25
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Lee J, Kang E, Kim SW, Park B, Park SK, Ahn SH, Lee HD, Jeong J, Jung SH, Lee BK, Chang MC, Bae YT, Cho YU, Hwang KT, Kim HA, Kim EK, Paik NS, Han S, Yoon CS, Lee MH. The Prevalence of Ovarian Cancer in Korean Women at High-Risk for Hereditary Breast-Ovarian Cancer. J Breast Cancer 2011. [DOI: 10.4048/jbc.2011.14.s.s24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jihyoun Lee
- Department of Surgery, Soonchunhyang University Hospital, Seoul, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul, Korea
| | - Sung-Won Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul, Korea
| | - Boyoung Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Sue K. Park
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Sei-Hyun Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hy-De Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoo Jung
- Department of Surgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Byoung Kil Lee
- Department of Surgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Myung Chul Chang
- Department of Surgery, Dankook University Hospital, Cheonan, Korea
| | - Young Tae Bae
- Department of Surgery, Pusan National University School of Medicine, Pusan, Korea
| | - Young Up Cho
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Ki-Tae Hwang
- Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Nam Sun Paik
- Department of Surgery, Konkuk University Hospital, Seoul, Korea
| | - Sehwan Han
- Department of Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Chan Seok Yoon
- Department of Surgery, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University Hospital, Seoul, Korea
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Wan YW, Qian Y, Rathnagiriswaran S, Castranova V, Guo NL. A breast cancer prognostic signature predicts clinical outcomes in multiple tumor types. Oncol Rep 2010; 24:489-94. [PMID: 20596637 DOI: 10.3892/or_00000883] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Epidemiological studies indicate an increased risk of subsequent primary ovarian cancer from women with breast cancer. We have recently identified a 28-gene expression signature that predicts, with high accuracy, the clinical course in a large population of breast cancer patients. This prognostic gene signature also accurately predicts response to chemotherapy commonly used for treating breast cancer, including CMF, Tamoxifen, Paclitaxel, Docetaxel and Doxorubicin (Adriamycin), in a panel of 60 cancer cell lines of nine different tissue origins. This prompted us to investigate whether this prognostic gene signature could also predict clinical outcome in other cancer types of epithelial origins, including ovarian cancer (n=124), colon tumors (n=74) and lung adenocarcinomas (n=442). The results show that the gene expression signature contributes significantly more accurate (P<0.05; compared with random prediction) prognostic information in multiple cancer types independent of established clinical parameters. Furthermore, the functional pathway analysis with curated database delineated a biological network with tight connections between the signature genes and numerous well established cancer hallmarks, indicating important roles of this prognostic gene signature in tumor genesis and progression.
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Affiliation(s)
- Ying-Wooi Wan
- Mary Babb Randolph Cancer Center/Community Medicine, West Virginia University, Morgantown, WV 26506-9300, USA
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27
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Einbeigi Z, Enerbäck C, Wallgren A, Nordling M, Karlsson P. BRCA1 gene mutations may explain more than 80% of excess number of ovarian cancer cases after breast cancer - a population based study from the Western Sweden Health Care region. Acta Oncol 2010; 49:361-7. [PMID: 20151938 DOI: 10.3109/02841860903521095] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM In a previous cohort study, we showed that there was a significant variation in the frequency of ovarian cancer after having breast cancer in Sweden, with the highest risk occuring in the Western region. The present study aimed to evaluate whether the high prevalence of the founder mutation BRCA1 3171ins5 may explain the excess number of ovarian cancer. METHOD Among more than 26 000 women with breast cancer in the Western Swedish Health Care Region, 159 cases were subsequently diagnosed with ovarian cancer, whereas the expected number was 96. Archived tissue material was analysed for six common Scandinavian BRCA1 and BRCA2 gene mutations. RESULTS The excess number of cases was 63 (95% CI 47-77), based on person-years at risk and national incidence rates of ovarian cancer. A BRCA1 gene mutation was detected in 33 cases corresponding to 52% of the excess number. The founder mutation, BRCA1 3171ins5, was detected in 44% of the excess number. The identified mutations decreased from 45% in women less than 50 years of age at follow-up to 14% at 60+ years at follow-up. There was no obvious decrease in mutation frequency by excess numbers with age. Age at follow-up and first-degree relatives with breast and/or ovarian cancer were the best predictors of a mutation in this material. CONCLUSION The founder mutation, BRCA1 3171ins5, explains the excess of ovarian cancer after breast cancer in the region. From the relative frequency of the studied mutations found at the cancer genetic counselling clinic, it is estimated that BRCA1 gene mutations are associated with about 80-85% of the excess cases. This means that a negative screening for these mutations in similar cases may have a predictive value and could strongly reduce the risk of ovarian cancer in relatives.
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Affiliation(s)
- Zakaria Einbeigi
- Department of Oncology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
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28
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Long-term outcomes of breast cancer in women aged 30 years or younger, based on family history, pathology and BRCA1/BRCA2/TP53 status. Br J Cancer 2010; 102:1091-8. [PMID: 20234365 PMCID: PMC2853095 DOI: 10.1038/sj.bjc.6605606] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: There are relatively few articles addressing long-term follow-up in women with breast cancer at very young ages. Methods: We have updated and extended our population-based analysis of breast cancer diagnosed at the age ⩽30 years in North-west England to include an extra 15 patients with mutation testing in BRCA1, BRCA2 and TP53, with 115 of 288 consecutive cases being tested. Kaplan–Meier curves were generated to assess overall survival, contralateral breast cancer and other second primaries. Results: Survival analysis of all 288 patients showed poor overall survival, although this improved from a 15-year survival of only 46% in those diagnosed between 1980 and 1989 to 58% in those diagnosed between 1990 and 1997 (P=0.05). Contralateral breast cancer rates were at a steady rate of 0.6 per 1000, although the rates in mutation carriers were ∼2 per 1000. Altogether, 16 BRCA1, 9 BRCA2 and 6 TP53 mutations have now been found among the 115 cases on whom DNA analysis has been performed. BRCAPRO accurately predicted the number of carriers for BRCA1 and BRCA2 and was sensitive and specific at the 10 and 20% threshold, respectively. However, BRCAPRO did not seem to give any weight to DCIS, which accounted for two BRCA1 carriers and three TP53 carriers and overpredicted mutations at the high end of the spectrum, with only 6 of 11 (54%) with a >90% probability having identifiable BRCA1/2 mutations. Interpretation: Rates of new primaries are predicted to some extent by mutation status. BRCAPRO is useful at determining those patients aged ⩽30 years to be tested.
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Leu M, Czene K, Reilly M. Bias correction of estimates of familial risk from population-based cohort studies. Int J Epidemiol 2009; 39:80-8. [PMID: 19825986 DOI: 10.1093/ije/dyp304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In addition to guiding molecular epidemiology investigations, estimates of the increased risk of disease in relatives of affected persons are also important for screening and counselling decisions. Since precise estimation of such familial risks (FRs) requires large sample sizes, many of the estimates in common use have been obtained from historical electronic records of disease in entire populations, where the relatives of affected and unaffected persons are compared. These estimates may be biased due to failure to identify relatives as affected if they are diagnosed before the start-up date of disease registration. METHODS This article presents a method for correcting the bias in FR estimates from such misclassification of family history, using a simple formula that depends on the prevalence and sensitivity of the observed family history. The sensitivity is estimated by using the R package poplab to create realistic populations of related individuals and then imposing the start-up effect of disease registration. RESULTS For a range of FRs, the truncation of family history is demonstrated to result in non-differential misclassification, and sensitivity that has little or no dependence on the FR. The bias is most pronounced for high FRs and for registers with a short life span, and increases with the age of the study cohort. In all the situations studied, the bias-corrected estimates are in excellent agreement with the true values. CONCLUSIONS In summary, our method can correct the inevitable bias in FRs induced by using electronic population data, and is a feasible alternative to the use of validation samples.
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Affiliation(s)
- Monica Leu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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30
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Einbeigi Z, Bergman A, Meis-Kindblom JM, Flodin A, Bjursell C, Martinsson T, Kindblom LG, Wahlström J, Wallgren A, Nordling M, Karlsson P. Occurrence of both breast and ovarian cancer in a woman is a marker for the BRCA gene mutations: a population-based study from western Sweden. Fam Cancer 2007; 6:35-41. [PMID: 16944270 DOI: 10.1007/s10689-006-9101-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 07/24/2006] [Indexed: 01/28/2023]
Abstract
AIM This study aimed to analyze whether the occurrence of both breast and ovarian cancer in a woman serves as a marker for BRCA gene mutations. MATERIAL AND METHODS This population-based study included 256 women in western Sweden who developed both invasive breast and ovarian tumors between 1958 and 1999. Archival paraffin tissue blocks of their tumors were retrieved for DNA-extraction to analyze the founder mutation, BRCA1 c.3171_3175dup (c.3171ins5), which is most common in this geographic area and four other common Scandinavian BRCA1 gene mutations and one BRCA2 mutation. Together, account these mutations for approximately 75% of the BRCA1/2 gene mutations in the clinical unit. RESULTS Ninteen percent (95% confidence interval (CI) 14-24%) of the women carried one of the analyzed BRCA1 gene mutations but none of the women were positive for the analyzed BRCA2 mutation. One-third of the women with both tumors before age 60 were mutation carriers. BRCA1 c.3171_3175dup (c.3171ins5) constituted 84% of all identified mutations. Although the majority of breast cancers were invasive ductal and atypical medullary types, a variety of other breast malignancies were seen among mutation carriers. Serous ovarian carcinomas predominated among ovarian tumors. A variety of other ovarian tumors, including three granulosa-theca cell tumors, were also observed among mutation carriers. CONCLUSIONS The occurrence of both breast and ovarian cancer in a woman is associated with a high likelihood of a constitutional BRCA1 mutation. These women and their families might therefore be considered for mutation screening after appropriate genetic counselling.
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Affiliation(s)
- Zakaria Einbeigi
- Department of Oncology, Sahlgrenska University Hospital, S413 45 Göteborg, Sweden.
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Heemskerk-Gerritsen BAM, Brekelmans CTM, Menke-Pluymers MBE, van Geel AN, Tilanus-Linthorst MMA, Bartels CCM, Tan M, Meijers-Heijboer HEJ, Klijn JGM, Seynaeve C. Prophylactic mastectomy in BRCA1/2 mutation carriers and women at risk of hereditary breast cancer: long-term experiences at the Rotterdam Family Cancer Clinic. Ann Surg Oncol 2007; 14:3335-44. [PMID: 17541692 PMCID: PMC2077910 DOI: 10.1245/s10434-007-9449-x] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 04/16/2007] [Indexed: 01/14/2023]
Abstract
BACKGROUND BRCA1/2 mutation carriers and women from a hereditary breast(/ovarian) cancer family have a highly increased risk of developing breast cancer (BC). Prophylactic mastectomy (PM) results in the greatest BC risk reduction. Long-term data on the efficacy and sequels of PM are scarce. METHODS From 358 high-risk women (including 236 BRCA1/2 carriers) undergoing PM between 1994 and 2004, relevant data on the occurrence of BC in relation to PM, complications in relation to breast reconstruction (BR), mutation status, age at PM and preoperative imaging examination results were extracted from the medical records, and analyzed separately for women without (unaffected, n = 177) and with a BC history (affected, n = 181). RESULTS No primary BCs occurred after PM (median follow-up 4.5 years). In one previously unaffected woman, metastatic BC was detected almost 4 years after PM (primary BC not found). Median age at PM was younger in unaffected women (P < .001), affected women more frequently were 50% risk carriers (P < .001). Unexpected (pre)malignant changes at PM were found in 3% of the patients (in 5 affected, and 5 unaffected women, respectively). In 49.6% of the women opting for BR one or more complications were registered, totaling 215 complications, leading to 153 surgical interventions (71%). Complications were mainly related to cosmetic outcome (36%) and capsular formation (24%). CONCLUSIONS The risk of developing a primary BC after PM remains low after longer follow-up. Preoperative imaging and careful histological examination is warranted because of potential unexpected (pre)malignant findings. The high complication rate after breast reconstruction mainly concerns cosmetic issues.
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Affiliation(s)
| | - Cecile T. M. Brekelmans
- Department of Medical Oncology , Family Cancer Clinic, Erasmus MC—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Marian B. E. Menke-Pluymers
- Department of Surgical Oncology, Family Cancer Clinic, Erasmus MC—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Albert N. van Geel
- Department of Surgical Oncology, Family Cancer Clinic, Erasmus MC—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | | | - Carina C. M. Bartels
- Department of Surgical Oncology, Family Cancer Clinic, Erasmus MC—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Murly Tan
- Department of Psychosocial Care, Family Cancer Clinic, Erasmus MC—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Hanne E. J. Meijers-Heijboer
- Department of Clinical Genetics, Erasmus MC—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Vrije Universiteit MC, Amsterdam, The Netherlands
| | - Jan G. M. Klijn
- Department of Medical Oncology , Family Cancer Clinic, Erasmus MC—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Caroline Seynaeve
- Department of Medical Oncology , Family Cancer Clinic, Erasmus MC—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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Turesson I, Linet MS, Björkholm M, Kristinsson SY, Goldin LR, Caporaso NE, Landgren O. Ascertainment and diagnostic accuracy for hematopoietic lymphoproliferative malignancies in Sweden 1964–2003. Int J Cancer 2007; 121:2260-6. [PMID: 17583571 DOI: 10.1002/ijc.22912] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Population-based cancer registries are widely used to provide key information about cancer incidence, survival, determinants of progression and clues about pathogenesis. To substantially expand the limited data on diagnostic accuracy and completeness for lymphoproliferative (LP) tumors in such databases, we conducted a retrospective investigation of close to 1,000 cases diagnosed during 4 decades in Sweden. We identified and reviewed medical records for 494 LP tumor patients reported to the population-based Swedish Cancer registry and 503 LP tumor patients identified from hospitals in Sweden among patients with LP tumors diagnosed during 1964-2003. The stratified samples were randomly selected from patients according to LP subtype, over 4 equal calendar periods, and among 6 selected hospitals of diverse size and from different geographic regions. We found 97.9% of reported LP tumor cases to fulfill current diagnostic criteria for having an LP tumor and observed 89.7% to have accurate LP tumor subtype. The overall completeness of non-Hodgkin lymphoma, Hodgkin lymphoma and multiple myeloma cases in the Cancer registry was 95-99% but was lower for the more indolent tumors, chronic lymphocytic leukemia (87.9%) and Waldenström's macroglobulinemia (68.1%). We observed increased overall under-ascertainment for patients diagnosed above age 80 (27%) and among individuals diagnosed before 1973 (12%). In conclusion the diagnostic accuracy and completeness for classically defined LP tumor entities in the Swedish Cancer registry is high. However, we found under-ascertainment of patients with indolent LP tumors, particularly among patients diagnosed at older ages, with early-stage disease and diagnosed in earlier years.
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Affiliation(s)
- Ingemar Turesson
- Section of Hematology, Department of Medicine, Malmö University Hospital, University of Lund, Malmö, Sweden.
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Lee JS, John EM, McGuire V, Felberg A, Ostrow KL, DiCioccio RA, Li FP, Miron A, West DW, Whittemore AS. Breast and ovarian cancer in relatives of cancer patients, with and without BRCA mutations. Cancer Epidemiol Biomarkers Prev 2006; 15:359-63. [PMID: 16492929 DOI: 10.1158/1055-9965.epi-05-0687] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND First-degree relatives of patients with breast or ovarian cancer have increased risks for these cancers. Little is known about how their risks vary with the patient's cancer site, carrier status for predisposing genetic mutations, or age at cancer diagnosis. METHODS We evaluated breast and ovarian cancer incidence in 2,935 female first-degree relatives of non-Hispanic White female patients with incident invasive cancers of the breast (n = 669) or ovary (n = 339) who were recruited from a population-based cancer registry in northern California. Breast cancer patients were tested for BRCA1 and BRCA2 mutations. Ovarian cancer patients were tested for BRCA1 mutations. We estimated standardized incidence ratios (SIR) and 95% confidence intervals (95% CI) for breast and ovarian cancer among the relatives according to the patient's mutation status, cancer site, and age at cancer diagnosis. RESULTS In families of patients who were negative or untested for BRCA1 or BRCA2 mutations, risks were elevated only for the patient's cancer site. The breast cancer SIR was 1.5 (95% CI, 1.2-1.8) for relatives of breast cancer patients, compared with 1.1 (95% CI, 0.8-1.6) for relatives of ovarian cancer patients (P = 0.12 for difference by patient's cancer site). The ovarian cancer SIR was 0.9 (95% CI, 0.5-1.4) for relatives of breast cancer patients, compared with 1.9 (95% CI, 1.0-4.0) for relatives of ovarian cancer patients (P = 0.04 for difference by site). In families of BRCA1-positive patients, relatives' risks also correlated with the patient's cancer site. The breast cancer SIR was 10.6 (95% CI, 5.2-21.6) for relatives of breast cancer patients, compared with 3.3 (95% CI, 1.4-7.3) for relatives of ovarian cancer patients (two-sided P = 0.02 for difference by site). The ovarian cancer SIR was 7.9 (95% CI, 1.2-53.0) for relatives of breast cancer patients, compared with 11.3 (3.6-35.9) for relatives of ovarian cancer patients (two-sided P = 0.37 for difference by site). Relatives' risks were independent of patients' ages at diagnosis, with one exception: In families ascertained through a breast cancer patient without BRCA mutations, breast cancer risks were higher if the patient had been diagnosed before age 40 years. CONCLUSION In families of patients with and without BRCA1 mutations, breast and ovarian cancer risks correlate with the patient's cancer site. Moreover, in families of breast cancer patients without BRCA mutations, breast cancer risk depends on the patient's age at diagnosis. These patterns support the presence of genes that modify risk specific to cancer site, in both carriers and noncarriers of BRCA1 and BRCA2 mutations.
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Affiliation(s)
- Jennifer S Lee
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, HRP Redwood Building, Stanford, California 94305-5405, USA.
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Liou WS, Hamilton CA, Cheung MK, Osann K, Longacre TA, Teng NN, Husain A, Dirbas FM, Chan JK. Outcomes of women with metachronous breast and ovarian carcinomas. Gynecol Oncol 2006; 103:190-4. [PMID: 16569424 DOI: 10.1016/j.ygyno.2006.02.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Revised: 02/10/2006] [Accepted: 02/14/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Women with a history of breast cancer have a significantly increased risk of developing a second primary ovarian cancer and vice versa. We proposed to determine the characteristics and outcomes of women diagnosed with metachronous breast and ovarian cancer. METHODS Patients were identified from the Surveillance, Epidemiology, and End Results program database between 1988 and 2001. Kaplan-Meier and Cox proportional hazards regression tests were used to determine survival outcomes. RESULTS Of 704 women, 526 developed breast cancer then ovarian cancer (B-O) and 178 developed ovarian cancer then breast cancer (O-B). The mean age at diagnosis of the first cancer in the B-O versus O-B group was 60.3 versus 58.9 years, respectively (P = 0.23). Twenty-five percent of women in the B-O group had stage I-II ovarian cancer versus 63% in the O-B group (P < 0.001). The percentage of those with stage I-II breast cancer was 94% and 91% in the B-O versus O-B group, respectively (P = 0.13). Women in the B-O group had more high grade of ovarian cancer compared to those in the O-B group (P < 0.001). The mean time interval between diagnoses of breast then ovarian versus ovarian then breast cancer was 58 versus 56 months, respectively (P = 0.42). CONCLUSIONS In the largest series to date, we found that women diagnosed with ovarian cancer first had significantly more early stage and lower grade ovarian cancers with better survival compared to those with breast cancer followed by ovarian cancer. Since half of the women had their second cancer beyond 5 years, continued surveillance of these high risk patients is recommended.
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Affiliation(s)
- Wen-Shiung Liou
- Department of Gynecology and Obstetrics, Stanford Cancer Center, Stanford University School of Medicine, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
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Carmon M, Olsha O, Levy-Lahad E, Zuckerman B, Rivkin L, Beller U. Laparoscopic oophorectomy combined with breast surgery for breast cancer patients. ACTA ACUST UNITED AC 2006. [DOI: 10.4993/acrt.14.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Németh K, Koppán M, Zámbó K, Bódis J. Prophylactic oophorectomy in patients with increased risk of ovarian cancer. Am J Obstet Gynecol 2005; 193:1580; author reply 1581. [PMID: 16202764 DOI: 10.1016/j.ajog.2005.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Indexed: 11/15/2022]
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Kauff ND, Mitra N, Robson ME, Hurley KE, Chuai S, Goldfrank D, Wadsworth E, Lee J, Cigler T, Borgen PI, Norton L, Barakat RR, Offit K. Risk of ovarian cancer in BRCA1 and BRCA2 mutation-negative hereditary breast cancer families. J Natl Cancer Inst 2005; 97:1382-4. [PMID: 16174860 DOI: 10.1093/jnci/dji281] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Women from site-specific hereditary breast cancer families who carry a BRCA1 or BRCA2 mutation are at increased risk for ovarian cancer. It is less clear, however, whether individuals from hereditary breast cancer families who do not carry such a mutation are also at increased ovarian cancer risk. To determine whether women from BRCA mutation-negative hereditary breast cancer families are at increased risk for ovarian cancer, 199 probands from BRCA mutation-negative, site-specific breast cancer kindreds who consented to prospective follow-up at the time of genetic testing were identified. The incidence of new breast and ovarian cancers in probands and their families since receipt of their genetic test results was determined by questionnaire. The expected number of cancers and standardized incidence ratios (SIRs) were determined from age-specific cancer incidence rates from the Surveillance, Epidemiology, and End Results (SEER) program by using the method of Byar. All statistical tests were two-sided. During 2534 women-years of follow-up in 165 kindreds, 19 new cases of breast cancer were diagnosed, whereas only 6.07 were expected (SIR = 3.13, 95% confidence interval [CI] = 1.88 to 4.89; P < .001), and one case of ovarian cancer was diagnosed, whereas only 0.66 was expected (SIR = 1.52, 95% CI = 0.02 to 8.46; P = .48). These results suggest that women from BRCA mutation-negative, site-specific breast cancer families are not at increased risk for ovarian cancer.
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Affiliation(s)
- Noah D Kauff
- Department of Gynecology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Kauff ND, Hurley KE, Hensley ML, Robson ME, Lev G, Goldfrank D, Castiel M, Brown CL, Ostroff JS, Hann LE, Offit K, Barakat RR. Ovarian carcinoma screening in women at intermediate risk: impact on quality of life and need for invasive follow-up. Cancer 2005; 104:314-20. [PMID: 15948173 DOI: 10.1002/cncr.21148] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Women with family histories suggestive of an increased risk of ovarian carcinoma who have not had a deleterious BRCA1 or BRCA2 mutation identified are commonly suggested to consider ovarian carcinoma screening with transvaginal ultrasound and/or assessment of CA 125 levels. Limited information is available regarding the impact of this approach on either quality of life (QOL) or need for invasive follow-up in this group of women. METHODS From November 1999 to October 2002, 184 women at intermediate risk of ovarian carcinoma were enrolled in a prospective study. Participants were screened with twice yearly transvaginal ultrasound and CA 125 assessments. Impact on QOL was measured using the Mental Component Summary (MCS) score of the Medical Outcomes Studies Short Form-36. Need for invasive follow-up was determined by questionnaire and medical record review. RESULTS In the current study, 135 participants underwent > or = 1 follow-up assessment. During a mean of 19.8 months of follow-up, 12.9% of ultrasounds and 3.8% of CA 125 assessments were abnormal. The authors reported that 38.5% of participants had > or = 1 abnormal ovarian screen that required a short interval follow-up. Because of either abnormal bleeding or ultrasound abnormalities, 24% of participants underwent > or = 1 endometrial sampling. Controlling for a history of breast carcinoma and menopausal status, abnormal ovarian screening results were associated with a decrease in MCS score (P = 0.034), whereas the need for endometrial sampling was not (P = 0.87). CONCLUSIONS Ovarian carcinoma screening in women at intermediate risk was associated with a substantial rate of abnormal screen results, endometrial sampling, and in women with abnormal ovarian screening findings, a decrease in MCS scores. These findings may have important implications for women considering ovarian carcinoma screening and for the design of future ovarian carcinoma screening trials.
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Affiliation(s)
- Noah D Kauff
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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Guppy AE, Nathan PD, Rustin GJS. Epithelial Ovarian Cancer: A Review of Current Management. Clin Oncol (R Coll Radiol) 2005; 17:399-411. [PMID: 16149282 DOI: 10.1016/j.clon.2005.05.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Epithelial ovarian cancer is the most lethal gynaecological cancer among women worldwide, with 6000 new cases diagnosed in the UK each year. Most women present with advanced disease, but, despite a good initial response to treatment, most relapse. The overall 5-year survival rate is 46%, although this drops to about 13% in women with advanced disease. Transvaginal ultrasound and the tumour marker CA125 are being investigated for screening in ongoing randomised trials. Treatment of ovarian cancer is dependent on clinical stage, and should always be managed within a multidisciplinary team. Most cases will require a pelvic clearance and adjuvant chemotherapy. Current guidelines by the National Institute of Clinical Excellence (NICE) recommend that first-line chemotherapy should include a platinum-based regimen with or without paclitaxel. Relapsed ovarian cancer is incurable; however, chemotherapy can improve quality of life and survival. Gene therapy, immunotherapy and signal transduction inhibitors are all potential future therapies, and are being investigated in ongoing clinical research. In this paper we review the literature on the epidemiology, pathology, clinical features and the current treatment options in epithelial ovarian cancer.
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Affiliation(s)
- A E Guppy
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, Middlesex, UK
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Bódis J, Koppán M, Németh K. Efficacy of radiotherapy for ovarian ablation. Cancer 2005; 104:220; author reply 220-1. [PMID: 15915479 DOI: 10.1002/cncr.21080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Madlensky L, Flatt SW, Bardwell WA, Rock CL, Pierce JP. Is family history related to preventive health behaviors and medical management in breast cancer patients? Breast Cancer Res Treat 2005; 90:47-54. [PMID: 15770526 DOI: 10.1007/s10549-004-2626-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Women diagnosed with breast cancer who also have a family history of the disease are at increased risk of developing additional primary breast or ovarian cancers. We investigated whether a relationship exists between family history and health behaviors in a cross-sectional study of breast cancer survivors. METHODS Participants in the Women's Healthy Eating and Living (WHEL) Study (a randomized trial designed to test the effect of a plant-based diet on breast cancer recurrence) completed baseline questionnaires about their family history and health behaviors. Medical records and self-reports provided treatment data. Participants were defined as having a family history (FH+) if they met specific family history criteria (n=195), and were compared with women having no family history (FH-) of breast cancer (n=1736). RESULTS The mean age of breast cancer diagnosis was 51.2 years for both groups, but FH+ women were more likely to be diagnosed before age 40. FH+ and FH- women had similar dietary patterns, alcohol intake, exercise patterns, body mass index and smoking histories. However, FH+ women were more likely to have undergone prophylactic contralateral mastectomy (OR=3.6, 95% CI=2.2 - 6.2) and bilateral oophorectomy (OR=1.6; 95% CI=1.0 - 2.3) following diagnosis, adjusted for age and time since diagnosis. The FH+ and FH- groups had similar patterns of use of anti-estrogen medications and frequency of medical follow-up. CONCLUSIONS Breast cancer survivors with a strong family history of breast cancer are more likely to undergo surgical preventive measures to reduce their risk of additional cancer, but do not report undertaking more preventive lifestyle behaviors compared to breast cancer survivors without a family history.
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Affiliation(s)
- Lisa Madlensky
- Cancer Prevention and Control, Rebecca and John Moores UCSD Cancer Center, University of California, SanDiego, 95000 Gilman Drive, San Diego, California 92093-0901, USA.
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Metcalfe KA, Lynch HT, Ghadirian P, Tung N, Olivotto IA, Foulkes WD, Warner E, Olopade O, Eisen A, Weber B, McLennan J, Sun P, Narod SA. The risk of ovarian cancer after breast cancer in BRCA1 and BRCA2 carriers. Gynecol Oncol 2005; 96:222-6. [PMID: 15589605 DOI: 10.1016/j.ygyno.2004.09.039] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the risk of ovarian cancer after a primary diagnosis of breast cancer among women with a BRCA1 or BRCA2 mutation and to identify host and treatment-related factors that might modify the risk. PATIENTS AND METHODS Patients were 491 women with stage I or stage II breast cancer, diagnosed from 1975 to 2000 and for whom a BRCA1 or BRCA2 mutation had been identified. Patients were followed from the initial diagnosis of breast cancer until either ovarian cancer, prophylactic oophorectomy, death, or 2002. The medical treatment records and pathology documents were reviewed. Information that was abstracted from the medical charts included date of breast cancer diagnosis, stage of disease, use of chemotherapy, use of radiation therapy, usage of tamoxifen, oophorectomy, recurrence, second malignancy, and vital status. RESULTS The 10-year actuarial risk of ovarian cancer after breast cancer was 12.7% for BRCA1 carriers and 6.8% for BRCA2 carriers (P = 0.03). The use of tamoxifen (OR = 1.79; P = 0.16) and chemotherapy (OR = 0.59; P = 0.15) did not significantly impact on the risk of subsequent ovarian cancer. Twenty-five percent of the deaths in women with stage I breast cancer were due to a subsequent ovarian cancer. CONCLUSIONS The high incidence of ovarian cancer suggests that oophorectomy should be recommended in female BRCA1 and BRCA2 mutation carriers with a diagnosis of breast cancer, especially those with stage I disease. Breast cancer systemic therapy did not significantly alter the risk of ovarian cancer.
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Affiliation(s)
- Kelly A Metcalfe
- Faculty of Nursing, University of Toronto, 50 St. George Street, Toronto, ON, Canada, M5S 3H4
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Pal T, Permuth-Wey J, Holtje T, Sutphen R. BRCA1 and BRCA2 Mutations in a Study of African American Breast Cancer Patients. Cancer Epidemiol Biomarkers Prev 2004. [DOI: 10.1158/1055-9965.1794.13.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
The spectrum of mutations in BRCA1 and BRCA2 among African Americans has not been well characterized because most studies to date have been done in Caucasian families. According to Myriad Genetic Laboratories, Inc., only ∼3% of individuals undergoing BRCA1/BRCA2 testing reported African American ancestry. Data from previous studies show that among African American women a greater proportion of breast cancer cases are diagnosed at age <45 years in comparison with Caucasians. Because breast cancer occurring at a young age is one of the hallmarks of high penetrance genes, the prevalence, spectrum, and effects of BRCA1/BRCA2 mutations may differ substantially between African Americans and Caucasians, and further investigation is warranted.
We conducted a hospital-based study of African American breast cancer patients with early age at diagnosis (≤45 years) or family history of breast or ovarian cancer. We identified four deleterious mutations in BRCA1 or BRCA2 among the 10 families tested, of which two were novel BRCA2 mutations, one was the west African founder mutation (BRCA1 943ins10), and one was a recurrent mutation that may be a candidate for a second African American founder mutation (BRCA1 IVS13+1G>A). Our results support previous data in demonstrating that (a) the spectrum of mutations among African Americans is unique, (b) family history of breast cancer is an important predictor of hereditary cancer susceptibility among African Americans, and (c) empirical data may be useful in estimating mutation risk among African Americans.
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Affiliation(s)
- Tuya Pal
- 1H. Lee Moffitt Cancer Center and Research Institute, and
- 2Department of Interdisciplinary Oncology, College of Medicine, University of South Florida, Tampa, Florida; and
- 3All Children's Hospital, Department of Pediatrics, College of Medicine, University of South Florida, St. Petersburg, Florida
| | - Jenny Permuth-Wey
- 1H. Lee Moffitt Cancer Center and Research Institute, and
- 2Department of Interdisciplinary Oncology, College of Medicine, University of South Florida, Tampa, Florida; and
| | - Tricia Holtje
- 1H. Lee Moffitt Cancer Center and Research Institute, and
| | - Rebecca Sutphen
- 1H. Lee Moffitt Cancer Center and Research Institute, and
- 2Department of Interdisciplinary Oncology, College of Medicine, University of South Florida, Tampa, Florida; and
- 3All Children's Hospital, Department of Pediatrics, College of Medicine, University of South Florida, St. Petersburg, Florida
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Nilsson PM, Nilsson JA, Berglund G. Family burden of cardiovascular mortality: risk implications for offspring in a national register linkage study based upon the Malmö Preventive Project. J Intern Med 2004; 255:229-35. [PMID: 14746560 DOI: 10.1046/j.1365-2796.2003.01287.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the adjusted relative risk of cardiovascular disease (CVD) events in offspring of parents with cardiovascular mortality before 75 years. SETTING The city of Malmö, Sweden. DESIGN A follow-up study based on register linkage analyses. SUBJECTS AND METHODS In the Malmö Preventive Project (MPP), a total of 22,444 men and 10,902 women attended the screening programme between 1974 and 1992. At the screening conventional risk factors for CVD were measured (blood pressure, lipids, glucose, smoking and social class). MAIN OUTCOME MEASURES Parental CVD mortality was determined via register linkage analysis between the Multiple-Generation Register and the National Mortality Register (NMR). CVD events (morbidity and mortality) in offspring were collected from national registers. The relative risk for CVD events in offspring, in relation to parental CVD mortality, was adjusted for age and risk factors at screening. RESULTS The age-adjusted relative risk (RR; 95%CI) for a son to experience a CVD event was increased in relation to a maternal positive family history of CVD mortality before 75 years when compared with no maternal history, RR 1.74 (1.43-2.11). This RR decreased to 1.51 (1.23-1.84; P < 0.001) after full adjustment for risk factors. The corresponding fully adjusted RRs for father-son heritage was RR 1.22 (1.02-1.47; P < 0.05), mother-daughter RR 0.87 (0.54-1.41), and father-daughter RR 1.20 (0.83-1.73). CONCLUSION The existence of maternal CVD mortality before the age of 75 years implies a substantial risk increase for CVD morbidity and mortality in sons that cannot be explained by social background, lifestyle, or conventional cardiovascular risk factors in the adult offspring.
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Affiliation(s)
- P M Nilsson
- Department of Medicine, University Hospital, Malmö, Sweden.
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Lorenzo Bermejo J, Rawal R, Hemminki K. Familial association of specific histologic types of ovarian malignancy with other malignancies. Cancer 2004; 100:1507-14. [PMID: 15042686 DOI: 10.1002/cncr.20138] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Population-based data on the familial association of specific histologic types of ovarian malignancy with other malignancies are limited. Such data may help to elucidate etiologic differences among histologic types of ovarian malignancy. METHODS The nationwide Swedish Family-Cancer Database, which includes 10.3 million individuals and 20,974 ovarian carcinomas, was used to calculate standardized incidence ratios and 95% confidence intervals for age- and histology-specific ovarian malignancies in women whose parents or siblings were affected with malignancies at the most common disease sites. RESULTS Ovarian malignancy was found to be associated with ovarian, laryngeal, breast, endometrial, liver, and colon carcinoma, as well as myeloma; epithelial ovarian malignancy was found to be associated with ovarian, endometrial, and skin malignancies and with melanoma and myeloma; papillary serous cystadenocarcinoma was found to be associated with ovarian and skin malignancies and with myeloma; and endometrioid carcinoma was found to be associated with endometrial, ovarian, and prostate malignancies and with melanoma. For younger women (ages 40-45 years) whose mothers were affected with endometrial malignancies, the risk of developing endometrioid carcinoma was slightly greater than the risk of developing papillary serous cystadenocarcinoma. CONCLUSIONS Specific types of ovarian malignancy may be associated with specific familial disease sites, with such associations depending on age at diagnosis; the strength of the observed associations varied according to histology. Associations were found between endometrioid carcinoma and endometrial malignancy and between serous carcinoma and Hodgkin disease.
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Affiliation(s)
- Justo Lorenzo Bermejo
- Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany.
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Hemminki K, Granström C. Familial invasive and borderline ovarian tumors by proband status, age and histology. Int J Cancer 2003; 105:701-5. [PMID: 12740921 DOI: 10.1002/ijc.11151] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Age-specific familial risks in ovarian cancer have not been assessed by histologic types of medically verified cancers. We used the nationwide Swedish Family-Cancer Database on 10.2 million individuals and 19,175 invasive and 3,436 borderline ovarian cancers to calculate, by affected family members, standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for familial ovarian cancer in 0-66 year old daughters. SIRs for all invasive ovarian cancer were 2.68 (95% CI 2.22-3.21) by ovarian cancer in mother, 2.94 (1.40-5.94) by an affected sister and 24.03 (6.12-74.46) by both an affected mother and sister. The population-attributable fraction from mothers was 2.52%. Seropapillary cystadenocarcinoma showed the highest familial risk, but the effect of histopathol subtype could not be fully assessed because of lack of data in probands. Age-specific data showed some early-onset components and an unusual maximal incidence in the 40s. A comparison to an earlier study on BRCA1/2 mutation analysis and relative risks of ovarian and breast cancer suggests that these mutations could account for 26% of the familial aggregation of ovarian cancer. Histopathology and age of onset appear to be important attributes of familial ovarian cancer, suggesting that further gene identification efforts should target a specific histopathology in early-onset patients.
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Affiliation(s)
- Kari Hemminki
- Department of Biosciences at Novum, Karolinska Institute, 141 57 Huddinge, Sweden.
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Affiliation(s)
- Andreas J Gescher
- Cancer Biomarkers and Prevention Group, Department of Oncology, University of Leicester, , Leicester, LE2 7LX, UK
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Narod SA, Olsson H. Risk of ovarian cancer in breast-cancer patients with a family history of either. Lancet 2003; 361:179; author reply 179-80. [PMID: 12531611 DOI: 10.1016/s0140-6736(03)12215-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Fackler MJ, Evron E, Khan SA, Sukumar S. Novel agents for chemoprevention, screening methods, and sampling issues. J Mammary Gland Biol Neoplasia 2003; 8:75-89. [PMID: 14587864 DOI: 10.1023/a:1025735405628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
An aggressive approach to breast cancer control based on preventing the disease must complement efforts at effective treatment. To date clinical trials testing new chemopreventative agents have not generally met with the kind of success expected. A wide range of new breast cancer chemopreventative agents are poised to be tested in clinical trials. We review these novel agents and approaches, including those for which clinical trials have been initiated and those that are promising in the preclinical arena. Further progress in this area requires not only new agents, but novel methods for screening for risk assessment, sampling and development of intermediate biomarkers. We review these novel potential surrogate endpoints, including new imaging-techniques, breast sampling approaches, and methods to assess biomarkers in breast epithelium. Factors that could contribute to a meaningful choice of the chemopreventive agents and the design of clinical trials are discussed.
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Affiliation(s)
- Mary Jo Fackler
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231-1000, USA
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