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Frank A, Bernstedt SW, Jamizadeh N, Forsberg A, Hedin C, Blom J, Backman AS. Complications of colonoscopy surveillance of patients with Lynch syndrome - 33 years of follow up. Fam Cancer 2024:10.1007/s10689-024-00416-w. [PMID: 39102097 DOI: 10.1007/s10689-024-00416-w] [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: 08/06/2024]
Abstract
BACKGROUND AND STUDY AIMS Lynch syndrome (LS) is a hereditary autosomal dominant condition, with an increased lifetime risk of developing malignancies including colorectal cancer (CRC). Current guidelines differ in recommended colonoscopy-surveillance intervals from 1 to 2 years. Although colonoscopy is considered a safe procedure, there are risks of severe adverse events (SAEs), such as perforation and bleeding, as well as adverse events (AEs), such as abdominal discomfort and post-colonoscopy gastrointestinal infections. Colonoscopy-related bleeding and perforation rates have been reported 0.17% and 0.11%, respectively. However, there are insufficient data regarding complications of colonoscopy-surveillance for LS patients. This study aims to investigate the risk of AEs among LS patients during colonoscopy in the Stockholm region. PATIENTS AND METHODS This retrospective cohort study includes 351 LS patients undergoing endoscopic surveillance at the Karolinska University Hospital, August 1989 - April 2021. Data from endoscopic surveillance colonoscopies were extracted from patients' medical records. RESULTS Of 1873 endoscopies in 351 LS patients, 12 complications (AEs) were documented within 30 days (0.64%) and with a total of 3 bleedings (SAEs, 0.16%). No perforations were identified. CONCLUSION Colonoscopy surveillance for LS patients shows a comparatively low risk of AEs per-examination. Colonoscopy complications per-patient, including both SAEs and AEs, show a significantly higher risk. Colonoscopy complications only including SAEs, show a comparatively low risk. Understanding the lifetime risk of surveillance-related colonoscopy complications is important when designing targeted surveillance programmes.
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Affiliation(s)
- Alexander Frank
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
- Gastroenterology unit, Dept. of Medicine, Capio S:t Görans Hospital, Stockholm, Sweden.
| | - Sophie Walton Bernstedt
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Gastroenterology unit, Dept. of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Div. of Upper Gastrointestinal diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Nigin Jamizadeh
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Anna Forsberg
- Gastroenterology unit, Dept. of Medicine, Capio S:t Görans Hospital, Stockholm, Sweden
- Dept. of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Hedin
- Gastroenterology unit, Dept. of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Dept. of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Johannes Blom
- Dept. of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Dept. of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Ann-Sofie Backman
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Gastroenterology unit, Dept. of Medicine, Ersta Hospital, Stockholm, Sweden
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2
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Castillo-Iturra J, Sánchez A, Balaguer F. Colonoscopic surveillance in Lynch syndrome: guidelines in perspective. Fam Cancer 2024:10.1007/s10689-024-00414-y. [PMID: 39066849 DOI: 10.1007/s10689-024-00414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/03/2024] [Indexed: 07/30/2024]
Abstract
Lynch syndrome predisposes to a high risk of colorectal cancer and colonoscopy remains the primary preventive strategy. The prevention of colorectal cancer through colonoscopy relies on identifying and removing adenomas, the main precursor lesion. Nevertheless, colonoscopy is not an optimal strategy since post-colonoscopy colorectal cancer remains an important issue. In continuation of a 2021 journal review, the present article seeks to offer an updated perspective by examining relevant articles from the past 3 years. We place recent findings in the context of existing guidelines, with a specific focus on colonoscopy surveillance. Key aspects explored include colonoscopy quality standards, timing of initiation, and surveillance intervals. Our review provides a comprehensive analysis of adenoma-related insights in Lynch syndrome, delving into emerging technologies like virtual chromoendoscopy and artificial intelligence-assisted endoscopy. This review aims to contribute valuable insights into the topic of colonoscopy surveillance in Lynch syndrome.
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Affiliation(s)
- Joaquín Castillo-Iturra
- Department of astroenterology, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ariadna Sánchez
- Department of astroenterology, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Balaguer
- Department of astroenterology, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
- Facultat de Medicina i Ciències de la Salud, Universitat de Barcelona (UB), Barcelona, Spain.
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3
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van Liere ELSA, Jacobs IL, Dekker E, Jacobs MAJM, de Boer NKH, Ramsoekh D. Colonoscopy surveillance in Lynch syndrome is burdensome and frequently delayed. Fam Cancer 2023; 22:403-411. [PMID: 37171677 PMCID: PMC10176312 DOI: 10.1007/s10689-023-00333-4] [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: 02/21/2023] [Accepted: 04/18/2023] [Indexed: 05/13/2023]
Abstract
Individuals with Lynch syndrome have an increased colorectal cancer risk, hence, biennial colonoscopy surveillance is recommended. We aimed to investigate patients' perception and preferences regarding surveillance, and to further explore compliance behaviour. Individuals with Lynch syndrome received a validated survey evaluating experiences of their three most recent colonoscopies. Individuals were non-compliant to surveillance if the interval between colonoscopies differed ≥ 6 months from the recommended interval. In total, 197 of 291 (68%) invited individuals returned the survey. They mostly underwent colonoscopy biennially (99%), under mild sedation (79%) and with bowel preparation performed by Moviprep® (99%). Surveillance was perceived as impacting quality of life in 21%, and as moderately to extremely burdensome in 57%, particularly in those below age 40. To lower the burden, patients prioritised improvements in volume and taste of bowel preparation, laxation-related bowel movements, waiting times, and a more personal and respectful approach of endoscopic staff. Additionally, many individuals (60%) would favour less-invasive surveillance modalities such as biomarkers. In total, 28% of individuals had delayed colonoscopy surveillance, predominantly for patient-related reasons. An additional 10% considered quitting/postponing surveillance. Upon multivariable analysis, patient-related delay was associated with low and medium education, history of ≤ 4 colonoscopies and having no hospital recall-system. Colonoscopy surveillance in Lynch syndrome is often experienced as burdensome, and frequently delayed. We identified determinants of surveillance behaviour in this population, and present potential interventions to reduce the burden and non-compliance rates.
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Affiliation(s)
- Elsa L S A van Liere
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, The Netherlands.
- School of Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Imke L Jacobs
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- School of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Maarten A J M Jacobs
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, The Netherlands
- School of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
| | - Dewkoemar Ramsoekh
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, The Netherlands
- School of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
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4
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Lau-Min KS, Bleznuck J, Wollack C, McKenna DB, Long JM, Hubert AP, Johnson M, Rochester SE, Constantino G, Dudzik C, Doucette A, Wangensteen K, Domchek SM, Landgraf J, Chen J, Nathanson KL, Katona BW. Development of an Electronic Health Record-Based Clinical Decision Support Tool for Patients With Lynch Syndrome. JCO Clin Cancer Inform 2023; 7:e2300024. [PMID: 37639653 PMCID: PMC10857752 DOI: 10.1200/cci.23.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/22/2023] [Accepted: 07/12/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE To develop an electronic health record (EHR)-based clinical decision support (CDS) tool to promote guideline-recommended cancer risk management among patients with Lynch syndrome (LS), an inherited cancer syndrome that confers an increased risk of colorectal and other cancer types. MATERIALS AND METHODS We conducted a cross-sectional study to determine the baseline prevalence and predictors of guideline-recommended colonic surveillance and annual genetics program visits among patients with LS. Multivariable log-binomial regressions estimated prevalence ratios (PRs) of cancer risk management adherence by baseline sociodemographic and clinical characteristics. These analyses provided rationale for the development of an EHR-based CDS tool to support patients and clinicians with LS-related endoscopic surveillance and annual genetics program visits. The CDS leverages an EHR platform linking discrete genetic data to LS Genomic Indicators, in turn driving downstream clinician- and patient-facing CDS. RESULTS Among 323 patients with LS, cross-sectional adherence to colonic surveillance and annual genetics program visits was 69.3% and 55.4%, respectively. Patients with recent electronic patient portal use were more likely to be adherent to colonic surveillance (PR, 1.67; 95% CI, 1.11 to 2.52). Patients more recently diagnosed with LS were more likely to be adherent to annual genetics program visits (PR, 0.58; 95% CI, 0.44 to 0.76 for 2-4 years; PR, 0.62; 95% CI, 0.51 to 0.75 for ≥4 compared with <2 years). Our EHR-based CDS tool is now active for 421 patients with LS throughout our health system. CONCLUSION We have successfully developed an EHR-based CDS tool to promote guideline-recommended cancer risk management among patients with LS.
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Affiliation(s)
- Kelsey S. Lau-Min
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Joseph Bleznuck
- Information Services Applications, Penn Medicine, University of Pennsylvania, Philadelphia, PA
| | - Colin Wollack
- Information Services Applications, Penn Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danielle B. McKenna
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica M. Long
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Anna P. Hubert
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mariah Johnson
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shavon E. Rochester
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gillain Constantino
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christina Dudzik
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Abigail Doucette
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kirk Wangensteen
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Susan M. Domchek
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jeffrey Landgraf
- Information Services Applications, Penn Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica Chen
- Information Services Applications, Penn Medicine, University of Pennsylvania, Philadelphia, PA
| | - Katherine L. Nathanson
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bryson W. Katona
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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5
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DeJesse J, Vajravelu RK, Dudzik C, Constantino G, Long JM, Wangensteen KJ, Valverde KD, Katona BW. Uptake and outcomes of small intestinal and urinary tract cancer surveillance in Lynch syndrome. World J Clin Oncol 2021; 12:1023-1036. [PMID: 34909397 PMCID: PMC8641013 DOI: 10.5306/wjco.v12.i11.1023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/26/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lynch syndrome (LS) is a hereditary cancer predisposition syndrome associated with increased risk of multiple cancers. While colorectal cancer surveillance decreases mortality in LS and is recommended by guidelines, there is lack of evidence for the efficacy of surveillance for extra-colonic cancers associated with LS, including small intestinal cancer (SIC) and urinary tract cancer (UTC). Given the limited evidence, guidelines do not consistently recommend surveillance for SIC and UTC, and it remains unclear how often individuals will choose to undergo and follow through with extra-colonic surveillance recommendations.
AIM To study factors associated with SIC and UTC surveillance uptake and outcomes in LS.
METHODS This is an IRB-approved retrospective analysis of individuals with LS seen at a tertiary care referral center. Included individuals had a pathogenic or likely pathogenic variant in MLH1, MSH2, MSH6, PMS2, or EPCAM, or were a confirmed obligate carrier, and had at least one documented visit to our center. Information regarding SIC and UTC surveillance was captured for each individual, and detailed personal and family history was obtained for individuals who had an initial LS management visit in our center’s dedicated high-risk LS clinic between January 1, 2017 and October 29, 2020. During these initial management visits, all patients had in-depth discussions of SIC and UTC surveillance with 1 of 3 providers experienced in LS management to promote informed decision-making about whether to pursue SIC and/or UTC surveillance. Statistical analysis using Pearson’s chi-squared test and Wilcoxon rank-sum test was completed to understand the factors associated with pursuit and completion of SIC and UTC surveillance, and a P value below 0.05 was deemed statistically significant.
RESULTS Of 317 individuals with LS, 86 (27%) underwent a total of 105 SIC surveillance examinations, with 5 leading to additional work-up and no SICs diagnosed. Additionally, 99 (31%) patients underwent a total of 303 UTC surveillance examinations, with 19 requiring further evaluation and 1 UTC identified. Of 155 individuals who had an initial LS management visit between January 1, 2017 and October 29, 2020, 63 (41%) chose to undergo SIC surveillance and 58 (37%) chose to undergo UTC surveillance. However, only 26 (41%) and 32 (55%) of those who initially chose to undergo SIC or UTC surveillance, respectively, successfully completed their surveillance examinations. Individuals with a pathogenic variant in MSH2 or EPCAM were more likely to initially choose to undergo SIC surveillance (P = 0.034), and older individuals were more likely to complete SIC surveillance (P = 0.007). Choosing to pursue UTC surveillance was more frequent among older individuals (P = 0.018), and females more frequently completed UTC surveillance (P = 0.002). Personal history of cancer and family history of SIC or UTC were not significantly associated with electing nor completing surveillance. Lastly, the provider discussing SIC/UTC surveillance was significantly associated with subsequent surveillance choices.
CONCLUSION Pursuing and completing SIC/UTC surveillance in LS is influenced by several factors, however broad incorporation in LS management is likely unhelpful due to low yield and frequent false positive results.
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Affiliation(s)
- Jeshua DeJesse
- Department of Genetics, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Ravy K Vajravelu
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
| | - Christina Dudzik
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
| | - Gillain Constantino
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
| | - Jessica M Long
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Kirk J Wangensteen
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
| | - Kathleen D Valverde
- Department of Genetics, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Bryson W Katona
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States
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6
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Mittendorf KF, Knerr S, Kauffman TL, Lindberg NM, Anderson KP, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Zepp JM, Syngal S, Wilfond BS, Goddard KAB. Systemic Barriers to Risk-Reducing Interventions for Hereditary Cancer Syndromes: Implications for Health Care Inequities. JCO Precis Oncol 2021; 5:PO.21.00233. [PMID: 34778694 PMCID: PMC8585306 DOI: 10.1200/po.21.00233] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kathleen F. Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sarah Knerr
- School of Public Health, University of Washington, Seattle, WA
| | - Tia L. Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Nangel M. Lindberg
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | | | - Marian J. Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Jamilyn M. Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sapna Syngal
- Dana Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Katrina A. B. Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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7
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Meiser B, Monnik M, Austin R, Nichols C, Cops E, Salmon L, Spurdle AB, Macrae F, Taylor N, Pachter N, James P, Kaur R. Stakeholder attitudes towards establishing a national genomics registry of inherited cancer predisposition: a qualitative study. J Community Genet 2021; 13:59-73. [PMID: 34727336 DOI: 10.1007/s12687-021-00559-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022] Open
Abstract
This study aimed to describe the acceptability and perceived barriers and enablers to establish a national registry targeting carriers of pathogenic variants in cancer susceptibility genes from stakeholders' perspectives. Such a registry may effectively target carriers to translate existing research findings into optimised clinical care and provide a population-level resource for further clinical research and new gene and therapy discovery. In-depth interviews were conducted with individuals from four stakeholder groups: carriers of pathogenic variants, healthcare professionals, data custodians from the field of familial cancer, and heads of molecular pathology laboratories. Interview data were subjected to a qualitative analysis guided by a thematic analysis framework using NVivo software. A total of 28 individuals were interviewed: 11 carriers, 8 healthcare professionals, 5 laboratory heads, and 4 data custodians. All carriers and healthcare professionals were enthusiastic about the potential research applications of the registry. Carriers described that altruistic motivations provided the foundation of their support of the planned registry. Some carriers felt comfortable with a broad consent (consenting once, prospectively), while others preferred a narrow consent approach (consenting each time data is accessed). Some carriers and data custodians and registry developers also expressed a reluctance to link family member data without appropriate consent. Participants' enthusiasm and support for a national registry herald a productive and responsive research partnership once the registry has been established. Participants' views can be used to inform the approaches to be taken to develop and manage such a registry as an implicit codesign approach.
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Affiliation(s)
- Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia. .,Lowy Cancer Research Centre C25, University of New South Wales, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Melissa Monnik
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Rachel Austin
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Cassandra Nichols
- Genetic Services of Western Australia, Perth, Western Australia, Australia
| | - Elisa Cops
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Lucinda Salmon
- Clinical Genetics, Austin Health, Heidelberg, Victoria, Australia
| | - Amanda B Spurdle
- Molecular Cancer Epidemiology Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Finlay Macrae
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, Department of Colorectal Medicine and Genetics, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Natalie Taylor
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Nicholas Pachter
- Genetic Services of Western Australia, Perth, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Paul James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Rajneesh Kaur
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
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8
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den Elzen N, Joseland SL, Saya S, Jonnagadla S, Isbister J, Winship I, Buchanan DD. "Left in limbo": Exploring how patients with colorectal cancer interpret and respond to a suspected Lynch syndrome diagnosis. Hered Cancer Clin Pract 2021; 19:43. [PMID: 34656160 PMCID: PMC8520179 DOI: 10.1186/s13053-021-00201-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/01/2021] [Indexed: 12/30/2022] Open
Abstract
Background A diagnosis of suspected Lynch syndrome (SLS) is given when a tumour displays characteristics consistent with Lynch syndrome (LS), but no germline pathogenic variant is identified. This inconclusive diagnosis results in uncertainty around appropriate cancer risk management. This qualitative study explored how patients with CRC interpret and respond to an SLS diagnosis. Methods Semi-structured telephone interviews were conducted with 15 patients with CRC who received an SLS diagnosis, recruited from cancer genetics services across Australia. Interviews were transcribed verbatim and analysed using thematic analysis. Participant responses were compared with appointment summary letters from cancer genetics services. Results Participants’ interpretations of genetic test results were found to vary widely. While this variation often aligned with variation in interpretations by cancer genetics services, participants also had difficulties with the complexity and recall of genetic test results. Participants had a range of psychological responses to the uncertainty that their results presented, from relief to disappointment and doubt. Cancer risk perceptions also varied widely, with participants’ interpretations of their genetic test results just one of several influencing factors. Despite this variability, almost all participants adhered to cancer risk management advice, although different participants received different advice. All participants also communicated any cancer risk management advice to first-degree relatives, motivated by protecting them, but information communicated was not always consistent with advice received. Conclusions Our study findings highlight the variability in patients’ interpretations of their diagnosis, cancer risk management and family communication when a diagnosis of SLS is received, and provide novel insights into how healthcare professionals can better support patients with SLS.
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Affiliation(s)
- Nicole den Elzen
- Colorectal Oncogenomics Group, Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, 305 Grattan Street, Parkville, Victoria, 3010, Australia.,The University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Sharelle L Joseland
- Colorectal Oncogenomics Group, Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, 305 Grattan Street, Parkville, Victoria, 3010, Australia.,The University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
| | - Sibel Saya
- The University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia.,Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia
| | - Sowmya Jonnagadla
- Colorectal Oncogenomics Group, Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, 305 Grattan Street, Parkville, Victoria, 3010, Australia.,The University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Joanne Isbister
- Genomic Medicine and Family Cancer Clinic, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ingrid Winship
- Genomic Medicine and Family Cancer Clinic, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Daniel D Buchanan
- Colorectal Oncogenomics Group, Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, 305 Grattan Street, Parkville, Victoria, 3010, Australia. .,The University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia. .,Genomic Medicine and Family Cancer Clinic, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
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9
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Vangala DB, Ladigan-Badura S, Engel C, Hüneburg R, Perne C, Bucksch K, Nattermann J, Steinke-Lange V, Rahner N, Weitz J, Kloor M, Tomann J, Canbay A, Nguyen HP, Strassburg C, Möslein G, Morak M, Holinski-Feder E, Büttner R, Aretz S, Löffler M, Schmiegel W, Pox C, Schulmann K. Early detection of duodenal cancer by upper gastrointestinal-endoscopy in Lynch syndrome. Int J Cancer 2021; 149:2052-2062. [PMID: 34331771 DOI: 10.1002/ijc.33753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/06/2022]
Abstract
Small bowel cancer (SBC) is the malignancy with the highest standardized incidence ratio in Lynch syndrome (LS) patients. Of all SBCs, about 50% are duodenal cancers (DCs), therefore being accessible by esophago-gastro-duodenoscopy (EGD) for surveillance. We asked whether early detection of DC is possible for LS patients undergoing surveillance by EGD and if surveillance should be limited to specific subgroups. Data for LS patients with DC were retrieved from the registry of the German Consortium for Familial Intestinal Cancer. Patients undergoing active surveillance by EGDs (surveillance group) were compared to those who did not (nonsurveillance group) regarding tumor stage at diagnosis. Union for International Cancer Control stages I-IIA were defined as early stage disease and IIB-IV as advanced stage disease. Statistical analysis was performed using Fisher's exact test. Among 2015 patients with pathogenic variants in any mismatch-repair-gene, 47 patients with 49 DCs were identified. In 10% of cases, patients were under 35 years at diagnosis; family and personal tumor history did not correlate with DC diagnosis. Pathogenic germline variants in MSH6, PMS2 or EPCAM were present in 10% of patients. Statistical analysis could be performed on 13 DC patients in the surveillance group and 14 in the nonsurveillance group. Early detection was possible for 71% of patients in the surveillance group and 29% of patients in the nonsurveillance group (P = .021). Early detection of DC by EGD in LS patients is feasible regardless of family history, mutational status and should start no later than 25 years of age.
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Affiliation(s)
- Deepak B Vangala
- Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany.,Molecular GI-Oncology, Ruhr-University Bochum, Bochum, Germany
| | - Swetlana Ladigan-Badura
- Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany.,Molecular GI-Oncology, Ruhr-University Bochum, Bochum, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Robert Hüneburg
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.,National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
| | - Claudia Perne
- National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany.,Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Karolin Bucksch
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Jacob Nattermann
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.,National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
| | - Verena Steinke-Lange
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany.,Medical Genetics Center Munich, Munich, Germany
| | - Nils Rahner
- Institute of Human Genetics, Medical School, Heinrich Heine University, Düsseldorf, Germany
| | - Jürgen Weitz
- Department of Surgery, Technische Universitaet Dresden, Dresden, Germany
| | - Matthias Kloor
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Cooperation Unit Applied Tumour Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Judith Tomann
- Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Ali Canbay
- Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Huu-Phuc Nguyen
- Department for Human Genetics, Ruhr-University Bochum, Bochum, Germany
| | - Christian Strassburg
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.,National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
| | - Gabriele Möslein
- Surgical Center for Hereditary Tumors, Evangelisches Bethesda Krankenhaus, Duisburg, Germany
| | - Monika Morak
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany.,Medical Genetics Center Munich, Munich, Germany
| | - Elke Holinski-Feder
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany.,Medical Genetics Center Munich, Munich, Germany
| | | | - Stefan Aretz
- National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany.,Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Markus Löffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Wolff Schmiegel
- Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Christian Pox
- Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany.,Department of Medicine, St. Joseph-Stift Bremen, Bremen, Germany
| | - Karsten Schulmann
- Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany.,Praxis für Hämatologie und Onkologie, MVZ Arnsberg, Arnsberg, Germany
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10
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Olivier R, Randrian V, Tougeron D, Saurin JC. Endoscopy to Diagnose and Prevent Digestive Cancers in Lynch Syndrome. Cancers (Basel) 2021; 13:cancers13143505. [PMID: 34298719 PMCID: PMC8305049 DOI: 10.3390/cancers13143505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/23/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022] Open
Abstract
Lynch syndrome patients could benefit from various recommendations to prevent digestive cancers. In this review, we summarize the criteria to identify Lynch syndrome in patients with digestive cancers. We detail endoscopic screening procedures in patients with Lynch syndrome for gastric, small bowel, pancreatic, and colorectal cancers. We review the precise modalities of endoscopic follow-up, particularly the discrepancies that exist between the guidelines of the various scientific societies. We discuss the treatment of colorectal cancers in Lynch syndrome cases and patient adherence to endoscopic follow-up programs.
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Affiliation(s)
- Raphael Olivier
- Gastroenterology Department, Poitiers University Hospital (CHU de Poitiers), 86000 Poitiers, France; (V.R.); (D.T.)
- Correspondence: ; Tel.:+33-05-49-44-37-51; Fax: +33-05-49-44-38-35
| | - Violaine Randrian
- Gastroenterology Department, Poitiers University Hospital (CHU de Poitiers), 86000 Poitiers, France; (V.R.); (D.T.)
| | - David Tougeron
- Gastroenterology Department, Poitiers University Hospital (CHU de Poitiers), 86000 Poitiers, France; (V.R.); (D.T.)
| | - Jean-Christophe Saurin
- Gastroenterology Department, Hospices Civils de Lyon—Centre Hospitalier Universitaire, 69002 Lyon, France;
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11
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Evaluation of implementation of risk management guidelines for carriers of pathogenic variants in mismatch repair genes: a nationwide audit of familial cancer clinics. Fam Cancer 2021; 19:337-346. [PMID: 32385704 DOI: 10.1007/s10689-020-00183-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This nationwide study assessed the impact of Lynch syndrome-related risk management guidelines on clinicians' recommendations of risk management strategies to carriers of pathogenic variants in mismatch repair genes and the extent to which carriers took up strategies in concordance with guidelines. MATERIALS AND METHODS Clinic files of 464 carriers (with and without colorectal cancer) were audited for carriers who received their genetic testing results in July 2008-July 2009 (i.e. before guideline release), July 2010-July 2011 and July 2012-July 2013 (both after guideline release) at 12 familial cancer clinics (FCCs) to ascertain the extent to which carriers were informed about risk management in accordance with guidelines. All carriers captured by the audit were invited to participate in interviews; 215 were interviewed to assess adherence to recommended risk management guidelines. RESULTS The rates of documentation in clinic files increased significantly from pre- to post-guideline for only two out of eight risk management strategies. The strategies with the highest compliance of carriers post-guidelines were: uptake of one or two-yearly colonoscopy (87%), followed by hysterectomy to prevent endometrial cancer (68%), aspirin as risk-reducing medication (67%) and risk-reducing salpingo-oophorectomy (63%). Interrater reliability check for all guidelines showed excellent agreement (k statistics = 0.89). CONCLUSION These results indicate that there is scope to further increase provision of advice at FCCs to ensure that all carriers receive recommendations about evidence-based risk management. A multi-pronged behaviour change and implementation science approach tailored to specific barriers is likely to be needed to achieve optimal clinician behaviours and outcomes for carriers.
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12
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Perrod G, Rahmi G, Cellier C. Colorectal cancer screening in Lynch syndrome: Indication, techniques and future perspectives. Dig Endosc 2021; 33:520-528. [PMID: 32314431 DOI: 10.1111/den.13702] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/04/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022]
Abstract
Lynch syndrome (LS) is an inherited predisposition to colorectal cancer (CRC), responsible for 3-5% of all CRC. This syndrome is characterized by the early occurrence of colorectal neoplastic lesions, with variable incidences depending on the type of pathogenic variants in MMR genes (MLH1, MSH2, MSH6, PMS2 and EPCAM) and demographics factors such as gender, body mass index, tobacco use and physical activity. Similar to sporadic cancers, colorectal screening by colonoscopy is efficient because it is associated with a reduction >50% of both CRC incidence and CRC related mortality. To that end, most guidelines recommend high definition screening colonoscopies in dedicated centers, starting at the age of 20-25 years old, with a surveillance interval of 1-2 years. In this review, we discuss the importance of high definition colonoscopies, including the compliance to specific key performance indicators, as well as the expected benefits of specific imaging modalities including virtual chromoendoscopy and dye-spray chromoendoscopy.
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Affiliation(s)
- Guillaume Perrod
- Hepato-gastroenterolgy and Digestive Endoscopy Department, Georges Pompidou European Hospital, APHP. Centre-Université de Paris, Paris, France.,PRED-IdF Network, Georges Pompidou European Hospital, Paris, France
| | - Gabriel Rahmi
- Hepato-gastroenterolgy and Digestive Endoscopy Department, Georges Pompidou European Hospital, APHP. Centre-Université de Paris, Paris, France.,PRED-IdF Network, Georges Pompidou European Hospital, Paris, France
| | - Christophe Cellier
- Hepato-gastroenterolgy and Digestive Endoscopy Department, Georges Pompidou European Hospital, APHP. Centre-Université de Paris, Paris, France.,PRED-IdF Network, Georges Pompidou European Hospital, Paris, France
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13
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Meiser B, Kaur R, Morrow A, Peate M, Wong WKT, McPike E, Cops E, Nichols C, Austin R, Fine M, Thrupp L, Ward R, Macrae F, Hiller JE, Trainer AH, Mitchell G. Impact of national guidelines on use of BRCA1/2 germline testing, risk management advice given to women with pathogenic BRCA1/2 variants and uptake of advice. Hered Cancer Clin Pract 2021; 19:24. [PMID: 33836815 PMCID: PMC8035714 DOI: 10.1186/s13053-021-00180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background This nationwide study assessed the impact of nationally agreed cancer genetics guidelines on use of BRCA1/2 germline testing, risk management advice given by health professionals to women with pathogenic BRCA1/2 variants and uptake of such advice by patients. Methods Clinic files of 883 women who had initial proband screens for BRCA1/2 pathogenic variants at 12 familial cancer clinics between July 2008–July 2009 (i.e. before guideline release), July 2010–July 2011 and July 2012–July 2013 (both after guideline release) were audited to determine reason given for genetic testing. Separately, the clinic files of 599 female carriers without a personal history of breast/ovarian cancer who underwent BRCA1/2 predictive genetic testing and received their results pre- and post-guideline were audited to ascertain the risk management advice given by health professionals. Carriers included in this audit were invited to participate in a telephone interview to assess uptake of advice, and 329 agreed to participate. Results There were no significant changes in the percentages of tested patients meeting at least one published indication for genetic testing - 79, 77 and 78% of files met criteria before guideline, and two-, and four-years post-guideline, respectively (χ = 0.25, p = 0.88). Rates of documentation of post-test risk management advice as per guidelines increased significantly from pre- to post-guideline for 6/9 risk management strategies. The strategies with the highest compliance amongst carriers or awareness post-release of guidelines were annual magnetic resonance imaging plus mammography in women 30–50 years (97%) and annual mammography in women > 50 years (92%). Of women aged over 40 years, 41% had a risk-reducing bilateral mastectomy. Amongst women aged > 40 years, 75% had a risk-reducing salpingo-oophorectomy. Amongst women who had not had a risk-reducing bilateral mastectomy, only 6% took risk-reducing medication. Fear of side-effects was cited as the main reasons for not taking these medicines by 73% of women. Conclusions Guidelines did not change the percentages of tested patients meeting genetic testing criteria but improved documentation of risk management advice by health professionals. Effective approaches to enhance compliance with guidelines are needed to improve risk management and quality of care. Supplementary Information The online version contains supplementary material available at 10.1186/s13053-021-00180-3.
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Affiliation(s)
- Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Rajneesh Kaur
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - April Morrow
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Michelle Peate
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia.,Department of Obstetrics and Oncology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - W K Tim Wong
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia.,School of Social Sciences, UNSW Sydney, Sydney, Australia
| | - Emily McPike
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Elisa Cops
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Cassandra Nichols
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia
| | - Rachel Austin
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Miriam Fine
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide and School of Medicine, University of Adelaide, Adelaide, Australia
| | - Letitia Thrupp
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Robyn Ward
- University of Queensland, Brisbane, Australia.,University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Finlay Macrae
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia.,Department of Colorectal Medicine and Genetics, University of Melbourne, Melbourne, Australia
| | - Janet E Hiller
- Swinburne University of Technology, Hawthorn, Australia.,School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Alison H Trainer
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Gillian Mitchell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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14
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Peterse EF, Naber SK, Daly C, Pollett A, Paszat LF, Spaander MC, Aronson M, Gryfe R, Rabeneck L, Lansdorp-Vogelaar I, Baxter NN. Cost-effectiveness of Active Identification and Subsequent Colonoscopy Surveillance of Lynch Syndrome Cases. Clin Gastroenterol Hepatol 2020; 18:2760-2767.e12. [PMID: 31629885 PMCID: PMC7162709 DOI: 10.1016/j.cgh.2019.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 10/02/2019] [Accepted: 10/11/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS The province of Ontario, Canada is considering immunohistochemical followed by cascade analyses of all patients who received a diagnosis of colorectal cancer (CRC) at an age younger than 70 years to identify individuals with Lynch syndrome. We evaluated the costs and benefits of testing for Lynch syndrome and determined the optimal surveillance interval for first-degree relatives (FDRs) found to have Lynch syndrome. METHODS We developed a patient flow diagram to determine costs and yield of immunohistochemical testing for Lynch syndrome in CRC cases and, for those found to have Lynch syndrome, their FDRs, accounting for realistic uptake. Subsequently, we used the MISCAN-colon model to compare costs and benefits of annual, biennial, and triennial surveillance in FDRs identified with Lynch syndrome vs colonoscopy screening every 10 years (usual care for individuals without a diagnosis of Lynch syndrome). RESULTS Testing 1000 CRC cases was estimated to identify 20 CRC index cases and 29 FDRs with Lynch syndrome at a cost of $310,274. Despite the high cost of Lynch syndrome tests, offering the FDRs with Lynch syndrome biennial colonoscopy surveillance was cost-effective at $8785 per life-year gained compared with usual care because of a substantial increase in life-years gained (+122%) and cost savings in CRC care. Triennial surveillance was more costly and less effective, and annual surveillance showed limited additional benefit compared with biennial surveillance. CONCLUSIONS Immunohistochemical testing for Lynch syndrome in persons younger than 70 years who received a diagnosis of CRC and then testing FDRs of those found to have Lynch syndrome provide a good balance between costs and long-term benefits. Colonoscopy surveillance every 2 years is the optimal surveillance interval for patients with Lynch syndrome.
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Affiliation(s)
- Elisabeth F.P. Peterse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Steffie K. Naber
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Corinne Daly
- Strategy Division, Canadian Partnership Against Cancer, Toronto, Canada
| | - Aaron Pollett
- Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada,Laboratory Medicine & Pathobiology, University of Toronto, Canada
| | | | - Manon C.W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada
| | - Robert Gryfe
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada,Department of Surgery, Mount Sinai Hospital, Toronto, Canada
| | - Linda Rabeneck
- Prevention and Cancer Control, Cancer Care Ontario and Department of Medicine, University of Toronto, Toronto, Canada
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nancy N. Baxter
- Department of Surgery, LiKaShing Knowledge Institute St. Michael’s Hospital, Toronto, Canada
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15
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Perrod G, Samaha E, Bats AS, Cellier C. [Role of the PRED-IdF, a regional network dedicated to patients with hereditary predisposition to digestive cancers]. Ann Pathol 2020; 40:114-119. [PMID: 32199653 DOI: 10.1016/j.annpat.2020.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/29/2022]
Abstract
Patients with hereditary predisposition to digestive cancer are at high risk of neoplasia and management in expert centers is recommended. The PRED-IdF network was thus created in 2009, with the support of the French National Cancer Institute (INCa), covering Paris and its suburbs, including five teaching hospitals and two oncology-dedicated institutes. The aim of this network is to offer optimized cancer screening programs based on expert recommendations to patients with hereditary predisposition. Any patient with suspicion of hereditary colorectal syndrome can be referred to the PRED-IdF network. The missions of this network include the establishment of a personalized screening program (PSP), coordination of PSP, expertise/recourse for difficult cases and research. Since 2009, 3384 patients have been included. We genetically identified 1925 patients with Lynch syndrome and 539 with familial adenomatous polyposis (FAP) (including both APC and MUTYH mutations), representing 72.8% of the PRED-IdF cohort. The PRED-IdF is also an important promotor of research in the field. We recently demonstrated the beneficial impact of the network in terms of colorectal cancer occurrence in patients with Lynch syndrome. Moreover, the PRED-IdF is involved in many studies ranging from basic science collaborations to randomized controlled trials. The long-term objective is to offer to all patients a personalized medical approach.
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Affiliation(s)
- Guillaume Perrod
- Service d'hépato-gastroentérologie et endoscopie digestive, hôpital européen Georges-Pompidou, centre université de Paris, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - Elia Samaha
- Service d'hépato-gastroentérologie et endoscopie digestive, hôpital européen Georges-Pompidou, centre université de Paris, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Anne-Sophie Bats
- Service de chirurgie cancérologique gynécologique et du sein, hôpital européen Georges-Pompidou, centre université de Paris, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Christophe Cellier
- Service d'hépato-gastroentérologie et endoscopie digestive, hôpital européen Georges-Pompidou, centre université de Paris, AP-HP, 20, rue Leblanc, 75015 Paris, France
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16
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Mittendorf KF, Hunter JE, Schneider JL, Shuster E, Rope AF, Zepp J, Gilmore MJ, Muessig KR, Davis JV, Kauffman TL, Bergen KM, Wiesner GL, Acheson LS, Peterson SK, Syngal S, Reiss JA, Goddard KAB. Recommended care and care adherence following a diagnosis of Lynch syndrome: a mixed-methods study. Hered Cancer Clin Pract 2019; 17:31. [PMID: 31890059 PMCID: PMC6915941 DOI: 10.1186/s13053-019-0130-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 11/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. This study assesses trends in diagnosis of LS and adherence to recommended LS-related care in a large integrated healthcare organization (~ 575,000 members). METHODS Electronic medical record (EMR) data (1999-2015) were examined to identify patients with a diagnosis of LS. We examined their LS-associated care recommendations and adherence to these recommendations. Qualitative patient and provider interviews were conducted with the aim of identifying opportunities for improved care delivery. RESULTS We identified 74 patients with a diagnosis of LS; 64% were diagnosed with a LS-related malignancy prior to their diagnosis of LS. The time to LS diagnosis following development of a LS-related cancer decreased over time: before 2009 11% of individuals received a diagnosis of LS within 1 year of developing a LS-related cancer compared to 83% after 2009 (p < 0.0001). Colonoscopy recommendations were documented in the EMR for almost all patients with LS (96%). Documentation of other recommendations for cancer surveillance was less commonly found. Overall, patient adherence to colonoscopy was high (M = 81.5%; SD = 32.7%), and adherence to other recommendations varied. To improve care coordination, patients and providers suggested providing automated reminder prompts for LS-related surveillance, adding a LS-specific diagnosis code, and providing guidelines for LS-related surveillance in the EMR. CONCLUSIONS We identified fewer than expected patients with LS in our large care system, indicating that there is still a diagnostic care gap. However, patients with LS were likely to receive and follow CRC surveillance recommendations. Recommendations for and adherence to extracolonic surveillance were variable. Improved care coordination and clearer documentation of the LS diagnosis is needed.
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Affiliation(s)
- Kathleen F. Mittendorf
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227 USA
| | - Jessica Ezzell Hunter
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227 USA
| | - Jennifer L. Schneider
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227 USA
| | - Elizabeth Shuster
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227 USA
| | - Alan F. Rope
- Northwest Permanente, Kaiser Permanente Northwest, Portland, OR USA
| | - Jamilyn Zepp
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, OR USA
| | - Marian J. Gilmore
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, OR USA
| | - Kristin R. Muessig
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227 USA
| | - James V. Davis
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227 USA
| | - Tia L. Kauffman
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227 USA
| | - Kellene M. Bergen
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227 USA
| | - Georgia L. Wiesner
- Vanderbilt Hereditary Cancer Program, Vanderbilt University Medical Center, Nashville, TN USA
| | - Louise S. Acheson
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH USA
| | | | - Sapna Syngal
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | - Jacob A. Reiss
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227 USA
| | - Katrina A. B. Goddard
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227 USA
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17
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An J, Chang S, Kim HI, Song GW, Shim JH. The clinical behavior and survival of patients with hepatocellular carcinoma and a family history of the disease. Cancer Med 2019; 8:6624-6633. [PMID: 31532075 PMCID: PMC6825981 DOI: 10.1002/cam4.2543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose Familial clustering is a common feature of hepatocellular carcinoma (HCC) as well as a risk factor for the disease. We aimed to assess whether such a family history affected prognostic outcomes in patients with HCC diagnosed at different stages of the disease. Materials/Methods This hospital registry‐based cohort study included 5484 patients initially diagnosed with HCC. Individual family histories of cancer were obtained by interview and reported by trained nurses who constructed three‐generation pedigrees. Overall survival data were compared between cases with and without first‐degree relatives affected by HCC, with adjustment for other potential predictors. Results Of 5484 patients, 845 (15.4%) had first‐degree relatives with a history of HCC. Family history was associated with longer survival in the entire cohort (adjusted hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.80‐0.98, P = .025). A significant trend for reduced risk of death with increasing number of affected family members was also observed (P for trend = 0.018). The stage‐stratified analysis showed that the presence of family history was especially associated with a reduced risk of death in the subset of patients with HCC at a (very) early stage (adjusted HR 0.83, 95% CI 0.69‐0.99; P = .042). The proportion of cases receiving curative treatment was also higher in early‐stage patients with a family history (72.6% vs 63.3%; P < .001). Conclusions A first‐degree family history of the disease is a prognostic factor for improved survival in patients with HCC, especially in those whose tumors can be cured by radical treatments.
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Affiliation(s)
- Jihyun An
- Gastroenterology and Hepatology, Hanyang University College of Medicine, Guri, Korea
| | - Seheon Chang
- Internal Medicine, Myongji Saint Mary's Hospital, Seoul, Korea
| | - Ha Il Kim
- Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju Hyun Shim
- Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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18
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Samadder NJ, Giridhar KV, Baffy N, Riegert-Johnson D, Couch FJ. Hereditary Cancer Syndromes-A Primer on Diagnosis and Management: Part 1: Breast-Ovarian Cancer Syndromes. Mayo Clin Proc 2019; 94:1084-1098. [PMID: 31171119 DOI: 10.1016/j.mayocp.2019.02.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 02/05/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022]
Abstract
Cancer is the second leading cause of death in both men and women in the United States, with colorectal cancer and breast cancer being two of the most frequent cancer types. Hereditary causes occurring due to pathogenic sequence variants and defects in certain genes makes up roughly 5% of all colorectal cancers and breast-ovarian cancers. High-risk hereditary predisposition syndromes have been associated with a substantially increased lifetime risk for the development of colorectal cancers and breast-ovarian cancers depending on the genetic syndrome, and many people also carry an increased risk of several other cancers compared with the general population. The aim of this review was to provide comprehensive literature on the most commonly encountered hereditary predisposition syndromes, including Lynch syndrome, familial adenomatous polyposis, MUTYH-associated polyposis, hamartomatous polyposis, and breast-ovarian cancer conditions. This will be presented as a 2-part series: the first part will cover the breast-ovarian cancer syndromes, and the second will focus on the inherited colorectal cancer and polyposis conditions.
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Affiliation(s)
- N Jewel Samadder
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ; Department of Clinical Genomics, Mayo Clinic, Scottsdale, AZ; Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL.
| | | | - Noemi Baffy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ
| | - Douglas Riegert-Johnson
- Department of Clinical Genomics, Mayo Clinic, Scottsdale, AZ; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL; Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL
| | - Fergus J Couch
- Department of Laboratory Medicine, Mayo Clinic, Rochester, MN
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19
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Hitchins MP, Vogelaar IP, Brennan K, Haraldsdottir S, Zhou N, Martin B, Alvarez R, Yuan X, Kim S, Guindi M, Hendifar AE, Kalady MF, DeVecchio J, Church JM, de la Chapelle A, Hampel H, Pearlman R, Christensen M, Snyder C, Lanspa SJ, Haile RW, Lynch HT. Methylated SEPTIN9 plasma test for colorectal cancer detection may be applicable to Lynch syndrome. BMJ Open Gastroenterol 2019; 6:e000299. [PMID: 31275589 PMCID: PMC6577308 DOI: 10.1136/bmjgast-2019-000299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/09/2019] [Accepted: 04/25/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The plasma-based methylated SEPTIN9 (mSEPT9) is a colorectal cancer (CRC) screening test for adults aged 50-75 years who are at average risk for CRC and have refused colonoscopy or faecal-based screening tests. The applicability of mSEPT9 for high-risk persons with Lynch syndrome (LS), the most common hereditary CRC condition, has not been assessed. This study sought preliminary evidence for the utility of mSEPT9 for CRC detection in LS. DESIGN Firstly, SEPT9 methylation was measured in LS-associated CRC, advanced adenoma, and subject-matched normal colorectal mucosa tissues by pyrosequencing. Secondly, to detect mSEPT9 as circulating tumor DNA, the plasma-based mSEPT9 test was retrospectively evaluated in LS subjects using the Epi proColon 2.0 CE assay adapted for 1mL plasma using the "1/1 algorithm". LS case groups included 20 peri-surgical cases with acolonoscopy-based diagnosis of CRC (stages I-IV), 13 post-surgical metastatic CRC, and 17 pre-diagnosis cases. The control group comprised 31 cancer-free LS subjects. RESULTS Differential hypermethylation was found in 97.3% (36/37) of primary CRC and 90.0% (18/20) of advanced adenomas, showing LS-associated neoplasia frequently produce the mSEPT9 biomarker. Sensitivity of plasma mSEPT9 to detect CRC was 70.0% (95% CI, 48%-88%)in cases with a colonoscopy-based CRC diagnosis and 92.3% (95% CI, 64%-100%) inpost-surgical metastatic cases. In pre-diagnosis cases, plasma mSEPT9 was detected within two months prior to colonoscopy-based CRC diagnosis in 3/5 cases. Specificity in controls was 100% (95% CI 89%-100%). CONCLUSION These preliminary findings suggest mSEPT9 may demonstrate similar diagnostic performance characteristics in LS as in the average-risk population, warranting a well-powered prospective case-control study.
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Affiliation(s)
- Megan P Hitchins
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Kevin Brennan
- Medicine, Stanford University, Stanford, California, USA
| | | | - Nianmin Zhou
- Medicine, Stanford University, Stanford, California, USA
| | - Brock Martin
- Medicine, Stanford University, Stanford, California, USA
| | - Rocio Alvarez
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Xiaopu Yuan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sungjin Kim
- Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Maha Guindi
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew E Hendifar
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Comprehensive Cancer Center, Los Angeles, California, USA
| | - Matthew F Kalady
- Departments of Stem Cell and Regenerative Medicine and Colorectal Surgery, Sanford R Weiss MD Center for Hereditary Colorectal Neoplasia, Digestive Disease and Surgery Institute, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Jennifer DeVecchio
- Department of Stem Cell and Regenerative Medicine, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - James M Church
- Departments of Stem Cell and Regenerative Medicine and Colorectal Surgery, Sanford R Weiss MD Center for Hereditary Colorectal Neoplasia, Digestive Disease and Surgery Institute, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Albert de la Chapelle
- Department of Internal Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | - Heather Hampel
- Department of Internal Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | - Rachel Pearlman
- Department of Internal Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | - Maria Christensen
- Hereditary Cancer Center, Creighton University, Omaha, Nebraska, USA
| | - Carrie Snyder
- Hereditary Cancer Center, Creighton University, Omaha, Nebraska, USA
| | - Stephen J Lanspa
- Hereditary Cancer Center, Creighton University, Omaha, Nebraska, USA
| | - Robert W Haile
- Department of Medicine, Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Henry T Lynch
- Hereditary Cancer Center, Creighton University, Omaha, Nebraska, USA
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20
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Pan JY, Haile RW, Templeton A, Macrae F, Qin F, Sundaram V, Ladabaum U. Worldwide Practice Patterns in Lynch Syndrome Diagnosis and Management, Based on Data From the International Mismatch Repair Consortium. Clin Gastroenterol Hepatol 2018; 16:1901-1910.e11. [PMID: 29702294 PMCID: PMC6440473 DOI: 10.1016/j.cgh.2018.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/22/2018] [Accepted: 04/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Families with a history of Lynch syndrome often do not adhere to guidelines for genetic testing and screening. We investigated practice patterns related to Lynch syndrome worldwide, to ascertain potential targets for research and public policy efforts. METHODS We collected data from the International Mismatch Repair Consortium (IMRC), which comprises major research and clinical groups engaged in the care of families with Lynch syndrome worldwide. IMRC institutions were invited to complete a questionnaire to characterize diagnoses of Lynch syndrome and management practice patterns. RESULTS Fifty-five providers, representing 63 of 128 member institutions (49%) in 21 countries, completed the questionnaire. For case finding, 55% of respondents reported participating in routine widespread population tumor testing among persons with newly diagnosed Lynch syndrome-associated cancers, whereas 27% reported relying on clinical criteria with selective tumor and/or germline analyses. Most respondents (64%) reported using multigene panels for germline analysis, and only 28% reported testing tumors for biallelic mutations for cases in which suspected pathogenic mutations were not confirmed by germline analysis. Respondents reported relying on passive dissemination of information to at-risk family members, and there was variation in follow through of genetic testing recommendations. Reported risk management practices varied-nearly all programs (98%) recommended colonoscopy every 1 to 2 years, but only 35% recommended chemoprevention with aspirin. CONCLUSIONS There is widespread heterogeneity in management practices for Lynch syndrome worldwide among IMRC member institutions. This may reflect the rapid pace of emerging technology, regional differences in resources, and the lack of definitive data for many clinical questions. Future efforts should focus on the large numbers of high-risk patients without access to state-of-the-art Lynch syndrome management.
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Affiliation(s)
- Jennifer Y Pan
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California; Division of Gastroenterology, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
| | - Robert W Haile
- Department of Medicine, Division of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Allyson Templeton
- International Mismatch Repair Consortium, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Finlay Macrae
- Department of Medicine, University of Melbourne, Melbourne, Australia; Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia
| | - FeiFei Qin
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California
| | - Vandana Sundaram
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, California
| | - Uri Ladabaum
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California
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21
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Update on the role of chromoendoscopy in colonoscopic surveillance of patients with Lynch syndrome. Eur J Gastroenterol Hepatol 2018; 30:1116-1124. [PMID: 30044237 DOI: 10.1097/meg.0000000000001214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
(Virtual) chromoendoscopy (CE) improves the detection of small or flat colorectal polyps; however, the evidence in high-risk groups, such as patients of Lynch syndrome (LS), is low. Our aim was to identify and update the evidence for the recommendations regarding surveillance of LS patients, for which the current underlying evidence for use of (virtual) CE was explored. A systematic literature search in PubMed, EMBASE, and Cochrane library was conducted, for all studies comparing (virtual) CE with white-light endoscopy in LS patients. Studies are explained in detail, with special attention to study design, type of (virtual) CE, and timing of polypectomy. Eight studies (409 patients) were included. Five were nonrandomized back-to-back studies and three were randomized back-to-back studies (one parallel and two cross-over design). In six studies the polyps were directly removed, while in two studies polyps were removed only during the second caecal withdrawal. Five studies researched CE with indigo carmine and three studies investigated virtual CE. Due to the heterogeneity between studies, no statistical analysis could be performed. There was a large variety in study design, timing of polypectomy, different (virtual) CE techniques and the patients that were included. Based on current literature, no firm conclusions can be drawn with respect to the additional value of (virtual) CE in the surveillance of patients with LS. However, training of endoscopists in detection and removal of nonpolypoid colorectal neoplasms is crucial, as well as stricter adherence to LS surveillance guidelines in daily clinical practice. For future research, standardization in study designs is needed.
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22
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Golemis EA, Scheet P, Beck TN, Scolnick EM, Hunter DJ, Hawk E, Hopkins N. Molecular mechanisms of the preventable causes of cancer in the United States. Genes Dev 2018; 32:868-902. [PMID: 29945886 PMCID: PMC6075032 DOI: 10.1101/gad.314849.118] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Annually, there are 1.6 million new cases of cancer and nearly 600,000 cancer deaths in the United States alone. The public health burden associated with these numbers has motivated enormous research efforts into understanding the root causes of cancer. These efforts have led to the recognition that between 40% and 45% of cancers are associated with preventable risk factors and, importantly, have identified specific molecular mechanisms by which these exposures modify human physiology to induce or promote cancer. The increasingly refined knowledge of these mechanisms, which we summarize here, emphasizes the need for greater efforts toward primary cancer prevention through mitigation of modifiable risk factors. It also suggests exploitable avenues for improved secondary prevention (which includes the development of therapeutics designed for cancer interception and enhanced techniques for noninvasive screening and early detection) based on detailed knowledge of early neoplastic pathobiology. Such efforts would complement the current emphasis on the development of therapeutic approaches to treat established cancers and are likely to result in far greater gains in reducing morbidity and mortality.
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Affiliation(s)
- Erica A Golemis
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
| | - Paul Scheet
- Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
| | - Tim N Beck
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
- Molecular and Cell Biology and Genetics Program, Drexel University College of Medicine, Philadelphia, Pennsylvania 19129, USA
| | - Eward M Scolnick
- Eli and Edythe L. Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts 02142, USA
| | - David J Hunter
- Nuffield Department of Population Health, University of Oxford, Medical Sciences Division, Oxford OX3 7LF, United Kingdom
| | - Ernest Hawk
- Division of Cancer Prevention and Population Sciences, University of Texas M.D. Anderson Cancer Center, Houston Texas 77030, USA
| | - Nancy Hopkins
- Koch Institute for Integrative Cancer Research, Biology Department, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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23
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Petr EJ, Else T. Adrenocortical carcinoma (ACC): When and why should we consider germline testing? Presse Med 2018; 47:e119-e125. [DOI: 10.1016/j.lpm.2018.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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24
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Perrod G, Samaha E, Rahmi G, Khater S, Abbes L, Savale C, Perkins G, Zaanan A, Chatellier G, Malamut G, Cellier C. Impact of an optimized colonoscopic screening program for patients with Lynch syndrome: 6-year results of a specialized French network. Therap Adv Gastroenterol 2018; 11:1756284818775058. [PMID: 29872454 PMCID: PMC5974573 DOI: 10.1177/1756284818775058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/03/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Despite colonoscopic screening, colorectal cancer (CRC) remains frequent in patients with Lynch syndrome (LS). The objective of this study was to evaluate the impact of an optimized colorectal screening program within a French dedicated network. METHODS All LS patients followed at our institution were consecutively included in the Prédisposition au Cancer Colorectal-Ile de France (PRED-IdF) network. Patients were offered an optimized screening program allowing an adjustment of the interval between colonoscopies, depending on bowel preparation, chromoendoscopy achievement and adenoma detection. Colonoscopies were defined as optimal when all the screening criteria were respected. We compared colonoscopy quality and colonoscopy detection rate before and after PRED-IdF inclusion, including polyp detection rate (PDR), adenoma detection rate (ADR) and cancer detection rate (CDR). RESULTS Between January 2010 and January 2016, 144 LS patients were consecutively included (male/female = 50/94, mean age = 51 ± 13 years and mutations: MLH1 = 39%, MSH2 = 44%, MSH6 = 15%, PMS2 = 1%). A total of 564 colonoscopies were analyzed, 353 after inclusion and 211 before. After PRED-IdF inclusion, 98/144 (68%) patients had optimal screening colonoscopies versus 33/132 (25%) before (p < 0.0005). The optimal colonoscopy rate was 304/353 (86%) after inclusion versus 87/211 (41%) before, (p < 0.0001). PRED-IdF inclusion was associated with a reduction of CRC occurrence with a CDR of 1/353 (0.3%) after inclusion versus 6/211 (2.8%) before (p = 0.012). ADR and PDR were 99/353 (28%) versus 60/211 (28.8%) (p > 0.05) and 167/353 (48.1%) versus 90/211 (42.2%) (p > 0.05), respectively after and before inclusion. CONCLUSIONS An optimized colonoscopic surveillance program in LS patients seems to improve colonoscopic screening quality and might possibly decrease colorectal interval cancer occurrence. Long-term cohort studies are needed to confirm these results.
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Affiliation(s)
| | - Elia Samaha
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France
| | - Gabriel Rahmi
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France,Faculté de médecine René Descartes, Paris, France
| | - Sherine Khater
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France
| | - Leila Abbes
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France
| | - Camille Savale
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France
| | - Geraldine Perkins
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’oncologie digestive, Paris, France
| | - Aziz Zaanan
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’oncologie digestive, Paris, France,Faculté de médecine René Descartes, Paris, France
| | - Gilles Chatellier
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité d’Epidémiologie et de Recherche Clinique, Paris, France,Faculté de médecine René Descartes, Paris, France
| | - Georgia Malamut
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France,Faculté de médecine René Descartes, Paris, France
| | - Christophe Cellier
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France,Faculté de médecine René Descartes, Paris, France
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Hereditary Colorectal Polyposis and Cancer Syndromes: A Primer on Diagnosis and Management. Am J Gastroenterol 2017; 112:1509-1525. [PMID: 28786406 DOI: 10.1038/ajg.2017.212] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 06/23/2017] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is the fourth most common cancer amongst men and women. Between 3 and 6% of all CRCs are attributed to well-defined inherited syndromes, including Lynch syndrome, familial adenomatous polyposis (FAP), MUTYH-associated polyposis (MAP), and several hamartomatous polyposis conditions. Identification of these patients through family history and appropriate genetic testing can provide estimates of cancer risk that inform appropriate cancer screening, surveillance and/or preventative interventions. This narrative review examines the hereditary colorectal cancer and polyposis syndromes, their genetic basis, clinical management, and evidence supporting cancer screening.
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Exploring clinicians' attitudes about using aspirin for risk reduction in people with Lynch Syndrome with no personal diagnosis of colorectal cancer. Fam Cancer 2017; 16:99-109. [PMID: 27677266 DOI: 10.1007/s10689-016-9933-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Recent research has shown that aspirin reduces the risk of cancers associated with Lynch Syndrome. However, uncertainty exists around the optimal dosage, treatment duration and whether the benefits of aspirin as a risk-reducing medication (RRM) outweigh adverse medication related side-effects. Little is known about clinicians' attitudes, current practice, and perceived barriers to recommending aspirin as a RRM. To explore the attitudes of clinicians who discuss risk management options with patients with Lynch Syndrome towards using aspirin as a RRM. Clinicians were invited through professional organisations to complete an online survey. Topics included their clinical experience with Lynch Syndrome, views and practice of recommending aspirin as a RRM, and knowledge about clinical risk management guidelines for Lynch Syndrome. Comparison of attitudes was made between three professional groups. 181 respondents were included in the analysis: 59 genetics professionals (genetic counsellors and clinical geneticists, medical oncologists with specialist training in familial cancer), 49 gastroenterologists and 73 colorectal surgeons. Most clinicians (76 %) considered aspirin to be an effective RRM and most (72 %) were confident about discussing it. In all professional categories, those who were confident about discussing aspirin with patients perceived it to be an effective RRM (OR = 2.8 [95 % CI = 1.8-4.2], p < 0.001). Eighty percent (47/59) of genetics professionals reported having discussed the use of aspirin with Lynch Syndrome patients compared to 69 % of gastroenterologists and 68 % of colorectal surgeons. Those who considered aspirin as an effective RRM or who felt confident in their knowledge of the aspirin literature were more likely (OR = 10 [95 % CI = 1.5-65], p = 0.010, OR = 6 [95 % CI = 2.2-16], p < 0.001, respectively) to discuss it with their patients than other professionals in the study. Similarly health professionals who felt confident in their knowledge of literature of aspirin/confident in discussing with the patients were more likely (OR = 6 [95 % CI = 2.2-16], p < 0.001) to discuss with their patients. Health professionals who saw more than ten patients with Lynch Syndrome per year were more likely to be confident in their knowledge of the aspirin literature and discussing it with patients (OR = 4.1 [95 % CI = 1.6-10.2], p = 0.003). Explicit recommendations to take aspirin, was reported by 65/83 (78 %) of health professionals. Eighty-seven percent of health professionals reported a need for patient educational materials about aspirin. Continuing training is needed to increase clinicians' confidence in their knowledge of the literature on the use of aspirin as a RRM. Patient education materials may be helpful in improving consistency in patient care and facilitate communication between clinicians and people living with Lynch Syndrome.
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Cancer screening behaviors and risk perceptions among family members of colorectal cancer patients with unexplained mismatch repair deficiency. Fam Cancer 2017; 16:231-237. [PMID: 27832499 DOI: 10.1007/s10689-016-9947-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Communication gaps in families with unexplained mismatch repair (MMR) deficiency (UMMRD) could negatively impact the screening behaviors of relatives of individual with UMMRD. We evaluated cancer risk perception, screening behaviors, and family communication among relatives of colorectal cancer (CRC) patients with UMMRD. Fifty-one family members of 17 probands with UMMRD completed a questionnaire about cancer risk perception, adherence to Lynch syndrome (LS) screening recommendations, and communication with relatives. Clinical data about the probands were obtained from medical records. Thirty-eight participants (78%) were worried from having cancer and twenty-one participants (42%) had undergone colonoscopy in the past 2 years, as recommended for LS families. In terms of screening for extracolonic cancers, only two eligible participants (3.9%) were screened for gastric, endometrial (10.0%), and ovarian (9.5%) cancers. Additionally, 5 participants (10%) underwent genetic counseling. Most participants were not told by anyone to be screened for extracolonic cancers (84, 85, and 95% for gastric, ovarian, and endometrial cancers, respectively). A minority of family members of CRC patients with UMMRD follow cancer screening as recommended for LS families. Health care providers should encourage patients with UMMRD to share information on LS-related cancers screening, especially extracolonic cancers, with their relatives.
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28
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Levin T, Mæhle L. Uptake of genetic counseling, genetic testing and surveillance in hereditary malignant melanoma (CDKN2A) in Norway. Fam Cancer 2017; 16:257-265. [PMID: 27804060 PMCID: PMC5357480 DOI: 10.1007/s10689-016-9939-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Germline mutations in the CDKN2A gene are associated with an increased risk of malignant melanoma and pancreatic cancer. In order to find out if the behavior pattern in families with a CDKN2A mutation is similar to what we previously have described in families with a BRCA1 mutation, we have studied the uptake of genetic services in probands and their relatives. We describe whether they attend genetic counseling when invited, whether they want a mutation test after being counseled and whether they adhere to recommendations for surveillance. 66 % (95/144) of first-degree relatives to mutation carriers contacted us within the study period. 98 % (126/128) of all relatives who came for genetic counseling decided on genetic testing for their family's mutation, and 93 % (66/71) of all mutation carriers wanted referral to yearly skin examinations. Female relatives had a significantly higher uptake of genetic services compared to males, similar to the findings in families with a BRCA1 mutation. Uptake of genetic services in general in families with a CDKN2A mutation is high. Females seem to have a higher interest in genetic testing than males, regardless of gene mutated.
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Affiliation(s)
- Trine Levin
- Section on Hereditary Cancer, Oslo University Hospital, PB 4950 Nydalen, 0424, Oslo, Norway.
| | - Lovise Mæhle
- Section on Hereditary Cancer, Oslo University Hospital, PB 4950 Nydalen, 0424, Oslo, Norway
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29
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Steel E, Robbins A, Jenkins M, Flander L, Gaff C, Keogh L. How does genetic risk information for Lynch syndrome translate to risk management behaviours? Hered Cancer Clin Pract 2017; 15:1. [PMID: 28070225 PMCID: PMC5217251 DOI: 10.1186/s13053-016-0061-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/09/2016] [Indexed: 01/16/2023] Open
Abstract
Background There is limited research on why some individuals who have undergone predictive genetic testing for Lynch syndrome do not adhere to screening recommendations. This study aimed to explore qualitatively how Lynch syndrome non-carriers and carriers translate genetic risk information and advice to decisions about risk managment behaviours in the Australian healthcare system. Methods Participants of the Australasian Colorectal Cancer Family Registry who had undergone predictive genetic testing for Lynch syndrome were interviewed on their risk management behaviours. Transcripts were analysed thematically using a comparative coding analysis. Results Thirty-three people were interviewed. Of the non-carriers (n = 16), 2 reported having apparently unnecessary colonoscopies, and 6 were unsure about what population-based colorectal cancer screening entails. Of the carriers (n = 17), 2 reported they had not had regular colonoscopies, and spoke about their discomfort with the screening process and a lack of faith in the procedure’s ability to reduce their risk of developing colorectal cancer. Of the female carriers (n = 9), 2 could not recall being informed about the associated risk of gynaecological cancers. Conclusion Non-carriers and female carriers of Lynch syndrome could benefit from further clarity and advice about appropriate risk management options. For those carriers who did not adhere to colonoscopy screening, a lack of faith in both genetic test results and screening were evident. It is essential that consistent advice is offered to both carriers and non-carriers of Lynch syndrome.
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Affiliation(s)
- Emma Steel
- Centre for Health Equity, The University of Melbourne, Melbourne, Australia
| | - Andrew Robbins
- Centre for Health Equity, The University of Melbourne, Melbourne, Australia
| | - Mark Jenkins
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Louisa Flander
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Clara Gaff
- Walter and Eliza Hall Institute, Melbourne, Australia
| | - Louise Keogh
- Centre for Health Equity, The University of Melbourne, Melbourne, Australia
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Féau S, Caulet M, Lecomte T. What is the Best Colonoscopy Surveillance for Lynch Syndrome Patients? CURRENT COLORECTAL CANCER REPORTS 2016. [DOI: 10.1007/s11888-016-0314-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Patel SG, Ahnen DJ, Kinney AY, Horick N, Finkelstein DM, Hill DA, Lindor NM, MaCrae F, Lowery JT. Knowledge and Uptake of Genetic Counseling and Colonoscopic Screening Among Individuals at Increased Risk for Lynch Syndrome and their Endoscopists from the Family Health Promotion Project. Am J Gastroenterol 2016; 111:285-93. [PMID: 26856748 PMCID: PMC5193129 DOI: 10.1038/ajg.2015.397] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/10/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Individuals whose families meet the Amsterdam II clinical criteria for hereditary non-polyposis colorectal cancer are recommended to be referred for genetic counseling and to have colonoscopic screening every 1-2 years. To assess the uptake and knowledge of guideline-based genetic counseling and colonoscopic screening in unaffected members of families who meet Amsterdam II criteria and their treating endoscopists. METHODS Participants in the Family Health Promotion Project who met the Amsterdam II criteria were surveyed regarding their knowledge of risk-appropriate guidelines for genetic counseling and colonoscopy screening. Endoscopy/pathology reports were obtained from patients screened during the study to determine the follow-up recommendations made by their endoscopists. Survey responses were compared using Fisher's Exact and the χ(2) test. Concordance in participant/provider-reported surveillance interval was assessed using the kappa statistic. RESULTS Of the 165 participants, the majority (98%) agreed that genetics and family history are important predictors of CRC, and 63% had heard of genetic testing for CRC, although only 31% reported being advised to undergo genetic counseling by their doctor, and only 7% had undergone genetic testing. Only 26% of participants reported that they thought they should have colonoscopy every 1-2 years and 30% of endoscopists for these participants recommended 1-2-year follow-up colonoscopy. There was a 65% concordance (weighted kappa 0.42, 95% CI 0.24-0.61) between endoscopist recommendations and participant reports regarding screening intervals. CONCLUSIONS A minority of individuals meeting Amsterdam II criteria in this series have had genetic testing and reported accurate knowledge of risk-appropriate screening, and only a small percentage of their endoscopists provided them with the appropriate screening recommendations. There was moderate concordance between endoscopist recommendations and participant knowledge suggesting that future educational interventions need to target both health-care providers and their patients.
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Affiliation(s)
- Swati G Patel
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Veterans Administration Medical Center, Denver, Colorado, USA
| | - Dennis J Ahnen
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Gastroenterology of the Rockies, Boulder, Colorado, USA
| | - Anita Y Kinney
- Department of Internal Medicine, University of New Mexico, Albequerque, New Mexico, USA
| | - Nora Horick
- Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts, USA
| | - Dianne M Finkelstein
- Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts, USA
- Harvard University, Boston, Massachusetts, USA
| | - Deirdre A Hill
- Department of Internal Medicine, Division of Epidemiology, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Finlay MaCrae
- Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital Department of Medicine, University of Melbourne, Victoria, Australia
| | - Jan T Lowery
- University of Colorado School of Public Health, Aurora, Colorado, USA
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Katz LH, Burton-Chase AM, Advani S, Fellman B, Polivka KM, Yuan Y, Lynch PM, Peterson SK. Screening adherence and cancer risk perceptions in colorectal cancer survivors with Lynch-like syndrome. Clin Genet 2015; 89:392-8. [PMID: 26272410 DOI: 10.1111/cge.12653] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/07/2015] [Accepted: 08/12/2015] [Indexed: 01/22/2023]
Abstract
Cancer screening recommendations for patients with Lynch-like syndrome (LLS) are not well defined. We evaluated adherence to Lynch syndrome (LS) screening recommendations, cancer risk perceptions, and communication within the families among colorectal cancer (CRC) survivors with LLS. Thirty-four participants with LLS completed a questionnaire about risk perception, adherence to LS screening recommendations, and communication with relatives. Clinical data were obtained from medical records. Most participants (76%) believed they should undergo colonoscopy every 1-2 years. Only 41% correctly interpreted their genetic tests as uninformative negative or as variant of unknown significance for LS. Less than half had had an upper gastrointestinal endoscopy for screening purpose. Among female participants, 86% had been screened for endometrial cancer (EC) and 71% for ovarian cancer. Most participants had informed relatives about the CRC diagnosis and advised them to undergo CRC screening, but only 50% advised female relatives to be screened for EC and only one-third advised relatives to have genetic counseling. Most CRC survivors with LLS follow the same cancer screening recommended for LS patients but do not understand the meaning of LLS. Greater care must be devoted to communicating the implications of nondiagnostic germline mutation testing among patients with LLS.
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Affiliation(s)
- L H Katz
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Gastroenterology, Sheba Medical Center, Tel-Aviv University, Ramat-Gan, Israel
| | - A M Burton-Chase
- Department of Behavioral Sciences, Sheba Medical Center, Tel-Aviv University, Ramat-Gan, Israel.,Department of Basic and Social Sciences, Albany College of Pharmacy and Health Sciences, Albany, NY, USA
| | - S Advani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Fellman
- Department of Biostatistics, Sheba Medical Center, Tel-Aviv University, Ramat-Gan, Israel
| | - K M Polivka
- Department of Behavioral Sciences, Sheba Medical Center, Tel-Aviv University, Ramat-Gan, Israel
| | - Y Yuan
- Department of Biostatistics, Sheba Medical Center, Tel-Aviv University, Ramat-Gan, Israel
| | - P M Lynch
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S K Peterson
- Department of Behavioral Sciences, Sheba Medical Center, Tel-Aviv University, Ramat-Gan, Israel
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A single institution experience in compliance with universal screening for Lynch syndrome in colorectal cancer. J Gastrointest Surg 2015; 19:543-50. [PMID: 25504462 DOI: 10.1007/s11605-014-2687-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/21/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Detection of Lynch syndrome has the potential to reduce morbidity and mortality among patients and their family members due to beneficial screening and treatment options. Several institutions have begun to adopt universal rather than risk-stratified screening protocols, but the lack of 100 % compliance rates requires identification of system-level interventions to improve screening practices. OBJECTIVE We aimed to identify patient, tumor, and system factors associated with lack of screening and identify system-based interventions to improve Lynch syndrome screening. DESIGN AND SETTINGS This study is a retrospective analysis of Lynch syndrome screening among colorectal cancer patients undergoing surgery in a single healthcare system. PATIENTS Two hundred and sixty-two patients who underwent surgery for colorectal cancer were studied. MAIN OUTCOME MEASURES Rate of Lynch syndrome screening. RESULTS We identified that 75 % of the total cohort was screened for Lynch syndrome. Of patients under the age of 50, 78 % percent were screened. Lower screening rates were found among patients with complete pathologic tumor response and lower pathologic stage of tumor. Higher screening rates were found at the academic hospital and with colorectal surgeons. In multivariable logistic regression analysis, lower screening rates were associated with community hospital location (OR, 0.22; 95 % CI, 0.08-0.56). LIMITATIONS Results may not be generalizable to different hospital settings. CONCLUSIONS Several potential system-level interventions were identified to improve screening rates including an emphasis on improved provider communication.
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Rahmi G, Lecomte T, Malka D, Maniere T, Le Rhun M, Guimbaud R, Lapalus MG, Le Sidaner A, Moussata D, Caron O, Barbieux JP, Gaudric M, Coron E, Barange K, Ponchon T, Sautereau D, Samaha E, Saurin JC, Chaussade S, Laurent-Puig P, Chatellier G, Cellier C. Impact of chromoscopy on adenoma detection in patients with Lynch syndrome: a prospective, multicenter, blinded, tandem colonoscopy study. Am J Gastroenterol 2015; 110:288-98. [PMID: 25601014 DOI: 10.1038/ajg.2014.423] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 12/02/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVES In Lynch syndrome, flat and diminutive adenomas are particularly prone to malignant transformation, but they can be missed by standard colonoscopy. It is not known whether chromocolonoscopy is able to detect more adenomas than standard colonoscopy in patients with Lynch syndrome. METHODS We conducted a prospective, multicenter, randomized trial to compare standard colonoscopy with standard colonoscopy followed by pancolonic chromoscopy with indigo carmine in patients with a proven germline mutation in a mismatch-repair gene related to Lynch syndrome and who were undergoing screening or surveillance colonoscopy. Standard colonoscopy was used first to detect visible lesions. Colonoscopy with chromoscopy was then performed by a second gastroenterologist (blinded to the findings of the first colonoscopy) to detect additional lesions. The primary end point was the number of patients in whom at least one adenoma was detected. RESULTS A total of 78 eligible patients (median age, 45 years) were enrolled at 10 centers from July 2008 to August 2009. Significantly more patients with at least one adenoma were identified by chromocolonoscopy (32/78 (41%)) than by standard colonoscopy (18/78 (23%); P<0.001). The percentage of patients in whom at least one additional adenoma was detected during the chromoscopy was 31% (24/78). Overall, chromocolonoscopy plus colonoscopy detected a total of 55 adenomas in 32 patients (mean number of adenomas detected per patient: 0.7 vs. standard colonoscopy alone: 0.3; P<0.001). CONCLUSION The results support the proposition that chromocolonoscopy may significantly improve the detection rate of colorectal adenomas in patients undergoing screening or surveillance colonoscopy for Lynch syndrome.
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Affiliation(s)
- Gabriel Rahmi
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Thierry Lecomte
- 1] Université François-Rabelais, Paris, France [2] Service d'Hépato-gastroentérologie et de Cancérologie digestive, CHRU de Tours, Paris, France
| | - David Malka
- Département de Médecine Oncologique, Unité d'oncologie digestive, Institut Gustave Roussy, Villejuif, France
| | - Thibault Maniere
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Marc Le Rhun
- Service d'Hépato-gastroentérologie, CHU de Nantes, Nantes, France
| | - Rosine Guimbaud
- 1] Service d'oncologie, Hôpital Purpan, Toulouse, France [2] Université de Toulouse 3 University, Toulouse, France
| | | | - Anne Le Sidaner
- Service d'Hépato-gastroentérologie, CHU Dupuytren, Limoges, France
| | - Driffa Moussata
- Service de Gastroentérologie, Hôpital Lyon Sud, Lyon, France
| | - Olivier Caron
- Service d'oncogénétique, Institut Gustave Roussy, Villejuif, France
| | - Jean-Pierre Barbieux
- Service d'Hépato-gastroentérologie et de Cancérologie digestive, CHRU de Tours, Paris, France
| | - Marianne Gaudric
- Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Cochin, Paris, France
| | - Emmanuel Coron
- Service d'Hépato-gastroentérologie, CHU de Nantes, Nantes, France
| | - Karl Barange
- Service d'Hépato-gastroentérologie, Hôpital Purpan, Toulouse, France
| | - Thierry Ponchon
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon, France
| | - Denis Sautereau
- Service d'Hépato-gastroentérologie, CHU Dupuytren, Limoges, France
| | - Elia Samaha
- Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Stanislas Chaussade
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Cochin, Paris, France
| | - Pierre Laurent-Puig
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Unité d'oncogénétique, Hôpital Européen Georges Pompidou, Paris, France
| | - Gilles Chatellier
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Unité d'épidémiologie et de recherche clinique, Hôpital européen Georges Pompidou, Paris, France
| | - Christophe Cellier
- 1] Université Paris Descartes, Paris, France; Paris Sorbonne Cité, Paris, France [2] Assistance Publique des Hôpitaux de Paris, Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Paris, France
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Bikhchandani J, Lynch HT. Commentary on 'Colonoscopy screening compliance and outcomes in patients with Lynch syndrome'. Colorectal Dis 2015; 17:46-9. [PMID: 25536883 DOI: 10.1111/codi.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Jai Bikhchandani
- Creighton University, 2500 California Plaza, Omaha, Nebraska, 68102, USA
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Newton K, Green K, Lalloo F, Evans DG, Hill J. Colonoscopy screening compliance and outcomes in patients with Lynch syndrome. Colorectal Dis 2015; 17:38-46. [PMID: 25213040 DOI: 10.1111/codi.12778] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 07/15/2014] [Indexed: 12/14/2022]
Abstract
AIM Colonic surveillance reduces the lifetime risk of colorectal cancer in patients with Lynch syndrome (hereditary nonpolyposis colorectal cancer) from 60 to 80% to 10% and confers a 7-year survival advantage. The British Society of Gastroenterologists recommends colonoscopy at least every 2 years from the age of 25. Currently in the UK, genetic diagnosis is made by a regional genetics service, and screening recommendations are made to the referring clinician. The aim of this study was to investigate compliance with and the effectiveness of large bowel surveillance in Lynch syndrome. METHOD A retrospective longitudinal study of Lynch syndrome mutation carriers on the Regional Familial Colorectal Cancer Registry under and not under screening was conducted. To investigate screening compliance, patients were included if they were alive at the start of the study. Data were gathered on timeliness, quality and outcome of screening. To examine the effectiveness of screening, the cumulative incidence of colorectal cancer was estimated using Kaplan-Meier curves and the screened population compared with patients not being screened. RESULTS A total of 227 Lynch syndrome mutation carriers were under screening at 26 hospitals. We assessed 439 colonoscopies for timeliness, of which 68% were compliant (interval < 27 months). Compliance on the 1 November 2011 was 87%. The cumulative incidence of colorectal cancer to the age of 70 was 25% (95% CI 17-32%) in the surveillance population and 81% (95% CI 78-84%) in 689 mutation-positive patients not being screened (P < 0.0001). CONCLUSION Overall, 68% of colonoscopies were on time. The incidence of colorectal cancer was greatly reduced by screening but remained significant. Patients with Lynch syndrome need proactive surveillance management.
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Affiliation(s)
- K Newton
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
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Cohen SA, Leininger A. The genetic basis of Lynch syndrome and its implications for clinical practice and risk management. APPLICATION OF CLINICAL GENETICS 2014; 7:147-58. [PMID: 25161364 PMCID: PMC4142571 DOI: 10.2147/tacg.s51483] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Lynch syndrome is the most common cause of hereditary colon cancer, and accounts for as much as 3% of all colon and endometrial cancers. The identification and management of individuals with Lynch syndrome have evolved over the past 20 years, yet the syndrome remains vastly underdiagnosed. It is important for clinicians to recognize individuals and families who are at risk in order to be able to manage them appropriately and reduce their morbidity and mortality from this condition. This review will touch on the history of Lynch syndrome, the current knowledge of genotype–phenotype correlations, the cancers associated with Lynch syndrome, and management of individuals who are gene carriers.
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Affiliation(s)
- Stephanie A Cohen
- Cancer Genetics Risk Assessment Program, St Vincent Health, Indianapolis, IN, USA
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Lowery JT, Horick N, Kinney AY, Finkelstein DM, Garrett K, Haile RW, Lindor NM, Newcomb PA, Sandler RS, Burke C, Hill DA, Ahnen DJ. A randomized trial to increase colonoscopy screening in members of high-risk families in the colorectal cancer family registry and cancer genetics network. Cancer Epidemiol Biomarkers Prev 2014; 23:601-10. [PMID: 24501379 PMCID: PMC3976708 DOI: 10.1158/1055-9965.epi-13-1085] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Individuals with a strong family history of colorectal cancer have significant risk for colorectal cancer, although adherence to colonoscopy screening in these groups remains low. This study assessed whether a tailored telephone counseling intervention can increase adherence to colonoscopy in members of high-risk families in a randomized, controlled trial. METHODS Eligible participants were recruited from two national cancer registries if they had a first-degree relative with colorectal cancer under age 60 or multiple affected family members, which included families that met the Amsterdam criteria for hereditary non-polyposis colon cancer (HNPCC), and if they were due for colonoscopy within 24 months. Participants were randomized to receive a tailored telephone intervention grounded in behavioral theory or a mailed packet with general information about screening. Colonoscopy status was assessed through follow-up surveys and endoscopy reports. Cox proportional hazards models were used to assess intervention effect. RESULTS Of the 632 participants (ages 25-80), 60% were female, the majority were White, non-Hispanic, educated, and had health insurance. Colonoscopy adherence increased 11 percentage points in the tailored telephone intervention group, compared with no significant change in the mailed group. The telephone intervention was associated with a 32% increase in screening adherence compared with the mailed intervention (HR, 1.32; P = 0.01). CONCLUSIONS A tailored telephone intervention can effectively increase colonoscopy adherence in high-risk persons. This intervention has the potential for broad dissemination to healthcare organizations or other high-risk populations. IMPACT Increasing adherence to colonoscopy among persons with increased colorectal cancer risk could effectively reduce incidence and mortality from this disease.
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Affiliation(s)
- Jan T Lowery
- Authors' Affiliations: Colorado School of Public Health, University of Colorado; University of Colorado Cancer Center, Division of Cancer Prevention and Control, Aurora; Department of Medicine, Department of Veterans Affairs Eastern Colorado Health Care System and University of Colorado School of Medicine, Denver, Colorado; Massachusetts General Hospital Biostatistics Center; Harvard University, Boston, Massachusetts; Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine; Cancer Center, University of New Mexico, Albuquerque, New Mexico; Stanford University, Population Sciences, Stanford, California; Department of Health Science Research, Mayo Clinic Arizona, Scottsdale, Arizona; Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; and Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
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Abstract
In the care of patients with Lynch Syndrome (LS), a range of psychosocial issues are encountered, which significantly affect patient outcomes. A brief historical background of 'psycho-onco-genetics' (the domain where psychology, oncology and genetics meet) in relation to LS is presented, followed by an overview of important psychosocial issues identified in the past 20 years. The identification of mismatch repair genes in 1993-1994 made possible genetic counseling and testing for patients who had cancer and for potentially high-risk relatives without cancer. At that time, concerns were raised about the potentially negative psychosocial impact of predictive genetic testing. Since 1993, a large number of studies have been conducted to investigate the possible psychosocial benefits and limitations of such testing. This article presents an overview of: the uptake of and motivations for genetic testing, its psychosocial impact (e.g. psychological adaptation, impact on risk perception and self-concept, and concerns about, and experiences of, genetic discrimination), psychological screening instruments, adherence to and decision-making about preventive strategies, family communication, lifestyle changes, reproductive technology utilization, and professional psychosocial support needs of members of families with LS. Finally, challenges for the future are discussed, including population screening and genomic testing.
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Balancing Life with an Increased Risk of Cancer: Lived Experiences in Healthy Individuals with Lynch Syndrome. J Genet Couns 2014; 23:778-84. [DOI: 10.1007/s10897-013-9682-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
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Rothenmund H, Singh H, Candas B, Chodirker BN, Serfas K, Aronson M, Holter S, Volenik A, Green J, Dicks E, Woods MO, Gilchrist D, Gryfe R, Cohen Z, Foulkes WD. Hereditary colorectal cancer registries in Canada: report from the Colorectal Cancer Association of Canada consensus meeting; Montreal, Quebec; October 28, 2011. ACTA ACUST UNITED AC 2013; 20:273-8. [PMID: 24155632 DOI: 10.3747/co.20.1566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
At a consensus meeting held in Montreal, October 28, 2011, a multidisciplinary group of Canadian experts in the fields of genetics, gastroenterology, surgery, oncology, pathology, and health care services participated in presentation and discussion sessions for the purpose of developing consensus statements pertaining to the development and maintenance of hereditary colorectal cancer registries in Canada. Five statements were approved by all participants.
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Affiliation(s)
- H Rothenmund
- Hereditary Colorectal Cancer Registry, Cancer Prevention Centre, Jewish General Hospital, Montreal, QC
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Stewart A. Genetic testing strategies in newly diagnosed endometrial cancer patients aimed at reducing morbidity or mortality from lynch syndrome in the index case or her relatives. PLOS CURRENTS 2013; 5:ecurrents.eogt.b59a6e84f27c536e50db4e46aa26309c. [PMID: 24056992 PMCID: PMC3775889 DOI: 10.1371/currents.eogt.b59a6e84f27c536e50db4e46aa26309c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Endometrial cancer is the first malignancy in 50% of women with Lynch syndrome, an autosomal dominant cancer-prone syndrome caused by germline mutations in genes encoding components of the DNA mismatch repair (MMR) pathway. These women (2-4% of all those with endometrial cancer) are at risk of metachronous colorectal cancer and other Lynch syndrome-associated cancers, and their first-degree relatives are at 50% risk of Lynch syndrome. Testing all women newly diagnosed with endometrial cancer for Lynch syndrome may have clinical utility for the index case and her relatives by alerting them to the benefits of surveillance and preventive options, primarily for colorectal cancer. The strategy involves offering germline DNA mutation testing to those whose tumour shows loss-of-function of MMR protein(s) when analysed for microsatellite instability (MSI) and/or by immunohistochemisty (IHC). In endometrial tumours from unselected patients, MSI and IHC have a sensitivity of 80-100% and specificity of 60-80% for detecting a mutation in an MMR gene, though the number of suitable studies for determining clinical validity is small. The clinical validity of strategies to exclude those with false-positive tumour test results due to somatic hypermethylation of the MLH1 gene promoter has not been determined. Options include direct methylation testing, and excluding those over the age of 60 who have no concerning family history or clinical features. The clinical utility of Lynch syndrome testing for the index case depends on her age and the MMR gene mutated: the net benefit is lower for those diagnosed at older ages and with less-penetrant MSH6 mutations. To date, women with these features are the majority of those diagnosed through screening unselected endometrial cancer patients but the number of studies is small. Similarly, clinical utility to relatives of the index case is higher if the family's mutation is in MLH1 or MSH2 than for MSH6 or PMS2. Gaps in current evidence include a need for large, prospective studies on unselected endometrial cancer patients, and for health-economic analysis based on appropriate assumptions.
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Affiliation(s)
- Alison Stewart
- (1) McKing Consulting Corp., and (2) Centers for Disease Control and Prevention
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Schneider KI, Schmidtke J. Patient compliance based on genetic medicine: a literature review. J Community Genet 2013; 5:31-48. [PMID: 23934761 DOI: 10.1007/s12687-013-0160-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 07/02/2013] [Indexed: 12/19/2022] Open
Abstract
For this literature review, medical literature data bases were searched for studies on patient compliance after genetic risk assessment. The review focused on conditions where secondary or tertiary preventive options exist, namely cancer syndromes (BRCA-related cancer, HNPCC/colon cancer), hemochromatosis, thrombophilia, smoking cessation, and obesity. As a counterpart, patient compliance was assessed regarding medication adherence and medical advice in some of the most epidemiologically important conditions (including high blood pressure, metabolic syndrome, and coronary heart disease) after receiving medical advice based on nongenetic risk information or a combination of genetic and nongenetic risk information. In the majority of studies based on genetic risk assessments, patients were confronted with predictive rather than diagnostic genetic profiles. Most of the studies started from a knowledge base around 10 years ago when DNA testing was at an early stage, limited in scope and specificity, and costly. The major result is that overall compliance of patients after receiving a high-risk estimate from genetic testing for a given condition is high. However, significant behavior change does not take place just because the analyte is "genetic." Many more factors play a role in the complex process of behavioral tuning. Without adequate counseling and guidance, patients may interpret risk estimates of predictive genetic testing with an increase in fear and anxiety.
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Affiliation(s)
- Kai Insa Schneider
- Institute of Human Genetics, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
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Fu L, Sheng JQ, Li XO, Jin P, Mu H, Han M, Huang JS, Sun ZQ, Li AQ, Wu ZT, Li SR. Mismatch repair gene mutation analysis and colonoscopy surveillance in Chinese Lynch syndrome families. Cell Oncol (Dordr) 2013; 36:225-31. [PMID: 23640085 DOI: 10.1007/s13402-013-0130-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Lynch syndrome (or HNPCC) is a colorectal cancer syndrome caused by germline mutations in either one of the DNA mismatch repair (MMR) genes hMLH1, hMSH2, hMSH6 or hPMS2. Mutations in hMLH1 and hMSH2 are most prevalent. Here we aimed to determine the cancer risk of MMR gene mutation carriers and, in addition, the efficacy of colonoscopy surveillance in Chinese Lynch syndrome family members with and without MMR gene mutations. METHODS A Lynch syndrome family registry encompassing 106 families in Northern China was recently established. Detailed pedigree data for each family were collected and hMLH1 and hMSH2 gene mutation analyses were performed. Germ-line mutations were identified in probands from 42 of these families, and additional genetic analyses were performed in each member of these 42 families to identify mutation and non-mutation carriers. Among the family members included, 180 received colonoscopy and the remaining cases were followed without colonoscopy. RESULTS Overall 54.8 % of the Lynch syndrome family members carried MMR gene mutations, and these mutation carriers exhibited significantly higher colorectal cancer and other Lynch syndrome-associated cancer risks as compared to non-mutation carriers. The cumulative risk for all Lynch syndrome-related cancers at age 70 was 93.8 % for both hMLH1 and hMSH2 mutation carriers, and 81.7 % and 93.1 % for colorectal cancer at this age, respectively. Whereas 43 of 102 (42.2 %) mutation carriers exhibited significant colonoscopy findings, including 10 colorectal cancers, none of 78 non-mutation carriers exhibited significant findings, and no cancers were detected. In addition, in the mutation carriers, colonoscopy surveillance led to the detection of more early stage cancers than in the non-surveillance group (70.0 % versus 36.5 %, p < 0.01). CONCLUSION In Lynch syndrome family members, we recommend pre-symptomatic MMR gene mutation analysis in order to identify high risk individuals for colonoscopy surveillance.
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Affiliation(s)
- Lei Fu
- Department of Gastroenterology, Third Military Medical University and General Hospital of Beijing Military Region, Chongqing, 400038, China
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Burton-Chase AM, Hovick SR, Peterson SK, Marani SK, Vernon SW, Amos CI, Frazier ML, Lynch PM, Gritz ER. Changes in screening behaviors and attitudes toward screening from pre-test genetic counseling to post-disclosure in Lynch syndrome families. Clin Genet 2013; 83:215-20. [PMID: 23414081 PMCID: PMC3833250 DOI: 10.1111/cge.12091] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/03/2013] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to examine colonoscopy adherence and attitudes toward colorectal cancer (CRC) screening in individuals who underwent Lynch syndrome genetic counseling and testing. We evaluated changes in colonoscopy adherence and CRC screening attitudes in 78 cancer-unaffected relatives of Lynch syndrome mutation carriers before pre-test genetic counseling (baseline) and at 6 and 12 months post-disclosure of test results (52 mutation negative and 26 mutation positive). While both groups were similar at baseline, at 12 months post-disclosure, a greater number of mutation-positive individuals had had a colonoscopy compared with mutation-negative individuals. From baseline to 12 months post-disclosure, the mutation-positive group demonstrated an increase in mean scores on measures of colonoscopy commitment, self-efficacy, and perceived benefits of CRC screening, and a decrease in mean scores for perceived barriers to CRC screening. Mean scores on colonoscopy commitment decreased from baseline to 6 months in the mutation-negative group. To conclude, adherence to risk-appropriate guidelines for CRC surveillance improved after genetic counseling and testing for Lynch syndrome. Mutation-positive individuals reported increasingly positive attitudes toward CRC screening after receiving genetic test results, potentially reinforcing longer term colonoscopy adherence.
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Affiliation(s)
- A M Burton-Chase
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Incidence of right-sided colonic tumors (non-appendiceal) in patient's ≥40 years of age presenting with features of acute appendicitis. Int J Surg 2013; 11:301-4. [PMID: 23416535 DOI: 10.1016/j.ijsu.2013.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 01/31/2013] [Accepted: 02/04/2013] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Non-appendiceal tumors can mimic and present with clinical features of acute appendicitis in patients of age 40 years or above. The aim of this prospective study is to investigate the incidence of right-sided (non-appendiceal) colonic tumors in patients presenting with clinical features of acute appendicitis. METHODS A prospective data analysis of 1662 patients using appendectomy database was performed from 2005 to 2011. Patients above age 40 years or older were included. Patients were compared for demographic data, clinical presentation, radiological findings, operative technique & findings, histo-pathological findings and postoperative complications. The primary outcome was incidence of right-sided colonic (non-appendiceal) tumors presenting with features of acute appendicitis. Secondary outcomes measured were, role of diagnostic radiology, negative appendectomy rate, length of stay and changing trends in operative techniques. RESULTS From 1662 patients initially reviewed, only 179 patients (10.77%) age 40 years or above mean (56 ± 11.75), median 54 (40-89), with clinical features of acute appendicitis were included in the final analysis. F:M ratio was (1:1.06). CT scan showed in only 1 patient (1.25%, OR = 0.806, p = 0.695), suspicion of cecal tumor and underwent right hemicolectomy. Histological examination of specimen showed, 2 patients (1.11%, OR = 1.10, p = 0.47) had primary appendiceal tumors, in which one patient was histologically reported as appendiceal mucocele (mucinous cystadenoma with low-grade dysplasia), while the other one had appendeceal carcinoid (Goblet cell carcinoid). In the other tumor group one patient had metastatic involvement of appendix from ovarian tumor. The time to appendectomy in radiological group was delayed by (9.2 ± 3.7 h). 131 (73.1%) had laparoscopic while 48 (26.81%) underwent open appendectomy. The negative appendectomy rate was (1.12%) and 30 days complication rate was (11.73%, p = 0.27). Mean length of stay was 3.54 ± 2.1 days. CONCLUSION Right-sided colonic (cecal) tumors rarely present with features of acute appendicitis. Only those patients with atypical presentation and findings should have pre-operative radiological evaluation.
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Bruwer Z, Futter M, Ramesar R. A mobile colonoscopic unit for lynch syndrome: trends in surveillance uptake and patient experiences of screening in a developing country. J Genet Couns 2013; 22:125-37. [PMID: 23299947 DOI: 10.1007/s10897-012-9523-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 06/21/2012] [Indexed: 01/01/2023]
Abstract
The Genetic and Endoscopic Surveillance Clinic is an annual outreach service offering accessible colonoscopic surveillance to known families with Lynch syndrome living in remote areas of the Western and Northern Cape Province of South Africa. Unfortunately attendance at this outreach clinic has been declining over several years and fewer than a quarter of participants, attending for surveillance, have been adherent with all their recommended screening appointments. Concerns exist for non-adherent individuals as screening can prevent colorectal cancer by removing the precancerous lesion or enabling the treatment of a malignancy at an early stage. This study explored the experience of surveillance from both the non-adherers' and adherers' perspectives and identified unique factors affecting attendance at the outreach clinic. Rates of compliance are calculated for 191 mutation-positive cases of Lynch syndrome, using strict attendance criteria, and compared to figures obtained from self-reported attendance. Non-compliance was under-reported and compliance was exaggerated when basing data on self-reported adherence to recommendations. Specific characteristics of the outreach clinic affecting compliance are identified and recommendations are made to facilitate improvements to the service. These improvements can result in increased compliance with screening regimens and ultimately reduce cancer-related mortality.
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Affiliation(s)
- Zandrè Bruwer
- MRC/UCT Human Genetics Research Unit, Division of Human Genetics, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
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Haq S, Ali S, Mohammad R, Sarkar FH. The complexities of epidemiology and prevention of gastrointestinal cancers. Int J Mol Sci 2012. [PMID: 23202913 PMCID: PMC3497287 DOI: 10.3390/ijms131012556] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cancer epidemiology and prevention is one of the most well studied fields today. The more we can understand about the incidence and pathogenesis of this disease, the better we will be able to prevent it. Effective prevention strategies can decrease the mortality rate of cancer significantly; this is why it is important to delineate the underlying causes. It has been well recognized that genetic mutations, sporadic or hereditary, may lead to increased chance of tumorigenesis. Detecting genetic mutations can lead to the identification of high-risk individuals with hereditary cancer syndromes, which may assist in devising prevention strategies. Further, environmental factors are known to play important roles in epidemiology and suggest prevention tools that could be implemented to reduce cancer incidence and subsequent cancer-associated morbidity and mortality. Chemoprevention has been tried in colon cancer and is finding new advancements in other carcinomas as well. Out of many environmental cancer preventive agents, the most notable developments are the identification of the role of vitamins E, vitamin D and folic acid. Increased consumption of these vitamins has shown to be inversely correlated with cancer risk. This review will highlight important aspects of cancer epidemiology in the most aggressive carcinomas of the gastrointestinal system focusing on colorectal adenocarcinoma and pancreatic adenocarcinoma. Additionally, some of the well-known and evolving aspects of epidemiology of colorectal and pancreatic cancer along with current and new prevention strategies will also be reviewed.
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Affiliation(s)
- Saba Haq
- Department of Pathology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA; E-Mail:
| | - Shadan Ali
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA; E-Mails: (S.A.); (R.M.)
| | - Ramzi Mohammad
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA; E-Mails: (S.A.); (R.M.)
| | - Fazlul H. Sarkar
- Department of Pathology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA; E-Mail:
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA; E-Mails: (S.A.); (R.M.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-313-576-8327; Fax: +1-313-576-8389
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Yurgelun MB, Mercado R, Rosenblatt M, Dandapani M, Kohlmann W, Conrad P, Blanco A, Shannon KM, Chung DC, Terdiman J, Gruber SB, Garber JE, Syngal S, Stoffel EM. Impact of genetic testing on endometrial cancer risk-reducing practices in women at risk for Lynch syndrome. Gynecol Oncol 2012; 127:544-51. [PMID: 22940489 DOI: 10.1016/j.ygyno.2012.08.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/17/2012] [Accepted: 08/19/2012] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Due to the increased lifetime risk of endometrial cancer (EC), guidelines recommend that women with Lynch syndrome (LS) age ≥ 35 undergo annual EC surveillance or prophylactic hysterectomy (PH). The aim of this study was to examine the uptake of these risk-reducing strategies. METHODS The study population included women meeting clinical criteria for genetic evaluation for LS. Data on cancer risk-reducing behaviors were collected from subjects enrolled in two distinct studies: (1) a multicenter cross-sectional study involving completion of a one-time questionnaire, or (2) a single-center longitudinal study in which subjects completed questionnaires before and after undergoing genetic testing. The main outcome was uptake of EC risk-reducing practices. RESULTS In the cross-sectional cohort, 58/77 (75%) women at risk for LS-associated EC reported engaging in EC risk-reduction. Personal history of genetic testing was associated with uptake of EC surveillance or PH (OR 17.1; 95% CI 4.1-70.9). Prior to genetic testing for LS, 26/40 (65%) women in the longitudinal cohort reported engaging in EC risk-reduction. At one-year follow-up, 16/16 (100%) mismatch repair (MMR) gene mutation carriers were adherent to guidelines for EC risk-reduction, 9 (56%) of whom had undergone PH. By three-year follow-up, 11/16 (69%) MMR mutation carriers had undergone PH. Among women with negative or uninformative genetic test results, none underwent PH after testing. CONCLUSIONS Genetic testing for LS is strongly associated with uptake of EC risk-reducing practices. Women found to have LS in this study underwent prophylactic gynecologic surgery at rates comparable to those published for BRCA1/2 mutation carriers.
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James AS, Chisholm P, Wolin KY, Baxter M, Kaphingst K, Davidson NO. Screening and Health Behaviors among Persons Diagnosed with Familial Adenomatous Polyposis and Their Relatives. J Cancer Epidemiol 2012; 2012:506410. [PMID: 22899922 PMCID: PMC3414059 DOI: 10.1155/2012/506410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 06/08/2012] [Accepted: 06/19/2012] [Indexed: 01/02/2023] Open
Abstract
Familial Adenomatous Polyposis (FAP) is a rare autosomal dominantly inherited colorectal cancer syndrome. Individuals with FAP often undergo colectomy and are recommended to follow several surveillance protocols. Biological relatives of persons with FAP may also be at risk and thus should undergo genetic counseling. Screening adherence, genetic testing, and other health behaviors among individuals with FAP and their relatives are not well characterized. We conducted a cross-sectional self-report survey with individuals who have FAP (n = 35) and their biological relatives (n = 15). Respondents were recruited through a cancer center registry for inherited colon cancers. Most relatives had undergone colon cancer screening; 40% had undergone genetic testing. One fifth of respondents with FAP had not undergone an upper endoscopy, contrary to usual recommendations. Cigarette smoking rates were above average and were higher among FAP respondents. Use of vitamin supplements was fairly common, more so among those with FAP. Although most people had been screened, there are areas for improvement, notably for upper endoscopy among individuals with FAP and genetic testing among family members. Several other health-risk behaviors and health concerns other than FAP were identified. Further research into factors contributing to screening rates and other health behaviors in this high-risk population is warranted.
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Affiliation(s)
- Aimee S. James
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis, 660 So. Euclid Avenue, P.O. Box 8100, Saint Louis, MO 63110, USA
| | - Phillip Chisholm
- Department of Medicine, Washington University in Saint Louis, 4950 Children's place St. Louis, MO 63110, USA
| | - Kathleen Y. Wolin
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis, 660 So. Euclid Avenue, P.O. Box 8100, Saint Louis, MO 63110, USA
| | - Melanie Baxter
- Siteman Cancer Center, Washington University in Saint Louis, 660 So. Euclid Avenue, P.O. Box 8100, Saint Louis, MO 63110, USA
| | - Kimberly Kaphingst
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis, 660 So. Euclid Avenue, P.O. Box 8100, Saint Louis, MO 63110, USA
| | - Nicholas O. Davidson
- Division of Gastroenterology, Department of Medicine, Washington University in Saint Louis, 660 So. Euclid Avenue, P.O. Box 8124, Saint Louis, MO 63110, USA
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