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Ferretti S, Sassoli de Bianchi P, Canuti D, Campari C, Cortesi L, Arcangeli V, Barbieri E, D'Aloia C, Danesi R, De Iaco P, De Lillo M, Lombardo L, Moretti G, Musolino A, Palli D, Palmonari C, Ravegnani M, Tafà A, Tononi A, Turchetti D, Zamagni C, Zampiga V, Bucchi L, The Hboc Study Group. Evaluation of an Italian Population-Based Programme for Risk Assessment and Genetic Counselling and Testing for BRCA1/2-Related Hereditary Breast and Ovarian Cancer after 10 Years of Operation: An Observational Study Protocol. Methods Protoc 2024; 7:63. [PMID: 39195440 DOI: 10.3390/mps7040063] [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: 06/25/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024] Open
Abstract
Hereditary breast/ovarian cancer (HBOC) syndrome is caused by the inheritance of monoallelic germline BRCA1/2 gene mutations. If BRCA1/2 mutation carriers are identified before the disease develops, effective actions against HBOC can be taken, including intensive screening, risk-reducing mastectomy and salpingo-oophorectomy, and risk-reducing medications. The Italian National Prevention Plan mandates the creation of regional BRCA genetic testing programmes. So far, however, only informal data have been reported on their implementation. We have designed a study aimed at evaluating the results of a population-based programme for risk assessment and genetic counselling and testing for BRCA1/2-related HBOC that is underway in the Emilia-Romagna region (northern Italy). The programme-which is entirely free-includes basic screening with an estimate of the likelihood of carrying a BRCA1/2 mutation using a familial risk assessment tool, a closer examination of women with suspected risk increase, an assessment of the need for further genetic counselling and, if needed, genetic testing and risk-reducing interventions. In this paper, the design of the programme and the protocol of the study are presented. The study has an observational, historical cohort design. Eligible are the women found to be at an increased risk of HBOC (profile 3 women). The main objectives are (i) to determine the precision of the programme in measuring the level of risk of HBOC for profile 3 women; (ii) to determine the characteristics of profile 3 women and their association with the risk management strategy chosen; (iii) to compare the age at onset, histologic type, tumour stage, molecular subtype, and prognosis of breast/ovarian cancers observed in the cohort of profile 3 women with the features of sporadic cancers observed in the general female population; (iv) to determine the level and the determinants of adherence to recommendations; and (v) to determine the appropriateness and timing of risk-reducing surgery and medications. Investigating the quality and results of the programme is necessary because the best practices in risk assessment and genetic counselling and testing for BRCA1/2-related cancer and the challenges they encounter should be identified and shared. The study has the potential to provide sound empirical evidence for the factors affecting the effectiveness of this type of service.
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Affiliation(s)
- Stefano Ferretti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy
- Local Health Authority, 44121 Ferrara, Italy
| | | | - Debora Canuti
- Department of Health, Emilia-Romagna Region, 40127 Bologna, Italy
| | - Cinzia Campari
- Azienda USL, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Laura Cortesi
- Struttura di Genetica Oncologica, Dipartimento di Oncologia ed Ematologia, AOU Policlinico di Modena, 41125 Modena, Italy
| | - Valentina Arcangeli
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, 47014 Forlì, Italy
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Italy
| | - Elena Barbieri
- Struttura di Oncologia, Dipartimento di Oncologia ed Ematologia, AOU Policlinico di Modena, 41125 Modena, Italy
| | - Cecilia D'Aloia
- Section of Radiology and Breast Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Rita Danesi
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, 47014 Forlì, Italy
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | | | | | - Antonino Musolino
- Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
- Medical Oncology, Breast Unit and Cancer Genetics Service, University Hospital of Parma, 43126 Parma, Italy
| | - Dante Palli
- UOC Chirurgia Generale a Indirizzo Senologico and Breast Unit, 29121 Piacenza, Italy
| | - Caterina Palmonari
- Cancer Screening Centre and Spoke Centre, AUSL Ferrara, 44121 Ferrara, Italy
| | - Mila Ravegnani
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, 47014 Forlì, Italy
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Italy
| | - Alfredo Tafà
- UOC Senologia, Ospedale Bellaria, AUSL Bologna, 40139 Bologna, Italy
| | - Alessandra Tononi
- Unità Operativa di Prevenzione Oncologica, Ospedale Infermi, 47923 Rimini, Italy
| | - Daniela Turchetti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Valentina Zampiga
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Italy
| | - Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, 47014 Forlì, Italy
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2
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Yi H, Trivedi MS, Crew KD, Schechter I, Appelbaum P, Chung WK, Allegrante JP, Kukafka R. Understanding Social, Cultural, and Religious Factors Influencing Medical Decision-Making on BRCA1/2 Genetic Testing in the Orthodox Jewish Community. Public Health Genomics 2024; 27:57-67. [PMID: 38402864 DOI: 10.1159/000536391] [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: 07/19/2023] [Accepted: 01/10/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Although the prevalence of a pathogenic variant in the BRCA1 and BRCA2 genes is about 1:400 (0.25%) in the general population, the prevalence is as high as 1:40 (2.5%) among the Ashkenazi Jewish population. Despite cost-effective preventive measures for mutation carriers, Orthodox Jews constitute a cultural and religious group that requires different approaches to BRCA1 and BRCA2 genetic testing relative to other groups. This study analyzed a dialog of key stakeholders and community members to explore factors that influence decision-making about BRCA1 and BRCA2 genetic testing in the New York Orthodox Jewish community. METHODS Qualitative research methods, based on Grounded Theory and Narrative Research, were utilized to analyze the narrative data collected from 49 key stakeholders and community members. A content analysis was conducted to identify themes; inter-rater reliability was 71%. RESULTS Facilitators of genetic testing were a desire for preventive interventions and education, while barriers to genetic testing included negative emotions, feared impact on family/romantic relationships, cost, and stigma. Views differed on the role of religious leaders and healthcare professionals in medical decision-making. Education, health, and community were discussed as influential factors, and concerns were expressed about disclosure, implementation, and information needs. CONCLUSION This study elicited the opinions of Orthodox Jewish women (decision-makers) and key stakeholders (influencers) who play critical roles in the medical decision-making process. The findings have broad implications for engaging community stakeholders within faith-based or culturally distinct groups to ensure better utilization of healthcare services for cancer screening and prevention designed to improve population health.
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Affiliation(s)
- Haeseung Yi
- Department of Health Studies and Applied Educational Psychology, Teachers College, Columbia University, New York, New York, USA,
| | - Meghna S Trivedi
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Katherine D Crew
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Isaac Schechter
- Achieve Behavioral Health, Monsey, New York, USA
- Institute for Applied Research and Community Collaboration (ARCC), Spring Valley, New York, USA
| | - Paul Appelbaum
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Center for Law, Ethics and Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Wendy K Chung
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - John P Allegrante
- Department of Health Studies and Applied Educational Psychology, Teachers College, Columbia University, New York, New York, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Rita Kukafka
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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3
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Tiller JM, Cousens NE, Kaur R, Rowley S, Ko YA, Mahale S, Bankier A, Meiser B, Barlow-Stewart K, Burnett L, Jacobs C, James P, Trainer A, Neil S, Campbell IG, Andrews L, Delatycki M. Population-based BRCA1/2 testing programmes are highly acceptable in the Jewish community: results of the JeneScreen Study. J Med Genet 2023; 60:265-273. [PMID: 36763037 DOI: 10.1136/jmedgenet-2022-108519] [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: 02/17/2022] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ashkenazi Jewish (AJ) people have a higher incidence of BRCA1/2 pathogenic variants (PVs) than unselected populations. Three BRCA-Jewish founder mutations (B-JFMs) comprise >90% of BRCA1/2 PVs in AJ people. Personal/family cancer history-based testing misses ≥50% of people with B-JFM. METHODS We compared two population-based B-JFM screening programmes in Australia-using (1) an online tool (Sydney) and (2) in-person group sessions (Melbourne). RESULTS Of 2167 Jewish people tested (Sydney n=594; Melbourne n=1573), 1.3% (n=28) have a B-JFM, only 2 of whom had a significant cancer family history (Manchester score ≥12). Pretest anxiety scores were normal (mean 9.9±3.5 (6-24)), with no significant post-result change (9.5±3.3). Decisional regret (mean 7.4±13.0 (0-100)), test-related distress (mean 0.8+/2.2 (0-30)) and positive experiences (reverse-scored) (mean 3.4±4.5 (1-20)) scores were low, with no significant differences between Sydney and Melbourne participants. Post-education knowledge was good overall (mean 11.8/15 (±2.9)) and significantly higher in Melbourne than Sydney. Post-result knowledge was the same (mean 11.7 (±2.4) vs 11.2 (±2.4)). Participants with a B-JFM had higher post-result anxiety and test-related distress and lower positive experiences, than those without a B-JFM, but scores were within the normal range. Family cancer history did not significantly affect knowledge or anxiety, or pretest perception of B-JFM or cancer risks. Most participants (93%) were satisfied/very satisfied with the programme. CONCLUSION Both B-JFM screening programmes are highly acceptable to Australian Jewish communities. The programme enabled identification of several individuals who were previously unaware they have a B-JFM, many of whom would have been ineligible for current criteria-based testing in Australia.
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Affiliation(s)
- Jane M Tiller
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Victorian Clinical Genetics Services, Parkville, Victoria, Australia
| | - Nicole E Cousens
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Hereditary Cancer Centre, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Rajneesh Kaur
- University of New South Wales, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Simone Rowley
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Yi-An Ko
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Sakshi Mahale
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Agnes Bankier
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Leslie Burnett
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Paul James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Genomic Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alison Trainer
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Institute, Parkville, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | | | - Ian G Campbell
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Lesley Andrews
- University of New South Wales, Sydney, New South Wales, Australia
| | - Martin Delatycki
- Murdoch Children's Research Institute, Parkville, Victoria, Australia .,Victorian Clinical Genetics Services, Parkville, Victoria, Australia
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Bell KA, Kim R, Aronson M, Gillies B, Ali Awan A, Chun K, Hart J, Healey R, Kim L, Klaric G, Panabaker K, Sabatini PJB, Sadikovic B, Selvarajah S, Smith AC, Stockley TL, Vaags AK, Eisen A, Pollett A, Feilotter H. Development of a comprehensive approach to adult hereditary cancer testing in Ontario. J Med Genet 2022:jmg-2022-108945. [PMID: 36564171 DOI: 10.1136/jmg-2022-108945] [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: 09/16/2022] [Accepted: 12/10/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Genetic testing for hereditary cancer susceptibility has advanced over time due to the discovery of new risk genes, improved technology and decreased cost. In the province of Ontario, testing eligibility criteria were initially developed to include hereditary breast, ovarian and colorectal cancer syndromes. The rapid evolution of genetic technologies has facilitated the ability to interrogate a large number of genes concurrently. This, coupled with new knowledge about risk genes, necessitated a coordinated approach to expanding the scope of genes and indications tested and synchronisation of access and test utilisation across the province as required in a publicly funded universal healthcare system. METHODS Ontario Health-Cancer Care Ontario convened expert working groups to develop a standardised and comprehensive cancer gene list for adults and accompanying hereditary cancer testing (HCT) criteria using an evidence-based framework and broad laboratory and clinical genetics engagement. RESULTS A standardised 76-cancer-gene panel, organised into 13 larger disease site panels and 25 single/small gene panels, was developed and endorsed by the working groups. Provincial genetic testing eligibility criteria were updated to align with the new panels and to guide clinical decision-making. In the first year following the implementation of these changes, 10 564 HCT panels were performed with an overall mutation detection rate of 12.2%. CONCLUSION Using an evidence framework and broad clinical engagement to develop and endorse an updated guidance document, cancer genetic testing for adults in Ontario is now standardised and coordinated across the province.
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Affiliation(s)
| | - Raymond Kim
- Division of Medical Oncology and Hematology, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Brittany Gillies
- Familial Cancer Clinic, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Arif Ali Awan
- Division of Medical Oncology, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Kathy Chun
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Hart
- Pathology and Laboratory Medicine Program, Ontario Health, Toronto, Ontario, Canada
| | - Rachel Healey
- Pathology and Laboratory Medicine Program, Ontario Health, Toronto, Ontario, Canada
| | - Linda Kim
- Department of Laboratory Medicine and Genetics, Credit Valley Hospital Site, Mississauga, Ontario, Canada
| | - Goran Klaric
- Pathology and Laboratory Medicine Program, Ontario Health, Toronto, Ontario, Canada
| | - Karen Panabaker
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | | | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.,Verspeeten Clinical Genome Centre, Western University, London, Ontario, Canada
| | - Shamini Selvarajah
- Department of Clinical Laboratory Genetics, University Health Network, Toronto, Ontario, Canada
| | | | - Tracy L Stockley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Andrea K Vaags
- Laboratory Medicine and Genetics, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Andrea Eisen
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Aaron Pollett
- Pathology and Laboratory Medicine Program, Ontario Health, Toronto, Ontario, Canada.,Division of Diagnostic Medical Genetics, Sinai Health System, Toronto, Ontario, Canada
| | - Harriet Feilotter
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
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5
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Mighton C, Shickh S, Aguda V, Krishnapillai S, Adi-Wauran E, Bombard Y. From the patient to the population: Use of genomics for population screening. Front Genet 2022; 13:893832. [PMID: 36353115 PMCID: PMC9637971 DOI: 10.3389/fgene.2022.893832] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/26/2022] [Indexed: 10/22/2023] Open
Abstract
Genomic medicine is expanding from a focus on diagnosis at the patient level to prevention at the population level given the ongoing under-ascertainment of high-risk and actionable genetic conditions using current strategies, particularly hereditary breast and ovarian cancer (HBOC), Lynch Syndrome (LS) and familial hypercholesterolemia (FH). The availability of large-scale next-generation sequencing strategies and preventive options for these conditions makes it increasingly feasible to screen pre-symptomatic individuals through public health-based approaches, rather than restricting testing to high-risk groups. This raises anew, and with urgency, questions about the limits of screening as well as the moral authority and capacity to screen for genetic conditions at a population level. We aimed to answer some of these critical questions by using the WHO Wilson and Jungner criteria to guide a synthesis of current evidence on population genomic screening for HBOC, LS, and FH.
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Affiliation(s)
- Chloe Mighton
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Salma Shickh
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Vernie Aguda
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Suvetha Krishnapillai
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ella Adi-Wauran
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Yvonne Bombard
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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6
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Lima SM, Nazareth M, Schmitt KM, Reyes A, Fleck E, Schwartz GK, Terry MB, Hillyer GC. Interest in genetic testing and risk-reducing behavioral changes: results from a community health assessment in New York City. J Community Genet 2022; 13:605-617. [PMID: 36227532 DOI: 10.1007/s12687-022-00610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/29/2022] [Indexed: 11/25/2022] Open
Abstract
Risk-based genetic tests are often used to determine cancer risk, when to initiate screening, and frequency of screening, but rely on interest in genetic testing. We examined overall interest in genetic testing for cancer risk assessment and willingness to change behavior, and whether these are affected by demographic or socioeconomic factors.We conducted a community needs health survey in 2019 among primary care and cancer patients, family members and community members in New York City. We used univariable analysis and relative risk regression to examine interest in genetic cancer risk testing and willingness to modify lifestyle behaviors in response to an informative genetic test.Of the 1225 participants, 74.0% (n = 906) expressed interest in having a genetic test to assess cancer risk. Interest in genetic testing was high across all demographic and socioeconomic groups; reported interest in genetic testing by group ranged from 65.0 (participants aged 65 years and older) to 83.6% (participants below federal poverty level). Among the 906 participants that reported interest in genetic testing, 79.6% were willing to change eating habits, 66.5% to change exercise habits, and 49.5% to lose weight in response to an informative genetic test result.Our study reveals that interest in genetic testing for cancer risk is high among patients and community members and is high across demographic and socioeconomic groups, as is the reported willingness to change behavior. Based on these results, we recommend that population-based genetic testing may result in greater reduction cancer risk, particularly among minoritized groups.
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Affiliation(s)
- Sarah M Lima
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY, USA
| | - Meaghan Nazareth
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY, USA
| | - Karen M Schmitt
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Division of Community and Population Health, New York Presbyterian Hospital, New York, NY, USA
| | - Andria Reyes
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Elaine Fleck
- Division of Community and Population Health, New York Presbyterian Hospital, New York, NY, USA
| | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Hematology and Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Mary Beth Terry
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Grace C Hillyer
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA.
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7
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Gynecologic Cancer Risk and Genetics: Informing an Ideal Model of Gynecologic Cancer Prevention. Curr Oncol 2022; 29:4632-4646. [PMID: 35877228 PMCID: PMC9322111 DOI: 10.3390/curroncol29070368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/09/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Individuals with proven hereditary cancer syndrome (HCS) such as BRCA1 and BRCA2 have elevated rates of ovarian, breast, and other cancers. If these high-risk people can be identified before a cancer is diagnosed, risk-reducing interventions are highly effective and can be lifesaving. Despite this evidence, the vast majority of Canadians with HCS are unaware of their risk. In response to this unmet opportunity for prevention, the British Columbia Gynecologic Cancer Initiative convened a research summit “Gynecologic Cancer Prevention: Thinking Big, Thinking Differently” in Vancouver, Canada on 26 November 2021. The aim of the conference was to explore how hereditary cancer prevention via population-based genetic testing could decrease morbidity and mortality from gynecologic cancer. The summit invited local, national, and international experts to (1) discuss how genetic testing could be more broadly implemented in a Canadian system, (2) identify key research priorities in this topic and (3) outline the core essential elements required for such a program to be successful. This report summarizes the findings from this research summit, describes the current state of hereditary genetic programs in Canada, and outlines incremental steps that can be taken to improve prevention for high-risk Canadians now while developing an organized population-based hereditary cancer strategy.
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8
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Frey MK, Finch A, Kulkarni A, Akbari MR, Chapman-Davis E. Genetic Testing for All: Overcoming Disparities in Ovarian Cancer Genetic Testing. Am Soc Clin Oncol Educ Book 2022; 42:1-12. [PMID: 35452249 DOI: 10.1200/edbk_350292] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nearly 3% of the population carries genetic variants that lead to conditions that include hereditary breast and ovarian cancer and Lynch syndrome. These pathogenic variants account for approximately 20% of ovarian cancer cases, and those with germline pathogenic variants have an odds ratio between 4 and 40 for developing ovarian cancer compared with noncarriers. Given the high prevalence of genetic variants, multiple organizations, including ASCO, recommend universal genetic counseling and testing for women diagnosed with epithelial ovarian cancer. Unfortunately, most individuals with a hereditary ovarian cancer syndrome are unaware of their underlying mutation, and racial and ethnic minority individuals as well as patients of low socioeconomic status experience disproportionate rates of underrecognition, leading to late and missed diagnoses. In this article, we review the current understanding of disparities in genetic testing for people with ovarian cancer, the role of population-based genetic testing, and innovative strategies to overcome the critical inequities present in current cancer genetic medicine. Underuse and disparities related to accessing recommended genetic services are complex and multifactorial, requiring improvements in processes related to provider identification, genetic counseling and testing referral, and patient uptake/adherence. Through the expansion of remote genetic counseling, offering online strategies for genetic testing, and reaching at-risk relatives through direct relative contact cascade testing and population-based genetic testing, there are a growing number of innovations in the field of genetic medicine, many of which emphasize health equity and offer promising alternatives to the current paradigm of genetic testing.
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Affiliation(s)
- Melissa K Frey
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
| | - Amy Finch
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Amita Kulkarni
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
| | - Mohammad R Akbari
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eloise Chapman-Davis
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
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9
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Finch A, Metcalfe K, Akbari M, Friedman E, Tung N, Rosen B, Eisen A, Karlan B, Foulkes W, Neuhausen SL, Senter L, McKinnon W, Elser C, Sun P, Narod SA. The Risks of Breast and Ovarian Cancer Associated with the Ashkenazi Jewish Founder Allele BRCA2 6174delT. Clin Genet 2021; 101:317-323. [PMID: 34897671 DOI: 10.1111/cge.14098] [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: 10/18/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
Approximately one percent of the Ashkenazi Jewish population carries the BRCA2 6174delT (c.5946del) pathogenic variant. It is important to have accurate knowledge of the risks of breast and ovarian cancer associated with this specific variant so that women may be counselled accordingly. In this prospective study, we estimated the risks of breast and ovarian cancer associated with the 6174delT variant compared with the risks for other pathogenic variants in the BRCA2 gene. The annual risk for developing breast cancer was significantly lower in 246 women who carried the 6174delT variant compared with 721 non-Jewish women who carried a variant at any other locus in BRCA2 (1.2% per year vs. 2.4% per year, p=0.003). We estimated the cumulative risk of breast cancer from age 30 to 70 to be 39% for carriers of the BRCA2 6174delT variant and 61% for carriers of other BRCA2 variants. The annual risk for ovarian or fallopian tube cancer was 0.51% per year for the 233 women who carried the 6174delT variant compared to 0.22% per year for the 1128 carriers of other BRCA2 variants; the difference was not significant. Lower risks for breast cancer associated with 6174delT may not impact screening and prevention choices, however, the discussion should be based on accurate risk assessment.
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Affiliation(s)
- Amy Finch
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Kelly Metcalfe
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Mohammad Akbari
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Eitan Friedman
- The Meiray Center High Risk Clinic, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Nadine Tung
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Andrea Eisen
- Toronto-Sunnybrook Regional Cancer Center, Toronto, ON, Canada
| | - Beth Karlan
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - William Foulkes
- Program in Cancer Genetics, Department of Oncology and Human Genetics, McGill University, Montréal, QC, Canada
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Leigha Senter
- Division of Human Genetics, the Ohio State University Medical Center, Comprehensive Cancer Center, Columbus, OH, USA
| | - Wendy McKinnon
- Familial Cancer Program, University of Vermont Medical Center, Burlington, Vermont
| | - Christine Elser
- Marvelle Koffler Breast Centre, Mt. Sinai Hospital, Toronto, ON, Canada
| | - Ping Sun
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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10
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Morgan KM, Hamilton JG, Symecko H, Kamara D, Jenkins C, Lester J, Spielman K, Pace LE, Gabriel C, Levin JD, Tejada PR, Braswell A, Marcell V, Wildman T, Devolder B, Baum RC, Block JN, Fesko Y, Boehler K, Howell V, Heitler J, Robson ME, Nathanson KL, Tung N, Karlan BY, Domchek SM, Garber JE, Offit K. Targeted BRCA1/2 population screening among Ashkenazi Jewish individuals using a web-enabled medical model: An observational cohort study. Genet Med 2021; 24:564-575. [PMID: 34906490 DOI: 10.1016/j.gim.2021.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE This study aimed to evaluate uptake and follow-up using internet-assisted population genetic testing (GT) for BRCA1/2 Ashkenazi Jewish founder pathogenic variants (AJPVs). METHODS Across 4 cities in the United States, from December 2017 to March 2020, individuals aged ≥25 years with ≥1 Ashkenazi Jewish grandparent were offered enrollment. Participants consented and enrolled online with chatbot and video education, underwent BRCA1/2 AJPV GT, and chose to receive results from their primary care provider (PCP) or study staff. Surveys were conducted at baseline, at 12 weeks, and annually for 5 years. RESULTS A total of 5193 participants enrolled and 4109 (79.1%) were tested (median age = 54, female = 77.1%). Upon enrollment, 35.1% of participants selected a PCP to disclose results, and 40.5% of PCPs agreed. Of those tested, 138 (3.4%) were AJPV heterozygotes of whom 21 (15.2%) had no significant family history of cancer, whereas 86 (62.3%) had a known familial pathogenic variant. At 12 weeks, 85.5% of participants with AJPVs planned increased cancer screening; only 3.7% with negative results and a significant family history reported further testing. CONCLUSION Although continued follow-up is needed, internet-enabled outreach can expand access to targeted GT using a medical model. Observed challenges for population genetic screening efforts include recruitment barriers, improving PCP engagement, and increasing uptake of additional testing when indicated.
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Affiliation(s)
| | | | - Heather Symecko
- Department of Medicine and Basser Center for BRCA, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniella Kamara
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Colby Jenkins
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA
| | - Jenny Lester
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Kelsey Spielman
- Department of Medicine and Basser Center for BRCA, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lydia E Pace
- Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | | | | | - Anthony Braswell
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | | | | | | | | | | | | | | | | | | | - Mark E Robson
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine L Nathanson
- Department of Medicine and Basser Center for BRCA, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nadine Tung
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Beth Y Karlan
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Susan M Domchek
- Department of Medicine and Basser Center for BRCA, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, New York, NY.
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11
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Brothers C, Etchegary H, Curtis F, Simmonds C, Houston J, Young TL, Pullman D, Mariathas HH, Connors S, Hodgkinson K. Psychological Distress and Quality of Life in Participants Undergoing Genetic Testing for Arrhythmogenic Right Ventricular Cardiomyopathy Caused by TMEM43 p.S358L: Is It Time to Offer Population-Based Genetic Screening? Public Health Genomics 2021; 24:253-260. [PMID: 34500452 DOI: 10.1159/000517265] [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: 11/17/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE We have identified 27 families in Newfoundland and Labrador (NL) with the founder variant TMEM43 p.S358L responsible for 1 form of arrhythmogenic right ventricular cardiomyopathy. Current screening guidelines rely solely on cascade genetic screening, which may result in unrecognized, high-risk carriers who would benefit from preemptive implantable cardioverter-defibrillator therapy. This pilot study explored the acceptability among subjects to TMEM43 p.S358L population-based genetic screening (PBGS) in this Canadian province. METHODS A prospective cohort study assessed attitudes, psychological distress, and health-related quality of life (QOL) in unselected individuals who underwent genetic screening for the TMEM43 p.S358L variant. Participants (n = 73) were recruited via advertisements and completed 2 surveys at baseline, 6 months, and 1 year which measured health-related QOL (SF-36v2) and psychological distress (Impact of Events Scale). RESULTS No variant-positive carriers were identified. Of those screened through a telephone questionnaire, >95% felt positive about population-genetic screening for TMEM43 p.S358L, though 68% reported some degree of anxiety after seeing the advertisement. There were no significant changes in health-related QOL or psychological distress scores over the study period. CONCLUSION Despite some initial anxiety, we show support for PBGS among research subjects who screened negative for the TMEM43 p.S358L variant in NL. These findings have implications for future PBGS programs in the province.
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Affiliation(s)
- Cassidy Brothers
- Postgraduate Medical Education, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Holly Etchegary
- Unit of Clinical Epidemiology, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Fiona Curtis
- Provincial Medical Genetics Program, Eastern Regional Health Authority, St. John's, Newfoundland, Canada
| | - Charlene Simmonds
- Health Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Jim Houston
- Discipline of Genetics, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Terry-Lynn Young
- Discipline of Genetics, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Daryl Pullman
- Centre for Bioethics, Memorial University, St. John's, Newfoundland, Canada
| | - Hensley H Mariathas
- Strategy for Patient-Oriented Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Sean Connors
- Division of Cardiology, Eastern Regional Health Authority, St. John's, Newfoundland, Canada
| | - Kathleen Hodgkinson
- Unit of Clinical Epidemiology, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada.,Provincial Medical Genetics Program, Eastern Regional Health Authority, St. John's, Newfoundland, Canada
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12
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Cousens NE, Tiller J, Meiser B, Barlow-Stewart K, Rowley S, Ko YA, Mahale S, Campbell IG, Kaur R, Bankier A, Burnett L, Jacobs C, James PA, Trainer A, Neil S, Delatycki MB, Andrews L. Evaluation of two population screening programmes for BRCA1/2 founder mutations in the Australian Jewish community: a protocol paper. BMJ Open 2021; 11:e041186. [PMID: 34172541 PMCID: PMC8237737 DOI: 10.1136/bmjopen-2020-041186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION People of Ashkenazi Jewish (AJ) ancestry are more likely than unselected populations to have a BRCA1/2 pathogenic variant, which cause a significantly increased risk of breast, ovarian and prostate cancer. Three specific BRCA1/2 pathogenic variants, referred to as BRCA-Jewish founder mutations (B-JFM), account for >90% of BRCA1/2 pathogenic variants in people of AJ ancestry. Current practice of identifying eligible individuals for BRCA testing based on personal and/or family history has been shown to miss at least 50% of people who have one of these variants. Here we describe the protocol of the JeneScreen study-a study established to develop and evaluate two different population-based B-JFM screening programmes, offered to people of Jewish ancestry in Sydney and Melbourne, Australia. METHODS AND ANALYSIS To rmeasure the acceptability of population-based B-JFM screening in Australia, two screening programmes using different methodologies have been developed. The Sydney JeneScreen programme provides information and obtains informed consent by way of an online tool. The Melbourne JeneScreen programme does this by way of community sessions attended in person. Participants complete questionnaires to measure clinical and psychosocial outcomes at baseline, and for those who have testing, 2 weeks postresult. Participants who decline testing are sent a questionnaire regarding reasons for declining. Participants with a B-JFM are sent questionnaires 12-month and 24-month post-testing. The questionnaires incorporate validated scales, which measure anxiety, decisional conflict and regret, and test-related distress and positive experiences, and other items specifically developed or adapted for the study. These measures will be assessed for each programme and the two population-based B-JFM screening methods will be compared. ETHICS AND DISSEMINATION Institutional Human Research Ethics Committee approval was obtained from the South Eastern Area Health Service Human Research Ethics Committee: HREC Ref 16/125.Following the analysis of the study results, the findings will be disseminated widely through conferences and publications, and directly to participants in writing.
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Affiliation(s)
- Nicole E Cousens
- Hereditary Cancer Centre, Prince of Wales Hospital Cancer Services, Randwick, New South Wales, Australia
- UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Jane Tiller
- Victorian Clinical Genetics Services Ltd, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Bettina Meiser
- UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | | | - Simone Rowley
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Yi-An Ko
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Sakshi Mahale
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Ian G Campbell
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Rajneesh Kaur
- Medical Education Office, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Agnes Bankier
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Leslie Burnett
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Chris Jacobs
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Paul A James
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Alison Trainer
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, New South Wales, Australia
| | - Suzanne Neil
- Epworth Hospital, Melbourne, Victoria, Australia
| | - Martin B Delatycki
- Victorian Clinical Genetics Services Ltd, Parkville, Victoria, Australia
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Lesley Andrews
- Hereditary Cancer Centre, Prince of Wales Hospital Cancer Services, Randwick, New South Wales, Australia
- UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
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13
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Tennen RI, Laskey SB, Koelsch BL, McIntyre MH, Tung JY. Identifying Ashkenazi Jewish BRCA1/2 founder variants in individuals who do not self-report Jewish ancestry. Sci Rep 2020; 10:7669. [PMID: 32376921 PMCID: PMC7203114 DOI: 10.1038/s41598-020-63466-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 03/27/2020] [Indexed: 12/15/2022] Open
Abstract
Current guidelines recommend BRCA1 and BRCA2 genetic testing for individuals with a personal or family history of certain cancers. Three BRCA1/2 founder variants - 185delAG (c.68_69delAG), 5382insC (c.5266dupC), and 6174delT (c.5946delT) - are common in the Ashkenazi Jewish population. We characterized a cohort of more than 2,800 research participants in the 23andMe database who carry one or more of the three Ashkenazi Jewish founder variants, evaluating two characteristics that are typically used to recommend individuals for BRCA testing: self-reported Jewish ancestry and family history of breast, ovarian, prostate, or pancreatic cancer. Of the 1,967 carriers who provided self-reported ancestry information, 21% did not self-report Jewish ancestry; of these individuals, more than half (62%) do have detectable Ashkenazi Jewish genetic ancestry. In addition, of the 343 carriers who provided both ancestry and family history information, 44% did not have a first-degree family history of a BRCA-related cancer and, in the absence of a personal history of cancer, would therefore be unlikely to qualify for clinical genetic testing. These findings may help inform the discussion around broader access to BRCA genetic testing.
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Affiliation(s)
- Ruth I Tennen
- 23andMe, Inc., 223 N Mathilda Ave, Sunnyvale, CA, 94086, USA
| | - Sarah B Laskey
- 23andMe, Inc., 223 N Mathilda Ave, Sunnyvale, CA, 94086, USA
| | | | | | - Joyce Y Tung
- 23andMe, Inc., 223 N Mathilda Ave, Sunnyvale, CA, 94086, USA.
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14
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Evans O, Gaba F, Manchanda R. Population-based genetic testing for Women's cancer prevention. Best Pract Res Clin Obstet Gynaecol 2020; 65:139-153. [PMID: 32245629 DOI: 10.1016/j.bpobgyn.2020.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/26/2020] [Indexed: 12/15/2022]
Abstract
Germline mutations in cancer-susceptibility-genes (CSG) can dramatically increase womens' lifetime risk of ovarian, endometrial, breast and bowel cancers. Identification of unaffected carriers is important to enable proactive engagement with highly effective screening and preventive options to minimise cancer risk. Currently, a family-history model is used to identify individuals with CSGs. Complex regional referral guidelines specify the family-history criteria required before an individual is eligible for genetic-testing. This model is ineffective, resource intense, misses >50% CSG carriers, is associated with underutilisation of genetic-testing services and delays detection of mutation carriers. Although awareness and detection of CSG-carriers has improved, over 97% carriers remain unidentified. This reflects significant missed opportunities for precision-prevention. Population-based genetic-testing (PBGT) represents a novel healthcare strategy with the potential to dramatically improve detection of unaffected CSG-carriers along with enabling population risk-stratification for cancer precision-prevention. Several research studies have assessed the impact, feasibility, acceptability, long-term psychological outcomes and cost-effectiveness of population-based BRCA-testing in the Ashkenazi-Jewish population. Initial data on PBGT in the general-population is beginning to emerge and large implementation studies investigating PBGT in the general-population are needed. This review will summarise the current research into the clinical, psycho-social, health-economic, societal and ethical consequences of a PBGT model for women's cancer precision-prevention.
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Affiliation(s)
- Olivia Evans
- Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK; Department of Gynaecological Oncology, St Bartholomew's Hospital, EC1A 7BE, London, UK
| | - Faiza Gaba
- Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK; Department of Gynaecological Oncology, St Bartholomew's Hospital, EC1A 7BE, London, UK
| | - Ranjit Manchanda
- Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK; Department of Gynaecological Oncology, St Bartholomew's Hospital, EC1A 7BE, London, UK.
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15
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Rubinsak LA, Kleinman A, Quillin J, Gordon SW, Sullivan SA, Sutton AL, Sheppard VB, Temkin SM. Awareness and acceptability of population-based screening for pathogenic BRCA variants: Do race and ethnicity matter? Gynecol Oncol 2019; 154:383-387. [DOI: 10.1016/j.ygyno.2019.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 02/07/2023]
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16
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Temkin SM, Mallen A, Bellavance E, Rubinsak L, Wenham RM. The role of menopausal hormone therapy in women with or at risk of ovarian and breast cancers: Misconceptions and current directions. Cancer 2018; 125:499-514. [PMID: 30570740 DOI: 10.1002/cncr.31911] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 12/17/2022]
Abstract
For women who are candidates for menopausal hormone therapy (MHT), estrogen can provide relief from symptomatic menopause, decrease rates of chronic illnesses, and improve health-related quality of life. However, confusion surrounds the evidence regarding the impact of exogenous estrogen and progesterone on the breast and ovary. Available data regarding the risks of MHT (estrogen and/or progestin) related to the development of breast and ovarian cancer are often inconsistent or incomplete. Modern molecular and genetic techniques have improved our understanding of the heterogeneity of breast and ovarian cancer. This enhanced understanding of the disease has impacted our understanding of carcinogenesis. Treatment options have evolved to be more targeted toward hormonal therapy for certain subtypes of disease, whereas cytotoxic chemotherapy remains the standard for other histological and molecular subtypes. The role of MHT in the breast and ovarian cancer survivor, as well as women who are at high risk for the development of hereditary breast and ovarian cancer, remains controversial despite evidence that this treatment can improve quality of life and survival outcomes. Through this article, we examine the evidence for and against the use of MHT with a focus on women who have or are at high risk for breast and ovarian cancer.
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Affiliation(s)
- Sarah M Temkin
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Adrianne Mallen
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Emily Bellavance
- Department of Surgery, Division of General and Oncologic Surgery, University of Maryland, Baltimore, Maryland
| | - Lisa Rubinsak
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, Florida
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17
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Affiliation(s)
- Steven Narod
- Steven Narod and Mohammad R. Akbari, Women's College Research Institute, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Mohammad R Akbari
- Steven Narod and Mohammad R. Akbari, Women's College Research Institute, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada
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18
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Evaluation of a Next-Generation Sequencing Assay for BRCA1 and BRCA2 Mutation Detection. J Mol Diagn 2018; 20:87-94. [DOI: 10.1016/j.jmoldx.2017.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/05/2017] [Accepted: 09/29/2017] [Indexed: 11/20/2022] Open
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19
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Abstract
Ovarian carcinoma is the most lethal malignancy of the female genital tract. Population-based trials in the general population have not demonstrated that screening improves early detection or survival. Therefore, application of prevention strategies is vital to improving outcomes from this disease. Surgical prevention reduces risk and prophylactic risk-reducing salpingo-oophorectomy is the most effective means to prevent ovarian carcinoma in the high-risk patient although the risks do not outweigh the benefits in average risk patients. Other surgical and medical options have unknown or limited efficacy in the high-risk patient. In this review, we define the patient at high risk for ovarian cancer, discuss how to identify these women and weigh their available ovarian cancer prevention strategies.
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Affiliation(s)
- Sarah M. Temkin
- Virginia Commonwealth University, Department of Obstetrics and Gynecology, Richmond, VA, USA
| | - Jennifer Bergstrom
- Johns Hopkins School of Medicine, Kelly Gynecologic Oncology Service, Baltimore, MD, USA
| | - Goli Samimi
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Lori Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
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20
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Cousens N, Kaur R, Meiser B, Andrews L. Community attitudes towards a Jewish community BRCA1/2 testing program. Fam Cancer 2017; 16:17-28. [PMID: 27480161 DOI: 10.1007/s10689-016-9918-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
About 2.5 % of the Ashkenazi-Jewish population carry one of three "founder" mutations in BRCA1 and BRCA2 (BRCA1/2). Currently, testing is offered to Jewish people with a personal and/or family history of breast and/or ovarian cancer; however less than half of BRCA1/2 carriers within the Jewish population are aware of their family history. Population-based testing in other countries has shown to greatly increase the number of mutation carriers identified, compared to targeted testing of people with a family history. We aimed to assess the Australian Jewish community's attitudes towards such a program, including acceptability and interest in having education and testing offered online. Members of Sydney-based Jewish organisations who self-identified as being Jewish were invited by e-mail to participate in an online survey. Of 370 individuals who completed the survey, 96.8 % supported a Jewish community-based BRCA1/2 testing program, and 65.6 % reported being personally interested in undergoing the test. Younger adults aged below 50 years were more interested in undergoing the test than those aged 50 years and above. Almost half (42.9 %) were aware of a family member with breast and/or ovarian cancer; however, of these, 77.1 % had not yet undergone testing. Sixty-five (65.1 %) percent were satisfied with providing consent online, while only 39.6 % of participants' first preference for method of information provision was online. Given the high level of support, and interest in a community testing program, the development and evaluation of a cost-effective and interactive, online BRCA1/2 community testing program appears warranted.
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Affiliation(s)
- Nicole Cousens
- Psychosocial Research Group, Prince of Wales Clinical School, The University of New South Wales, Sydney, NSW, Australia.
| | - Rajneesh Kaur
- Psychosocial Research Group, Prince of Wales Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - Lesley Andrews
- Prince of Wales Clinical School, The University of New South Wales, Sydney, NSW, Australia.,Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, NSW, Australia
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21
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Affiliation(s)
- Kevin S Hughes
- Kevin S. Hughes, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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22
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Özdemir BC, Dotto GP. Racial Differences in Cancer Susceptibility and Survival: More Than the Color of the Skin? Trends Cancer 2017; 3:181-197. [PMID: 28718431 DOI: 10.1016/j.trecan.2017.02.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 12/14/2022]
Abstract
Epidemiological studies point to race as a determining factor in cancer susceptibility. In US registries recording cancer incidence and survival by race (distinguishing 'black versus white'), individuals of African ancestry have a globally increased risk of malignancies compared with Caucasians and Asian Americans. Differences in socioeconomic status and health-care access play a key role. However, the lesser disease susceptibility of Hispanic populations with comparable lifestyles and socioeconomic status as African Americans (Hispanic paradox) points to the concomitant importance of genetic determinants. Here, we overview the molecular basis of racial disparity in cancer susceptibility ranging from genetic polymorphisms and cancer-driver gene mutations to obesity, chronic inflammation, and immune responses. We discuss implications for race-adapted cancer screening programs and clinical trials to reduce disparities in cancer burden.
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Affiliation(s)
- Berna C Özdemir
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Gian-Paolo Dotto
- Department of Biochemistry, University of Lausanne, Chemin des Boveresses 155, 1066 Épalinges, Switzerland; Harvard Dermatology Department and Cutaneous Biology Research Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02129, USA.
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23
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Wiesman C, Rose E, Grant A, Zimilover A, Klugman S, Schreiber-Agus N. Experiences from a pilot program bringing BRCA1/2 genetic screening to theUS Ashkenazi Jewish population. Genet Med 2016; 19:529-536. [PMID: 27735926 DOI: 10.1038/gim.2016.154] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The notion of offering population-based screening to the Ashkenazi Jewish (AJ) population for the BRCA1/2 founder mutations continues to gain support. A program called the BRCAcommunity initiative was designed to identify the benefits and barriers associated with implementing this screening in a clinical setting. METHODS Interested AJ individuals were stratified into high-risk (HR) and low-risk (LR) groups based on self-reported cancer histories. Those at HR were offered traditional genetic counseling/testing; those at LR were offered group genetic counseling and subsidized AJ BRCA founder mutation testing. RESULTS During the pilot year, 62% of initial registrants and 53% of ultimate study participants were classified into the HR group. Among the 101 HR and 88 LR study participants, 8 and 2 BRCA carriers were identified, respectively. The LR carriers would have been missed by current mechanisms. Survey responses provided insight into the motivations and fears associated with pursuing testing, the efficacy of the initiative design, and challenges that exist on multiple levels, including the community, health-care providers, and insurance coverage. CONCLUSION Although the medical value of identifying presymptomatic BRCA carriers in Ashkenazi Jews is evident, further measures need to be taken before this effort can be accomplished on a large scale.Genet Med advance online publication 13 October 2016.
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Affiliation(s)
- Chana Wiesman
- Department of Obstetrics &Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.,Program for Jewish Genetic Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Esther Rose
- Department of Obstetrics &Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.,Program for Jewish Genetic Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Allison Grant
- Program for Jewish Genetic Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Adam Zimilover
- Program for Jewish Genetic Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Susan Klugman
- Department of Obstetrics &Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.,Program for Jewish Genetic Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Nicole Schreiber-Agus
- Department of Obstetrics &Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.,Program for Jewish Genetic Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.,Department of Genetics, Albert Einstein College of Medicine, Bronx, New York, USA
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24
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Abstract
The current and future applications of genomics to the practice of preventive oncology are being impacted by a number of challenges. These include rapid advances in genomic science and technology that allow massively parallel sequencing of both tumors and the germline, a diminishing of intellectual property restrictions on diagnostic genetic applications, rapid expansion of access to the internet which includes mobile access to both genomic data and tools to communicate and interpret genetic data in a medical context, the expansion of for-profit diagnostic companies seeking to monetize genetic information, and a simultaneous effort to depict medical professionals as barriers to rather than facilitators of understanding one's genome. Addressing each of these issues will be required to bring "personalized" germline genomics to cancer prevention and care. A profound future challenge will be whether clinical cancer genomics will be "de-medicalized" by commercial interests and their advocates, or whether the future course of this field can be modulated in a responsible way that protects the public health while implementing powerful new medical tools for cancer prevention and early detection.
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Affiliation(s)
- Kenneth Offit
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
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25
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Kang HP, Maguire JR, Chu CS, Haque IS, Lai H, Mar-Heyming R, Ready K, Vysotskaia VS, Evans EA. Design and validation of a next generation sequencing assay for hereditary BRCA1 and BRCA2 mutation testing. PeerJ 2016; 4:e2162. [PMID: 27375968 PMCID: PMC4928470 DOI: 10.7717/peerj.2162] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 06/01/2016] [Indexed: 12/02/2022] Open
Abstract
Hereditary breast and ovarian cancer syndrome, caused by a germline pathogenic variant in the BRCA1 or BRCA2 (BRCA1/2) genes, is characterized by an increased risk for breast, ovarian, pancreatic and other cancers. Identification of those who have a BRCA1/2 mutation is important so that they can take advantage of genetic counseling, screening, and potentially life-saving prevention strategies. We describe the design and analytic validation of the Counsyl Inherited Cancer Screen, a next-generation-sequencing-based test to detect pathogenic variation in the BRCA1 and BRCA2 genes. We demonstrate that the test is capable of detecting single-nucleotide variants (SNVs), short insertions and deletions (indels), and copy-number variants (CNVs, also known as large rearrangements) with zero errors over a 114-sample validation set consisting of samples from cell lines and deidentified patient samples, including 36 samples with BRCA1/2pathogenic germline mutations.
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Affiliation(s)
| | | | - Clement S Chu
- Counsyl Inc. , South San Francisco , CA , United States
| | - Imran S Haque
- Counsyl Inc. , South San Francisco , CA , United States
| | - Henry Lai
- Counsyl Inc. , South San Francisco , CA , United States
| | | | - Kaylene Ready
- Counsyl Inc. , South San Francisco , CA , United States
| | | | - Eric A Evans
- Counsyl Inc. , South San Francisco , CA , United States
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26
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Karakasis K, Burnier JV, Bowering V, Oza AM, Lheureux S. Ovarian Cancer and BRCA1/2 Testing: Opportunities to Improve Clinical Care and Disease Prevention. Front Oncol 2016; 6:119. [PMID: 27242959 PMCID: PMC4862980 DOI: 10.3389/fonc.2016.00119] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/28/2016] [Indexed: 01/07/2023] Open
Abstract
Without prevention or screening options available, ovarian cancer is the most lethal malignancy of the female reproductive tract. High-grade serous ovarian cancer (HGSOC) is the most common histologic subtype, and the role of germline BRCA1/2 mutation in predisposition and prognosis is established. Given the targeted treatment opportunities with PARP inhibitors, a predictive role for BRCA1/2 mutation has emerged. Despite recommendations to provide BRCA1/2 testing to all women with histologically confirmed HGSOC, uniform implementation remains challenging. The opportunity to review and revise genetic screening and testing practices will identify opportunities, where universal adoption of BRCA1/2 mutation testing will impact and improve treatment of women with ovarian cancer. Improving education and awareness of genetic testing for women with cancer, as well as the broader general community, will help focus much-needed attention on opportunities to advance prevention and screening programs in ovarian cancer. This is imperative not only for women with cancer and those at risk of developing cancer but also for their first-degree relatives. In addition, BRCA1/2 testing may have direct implications for patients with other types of cancers, many of which are now being found to have BRCA1/2 involvement.
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Affiliation(s)
- Katherine Karakasis
- Drug Development Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Julia V. Burnier
- Drug Development Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Valerie Bowering
- Drug Development Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Amit M. Oza
- Drug Development Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Stephanie Lheureux
- Drug Development Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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27
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Abstract
The current standard model for identifying carriers of high-risk mutations in cancer-susceptibility genes (CSGs) generally involves a process that is not amenable to population-based testing: access to genetic tests is typically regulated by health-care providers on the basis of a labour-intensive assessment of an individual's personal and family history of cancer, with face-to-face genetic counselling performed before mutation testing. Several studies have shown that application of these selection criteria results in a substantial proportion of mutation carriers being missed. Population-based genetic testing has been proposed as an alternative approach to determining cancer susceptibility, and aims for a more-comprehensive detection of mutation carriers. Herein, we review the existing data on population-based genetic testing, and consider some of the barriers, pitfalls, and challenges related to the possible expansion of this approach. We consider mechanisms by which population-based genetic testing for cancer susceptibility could be delivered, and suggest how such genetic testing might be integrated into existing and emerging health-care structures. The existing models of genetic testing (including issues relating to informed consent) will very likely require considerable alteration if the potential benefits of population-based genetic testing are to be fully realized.
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28
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Finch A, Wang M, Fine A, Atri L, Khalouei S, Pupavac M, Rosen B, Eisen A, Elser C, Charames G, Metcalfe K, Chang MC, Narod SA, Lerner-Ellis J. Genetic testing for BRCA1 and BRCA2 in the Province of Ontario. Clin Genet 2015. [PMID: 26219728 DOI: 10.1111/cge.12647] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In 2001, genetic testing for BRCA1 and BRCA2 was introduced in Ontario, for women at high-risk of breast or ovarian cancer. To date over 30,000 individuals have been tested throughout Ontario. Testing was offered to all Ontario residents who were eligible under any of 13 criteria. We report the results of tests conducted at Mount Sinai Hospital from 2007 to 2014. A total of 4726 individuals were tested, 764 (16.2%) were found to carry a pathogenic variant (mutation). Among 3684 women and men who underwent testing without a known familial BRCA mutation, 331 (9.0%) were found to carry a mutation. Among 1042 women and men tested for a known family mutation, 433 (41.6%) were positive. There were 603 female mutation carriers, of these, 303 were affected with breast or ovarian cancer (50%) and 16 with another cancer (2.3%). Of 284 unaffected female carriers, 242 (85%) were tested for a known family mutation and 42 (15%) were the first person in the family to be tested. By placing greater emphasis on recruiting unaffected female relatives of known mutation carriers for testing, greater than one-half of newly identified carriers will be unaffected.
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Affiliation(s)
- A Finch
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Sunnybrook Odette Cancer Centre, Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada
| | - M Wang
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - A Fine
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - L Atri
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - S Khalouei
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - M Pupavac
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - B Rosen
- Department of Obstetrics and Gynecology, University of Toronto and Gynecologic Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - A Eisen
- Sunnybrook Odette Cancer Centre, Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada
| | - C Elser
- Division of Medical Oncology and Hematology, Department of Medicine, Mount Sinai Hospital and The Princess Margaret Cancer Center
| | - G Charames
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - K Metcalfe
- Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - M C Chang
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - S A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - J Lerner-Ellis
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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29
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Metcalfe KA, Eisen A, Lerner-Ellis J, Narod SA. Is it time to offer BRCA1 and BRCA2 testing to all Jewish women? ACTA ACUST UNITED AC 2015; 22:e233-6. [PMID: 26300672 DOI: 10.3747/co.22.2527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
It was 2007 when Women’s College Hospital first began to test for BRCA1 and BRCA2 mutations among all Jewish women in Ontario [...]
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Affiliation(s)
- K A Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON; ; Familial Cancer Program, Odette Cancer Centre, Toronto, ON
| | - A Eisen
- Familial Breast Cancer Program, Women's College Research Institute, Toronto, ON; ; Cancer Care Ontario, Toronto, ON
| | - J Lerner-Ellis
- Advanced Molecular Diagnostics, Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON
| | - S A Narod
- Familial Breast Cancer Program, Women's College Research Institute, Toronto, ON
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30
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Trottier M, Lunn J, Butler R, Curling D, Turnquest T, Francis W, Halliday D, Royer R, Zhang S, Li S, Thompson I, Donenberg T, Hurley J, Akbari MR, Narod SA. Prevalence of founder mutations in the BRCA1 and BRCA2 genes among unaffected women from the Bahamas. Clin Genet 2015; 89:328-31. [PMID: 25920394 DOI: 10.1111/cge.12602] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/16/2015] [Accepted: 04/23/2015] [Indexed: 01/17/2023]
Abstract
Population-based testing for BRCA1/2 mutations detects a high proportion of carriers not identified by cancer family history-based testing. We sought to determine whether population-based testing is an effective approach to genetic testing in the Bahamas, where 23% of women with breast cancer carry one of seven founder mutations in the BRCA1 or BRCA2 gene. We determined the prevalence of founder BRCA mutations in 1847 Bahamian women without a personal history of breast or ovarian cancer, unselected for age or family history. We found that 2.8% (20/705) of unaffected women with a family history of breast/ovarian cancer and 0.09% (1/1089) of unaffected women without a family history carry a BRCA mutation. A total of 38% of unaffected women with a known mutation in the family were found to carry the familial mutation. We previously suggested that all Bahamian women with breast or ovarian cancer be offered genetic testing. These current data suggest that additionally all unaffected Bahamian women with a family history of breast/ovarian cancer should be offered genetic testing for the founder BRCA mutations.
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Affiliation(s)
- M Trottier
- Bahamas Breast Cancer Initiative Foundation, Nassau, Bahamas
| | - J Lunn
- Department of Hematology and Oncology, Doctors Hospital, Nassau, Bahamas
| | - R Butler
- Department of Oncology, Princess Margaret Hospital, Nassau, Bahamas.,Department of Obstetrics and Gynecology, Princess Margaret Hospital, Nassau, Bahamas
| | - D Curling
- Department of Oncology, Princess Margaret Hospital, Nassau, Bahamas
| | - T Turnquest
- Department of Oncology, Princess Margaret Hospital, Nassau, Bahamas
| | - W Francis
- Department of Oncology, Princess Margaret Hospital, Nassau, Bahamas
| | - D Halliday
- Department of Oncology, Princess Margaret Hospital, Nassau, Bahamas.,Department of Obstetrics and Gynecology, Princess Margaret Hospital, Nassau, Bahamas
| | - R Royer
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - S Zhang
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - S Li
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - I Thompson
- Bahamas Breast Cancer Initiative Foundation, Nassau, Bahamas
| | - T Donenberg
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - J Hurley
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - M R Akbari
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - S A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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31
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Sun L, Liu J, Wang S, Chen Y, Li Z. Prevalence of BRCA1 gene mutation in breast cancer patients in Guangxi, China. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:6262-6269. [PMID: 25337278 PMCID: PMC4203249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/23/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The prevalence of breast cancer susceptibility gene 1 mutation in breast cancer patients of south China has not been well revealed. This study was to invest the prevalence of BRCA1 gene mutation in breast cancer patients in Guangxi, China, and to try reflecting its relevance in genetic counseling of breast cancer. METHODS In this study, 463 breast cancer patients and 30 healthy women (control group) were involved. Entire sequence and splicing sites of BRCA1 genes were detected by PCR-DNA sequencing. RESULTS About 8.9% (41/463) patients were with 22 BRCA1 mutations (all in exon 10). The average hospitalized age of BRCA1-associated breast cancer cases was significantly younger (t = -2.965, P = 0.003). The nuclear grade (U = 2321.0, P = 0.030), ER (U = 4343.5, P = 0.041) and CerbB-2 (U = 3894.0, P = 0.038) expression levels, and triple negative breast cancer diagnosing rate (χ(2) = 4.719, P = 0.03) were disclosed more in BRCA1-associated patients. CONCLUSIONS The four most frequent BRCA1 mutation (2798 T > C, 3971 G > A, 3971 G > A and 624 C > T) found in female breast cancer cases in Guangxi are all located in exon 10. BRCA1-associated breast cancer cases have earlier onset age, higher nuclear grade and negative ER and CerbB-2 expression.
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Affiliation(s)
- Liping Sun
- Department of Diagnostic Ultrasound, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi, China
| | - Junjie Liu
- Department of Diagnostic Ultrasound, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi, China
| | - Sida Wang
- Department of Diagnostic Ultrasound, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi, China
| | - Yuanyuan Chen
- Department of Diagnostic Ultrasound, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi, China
| | - Zhixian Li
- Department of Diagnostic Ultrasound, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi, China
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