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Kendel F, Speiser D, Fechner K, Olbrich C, Stegen S, Rörig A, Feufel MA, Haering S. Talking about Familial Breast and Ovarian Cancer Risk-Evaluation of a Psychosocial Training Module for Gynecologists in Germany. Cancers (Basel) 2024; 16:310. [PMID: 38254800 PMCID: PMC10813984 DOI: 10.3390/cancers16020310] [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: 12/10/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Primary care gynecologists are increasingly integrated into the care of patients with hereditary breast and ovarian cancer (HBOC) risks. These physicians should not only have basic genetic knowledge; they should also feel able to sensitively address an increased HBOC risk and deal with emotional, stressful situations in this context. Our project aimed at developing a training module, 'iKNOWgynetics', addressing psychosocial challenges in the context of HBOC care for primary care gynecologists. We developed the psychosocial training module in three phases: first, we conducted an online survey with n = 35 women with a family history of breast or ovarian cancer to assess patients' experiences and needs. Second, based on the results of the needs assessment, we developed the training module. Third, we evaluated the training by assessing physicians' (n = 109) self-efficacy with regard to communication skills in the context of HBOC before and after the training. In the needs assessment, seven psychosocial themes emerged. These themes, complementing a review of the literature, informed the training curriculum. The training was divided into two parts: (1) communicating with women before genetic testing and (2) care co-management for women with HBOC after genetic testing. After the training, participants reported a significant increase in self-efficacy in three domains: communicating empathetically, educating patients in a comprehensible way and dealing with emotionally challenging situations. Our results highlight the relevance of psychosocial issues for patients with HBOC. A genetic literacy training module that integrates aspects of psychosocial care increases physicians' confidence in dealing with emotionally challenging situations before and after their patients' genetic testing. Thus, such trainings may improve the care of women with hereditary cancer risks.
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Affiliation(s)
- Friederike Kendel
- Gender in Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany;
| | - Dorothee Speiser
- Hereditary Breast and Ovarian Cancer Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (D.S.); (K.F.); (C.O.); (S.S.)
| | - Karen Fechner
- Hereditary Breast and Ovarian Cancer Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (D.S.); (K.F.); (C.O.); (S.S.)
| | - Christine Olbrich
- Hereditary Breast and Ovarian Cancer Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (D.S.); (K.F.); (C.O.); (S.S.)
| | - Stephanie Stegen
- Hereditary Breast and Ovarian Cancer Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (D.S.); (K.F.); (C.O.); (S.S.)
- BRCA-Netzwerk e.V., Thomas-Mann-Str. 40, 53111 Bonn, Germany
| | - Alina Rörig
- Division of Ergonomics, Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Marchstr. 23, 10587 Berlin, Germany; (A.R.); (M.A.F.)
| | - Markus A. Feufel
- Division of Ergonomics, Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Marchstr. 23, 10587 Berlin, Germany; (A.R.); (M.A.F.)
| | - Stephanie Haering
- Gender in Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany;
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Padamsee TJ, Bijou C, Swinehart-Hord P, Hils M, Muraveva A, Meadows RJ, Shane-Carson K, Yee LD, Wills CE, Paskett ED. Risk-management decision-making data from a community-based sample of racially diverse women at high risk of breast cancer: rationale, methods, and sample characteristics of the Daughter Sister Mother Project survey. Breast Cancer Res 2024; 26:8. [PMID: 38212792 PMCID: PMC10785448 DOI: 10.1186/s13058-023-01753-x] [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: 09/08/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND To understand the dynamics that limit use of risk-management options by women at high risk of breast cancer, there is a critical need for research that focuses on patient perspectives. Prior research has left important gaps: exclusion of high-risk women not in risk-related clinical care, exclusion of non-white populations, and lack of attention to the decision-making processes that underlie risk-management choices. Our objective was to create a more inclusive dataset to facilitate research to address disparities related to decision making for breast cancer risk management. METHODS The Daughter Sister Mother Project survey collects comprehensive information about the experiences of women at high risk of breast cancer. We collected novel measures of feelings about and reactions to cancer screenings; knowledge, barriers, and facilitators of risk-management options; beliefs related to cancer risk and risk management; and involvement with loved ones who had cancer. Eligible individuals were non-Hispanic white and non-Hispanic Black adult women who self-identified as having high risk of breast cancer and had no personal history of cancer. Between October 2018 and August 2019, 1053 respondents completed the online survey. Of these, 717 were confirmed through risk prediction modeling to have a lifetime breast cancer risk of ≥ 20%. Sociodemographic characteristics of this sample were compared to those of nationally representative samples of the US population: the 2019 Health Information National Trends Survey and the Pew Research Center report: Jewish Americans in 2020. RESULTS The sample of 717 women at objectively high risk of breast cancer was largely (95%) recruited from non-clinical sources. Of these respondents, only 31% had seen a genetic counselor, 34% had had genetic testing specific to breast cancer risk, and 35% had seen at least one breast or cancer care specialist. The sample includes 35% Black respondents and 8% with Ashkenazi Jewish ancestry. Although encompassing a substantial range of ages, incomes, and education levels, respondents are overall somewhat younger, higher-income, and more educated than the US population as a whole. CONCLUSIONS The DSM dataset offers comprehensive data from a community-based, diverse sample of women at high risk of breast cancer. The dataset includes substantial proportions of Black and Ashkenazi Jewish women and women who are not already in clinical care related to their breast cancer risk. This sample will facilitate future studies of risk-management behaviors among women who are and are not receiving high-risk care, and of variations in risk-management experiences across race and ethnicity.
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Affiliation(s)
- Tasleem J Padamsee
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA.
| | - Christina Bijou
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Paige Swinehart-Hord
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA
| | - Megan Hils
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA
| | - Anna Muraveva
- Government Resources Center, The Ohio State University, Columbus, OH, USA
| | - Rachel J Meadows
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | | | - Lisa D Yee
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Celia E Wills
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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Rana HQ, Stopfer JE, Weitz M, Kipnis L, Koeller DR, Culver S, Mercado J, Gelman RS, Underhill-Blazey M, McGregor BA, Sweeney CJ, Petrucelli N, Kokenakes C, Pirzadeh-Miller S, Reys B, Frazier A, Knechtl A, Fateh S, Vatnick DR, Silver R, Kilbridge KE, Pomerantz MM, Wei XX, Choudhury AD, Sonpavde GP, Kozyreva O, Lathan C, Horton C, Dolinsky JS, Heath EI, Ross TS, Courtney KD, Garber JE, Taplin ME. Pretest Video Education Versus Genetic Counseling for Patients With Prostate Cancer: ProGen, A Multisite Randomized Controlled Trial. JCO Oncol Pract 2023; 19:1069-1079. [PMID: 37733980 PMCID: PMC10667014 DOI: 10.1200/op.23.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/10/2023] [Accepted: 08/07/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE Germline genetic testing (GT) is recommended for men with prostate cancer (PC), but testing through traditional models is limited. The ProGen study examined a novel model aimed at providing access to GT while promoting education and informed consent. METHODS Men with potentially lethal PC (metastatic, localized with a Gleason score of ≥8, persistent prostate-specific antigen after local therapy), diagnosis age ≤55 years, previous malignancy, and family history suggestive of a pathogenic variant (PV) and/or at oncologist's discretion were randomly assigned 3:1 to video education (VE) or in-person genetic counseling (GC). Participants had 67 genes analyzed (Ambry), with results disclosed via telephone by a genetic counselor. Outcomes included GT consent, GT completion, PV prevalence, and survey measures of satisfaction, psychological impact, genetics knowledge, and family communication. Two-sided Fisher's exact tests were used for between-arm comparisons. RESULTS Over a 2-year period, 662 participants at three sites were randomly assigned and pretest VE (n = 498) or GC (n = 164) was completed by 604 participants (VE, 93.1%; GC, 88.8%), of whom 596 participants (VE, 98.9%; GC, 97.9%) consented to GT and 591 participants completed GT (VE, 99.3%; GC, 98.6%). These differences were not statistically significant although subtle differences in satisfaction and psychological impact were. Notably, 84 PVs were identified in 78 participants (13.2%), with BRCA1/2 PV comprising 32% of participants with a positive result (BRCA2 n = 21, BRCA1 n = 4). CONCLUSION Both VE and traditional GC yielded high GT uptake without significant differences in outcome measures of completion, GT uptake, genetics knowledge, and family communication. The increased demand for GT with limited genetics resources supports consideration of pretest VE for patients with PC.
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Affiliation(s)
- Huma Q. Rana
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA
| | - Jill E. Stopfer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA
| | - Michelle Weitz
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Lindsay Kipnis
- Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA
| | - Diane R. Koeller
- Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA
| | - Samantha Culver
- Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA
| | - Joanna Mercado
- Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA
| | | | - Meghan Underhill-Blazey
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA
| | - Bradley A. McGregor
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Christopher J. Sweeney
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | - Brian Reys
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Arthur Frazier
- Karmanos Cancer Institute at McLaren Clarkston, Clarkston, MI
| | - Andrew Knechtl
- Karmanos Cancer Institute at McLaren Clarkston, Clarkston, MI
| | - Salman Fateh
- Karmanos Cancer Institute at McLaren Clarkston, Clarkston, MI
| | | | - Rebecca Silver
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kerry E. Kilbridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Mark M. Pomerantz
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Xiao X. Wei
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Atish D. Choudhury
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Guru P. Sonpavde
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Olga Kozyreva
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | | - Judy E. Garber
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA
| | - Mary-Ellen Taplin
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
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Dibble KE, Connor AE. Residential Locale Is Associated with Disparities in Genetic Testing-Related Outcomes Among BRCA1/2-Positive Women. J Racial Ethn Health Disparities 2023; 10:718-729. [PMID: 35178668 PMCID: PMC8853067 DOI: 10.1007/s40615-022-01259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND While research on hereditary genetic testing for BRCA1/2 mutations continues to emerge, there remain unanswered questions regarding access to testing and cancer-related care. Our study determined the associations between race/ethnicity, residential locale, and genetic testing provider and related outcomes among US women with BRCA1/2 genetic mutations. METHODS One hundred ninety-three BRCA1/2-positive women from vulnerable health backgrounds were recruited via private national Facebook BRCA1/2-oriented support groups and completed an online survey. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression for the associations between race/ethnicity, residential locale, and genetic testing-related outcomes. RESULTS Women ranged in age (18-75, M = 39.5, SD = 10.7), and most were non-Hispanic white (66.3%) and lived in a suburban locale (54.9%). Women living in suburban areas were significantly less likely (aOR, .369, 95% CI, .177-.771) to receive behavioral referrals after genetic testing compared to those living in an urban locale. Women living in rural areas and suburban areas were 4.72 times more likely (95% CI, 1.48-15.1, p = .009) and 2.61 times more likely (95% CI, 1.05-6.48, p = .038), respectively, to receive genetic testing from a primary care provider versus private genetic testing office/hospital compared to women in urban locales. Associations between race/ethnicity and genetic testing outcomes were not statistically significant. Residential locale did not predict the odds of undergoing surgery for risk reduction or surveillance for early detection. CONCLUSION Our study identifies disparities in genetic testing resources among women living in suburban and rural areas. These findings can be used to inform future care, research, and community resources that may impact services relating to genetic testing within these locales.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Avonne E Connor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, 21205, USA
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Primary care physician referral practices regarding BRCA1/2 genetic counseling in a major health system. Breast Cancer Res Treat 2022; 195:153-160. [PMID: 35842521 DOI: 10.1007/s10549-022-06523-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/16/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The United States Preventive Services Task Force recommends primary care physicians refer patients at high risk for BRCA1/2 mutations to genetic testing when appropriate. The objective of our study was to describe referrals for BRCA1/2 testing in a large integrated health system and to assess factors associated with referral. METHODS This retrospective cohort study includes female patients between 18 and 50 years who had a primary care visit in the Cleveland Clinic Health System between 2010 and 2019. We used multivariable logistic regression to estimate differences in the odds of a woman being referred for BRCA1/2 testing by patient factors and referring physician specialty. We also assessed variation in referrals by physicians. RESULTS Among 279,568 women, 5% were high risk. Of those, 22% were referred for testing. Black patients were significantly less likely to be referred than white patients (aOR 0.87; 95% CI 0.77, 0.98) and Jewish patients were more likely to be referred than non-Jewish patients (aOR 2.13; 95% CI 1.68, 2.70). Patients primarily managed by OB/GYN were significantly more likely to be referred than those cared for via Internal/Family Medicine (aOR 1.45; 95% CI 1.30, 1.61). Less than a quarter of primary care physicians ever referred a patient for testing. CONCLUSION The majority of primary care patients at high risk for a BRCA1/2 mutation were not referred for testing, and over a decade, most physicians never referred a single patient. Internal/Family Medicine physicians, in particular, need support in identifying and referring women who could benefit from testing.
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Kumerow MT, Rodriguez JL, Dai S, Kolor K, Rotunno M, Peipins LA. Prevalence of Americans reporting a family history of cancer indicative of increased cancer risk: Estimates from the 2015 National Health Interview Survey. Prev Med 2022; 159:107062. [PMID: 35460723 PMCID: PMC9162122 DOI: 10.1016/j.ypmed.2022.107062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 11/27/2022]
Abstract
The collection and evaluation of family health history in a clinical setting presents an opportunity to discuss cancer risk, tailor cancer screening recommendations, and identify people with an increased risk of carrying a pathogenic variant who may benefit from referral to genetic counseling and testing. National recommendations for breast and colorectal cancer screening indicate that men and women who have a first-degree relative affected with these types of cancers may benefit from talking to a healthcare provider about starting screening at an earlier age and other options for cancer prevention. The prevalence of reporting a first-degree relative who had cancer was assessed among adult respondents of the 2015 National Health Interview Survey who had never had cancer themselves (n = 27,999). We found 35.6% of adults reported having at least one first-degree relative with cancer at any site. Significant differences in reporting a family history of cancer were observed by sex, age, race/ethnicity, educational attainment, and census region. Nearly 5% of women under age 50 and 2.5% of adults under age 50 had at least one first-degree relative with breast cancer or colorectal cancer, respectively. We estimated that 5.8% of women had a family history of breast or ovarian cancer that may indicate increased genetic risk. A third of U.S. adults who have never had cancer report a family history of cancer in a first-degree relative. This finding underscores the importance of using family history to inform discussions about cancer risk and screening options between healthcare providers and their patients.
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Affiliation(s)
- Marie T Kumerow
- Tanaq Support Services, LLC, 3201 C St Site 602, Anchorage, AK 99503, USA.
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-4, Atlanta, GA 30341, USA.
| | - Shifan Dai
- Cyberdata Technologies, Inc., 455 Springpark Pl # 300, Herndon, VA 20701, USA.
| | - Katherine Kolor
- Office of Genomics and Precision Public Health, Centers for Disease Control and Prevention, 2500 Century Parkway NE, MS V25-5, Atlanta, GA 30345, USA.
| | - Melissa Rotunno
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr RM 4E548, Bethesda, MD 20892, USA.
| | - Lucy A Peipins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-4, Atlanta, GA 30341, USA.
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Hereditary Cancer Risk Using a Genetic Chatbot Before Routine Care Visits. Obstet Gynecol 2021; 138:860-870. [PMID: 34735417 PMCID: PMC8594498 DOI: 10.1097/aog.0000000000004596] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
A clinical chatbot can be used effectively to perform cancer risk assessment by remotely collecting and analyzing personal and family cancer history before appointments. To examine user uptake and experience with a clinical chatbot that automates hereditary cancer risk triage by collecting personal and family cancer history in routine women's health care settings.
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Coffin T, Bowen D, Swisher E, Lu K, Lu K, Lu K, Rayes N, Norquist B, Norquist B, Norquist B, Blank S, Levine D, Levine D, Levine D, Bakkum-Gamez J, Bakkum-Gamez J, Bakkum-Gamez J, Bakkum-Gamez J, Fleming G, Fleming G, Olopade O, Olopade O, Olopade O, D’Andrea A, D’Andrea A, Nebgen D, Nebgen D, Nebgen D, Nebgen D, Peterson C, Peterson C, Peterson C, Munsell M, Gavin K, Gavin K, Lechner R, Lechner R, Crase J, Crase J, Polinsky D, Romero I. Development and assessment of an accessible communication system for population based genetic testing (Preprint). JMIR Form Res 2021; 6:e34055. [DOI: 10.2196/34055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
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Buranello MC, Walsh IAPD, Pereira GDA, Castro SSD. Histórico familiar para câncer de mama em mulheres: estudo populacional em Uberaba (MG) utilizando o Family History Screen-7. SAÚDE EM DEBATE 2021. [DOI: 10.1590/0103-1104202113009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetiva-se determinar a prevalência de mulheres com risco de desenvolvimento de câncer de mama pelo histórico familiar em Uberaba (MG), e essa prevalência nas diferentes condições socioeconômicas e epidemiológicas. Pesquisa quantitativa, analítica, observacional e transversal de base populacional. Amostra com 1.520 mulheres a partir de 20 anos. Dados coletados por entrevistas domiciliares sobre informações socioeconômicas e epidemiológicas. A avaliação do risco hereditário de câncer de mama foi realizada pelo Family History Screen-7 (FHS-7). Como resultado, 28,6% da amostra apresentaram risco hereditário para câncer de mama. Houve associação significativa do risco de câncer quanto a: faixa etária, sendo nas mulheres com idade de 70 anos ou mais a maior proporção com risco (33,5%); etnia, sendo a maior proporção entre mulheres de etnia branca (31,2%); renda familiar, com maior ocorrência para renda per capita > 2,5 salários-mínimos (31,6%); prática de exames preventivos (30,6%); e alterações benignas na mama (46,7%). Conclui-se que, a partir do histórico familiar pelo FHS-7, o risco de as mulheres desenvolverem câncer mostrou-se significativamente associado com maior faixa etária, etnia branca e maior renda per capita, com a prática de exames preventivos em dia e alterações benignas na mama. Tais resultados possibilitam melhores direcionamentos de políticas públicas.
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Somasegar S, Weiss AS, Norquist BM, Khasnavis N, Radke M, Manhardt E, Pennil C, Pennington KP, Eckert MA, Chryplewicz A, Lengyel E, Swisher EM. Germline mutations in Black patients with ovarian, fallopian tube and primary peritoneal carcinomas. Gynecol Oncol 2021; 163:130-133. [PMID: 34452747 DOI: 10.1016/j.ygyno.2021.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Routine genetic testing for ovarian cancer and identification of germline mutations can help improve early detection of cancer as well as guide treatment. Knowledge of genetic counseling and referral rates for genetic testing has been lower for Black patients, compared to White patients. We aimed to describe the demographics and presence of germline mutations in Black individuals with ovarian, fallopian tube or peritoneal carcinoma at two large academic institutions. METHODS Fifty-one Black patients with invasive epithelial ovarian, fallopian tube, or primary peritoneal carcinoma were identified via institutional tissue banks over a 20-year time-period. Germline DNA was sequenced using BROCA, a targeted capture and parallel sequencing assay that identified pathogenic germline mutations in ovarian carcinoma susceptibility genes. RESULTS Germline mutations in ovarian cancer susceptibility genes were found in 25.5% of women, most commonly BRCA1 and BRCA2. This mutation frequency mirrors those previously described among predominantly White populations. Our data suggests there may be an advantage in survival among those with germline mutations, although this was not statistically significant. CONCLUSIONS Given similar frequencies of germline mutations between Black and White patients with ovarian cancer, we conclude that there are not major differences in the genetic predisposition to ovarian carcinoma. Equitable access to genomic advancements including germline and tumor sequencing would facilitate equal access to PARP inhibitors, the standard of care for patients with BRCA mutated advanced ovarian cancer.
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Affiliation(s)
- Sahana Somasegar
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States of America
| | - Arielle S Weiss
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Barbara M Norquist
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Nithisha Khasnavis
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Marc Radke
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Enna Manhardt
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Christopher Pennil
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Kathryn P Pennington
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Mark A Eckert
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States of America
| | - Agnieszka Chryplewicz
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States of America
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States of America
| | - Elizabeth M Swisher
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America.
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"Being proactive, not reactive": exploring perceptions of genetic testing among White, Latinx, and Pacific Islander Populations. J Community Genet 2021; 12:617-630. [PMID: 34415555 DOI: 10.1007/s12687-021-00542-3] [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: 11/04/2020] [Accepted: 07/25/2021] [Indexed: 12/20/2022] Open
Abstract
Genetic testing is becoming an integral part of healthcare, but evidence suggests that both race and ethnicity influence access to and utilization of genetic testing. Given this barrier, data are needed on the perceptions of genetic testing in racial and ethnic minority groups. The purpose of this study was to explore the perceptions of three types of genetic testing (genetic testing for adult-onset conditions, prenatal screening, and newborn screening) in a sample of US participants who identified as White, Pacific Islander, and Latinx (10 dyads from each group for 60 participants total). Data were collected through semi-structured dyadic interviews and assessed using thematic analysis. The major themes were knowledge as empowering, knowledge as stressful, and predictive nature of prenatal testing and newborn screening. Some differences were seen in themes by race and ethnicity. A sense of collective and familial health appeared to be a more important theme for Pacific Islander and Latinx participants compared to White participants. Adult-onset genetic testing was viewed variously across all groups with some noting how it may increase anxiety, particularly if the disease screened for was unable to be prevented with action. All three groups reported on the positives of prenatal testing and newborn screening yet often were confused on the differences between them. This study presents novel perceptions of genetic testing in participants from diverse communities across three types of genetic testing. Genetic healthcare providers should incorporate participants' perceptions, values, and beliefs into their counseling delivery as a way to engage with diverse communities.
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Kast K, Häfner J, Schröck E, Jahn A, Werner C, Meisel C, Wimberger P. Recommendation and Acceptance of Counselling for Familial Cancer Risk in Newly Diagnosed Breast Cancer Cases. Breast Care (Basel) 2021; 17:153-158. [DOI: 10.1159/000517021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/11/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> In clinical routine, not every patient who is offered genetic counselling and diagnostics in order to investigate a familial cancer risk predisposition opts for it. Little is known about acceptance of counselling and testing in newly diagnosed breast cancer cases in Germany. <b><i>Methods:</i></b> All primary breast cancer cases and patients with DCIS (ductal carcinoma in situ) treated at the University Hospital of Dresden between 2016 and 2019 were included. The number of tumor board recommendations for genetic counselling on the basis of the GC-HBOC risk criteria was recorded. Acceptance was analyzed by number of cases with counselling in the GC-HBOC-Center Dresden. <b><i>Results:</i></b> Of 996 primary breast cancer and DCIS cases, 262 (26.3%) were eligible for genetic counselling. Recommendation for genetic counselling was accepted by 64.1% (168/262). Of these 90.5% (152/168) opted for molecular genetic analysis. The acceptance rate for counselling increased between 2016 and 2019 from 58.3 to 72.6%. Altogether, 20.4% (31/152) patients were found to carry a pathogenic variant in the breast cancer genes <i>BRCA1</i> or <i>BRCA2</i>. <b><i>Conclusion:</i></b> Acceptance of recommendation is increasing as clinical consequences augment. Optimization in providing information about hereditary cancer risk and in accessibility of counselling and testing is required to further improve acceptance of recommendation.
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Grindedal EM, Jørgensen K, Olsson P, Gravdehaug B, Lurås H, Schlichting E, Vamre T, Wangensteen T, Heramb C, Mæhle L. Mainstreamed genetic testing of breast cancer patients in two hospitals in South Eastern Norway. Fam Cancer 2021; 19:133-142. [PMID: 32002722 PMCID: PMC7101297 DOI: 10.1007/s10689-020-00160-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Studies have shown that a significant number of eligible breast cancer patients are not offered genetic testing or referral to genetic counseling. To increase access to genetic testing in South Eastern Norway, testing has since 2014 been offered directly to breast cancer patients by surgeons and oncologists. This practice is termed “mainstreamed genetic testing”. The aim of this study was to investigate to what extent patients in South Eastern Norway are offered testing. Three hundred and sixty one patients diagnosed in 2016 and 2017 at one regional and one university hospital in South Eastern Norway were included. Data on whether the patients fulfilled the criteria, whether they had been offered testing and if they were tested were collected. In total, 26.6% (96/361) fulfilled the criteria for testing. Seventy five percent (69/92) of these were offered testing, and 71.7% (66/92) were tested. At the university hospital, 90.2% (37/41) of eligible patients were offered testing, and at the regional hospital 62.7% (32/51). Fifty two percent (12/23) of eligible patient not offered testing were younger than 50 years at time of diagnosis. As many as 95.4% (125/131) of all patients who were offered testing, wanted to be tested. The majority of patients who fulfilled the criteria were offered testing, supporting the practice of mainstreamed genetic testing. There were nevertheless differences in rates of testing between the hospitals that affected all groups of patients, indicating that genetic testing may not be equally accessible to all patients. We suggest that efforts should be made to increase awareness and improve routines for genetic testing of breast cancer patients in Norway.
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Affiliation(s)
| | - Kjersti Jørgensen
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Pernilla Olsson
- Department of Surgery, Section of Breast and Endocrine Surgery, Innlandet Hospital, Hamar, Norway
| | - Berit Gravdehaug
- Department of Breast and Endocrine Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Hilde Lurås
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ellen Schlichting
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Section of Breast- and Endocrine Surgery, Oslo University Hospital, Oslo, Norway
| | - Tone Vamre
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | | | - Cecilie Heramb
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Lovise Mæhle
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
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14
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McCarthy AM, Armstrong K. Genetic Testing May Help Reduce Breast Cancer Disparities for African American Women. J Natl Cancer Inst 2020; 112:1179-1180. [PMID: 32427327 PMCID: PMC7735768 DOI: 10.1093/jnci/djaa042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anne Marie McCarthy
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Katrina Armstrong
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Snir M, Nazareth S, Simmons E, Hayward L, Ashcraft K, Bristow SL, Esplin ED, Aradhya S. Democratizing genomics: Leveraging software to make genetics an integral part of routine care. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2020; 187:14-27. [PMID: 33296144 DOI: 10.1002/ajmg.c.31866] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/25/2022]
Abstract
Genetic testing can provide definitive molecular diagnoses and guide clinical management decisions from preconception through adulthood. Innovative solutions for scaling clinical genomics services are necessary if they are to transition from a niche specialty to a routine part of patient care. The expertise of specialists, like genetic counselors and medical geneticists, has traditionally been relied upon to facilitate testing and follow-up, and while ideal, this approach is limited in its ability to integrate genetics into primary care. As individuals, payors, and providers increasingly realize the value of genetics in mainstream medicine, several implementation challenges need to be overcome. These include electronic health record integration, patient and provider education, tools to stay abreast of guidelines, and simplification of the test ordering process. Currently, no single platform offers a holistic view of genetic testing that streamlines the entire process across specialties that begins with identifying at-risk patients in mainstream care settings, providing pretest education, facilitating consent and test ordering, and following up as a "genetic companion" for ongoing management. We describe our vision for using software that includes clinical-grade chatbots and decision support tools, with direct access to genetic counselors and pharmacists within a modular, integrated, end-to-end testing journey.
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16
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Rana HQ, Kipnis L, Hehir K, Cronin A, Jaung T, Stokes SM, Fekrmandi F, Vatnick D, Matulonis UA, Garber JE, Wright AA. Embedding a genetic counselor into oncology clinics improves testing rates and timeliness for women with ovarian cancer. Gynecol Oncol 2020; 160:457-463. [PMID: 33229043 DOI: 10.1016/j.ygyno.2020.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/04/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Germline genetic testing is crucial to the care of ovarian cancer patients, and as part of the guideline-based care for ovarian cancer patient's adherence to this recommendation has been low. We sought to determine whether embedding a genetic counselor (GC) within a medical and gynecologic oncology clinic would increase testing rates and improve the timeliness of testing. METHODS Prospective cohort study of 358 ovarian cancer patients seen by medical and gynecologic oncologists between 2013 and 2015. Rates of referrals, completion of counseling, and genetic testing and timeliness of counseling were abstracted before and after a GC was embedded in the clinic in 2014. An additional year of data (2015) was collected to evaluate sustainability of the intervention. RESULTS Between 2013 and 2015, 88-92% of women were referred for genetic testing, but in 2013 only 66% completed counseling and 61% were tested. After a GC was embedded in the clinic in 2014, more than 80% of referred women completed counseling and germline genetic testing. Time to genetic counseling also decreased from a median of 107 to 40 days, irrespective of age and cancer family history (p < 0.01). CONCLUSIONS Embedding a GC into the workflow for ovarian cancer patients is an effective way of improving access to genetic counseling, testing rates, and the timeliness of testing.
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Affiliation(s)
- Huma Q Rana
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Lindsay Kipnis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kristin Hehir
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Angel Cronin
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tim Jaung
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Samantha M Stokes
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fatemeh Fekrmandi
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Donna Vatnick
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Judy E Garber
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alexi A Wright
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
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17
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Knerr S, Bowles EJA, Leppig KA, Buist DSM, Gao H, Wernli KJ. Trends in BRCA Test Utilization in an Integrated Health System, 2005-2015. J Natl Cancer Inst 2020; 111:795-802. [PMID: 30753636 DOI: 10.1093/jnci/djz008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/08/2018] [Accepted: 01/15/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Genetic testing to determine BRCA status has been available for over two decades, but there are few population-based studies of test diffusion. We report 10-year trends in BRCAtesting in an integrated health-care system with long-standing access to genetic services. METHODS A cohort of women aged 18 years and older was created to ascertain BRCA testing (n = 295 087). Annual testing rates between 2005 and 2015 were calculated in all women with and without incident (ie, newly diagnosed) breast and ovarian cancers and in clinically eligible subgroups by family cancer history, personal cancer history, and age at diagnosis. Secular trends were assessed using Poisson regression. Women tested early (2005-2008), midway (2009-2012), and late (2013-2015) in the study period were compared in cross-sectional analyses. RESULTS Between 2005 and 2015, annual testing rates increased from 0.6/1000 person-years (pys) (95% confidence interval [CI] = 0.4 to 0.7/1000 pys) to 0.8/1000 pys (95% CI = 0.6 to 1.0/1000 pys) in women without incident breast or ovarian cancers. Rates decreased from 71.5/1000 pys (95% CI = 42.4 to 120.8/1000 pys) to 44.4/1000 pys (95% CI = 35.5 to 55.6/1000 pys) in women with incident diagnoses, despite improvements in provision of timely BRCA testing during this time frame. We found no evidence of secular trends in clinically eligible subgroups including women with family history indicating increased hereditary cancer risk, but no personal cancer history. At the end of the study period, 97.0% (95% CI = 96.6% to 97.3%) of these women remained untested. CONCLUSION Many eligible women did not receive BRCA testing despite having insurance coverage and access to specialty genetic services, underscoring challenges to primary and secondary hereditary cancer prevention.
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Affiliation(s)
- Sarah Knerr
- See the Notes section for the authors' affiliations
| | | | | | | | - Hongyuan Gao
- See the Notes section for the authors' affiliations
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18
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McCarthy AM. Persistent Underutilization of BRCA1/2 Testing Suggest the Need for New Approaches to Genetic Testing Delivery. J Natl Cancer Inst 2020; 111:751-753. [PMID: 30753664 DOI: 10.1093/jnci/djz009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 02/07/2023] Open
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19
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Jatho A, Bikaitwoha ME, Mugisha NM. Socio-culturally mediated factors and lower level of education are the main influencers of functional cervical cancer literacy among women in Mayuge, Eastern Uganda. Ecancermedicalscience 2020; 14:1004. [PMID: 32104206 PMCID: PMC7039689 DOI: 10.3332/ecancer.2020.1004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Indexed: 11/17/2022] Open
Abstract
Background Health literacy (HL) is the degree of an individual’s knowledge and capacity to seek, understand and use health information to make decisions on one’s health, yet information on the functional level of cervical cancer literacy in Mayuge and Uganda as a whole is lacking. We, therefore, assessed the level of functional cervical cancer literacy among women aged 18–65 years in Mayuge district in five functional HL domains; prior knowledge, oral, print, numeracy and e-health. Understanding the factors associated with cervical cancer literacy is also pertinent to cervical health communication programming, however, no study has documented this in Uganda and particularly in Mayuge. Mayuge is a rural population based cancer registry and one of the sites for piloting cancer control interventions in Uganda. We also assessed the factors associated with cervical cancer literacy and awareness about currently available cervical cancer preventive services. Methods The study protocol was approved by the Uganda Cancer Institute research and ethic committee (UCI-REC). In August 2017, we assessed five HL domains; cervical cancer knowledge, print literacy, oral literacy using audio-clip, numeral literacy and perceived e-HL among 400 women at household levels. Correct response was scored 1 and incorrect response was scored 0 to generate the mean percentage score for each domain. The mean scores were classified as limited, basic and proficient bands based on the McCormack HL cut-offs scale for knowledge, print, oral and e-health and Weiss cut-offs in the newest vital signs (NVS) for numeracy. We used the cervical cancer literacy scores to explore the effect of selected study variables on cervical cancer literacy. We also conducted five focus group discussions (FGDs) based on the theoretical constructs of the PEN-3 model. Results The majority (96.8%) of the participants demonstrated a limited level of cervical cancer literacy with a mean score of 42%. Women who had completed a primary level of education or lower (OR = 3.91; p = 0.044) were more likely to have limited cervical cancer literacy. The qualitative data indicated that the women had limited cervical cancer literacy coupled with limited decisional, social and financial support from their male partners with overall low locus of control. Most (92.3%) of the women were not aware of the available cervical cancer services and had no intention to screen (52.5%). Conclusions The women in Mayuge in general have limited cervical cancer literacy except oral HL domain. Limited cervical cancer literacy was highest among women with lower level of education and overall literacy seemed to be influenced on the higher side by socio-cultural constructs characterised by limited decisional, social and personal resources among the women with overall low locus of control. The Mayuge women further demonstrated scant knowledge about the available health services in their district and low intention to screen. Multi-strategy cervical health empowerment programme is needed to improve cervical HL using orally disseminated messages.
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Affiliation(s)
- Alfred Jatho
- Uganda Cancer Institute, PO Box 3935, Kampala, Uganda.,Uganda Martyrs University, PO Box 5498, Kampala, Uganda.,Department of Cancer Control and Population Health, National Cancer Centre Graduate School of Cancer Science and Policy, Goyang, South Korea
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20
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Kemp Z, Turnbull A, Yost S, Seal S, Mahamdallie S, Poyastro-Pearson E, Warren-Perry M, Eccleston A, Tan MM, Teo SH, Turner N, Strydom A, George A, Rahman N. Evaluation of Cancer-Based Criteria for Use in Mainstream BRCA1 and BRCA2 Genetic Testing in Patients With Breast Cancer. JAMA Netw Open 2019; 2:e194428. [PMID: 31125106 PMCID: PMC6632150 DOI: 10.1001/jamanetworkopen.2019.4428] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Increasing BRCA1 and BRCA2 (collectively termed herein as BRCA) gene testing is required to improve cancer management and prevent BRCA-related cancers. OBJECTIVE To evaluate mainstream genetic testing using cancer-based criteria in patients with cancer. DESIGN, SETTING, AND PARTICIPANTS A quality improvement study and cost-effectiveness analysis of different BRCA testing selection criteria and access procedures to evaluate feasibility, acceptability, and mutation detection performance was conducted at the Royal Marsden National Health Service Foundation Trust as part of the Mainstreaming Cancer Genetics (MCG) Programme. Participants included 1184 patients with cancer who were undergoing genetic testing between September 1, 2013, and February 28, 2017. MAIN OUTCOMES AND MEASURES Mutation rates, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were the primary outcomes. RESULTS Of the 1184 patients (1158 women [97.8%]) meeting simple cancer-based criteria, 117 had a BRCA mutation (9.9%). The mutation rate was similar in retrospective United Kingdom (10.2% [235 of 2294]) and prospective Malaysian (9.7% [103 of 1061]) breast cancer studies. If traditional family history criteria had been used, more than 50% of the mutation-positive individuals would have been missed. Of the 117 mutation-positive individuals, 115 people (98.3%) attended their genetics appointment and cascade to relatives is underway in all appropriate families (85 of 85). Combining with the equivalent ovarian cancer study provides 5 simple cancer-based criteria for BRCA testing with a 10% mutation rate: (1) ovarian cancer; (2) breast cancer diagnosed when patients are 45 years or younger; (3) 2 primary breast cancers, both diagnosed when patients are 60 years or younger; (4) triple-negative breast cancer; and (5) male breast cancer. A sixth criterion-breast cancer plus a parent, sibling, or child with any of the other criteria-can be added to address family history. Criteria 1 through 5 are considered the MCG criteria, and criteria 1 through 6 are considered the MCGplus criteria. Testing using MCG or MCGplus criteria is cost-effective with cost-effectiveness ratios of $1330 per discounted QALYs and $1225 per discounted QALYs, respectively, and appears to lead to cancer and mortality reductions (MCG: 804 cancers, 161 deaths; MCGplus: 1020 cancers, 204 deaths per year over 50 years). Use of MCG or MCGplus criteria might allow detection of all BRCA mutations in patients with breast cancer in the United Kingdom through testing one-third of patients. Feedback questionnaires from 259 patients and 23 cancer team members (12 oncologists, 8 surgeons, and 3 nurse specialists) showed acceptability of the process with 100% of patients pleased they had genetic testing and 100% of cancer team members confident to approve patients for genetic testing. Use of MCGplus criteria also appeared to be time and resource efficient, requiring 95% fewer genetic consultations than the traditional process. CONCLUSIONS AND RELEVANCE This study suggests that mainstream testing using simple, cancer-based criteria might be able to efficiently deliver consistent, cost-effective, patient-centered BRCA testing.
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Affiliation(s)
- Zoe Kemp
- Breast Unit, Royal Marsden National Health Service Foundation Trust, London, United Kingdom
- Cancer Genetics Unit, Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Alice Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom
| | - Shawn Yost
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom
- TGLclinical, Institute of Cancer Research, London, United Kingdom
| | - Sheila Seal
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom
- TGLclinical, Institute of Cancer Research, London, United Kingdom
| | - Shazia Mahamdallie
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom
- TGLclinical, Institute of Cancer Research, London, United Kingdom
| | - Emma Poyastro-Pearson
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom
- TGLclinical, Institute of Cancer Research, London, United Kingdom
| | - Margaret Warren-Perry
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom
| | | | - Min-Min Tan
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Soo Hwang Teo
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
- Department of Surgery, Faculty of Medicine, University Malaya, Kuala Lumpar, Malaysia
| | - Nicholas Turner
- Breast Unit, Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Ann Strydom
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom
- TGLclinical, Institute of Cancer Research, London, United Kingdom
| | - Angela George
- Cancer Genetics Unit, Royal Marsden National Health Service Foundation Trust, London, United Kingdom
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom
- TGLclinical, Institute of Cancer Research, London, United Kingdom
| | - Nazneen Rahman
- Cancer Genetics Unit, Royal Marsden National Health Service Foundation Trust, London, United Kingdom
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, United Kingdom
- TGLclinical, Institute of Cancer Research, London, United Kingdom
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Racial/Ethnic Disparities in BRCA Counseling and Testing: a Narrative Review. J Racial Ethn Health Disparities 2019; 6:570-583. [DOI: 10.1007/s40615-018-00556-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 01/12/2023]
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Bucheit L, Johansen Taber K, Ready K. Validation of a digital identification tool for individuals at risk for hereditary cancer syndromes. Hered Cancer Clin Pract 2019; 17:2. [PMID: 30651894 PMCID: PMC6330430 DOI: 10.1186/s13053-018-0099-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/15/2018] [Indexed: 01/05/2023] Open
Abstract
Background The number of individuals meeting criteria for genetic counseling and testing for hereditary cancer syndromes (HCS) is far less than the number that actually receive it. To facilitate identification of patients at risk for HCS, Counsyl developed a digital identification tool (digital ID tool) to match personal and family cancer history to National Comprehensive Cancer Network (NCCN) BRCA-related Hereditary Breast and Ovarian Cancer (HBOC), Lynch syndrome, and polyposis testing criteria in one-to-one, automated fashion. The purpose of this study was to validate the ability of the digital ID tool to accurately identify histories that do and do not meet NCCN testing criteria. Methods Third-party recorded three-generation pedigrees were retrospectively reviewed by a certified genetic counselor (CGC) to determine if independent events included in pedigree histories met NCCN guidelines, and were then sorted into groups: high risk events (meets criteria) and low risk events (does not meet criteria). Events were entered into the digital ID tool to determine the extent of its concordance with events sorted by CGC review. Statistical tests of accuracy were calculated at a 95% confidence interval (CI). Results One hundred ninety-seven pedigrees were reviewed consecutively representing 765 independent events for analysis across groups. 382/382 (100%) high risk events identified by the digital ID tool and 381/383 (99.47%) low risk events identified by the digital ID tool were concordant with CGC sorting. The digital ID tool had a sensitivity of 100% (99.04–100% CI) and specificity of 99.48% (98.13–99.94% CI). The overall accuracy of the digital ID tool was estimated to be 99.74% (99.06–99.97% CI), reflecting the rate at which the digital ID tool reached the same conclusion as that of CGC review of pedigree events for the recommendation of genetic testing for individuals at risk for HCS. Conclusions The digital ID tool accurately matches NCCN criteria in one-to-one fashion to identify at-risk individuals for HCS and may be useful in clinical practice, specifically for BRCA-related HBOC and Lynch Syndrome. Electronic supplementary material The online version of this article (10.1186/s13053-018-0099-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leslie Bucheit
- Counsyl, 180 Kimball Way, South San Francisco, CA 98040 USA
| | | | - Kaylene Ready
- Counsyl, 180 Kimball Way, South San Francisco, CA 98040 USA
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23
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Hoskins KF, Tejeda S, Vijayasiri G, Chukwudozie IB, Remo MH, Shah HA, Abraham IE, Balay LE, Maga TK, Searles ER, Korah VJ, Biggers A, Stolley MR, Warnecke RB. A feasibility study of breast cancer genetic risk assessment in a federally qualified health center. Cancer 2018; 124:3733-3741. [PMID: 30320429 PMCID: PMC6214782 DOI: 10.1002/cncr.31635] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND The US Preventive Services Task Force (USPSTF) endorses routine screening for genetic risk of breast and/or ovarian cancer as a component of primary health care. Implementation of this recommendation may prove challenging, especially in clinics serving disadvantaged communities. METHODS The authors tested the feasibility of implementing the USPSTF mandate at a federally qualified health center (FQHC) to identify women who were eligible for genetic counseling (GC). A 12-month usual-care phase was followed by a 12-month intervention phase, during which time cancer genetic risk assessment (CGRA) was systematically performed for all women aged 25 to 69 years who presented for an annual examination. Women who were eligible for GC were recruited to participate in the study. RESULTS After initiating CGRA, 112 women who were eligible for GC consented to study participation, and 56% of them received a referral for GC from their primary care physician. A subgroup of 50 participants were seen by the same primary care physician during both the usual-care and intervention phases. None of these patients was referred for GC during usual care, compared with 64% after the initiation of CGRA (P < .001). Only 16% of referred participants attended a GC session. CONCLUSIONS Implementing USPSTF recommendations for CGRA as a standard component of primary health care in FQHCs is feasible and improves referral of minority women for GC, but more work is needed to understand the beliefs and barriers that prevent many underserved women from accessing cancer genetic services.
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Affiliation(s)
- Kent F Hoskins
- Section of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Silvia Tejeda
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Ganga Vijayasiri
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Ifeanyi Beverly Chukwudozie
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Mylene H Remo
- Section of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Hiral A Shah
- Section of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Ivy E Abraham
- Section of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Lara E Balay
- Section of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Tara K Maga
- Section of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | | | | | - Alana Biggers
- Section of General Internal Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Melinda R Stolley
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Richard B Warnecke
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
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Gordon ES, Babu D, Laney DA. The future is now: Technology's impact on the practice of genetic counseling. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018. [DOI: 10.1002/ajmg.c.31599] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Dawn A. Laney
- Department of Human GeneticsEmory School of MedicineDecatur Georgia
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Greenberg S, Yashar BM, Pearlman M, Duquette D, Milliron K, Marvin M. Evaluating and improving the implementation of a community-based hereditary cancer screening program. J Community Genet 2018; 10:51-60. [PMID: 29508367 DOI: 10.1007/s12687-018-0357-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 02/05/2018] [Indexed: 11/26/2022] Open
Abstract
Healthcare disparities exist in the provision of cancer genetic services including genetic counseling and testing related to BRCA1/2 mutations. To address this in a community health setting a screening tool was created to identify high-risk women. This study evaluates the implementation of the tool and identifies opportunities for improved cancer genetic screening, including regular clinician education. A mixed-method approach was used to evaluate clinician utilization of the screening tool at Planned Parenthood affiliates. Novel surveys that evaluated acceptance and implementation were administered to clinicians (n = 14) and semi-structured interviews (n = 6) were used to explore clinicians' perspectives and identify gaps in its utilization. Educational modules that addressed gaps were developed, implemented, and evaluated using a post-education survey (n = 8). Clinicians reported confidence in administering and interpreting the screening tool, but reported less confidence in their knowledge of cancer genetics and ability to connect clients with genetic counseling and testing (p = .003). Educational modules resulted in significant gains in clinician knowledge on genetic topics (p < .05) and increased self-reported confidence in connecting clients with genetic services. The modules reinforced the belief that genetic testing is beneficial for patients at increased risk (p = .001) and is important to inform subsequent medical management (p = .027). While building community clinicians' capacity to connect clients with genetic services is crucial, it is challenged by knowledge and confidence gaps in discussions of genetic services with clients. Consistent genetic-focused education with non-genetic clinicians can improve confidence and knowledge, enabling a more effective screening program in community health settings.
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Affiliation(s)
- Samantha Greenberg
- Department of Human Genetics, University of Michigan, 4909 Buhl Building, 1241 E Catherine St, Ann Arbor, MI, 48109-5618, USA.
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, 4909 Buhl Building, 1241 E Catherine St, Ann Arbor, MI, 48109-5618, USA
| | - Mark Pearlman
- University of Michigan Obstetrics and Gynecology, 1540 E Hospital DR SPC 4276, Ann Arbor, MI, 48109-4276, USA
| | - Deb Duquette
- Feinberg School of Medicine, 645 North Michigan Avenue, Suite 630, Chicago, IL, 60611, USA
| | - Kara Milliron
- University of Michigan Comprehensive Cancer Center, 300 N Ingalls- 3A12, Ann Arbor, MI, 48109-5471, USA
| | - Monica Marvin
- Department of Human Genetics, University of Michigan, 4909 Buhl Building, 1241 E Catherine St, Ann Arbor, MI, 48109-5618, USA
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Paternal lineage early onset hereditary ovarian cancers: A Familial Ovarian Cancer Registry study. PLoS Genet 2018; 14:e1007194. [PMID: 29447163 PMCID: PMC5813894 DOI: 10.1371/journal.pgen.1007194] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/09/2018] [Indexed: 11/19/2022] Open
Abstract
Given prior evidence that an affected woman conveys a higher risk of ovarian cancer to her sister than to her mother, we hypothesized that there exists an X-linked variant evidenced by transmission to a woman from her paternal grandmother via her father. We ascertained 3,499 grandmother/granddaughter pairs from the Familial Ovarian Cancer Registry at the Roswell Park Cancer Institute observing 892 informative pairs with 157 affected granddaughters. We performed germline X-chromosome exome sequencing on 186 women with ovarian cancer from the registry. The rate of cancers was 28.4% in paternal grandmother/granddaughter pairs and 13.9% in maternal pairs consistent with an X-linked dominant model (Chi-square test X2 = 0.02, p = 0.89) and inconsistent with an autosomal dominant model (X2 = 20.4, p<0.001). Paternal grandmother cases had an earlier age-of-onset versus maternal cases (hazard ratio HR = 1.59, 95%CI: 1.12–2.25) independent of BRCA1/2 status. Reinforcing the X-linked hypothesis, we observed an association between prostate cancer in men and ovarian cancer in his mother and daughters (odds ratio, OR = 2.34, p = 0.034). Unaffected mothers with affected daughters produced significantly more daughters than sons (ratio = 1.96, p<0.005). We performed exome sequencing in reported BRCA negative cases from the registry. Considering age-of-onset, one missense variant (rs176026 in MAGEC3) reached chromosome-wide significance (Hazard ratio HR = 2.85, 95%CI: 1.75–4.65) advancing the age of onset by 6.7 years. In addition to the well-known contribution of BRCA, we demonstrate that a genetic locus on the X-chromosome contributes to ovarian cancer risk. An X-linked pattern of inheritance has implications for genetic risk stratification. Women with an affected paternal grandmother and sisters of affected women are at increased risk for ovarian cancer. Further work is required to validate this variant and to characterize carrier families. Our article uses the largest familial study of ovarian cancer to argue that there exists an ovarian cancer susceptibility gene on the X-chromosome acting independently of BRCA1 and BRCA2. This observation implies that there may be many cases of seemingly sporadic ovarian cancer that are actually inherited; for example, only daughters who inherit risk from their fathers. This X-linked pattern implies novel ways to prioritize families for screening even without additional testing—sisters must both be carriers or neither; fathers of women with potentially inherited ovarian cancer may receive new attention. In addition, we found evidence that other cancers affect fathers and sons in these families. Using sequencing technology, we isolated a candidate gene, MAGEC3, that may be associated with earlier onset of ovarian cancer. The further study of this gene and the X-linked pattern will require additional study.
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Hull LE, Haas JS, Simon SR. Provider Discussions of Genetic Tests With U.S. Women at Risk for a BRCA Mutation. Am J Prev Med 2018; 54:221-228. [PMID: 29241717 DOI: 10.1016/j.amepre.2017.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 09/05/2017] [Accepted: 10/20/2017] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The U.S. Preventive Services Task Force recommends that primary care providers screen unaffected women with a family history of BRCA mutation-associated cancers, but without a personal history of BRCA-related cancer, for referral to genetic counseling and potential genetic testing. METHODS The 2015 National Health Interview Survey was analyzed in January 2017 to determine the rates at which unaffected adult women with a positive family history of BRCA-related cancers, assessed using the Family History Screen-7, reported discussing genetic testing with a provider, using genetic counseling services, and having genetic testing for increased cancer risk. Clinical correlates associated with these outcomes were assessed using multivariable logistic regression (AOR with 95% CI). RESULTS Among unaffected Family History Screen-7 screen-positive women, 9.5% reported discussing genetic testing with a provider, 5.1% reported genetic counseling, and 2.7% reported uptake of genetic testing. Younger women (aged 18-39 and 40-49 years) were more likely to discuss genetic testing than women aged ≥60 years (AOR=1.50, 95% CI=1.09, 2.06 and AOR=1.64, 95% CI=1.15, 2.33, respectively). Women of black race (AOR=1.50, 95% CI=1.09, 2.07) and women with greater than a high school education (AOR=1.85, 95% CI=1.41, 2.43) were more likely to discuss genetic testing than women of white race and women with a high school education or less, respectively. Among a higher risk subgroup with an even stronger family history of BRCA-associated cancers, 18.5% of women reported discussions. CONCLUSIONS Despite a decade-old U.S. Preventive Services Task Force recommendation, few unaffected women at risk for BRCA-associated cancer report discussing genetic testing with a provider.
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Affiliation(s)
- Leland E Hull
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; Section of General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts.
| | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Steven R Simon
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; Geriatrics and Extended Care Service, VA Boston Healthcare System, Boston, Massachusetts
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28
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Ngene SO, Adedokun B, Adejumo P, Olopade O. Breast Cancer Genetics Knowledge and Testing Intentions among Nigerian Professional Women. J Genet Couns 2017; 27:863-873. [PMID: 29260484 DOI: 10.1007/s10897-017-0194-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 12/12/2017] [Indexed: 01/29/2023]
Abstract
Genetic testing services for breast cancer are well established in developed countries compared to African populations that bear a disproportionate burden of breast cancer (BC). The objective of this study is to examine the knowledge of professional Nigerian women about BC genetics and their intentions to utilize genetic testing services when it is made available in Nigeria. In this study, 165 lecturers and 189 bankers were recruited and studied using a validated self-administered questionnaire. The respondents' mean age was 34.9 years (SD = 10.9), 6.5% had family history of BC, and 84.7% had limited knowledge of breast cancer genetics. The proportion of women with genetic testing intentions for breast cancer was 87.3%. Health care access (OR = 2.35, 95% CI, 1.07-5.13), religion (OR = 3.51, 95% CI, 1.03-11.92), and perceived personal risk if a close relative had breast cancer (OR = 2.31, 95% CI, 1.05-5.08) independently predicted testing intentions. The genetic testing intentions for BC were high despite limited knowledge about breast cancer genetics. Promotion of BC genetics education as well as efforts to make BC genetic testing services available in Nigeria at reduced cost remains essential.
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Affiliation(s)
- Samuel O Ngene
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Babatunde Adedokun
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Prisca Adejumo
- Department of Nursing, University of Ibadan, Ibadan, Nigeria
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29
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Hoskins PJ, Gotlieb WH. Missed therapeutic and prevention opportunities in women with BRCA-mutated epithelial ovarian cancer and their families due to low referral rates for genetic counseling and BRCA testing: A review of the literature. CA Cancer J Clin 2017; 67:493-506. [PMID: 28881380 DOI: 10.3322/caac.21408] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 12/24/2022] Open
Abstract
Answer questions and earn CME/CNE Fifteen percent of women with epithelial ovarian cancer have inherited mutations in the BRCA breast cancer susceptibility genes. Knowledge of her BRCA status has value both for the woman and for her family. A therapeutic benefit exists for the woman with cancer, because a new family of oral drugs, the poly ADP-ribose polymerase (PARP) inhibitors, has recently been approved, and these drugs have the greatest efficacy in women who carry the mutation. For her family, there is the potential to prevent ovarian cancer in those carrying the mutation by using risk-reducing surgery. Such surgery significantly reduces the chance of developing this, for the most part, incurable cancer. Despite these potential benefits, referral rates for genetic counseling and subsequent BRCA testing are low, ranging from 10% to 30%, indicating that these therapeutic and prevention opportunities are being missed. The authors have reviewed the relevant available literature. Topics discussed are BRCA and its relation to ovarian cancer, the rates of referral for genetic counseling/BRCA testing, reasons for these low rates, potential strategies to improve on those rates, lack of effectiveness of current screening strategies, the pros and cons of risk-reducing surgery, other prevention options, and the role and value of PARP inhibitors. CA Cancer J Clin 2017;67:493-506. © 2017 American Cancer Society.
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Affiliation(s)
- Paul J Hoskins
- Medical Oncologist and Past President, Society of Gynecologic Oncology Canada, British Columbia Cancer Agency, Vancouver Center, BC, Canada
| | - Walter H Gotlieb
- Gynecologic Oncologist and President, Society of Gynecologic Oncology Canada, McGill University, Jewish General Hospital, Montreal, QC, Canada
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30
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Chun DS, Berse B, Venne VL, DuVall SL, Filipski KK, Kelley MJ, Meyer LJ, Icardi MS, Lynch JA. BRCA testing within the Department of Veterans Affairs: concordance with clinical practice guidelines. Fam Cancer 2017; 16:41-49. [PMID: 27589855 DOI: 10.1007/s10689-016-9921-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Guideline-concordant cancer care is a priority within the Department of Veterans Affairs (VA). In 2009, the VA expanded its capacity to treat breast cancer patients within VA medical centers (VAMCs). We sought to determine whether male and female Veterans diagnosed with breast cancer received BRCA testing as recommended by the National Comprehensive Cancer Network (NCCN) guidelines on Genetic/Familial High-Risk Assessment in Breast and Ovarian Cancer (v. 1.2010-1.2012). Using the 2011-2012 VA Central Cancer Registry and BRCA test orders from Myriad Genetics, we conducted a retrospective study. The outcome variable was a recommendation for genetic counseling or BRCA testing, determined by chart review. Independent variables expected to predict testing included region, site of care, and patient characteristics. We performed descriptive analysis of all patients and conducted multivariable logistic regression on patients who sought care at VAMCs that offered BRCA testing. Of the 462 Veterans who met NCCN testing criteria, 126 (27 %) received guideline-concordant care, either a referral for counseling or actual testing. No BRCA testing was recommended in 49 (50 %) VAMCs that provide cancer treatment. Surprisingly, patients with second primary breast cancer were less likely to be referred/tested (OR 0.39; CI 0.17, 0.89; p = 0.025). For patients under age 51, a yearly increase in age decreased likelihood of referral or testing (OR 0.85; CI 0.76, 0.94; p < 0.001). There were no differences in testing by race. In conclusion, there was significant underutilization and lack of access to BRCA testing for Veterans diagnosed with breast cancer. Our research suggests the need for clinical decision support tools to facilitate delivery of guideline-concordant cancer care and improve Veteran access to BRCA testing.
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Affiliation(s)
- Danielle S Chun
- VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.,University of Utah School of Medicine, 500 Foothill Drive, Salt Lake City, UT, 84148, USA
| | - Brygida Berse
- Veterans Health Administration, 200 Springs Rd, Bedford, MA, 01730, USA.,Boston University School of Medicine, 72 E. Concord Street, Boston, MA, 02118, USA.,RTI International, 307 Waverley Oaks Rd, Waltham, MA, 02452, USA
| | - Vickie L Venne
- VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA
| | - Scott L DuVall
- VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.,University of Utah School of Medicine, 500 Foothill Drive, Salt Lake City, UT, 84148, USA
| | - Kelly K Filipski
- National Cancer Institute, 9609 Medical Center Drive, Rm. 4E228, MSC 9763, Rockville, Bethesda, MD, 20892, USA
| | - Michael J Kelley
- Durham VA Medical Center, 508 Fulton St, Durham, NC, 27705, USA.,Duke University, 508 Fulton St, Hem-onc 111G, Durham, NC, 27705, USA
| | - Laurence J Meyer
- VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.,University of Utah School of Medicine, 500 Foothill Drive, Salt Lake City, UT, 84148, USA
| | - Michael S Icardi
- Veterans Health Administration, 601 Highway 6 West, Iowa City, IA, 52246-2208, USA.,University of Iowa, 601 Highway 6 West, Iowa City, IA, 52246-2208, USA
| | - Julie A Lynch
- University of Utah School of Medicine, 500 Foothill Drive, Salt Lake City, UT, 84148, USA. .,RTI International, 307 Waverley Oaks Rd, Waltham, MA, 02452, USA. .,VA Salt Lake City Health Care System, 200 Springs Road, Bedford, MA, 01730, USA.
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31
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van der Giessen JAM, van Riel E, Velthuizen ME, van Dulmen AM, Ausems MGEM. Referral to cancer genetic counseling: do migrant status and patients' educational background matter? J Community Genet 2017; 8:303-310. [PMID: 28868568 PMCID: PMC5614888 DOI: 10.1007/s12687-017-0326-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/21/2017] [Indexed: 12/17/2022] Open
Abstract
Participation rates in cancer genetic counseling differ among populations, as patients with a lower educational background and migrant patients seem to have poorer access to it. We conducted a study to determine the present-day educational level and migrant status of counselees referred to cancer genetic counseling. We assessed personal characteristics and demographics of 731 newly referred counselees. Descriptive statistics were used to describe these characteristics. The results show that about 40% of the counselees had a high educational level and 89% were Dutch natives. Compared to the Dutch population, we found a significant difference in educational level (p = < 0.01) and migrant status (p = < 0.001). This suggests disparities in cancer genetic counseling and as a result of that, suboptimal care for vulnerable groups. Limited health literacy is likely to pose a particular challenge to cancer genetic counseling for counselees with a lower education or a migrant background. Our study points to considerable scope for improvement in referring vulnerable groups of patients for cancer genetic counseling.
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Affiliation(s)
- J A M van der Giessen
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands
| | - E van Riel
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands
| | - M E Velthuizen
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands
| | - A M van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.,Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - M G E M Ausems
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands.
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Dubovsky SL. The Limitations of Genetic Testing in Psychiatry. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 85:129-35. [PMID: 27043036 DOI: 10.1159/000443512] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/20/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Steven L Dubovsky
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, N.Y., and Departments of Psychiatry and Medicine, University of Colorado, Denver, Colo., USA
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33
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Stewart SL, Kaplan CP, Lee R, Joseph G, Karliner L, Livaudais-Toman J, Pasick RJ. Validation of an Efficient Screening Tool to Identify Low-Income Women at High Risk for Hereditary Breast Cancer. Public Health Genomics 2016; 19:342-351. [PMID: 27788513 DOI: 10.1159/000452095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/28/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND/AIMS We compared the 6-Point Scale, a screening tool to identify low-income women for referral to genetic counseling, with genetic counselors' (GCs') recommendation and the Referral Screening Tool (RST). METHODS RST and 6-Point Scale scores were computed for 2 samples: (1) S1, public hospital mammography clinic patients in 2006-2010 (n = 744), classified by GCs as high risk (meriting referral to counseling) or not high risk, and (2) S2, primary care patients enrolled in an education intervention study in 2011-2012 (n = 1,425). Sensitivity, specificity, and area under the ROC curve (AUROC) were computed for the 6-Point Scale score versus GC and RST classification as high risk. RESULTS The 6-Point Scale had low sensitivity (0.27, 95% confidence interval [CI] 0.21-0.34) but high specificity (0.97, 95% CI 0.95-0.99) and AUROC (0.85, 95% CI 0.81-0.90) versus GC classification, and high sensitivity (S1: 0.90, 95% CI 0.79-1.00; S2: 0.94, 95% CI 0.87-0.97), specificity (S1: 0.95, 95% CI 0.93-0.97; S2: 0.94, 95% CI 0.93-0.96), and AUROC (S1: 0.98, 95% CI 0.96-0.99; S2: 0.98, 95% CI 0.98-0.99) versus the RST. CONCLUSION The 6-Point Scale compared favorably with the RST, a validated instrument, and is potentially useful as a simple tool for administration in a safety net setting, requiring minimal time investment by primary care physicians and their staff and no financial investment in tablet computers or software.
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Affiliation(s)
- Susan L Stewart
- University of California, Davis Division of Biostatistics, Sacramento, CA, USA
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34
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Jones T, Lockhart JS, Mendelsohn-Victor KE, Duquette D, Northouse LL, Duffy SA, Donley R, Merajver SD, Milliron KJ, Roberts JS, Katapodi MC. Use of Cancer Genetics Services in African-American Young Breast Cancer Survivors. Am J Prev Med 2016; 51:427-36. [PMID: 27117712 DOI: 10.1016/j.amepre.2016.03.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/25/2016] [Accepted: 03/22/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION African-American women have higher rates of early-onset breast cancer compared with their Caucasian counterparts; yet, when diagnosed with breast cancer at a young age, they underuse genetic counseling and testing to manage their risk of developing future cancers. METHODS Self-reported baseline data were collected between September 2012 and January 2013 and analyzed in 2014 from a subpopulation of 340 African-American young breast cancer survivors (YBCSs) enrolled in an RCT. YBCSs were diagnosed with invasive breast cancer or ductal carcinoma in situ between ages 20 and 45 years and were randomly selected from a statewide cancer registry. Logistic regression examined predictors of using cancer genetics services. RESULTS Overall, 28% of the sample reported having genetic counseling and 21% reported having genetic testing, which were significantly lower (p≤0.005) compared with white/other YBCSs participating in the parent study. In a multivariate analysis, income was positively associated with counseling (B=0.254, p≤0.01) and testing (B=0.297, p≤0.01), whereas higher education levels (B=-0.328, p≤0.05) and lack of access to healthcare services owing to cost (B=-1.10, p≤0.03) were negatively associated with genetic counseling. Lower income and lack of care because of high out-of-pocket costs were commonly reported barriers. CONCLUSIONS Despite national recommendations for genetic evaluation among women with early-onset breast cancer, few African-American YBCSs reported undergoing genetic counseling and testing. Most reported that their healthcare provider did not recommend these services. Interventions addressing patient, provider, and structural healthcare system barriers to using genetic counseling and testing in this population are needed.
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Affiliation(s)
- Tarsha Jones
- The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services at Dana-Farber Cancer Institute, Boston, Massachusetts; Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | - Joan S Lockhart
- Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | | | - Debra Duquette
- Michigan Department of Health and Human Services, Cancer Genomics Program, Lansing, Michigan
| | | | - Sonia A Duffy
- Ohio State University College of Nursing, Columbus, Ohio
| | - Rosemary Donley
- Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | | | - Kara J Milliron
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - J Scott Roberts
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Maria C Katapodi
- University of Michigan School of Nursing, Ann Arbor, Michigan; University of Basel, Institute of Nursing Science, Basel, Switzerland.
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