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Fasulo V, Buffi N, Chiarelli G, Lughezzani G, Zuradelli M, Ripamonti CB, Barile M, Bianchi P, Benetti A, Paciotti M, Uleri A, Avolio PP, Saita A, Hurle R, Maura F, Germagnoli L, Asselta R, Soldà G, Casale P, Lazzeri M. Male awareness of prostate cancer risk remains poor in relatives of women with germline variants in DNA-repair genes. BJUI COMPASS 2023; 4:738-745. [PMID: 37818031 PMCID: PMC10560622 DOI: 10.1002/bco2.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/25/2023] [Accepted: 05/07/2023] [Indexed: 10/12/2023] Open
Abstract
Abstract. Objective The aim of this study is to evaluate male awareness of developing prostate cancer (PCa) in families with germline DNA-repair genes (DRG) variants. Materials and methods Data were collected from a prospective, monocentric cohort study. The study was conducted in a university hospital with a multidisciplinary approach to the patient (collaboration of the Departments of Oncology, Urology, Pathology, Radiology, and Medical Genetics Laboratory). We recruited healthy males, relatives of families of women with breast or ovarian cancer who tested positive for pathogenic variants (PVs) or likely pathogenic variants (LPVs) in DRGs. A dedicated PCa screening was designed and offered to men aged 35 to 69 years, based on early visits with digital rectal examination (DRE), prostate health index (PHI) measurement, multiparametric magnetic resonance imaging (mpMRI) and, if necessary, targeted/systematic prostate biopsies. The primary endpoint was to evaluate the willingness of healthy men from families with a DRG variants detected in female relatives affected with breast and/or ovarian cancer to be tested for the presence of familial PVs. The secondary endpoints were the acceptance to participate if resulted positive and compliance with the screening programme. Results Over 1256 families, of which 139 resulted positive for PVs in DRGs, we identified 378 'healthy' men aged between 35 and 69 years old. Two hundred sixty-one (69.0%) refused to be tested for DRG variants, 66 (17.5%) declared to have been previously tested, and 51 (13.5%) males were interested to be tested. Between those previously tested and those who accepted to be tested, 62 (53.0%) were positive for a DRG variant, and all of them accepted to participate in the subsequent surveillance steps. The main limitation is that is a single-centre study and a short follow-up. Conclusions All men tested positive for a DRG variants agreed to go under the surveillance scheme. However, only 31% of 'men at risk' (i.e., relative of a DRG variant carrier) expressed their willingness to be tested for the familial DRG variant. This observation strongly supports the urgent need to implement awareness of genetic risk for PCa within the male population.
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Affiliation(s)
- Vittorio Fasulo
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - NicolòMaria Buffi
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Giuseppe Chiarelli
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Giovanni Lughezzani
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Monica Zuradelli
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Medical Oncology and Hematology UnitIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | | | - Monica Barile
- Laboratory Analysis UnitIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Paolo Bianchi
- Laboratory Analysis UnitIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Alessio Benetti
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Marco Paciotti
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Alessandro Uleri
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Pier Paolo Avolio
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Alberto Saita
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Rodolfo Hurle
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Federica Maura
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- Laboratory Analysis UnitIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Luca Germagnoli
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- IRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Rosanna Asselta
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- IRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Giulia Soldà
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMIItaly
- IRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Paolo Casale
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
| | - Massimo Lazzeri
- Department of UrologyIRCCS‐Humanitas Research HospitalRozzanoMIItaly
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What is the most effective way to ensure that patients successfully undergo germline testing for prostate cancer? Urol Oncol 2023; 41:49.e1-49.e6. [PMID: 36283931 DOI: 10.1016/j.urolonc.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/26/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We sought to identify the most effective way to refer patients with prostate cancer to germline testing. METHODS After IRB approval, we queried the electronic medical records (EMR) to identify patients (ages 18-89) with prostate cancer who were referred for or offered germline testing for prostate cancer from May 1, 2019 to February 24, 2021 through either telephone referral, EMR referral or in-office testing. The 3 cohorts were compared on receipt of testing and time to testing. Multivariate logistic regression and Cox regression evaluated the influence of referral cohort and reason for testing on receipt of testing and time to testing, respectively. RESULTS A total of 184 patients met study inclusion criteria; 47 were referred for germline testing via telephone, 70 were referred through the EMR and 67 were offered testing in the office. No significant demographic or clinical differences were observed. Telephone referral yielded the lowest response (17%; P < 0.001) with the longest time interval between referral and testing (103 days; P < 0.001); in-office testing yielded the highest response (66%). More patients were referred because of both family history and high risk characteristics in the EMR and in-office testing cohorts (21.4% and 25.4% respectively). Referral method was significantly (P < 0.001) associated with receipt of test, while reason for testing was not. Referral method was also independently related to time to testing (P < 0.001) while reason for referral was not. CONCLUSIONS Urologists should offer germline testing in the office for the most effective and expedient results.
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Dean M, Campbell-Salome G, Rauscher EA. Engaging Men With BRCA-Related Cancer Risks: Practical Advice for BRCA Risk Management From Male Stakeholders. Am J Mens Health 2021; 14:1557988320924932. [PMID: 32449425 PMCID: PMC7249566 DOI: 10.1177/1557988320924932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Men are at risk for developing hereditary cancers such as breast, prostate, pancreatic, and melanoma due to a pathogenic germline variant in either the BRCA1 or BRCA2 gene. The purpose of this study was to identify and provide practical advice for men managing their BRCA-related cancer risks based on men's real-life experiences. Semistructured interviews were conducted with 25 men who either tested positive for a pathogenic variant in BRCA1/2 gene or who had an immediate family member who had tested positive for a pathogenic variant in BRCA1/2. A thematic analysis of the interview transcripts was completed utilizing the constant comparison method. Qualitative analysis produced three categories of participant advice for men who recently learned of their hereditary cancer risk. Specifically, participants advised the following: (a) know the basics, (b) engage in the family narrative, and (c) advocate for yourself. Results showed the need for men to know and understand their BRCA cancer risks and communicate that genetic risk information to their family members and practitioners. In particular, the findings stress the importance of addressing men's risks and medical management from a family-focused approach. Overall, because men are historically undereducated about their BRCA-related cancer risks, this practical advice serves as a first step for men managing BRCA-related cancer risks and may ultimately assist them in making preventive and screening health behaviors.
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Affiliation(s)
- Marleah Dean
- Department of Communication,
Collaborator Member of the Health Outcomes & Behavior Program, Moffitt Cancer
Center, the University of South Florida, Tampa, FL, USA
- Marleah Dean, PhD, Associate Professor,
Department of Communication, Collaborator Member of the Health Outcomes &
Behavior Program, Moffitt Cancer Center, the University of South Florida, 4202
E. Fowler Ave, CIS 1040, Tampa, FL 33620, USA.
| | | | - Emily A. Rauscher
- Department of Communication, Huntsman
Cancer Institute, The University of Utah, Salt Lake City, UT, USA
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Sanghavi K, Feero WG, Mathews DJH, Prince AER, Price LL, Liu ET, Brothers KB, Roberts JS, Lee C. Employees' Views and Ethical, Legal, and Social Implications Assessment of Voluntary Workplace Genomic Testing. Front Genet 2021; 12:643304. [PMID: 33815477 PMCID: PMC8010177 DOI: 10.3389/fgene.2021.643304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Employers have begun to offer voluntary workplace genomic testing (wGT) as part of employee wellness benefit programs, but few empirical studies have examined the ethical, legal, and social implications (ELSI) of wGT. To better understand employee perspectives on wGT, employees were surveyed at a large biomedical research institution. Survey respondents were presented with three hypothetical scenarios for accessing health-related genomic testing: via (1) their doctor; (2) their workplace; and 3) a commercial direct-to-consumer (DTC) genetic testing company. Overall, 594 employees (28%) responded to the survey. Respondents indicated a preference for genomic testing in the workplace setting (70%; 95% CI 66-74%), followed by doctor's office (54%; 95% CI 50-58%), and DTC testing (20%; 95% CI 17-24%). Prior to participating in wGT, respondents wanted to know about confidentiality of test results (79%), existence of relevant laws and policies (70%), and privacy protection (64%). Across scenarios, 92% of respondents preferred to view the test results with a genetic counselor. These preliminary results suggest that many employees are interested and even prefer genetic testing in the workplace and would prefer testing with support from genetic health professionals. Confirmation in more diverse employer settings will be needed to generalize such findings.
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Affiliation(s)
- Kunal Sanghavi
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
| | - W Gregory Feero
- Maine-Dartmouth Family Medicine Residency, Augusta, ME, United States
| | - Debra J H Mathews
- Berman Institute of Bioethics, Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Anya E R Prince
- College of Law, University of Iowa College of Law, Iowa City, IA, United States
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States.,Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, United States
| | - Edison T Liu
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
| | - Kyle B Brothers
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
| | - J Scott Roberts
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Charles Lee
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States.,Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Mayer M, Selig K, Tüttelmann F, Dinkel A, Gschwend JE, Herkommer K. Interest in, willingness-to-pay for and willingness-to-recommend genetic testing for prostate cancer among affected men after radical prostatectomy. Fam Cancer 2019; 18:221-230. [PMID: 30229510 DOI: 10.1007/s10689-018-0101-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Knowledge about interest in genetic testing and willingness-to-pay for a genetic test among men affected from prostate cancer (PCa) is limited. This study aimed to gain insight into men's attitudes in genetic testing for PCa. 4699 men with PCa from the German multicenter prospective database "Familial Prostate Cancer" were included. Interest in, Willingness-to-pay for and Willingness-to-recommend a genetic test for PCa were quantified. Associations with several sociodemographic and psychosocial variables were evaluated by logistic regression. 76.8% of the affected men with a median follow-up of 12.9 years were interested in a genetic test for PCa. Newly identified variables significantly associated with interest were having sons (OR 1.66, p < 0.001) and a high perceived severity of the PCa (OR 1.40, p < 0.001). 19% of men were willing to pay more than 500 € for a genetic test. Men with higher education, men with a better self-reported economic situation and men with a lethal PCa in their family were more likely to be willing to pay a larger sum for a test. 84.9% of men were willing to recommend a test to their relatives. Interest in genetic testing for PCa among affected men was generally high with most men willing to recommend a test to their relatives. Various characteristics associated with interest and willingness-to-pay larger sums for genetic testing were uncovered and need to be addressed when designing both future educational material and genetic tests for PCa.
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Affiliation(s)
- Marcel Mayer
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Katharina Selig
- Department of Mathematics, Technical University of Munich, Boltzmannstr. 3, 85748, Garching, Germany
| | - Frank Tüttelmann
- Institute of Human Genetics, University of Münster, Vesaliusweg 12-14, 48149, Münster, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Langerstr. 3, 81675, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Freitas AC, Opinião A, Fragoso S, Nunes H, Santos M, Clara A, Bento S, Luis A, Silva J, Moura C, Filipe B, Machado P, Santos S, André S, Rodrigues P, Parreira J, Vaz F. Men seeking counselling in a Breast Cancer Risk Evaluation Clinic. Ecancermedicalscience 2018; 12:804. [PMID: 29456621 PMCID: PMC5813915 DOI: 10.3332/ecancer.2018.804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Hereditary breast and ovary cancer syndrome affects both genders but little is known about the uptake of genetic services by men. The objective of this study is to characterise the male population counselled through a multidisciplinary breast/ovarian program. METHODS Descriptive analysis of male patients counselled from January 2000 to December 2015. Data in this analysis include new cancer diagnoses during prospective follow up. RESULTS From 4,320 families registered, 362 male patients were identified: 236 (65.2%) from hereditary cancer families (HCF) and 126 (34.8%) from non-HCF. In HCF, 121 patients (51.3%) were mutation carriers (MC): BRCA2 - 102 (84.3%), BRCA1 - 16 (13.2%), CHEK2 - 1 (0.8%) and TP53 - 2 (1.7%). Non-HCF included 126 patients: 85 (67.5%) belonged to families without pathogenic mutations or with variants of unknown clinical significance; 22 (17.5%) refused testing after counselling and 19 (15.0%) did not meet criteria for testing. Both HCF and non-HCF included patients with previous cancer diagnoses: HCF- Breast Cancer (BC) - 18; prostate cancer (PC) - 13; melanoma - 1; others - 7) and non-HCF (BC - 77; PC - 20; gastric cancer (GC) - 1; melanoma - 8; bladder cancer - 1; others - 22). From the 121 MC identified (including the TP53 and CHEK2 carriers), 97 patients (80.2%) adhered to prospective surveillance. With a median follow-up of 36.9 months, 17 cancers were diagnosed in 14 patients, PC being the most frequently diagnosed neoplasia (5 cases). Eleven patients (78.6%) are alive and three patients died of advanced cancer (2 with GC, 1 with disseminated adenocarcinoma). CONCLUSION We observed a high adherence to counselling, genetic testing and active surveillance by men belonging to hereditary BC families. Male carriers of pathogenic DNA variants are at risk for several cancers and should be included in prospective follow-up studies.
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Affiliation(s)
- Ana Catarina Freitas
- Service of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Ana Opinião
- Service of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
- Breast Cancer Risk Evaluation Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Sofia Fragoso
- Molecular Pathobiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Hugo Nunes
- Service of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Madalena Santos
- Service of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Ana Clara
- Service of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
- Breast Cancer Risk Evaluation Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Sandra Bento
- Breast Cancer Risk Evaluation Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Ana Luis
- Service of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
- Breast Cancer Risk Evaluation Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Jorge Silva
- Breast Cancer Risk Evaluation Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
- Service of Urology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Cecília Moura
- Service of Dermatology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Bruno Filipe
- Molecular Pathobiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Patrícia Machado
- Molecular Pathobiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Sidónia Santos
- Molecular Pathobiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Saudade André
- Laboratorial Diagnosis Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Paula Rodrigues
- Breast Cancer Risk Evaluation Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Joana Parreira
- Breast Cancer Risk Evaluation Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
| | - Fátima Vaz
- Service of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
- Breast Cancer Risk Evaluation Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Bastos, 1099-023 Lisboa, Portugal
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