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Poylin VY, Shaffer VO, Felder SI, Goldstein LE, Goldberg JE, Kalady MF, Lightner AL, Feingold DL, Paquette IM. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Inherited Adenomatous Polyposis Syndromes. Dis Colon Rectum 2024; 67:213-227. [PMID: 37682806 DOI: 10.1097/dcr.0000000000003072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Affiliation(s)
- Vitaliy Y Poylin
- Division of Gastrointestinal and Oncologic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Virginia O Shaffer
- Department of Surgery, Emory University College of Medicine, Atlanta, Georgia
| | - Seth I Felder
- Department of Surgery, Moffit Cancer Center, Tampa, Florida
| | - Lindsey E Goldstein
- Division of General Surgery, North Florida/South Georgia Veteran's Health System, Gainesville, Florida
| | - Joel E Goldberg
- Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew F Kalady
- Division of Colon and Rectal Surgery, Ohio State University, Columbus, Ohio
| | - Amy L Lightner
- Department of Colorectal Surgery, Scripps Clinic, San Diego, California
| | - Daniel L Feingold
- Division of Colorectal Surgery, Rutgers University, New Brunswick, New Jersey
| | - Ian M Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati, Cincinnati, Ohio
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2
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Kamil D, Wojcik KM, Smith L, Zhang J, Wilson OWA, Butera G, Jayasekera J. A Scoping Review of Personalized, Interactive, Web-Based Clinical Decision Tools Available for Breast Cancer Prevention and Screening in the United States. MDM Policy Pract 2024; 9:23814683241236511. [PMID: 38500600 PMCID: PMC10946080 DOI: 10.1177/23814683241236511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/04/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction. Personalized web-based clinical decision tools for breast cancer prevention and screening could address knowledge gaps, enhance patient autonomy in shared decision-making, and promote equitable care. The purpose of this review was to present evidence on the availability, usability, feasibility, acceptability, quality, and uptake of breast cancer prevention and screening tools to support their integration into clinical care. Methods. We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist to conduct this review. We searched 6 databases to identify literature on the development, validation, usability, feasibility, acceptability testing, and uptake of the tools into practice settings. Quality assessment for each tool was conducted using the International Patient Decision Aid Standard instrument, with quality scores ranging from 0 to 63 (lowest-highest). Results. We identified 10 tools for breast cancer prevention and 9 tools for screening. The tools included individual (e.g., age), clinical (e.g., genomic risk factors), and health behavior (e.g., alcohol use) characteristics. Fourteen tools included race/ethnicity, but no tool incorporated contextual factors (e.g., insurance, access) associated with breast cancer. All tools were internally or externally validated. Six tools had undergone usability testing in samples including White (median, 71%; range, 9%-96%), insured (99%; 97%-100%) women, with college education or higher (60%; 27%-100%). All of the tools were developed and tested in academic settings. Seven (37%) tools showed potential evidence of uptake in clinical practice. The tools had an average quality assessment score of 21 (range, 9-39). Conclusions. There is limited evidence on testing and uptake of breast cancer prevention and screening tools in diverse clinical settings. The development, testing, and integration of tools in academic and nonacademic settings could potentially improve uptake and equitable access to these tools. Highlights There were 19 personalized, interactive, Web-based decision tools for breast cancer prevention and screening.Breast cancer outcomes were personalized based on individual clinical characteristics (e.g., age, medical history), genomic risk factors (e.g., BRCA1/2), race and ethnicity, and health behaviors (e.g., smoking). The tools did not include contextual factors (e.g., insurance status, access to screening facilities) that could potentially contribute to breast cancer outcomes.Validation, usability, acceptability, and feasibility testing were conducted mostly among White and/or insured patients with some college education (or higher) in academic settings. There was limited evidence on testing and uptake of the tools in nonacademic clinical settings.
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Affiliation(s)
- Dalya Kamil
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlyn M. Wojcik
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Laney Smith
- Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | | | - Oliver W. A. Wilson
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA
| | - Jinani Jayasekera
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Bradshaw RL, Kawamoto K, Bather JR, Goodman MS, Kohlmann WK, Chavez-Yenter D, Volkmar M, Monahan R, Kaphingst KA, Del Fiol G. Enhanced family history-based algorithms increase the identification of individuals meeting criteria for genetic testing of hereditary cancer syndromes but would not reduce disparities on their own. J Biomed Inform 2024; 149:104568. [PMID: 38081564 PMCID: PMC10842777 DOI: 10.1016/j.jbi.2023.104568] [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: 09/21/2023] [Revised: 11/07/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE This study aimed to 1) investigate algorithm enhancements for identifying patients eligible for genetic testing of hereditary cancer syndromes using family history data from electronic health records (EHRs); and 2) assess their impact on relative differences across sex, race, ethnicity, and language preference. MATERIALS AND METHODS The study used EHR data from a tertiary academic medical center. A baseline rule-base algorithm, relying on structured family history data (structured data; SD), was enhanced using a natural language processing (NLP) component and a relaxed criteria algorithm (partial match [PM]). The identification rates and differences were analyzed considering sex, race, ethnicity, and language preference. RESULTS Among 120,007 patients aged 25-60, detection rate differences were found across all groups using the SD (all P < 0.001). Both enhancements increased identification rates; NLP led to a 1.9 % increase and the relaxed criteria algorithm (PM) led to an 18.5 % increase (both P < 0.001). Combining SD with NLP and PM yielded a 20.4 % increase (P < 0.001). Similar increases were observed within subgroups. Relative differences persisted across most categories for the enhanced algorithms, with disproportionately higher identification of patients who are White, Female, non-Hispanic, and whose preferred language is English. CONCLUSION Algorithm enhancements increased identification rates for patients eligible for genetic testing of hereditary cancer syndromes, regardless of sex, race, ethnicity, and language preference. However, differences in identification rates persisted, emphasizing the need for additional strategies to reduce disparities such as addressing underlying biases in EHR family health information and selectively applying algorithm enhancements for disadvantaged populations. Systematic assessment of differences in algorithm performance across population subgroups should be incorporated into algorithm development processes.
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Affiliation(s)
- Richard L Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA; University of Utah Health, Salt Lake City, UT, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA; University of Utah Health, Salt Lake City, UT, USA
| | - Jemar R Bather
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA; Center for Anti-racism, Social Justice, & Public Health, New York University School of Global Public Health, New York, NY, USA
| | - Melody S Goodman
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA; Center for Anti-racism, Social Justice, & Public Health, New York University School of Global Public Health, New York, NY, USA
| | - Wendy K Kohlmann
- University of Utah Health, Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Daniel Chavez-Yenter
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Molly Volkmar
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA; University of Utah Health, Salt Lake City, UT, USA.
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Badran AR, Youngs A, Forman A, Elms M, Chang LL, Lebbe F, Reekie A, Short J, Hlaing MT, Watts E, Hipps D, Snape K. Proactive familial cancer risk assessment: a service development study in UK primary care. BJGP Open 2023; 7:BJGPO.2023.0076. [PMID: 37591554 PMCID: PMC11176673 DOI: 10.3399/bjgpo.2023.0076] [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: 04/28/2023] [Revised: 07/31/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Family history assessment can identify individuals above population-risk for cancer to enable targeted Screening, Prevention, and Early Detection (SPED). Family History Questionnaire Service (FHQS) is a resource-efficient patient-facing online tool to facilitate this. In the UK, cancer risk assessment is usually only offered to concerned individuals proactively self-presenting to their GP, leading to inequity in accessing SPED in the community. AIM To improve access to community cancer genetic risk assessment and explore barriers to uptake. DESIGN & SETTING Service development project of a digital pathway using the FHQS for cancer risk assessment across four general practices within the clinical remit of the South West Thames Centre for Genomics (SWTCG). METHOD 3100 individuals aged 38-50 years were invited to complete the FHQS through either text message or email. A random selection of 100 non-responders were contacted to determine barriers to uptake. RESULTS In total, n = 304/3100 (10%) registered for the FHQS. Responders were more likely to be British (63% vs 47%, P<0.001), speak English as their main language (92% vs 76%, P<0.001), and not require an interpreter (99.6% vs 94.9%, P = 0.001). Of 304 responders, 158 (52%) were automatically identified as at population-risk without full family history review. Of the remaining 146 responders, 52 (36%) required either additional screening referral (n = 23), genetics referral (n = 15), and/or advice to relatives (n = 18). Of 100 non-responders contacted, eight had incorrect contact details and 53 were contactable. Reasons for not responding included not receiving invitation details (n = 26), losing the invitation (n = 5), or forgetting (n = 4). CONCLUSION The FHQS can be used as part of a low-resource primary care pathway to identify individuals in the community above population-risk for cancer requiring action. This study highlighted barriers to uptake requiring consideration to maximise impact and minimise inequity.
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Affiliation(s)
- Abdul Rahman Badran
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, London, UK
- Fieldway Medical Centre, Danebury, New Addington, Croydon, UK
| | - Alice Youngs
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Andrea Forman
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marisa Elms
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Fiyaz Lebbe
- Fieldway Medical Centre, Danebury, New Addington, Croydon, UK
| | - Adam Reekie
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - John Short
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Min Theik Hlaing
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Emma Watts
- Shere Surgery, Gomshall Lane, Guildford, UK
| | - Deborah Hipps
- The Exchange Surgery, Gracefield Gardens, London, UK
| | - Katie Snape
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, London, UK
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Ferreyra Y, Rosas G, Cock-Rada AM, Araujo J, Bravo L, Doimi F, Casas J, Clavo MDLÁ, Pinto JA, Belmar-López C. Landscape of germline BRCA1/BRCA2 variants in breast and ovarian cancer in Peru. Front Oncol 2023; 13:1227864. [PMID: 37664050 PMCID: PMC10470619 DOI: 10.3389/fonc.2023.1227864] [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: 05/23/2023] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
Background There is an increasing amount of data from Latin America on the characterization of BRCA variants; however, there is limited information from Peru. We conducted a retrospective study to describe germline pathogenic/likely pathogenic(P/LP) variants and variants of uncertain/unknown significance (VUS) in the BRCA1 and BRCA2 genes in Peru, in patients with breast and ovarian cancer, candidates for treatment with poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitors. Methods The patients were evaluated during the period 2019-2021. Genomic DNA was isolated from peripheral blood samples and targeted sequencing was performed using the Ampliseq BRCA panel. Genetic variant interpretation was carried out in accordance with the recommendations of the American College of Medical Genetics and ClinVar. During this period, 525 patients (143 with breast cancer and 382 with ovarian cancer) were studied. Results We found that 14.7% (21/143) of breast cancer patients and 20.7% (79/382) of ovarian cancer patients were carriers of P/LP variants in BRCA1/2. The most frequent pathogenic variants detected in BRCA1 were c.2105dupT (BIC: 2224insT, n=12, 18.75%), c.68_69delAG (BIC: 185delAG, n=6, 9.38%), c.140G>T and c.815_824dupAGCCATGTGG (n=5, 7.81%), while in BRCA2 were c.8023A>G (n=6, 16.67%), c.6024dupG (BIC: 6252insG, n=4, 11.11%), and c.9235delG (BIC: 9463delG, n=3, 8.33%). Regarding VUS, we found that 6.99% (10/143) of breast cancer patients and 7.33% (28/382) of ovarian cancer patients were carriers of a VUS in BRCA1/2. For BRCA1, the most frequent VUS was c.93C>G (n=2), and for BRCA2, c.5465A>T (n=4), c.3101T>C (n=3), c.205C>A and c.437T>C (n=2). Conclusion We found a frequency of 14.7% germline mutations in breast cancer patients and 20.7% in ovarian cancer patients. The most recurrent mutations were BRCA1 c.2105dupT and BRCA2 c.8023A>G. We found that BRCA2 c.8023A>G, c.6024dupG, and c.9235delG were not previously reported in Peruvian patients. BRCA1 c.2344dupA is a novel mutation that has not been previously reported in any database. The frequency of VUS in our cohort was 7.2%.
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Affiliation(s)
- Yomali Ferreyra
- Departamento de Bioingeniería, Universidad de Ingenieria y Tecnología, Lima, Peru
| | - Gina Rosas
- Departamento de Patología, Insituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Alicia M. Cock-Rada
- Departmento de Oncología Médica, Instituto de Cancerología Las Américas - Auna, Medellín, Colombia
| | - Jhajaira Araujo
- Centro de Investigación Básicas y traslacional, Auna Ideas, Lima, Peru
| | - Leny Bravo
- Escuela Profesional de Medicina Humana-Filial Ica, Universidad Privada San Juan Bautista, Ica, Peru
| | | | | | | | - Joseph A. Pinto
- Centro de Investigación Básicas y traslacional, Auna Ideas, Lima, Peru
| | - Carolina Belmar-López
- Escuela Profesional de Medicina Humana-Filial Ica, Universidad Privada San Juan Bautista, Ica, Peru
- Oncogenomics, Auna, Lima, Peru
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Scheuner MT, Sales P, Hoggatt K, Zhang N, Whooley MA, Kelley MJ. Genetics professionals are key to the integration of genetic testing within the practice of frontline clinicians. Genet Med 2023; 25:103-114. [PMID: 36301261 DOI: 10.1016/j.gim.2022.09.012] [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: 04/01/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Genetic tests have become widely available. We sought to understand the use of genetic tests in the practice of frontline clinicians within the United States Department of Veterans Affairs (VA). METHODS We administered a web-based survey to clinicians at 20 VA facilities. Physicians, nurse practitioners, physician assistants, and pharmacists were eligible. We excluded genetics providers and clinicians not seeing patients. We used multiple logistic regression to evaluate the associations between clinician characteristics and experience with genetics. RESULTS The response rate was 11.3% (1207/10,680) and of these, 909 respondents were eligible. Only 20.8% of the respondents reported feeling prepared to use genetic tests and 13.0% of the respondents were currently ordering genetic tests; although, it was usually only 1 or 2 a year. Delivery of genetic tests without involving genetics providers was preferred by only 7.9% of the respondents. Characteristics positively associated with currently ordering genetic tests included practice in clinical and research settings, believing improving genetics knowledge could alter their practice, feeling prepared to use genetic tests, and referral of at least 1 patient to genetics in the past year. CONCLUSION Most VA clinicians don't feel prepared to use genetic tests. Those with genetic testing experience are more likely to consult genetics providers. The demand for genetics providers should increase as frontline clinicians use genetic tests in their practice.
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Affiliation(s)
- Maren T Scheuner
- Medicine Service, Hematology-Oncology Section, San Francisco VA Health Care System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Francisco, San Francisco, CA.
| | - Paloma Sales
- Medicine Service, Hematology-Oncology Section, San Francisco VA Health Care System, San Francisco, CA
| | - Katherine Hoggatt
- Medicine Service, Hematology-Oncology Section, San Francisco VA Health Care System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Ning Zhang
- Medicine Service, Hematology-Oncology Section, San Francisco VA Health Care System, San Francisco, CA
| | - Mary A Whooley
- Medicine Service, Hematology-Oncology Section, San Francisco VA Health Care System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Michael J Kelley
- National Oncology Program, Specialty Care Services, Department of Veterans Affairs, Washington, DC; Durham VA Health Care System, Durham, NC; Department of Medicine, Duke University, Durham, NC
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7
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Filipowicz N, Drężek K, Horbacz M, Wojdak A, Szymanowski J, Rychlicka-Buniowska E, Juhas U, Duzowska K, Nowikiewicz T, Stańkowska W, Chojnowska K, Andreou M, Ławrynowicz U, Wójcik M, Davies H, Śrutek E, Bieńkowski M, Milian-Ciesielska K, Zdrenka M, Ambicka A, Przewoźnik M, Harazin-Lechowska A, Adamczyk A, Kowalski J, Bała D, Wiśniewski D, Tkaczyński K, Kamecki K, Drzewiecka M, Wroński P, Siekiera J, Ratnicka I, Jankau J, Wierzba K, Skokowski J, Połom K, Przydacz M, Bełch Ł, Chłosta P, Matuszewski M, Okoń K, Rostkowska O, Hellmann A, Sasim K, Remiszewski P, Sierżęga M, Hać S, Kobiela J, Kaska Ł, Jankowski M, Hodorowicz-Zaniewska D, Jaszczyński J, Zegarski W, Makarewicz W, Pęksa R, Szpor J, Ryś J, Szylberg Ł, Piotrowski A, Dumanski JP. Comprehensive cancer-oriented biobanking resource of human samples for studies of post-zygotic genetic variation involved in cancer predisposition. PLoS One 2022; 17:e0266111. [PMID: 35390022 PMCID: PMC8989288 DOI: 10.1371/journal.pone.0266111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
The progress in translational cancer research relies on access to well-characterized samples from a representative number of patients and controls. The rationale behind our biobanking are explorations of post-zygotic pathogenic gene variants, especially in non-tumoral tissue, which might predispose to cancers. The targeted diagnoses are carcinomas of the breast (via mastectomy or breast conserving surgery), colon and rectum, prostate, and urinary bladder (via cystectomy or transurethral resection), exocrine pancreatic carcinoma as well as metastases of colorectal cancer to the liver. The choice was based on the high incidence of these cancers and/or frequent fatal outcome. We also collect age-matched normal controls. Our still ongoing collection originates from five clinical centers and after nearly 2-year cooperation reached 1711 patients and controls, yielding a total of 23226 independent samples, with an average of 74 donors and 1010 samples collected per month. The predominant diagnosis is breast carcinoma, with 933 donors, followed by colorectal carcinoma (383 donors), prostate carcinoma (221 donors), bladder carcinoma (81 donors), exocrine pancreatic carcinoma (15 donors) and metachronous colorectal cancer metastases to liver (14 donors). Forty percent of the total sample count originates from macroscopically healthy cancer-neighboring tissue, while contribution from tumors is 12%, which adds to the uniqueness of our collection for cancer predisposition studies. Moreover, we developed two program packages, enabling registration of patients, clinical data and samples at the participating hospitals as well as the central system of sample/data management at coordinating center. The approach used by us may serve as a model for dispersed biobanking from multiple satellite hospitals. Our biobanking resource ought to stimulate research into genetic mechanisms underlying the development of common cancers. It will allow all available "-omics" approaches on DNA-, RNA-, protein- and tissue levels to be applied. The collected samples can be made available to other research groups.
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Affiliation(s)
| | - Kinga Drężek
- 3P-Medicine Laboratory, Medical University of Gdańsk, Gdańsk, Poland
| | - Monika Horbacz
- 3P-Medicine Laboratory, Medical University of Gdańsk, Gdańsk, Poland
| | - Agata Wojdak
- 3P-Medicine Laboratory, Medical University of Gdańsk, Gdańsk, Poland
| | - Jakub Szymanowski
- 3P-Medicine Laboratory, Medical University of Gdańsk, Gdańsk, Poland
- Bioenit Jakub Szymanowski, Gdańsk, Poland
| | | | - Ulana Juhas
- 3P-Medicine Laboratory, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Tomasz Nowikiewicz
- Department of Breast Cancer and Reconstructive Surgery, Oncology Center—Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
- Surgical Oncology, Ludwik Rydygier’s Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | | | | | - Maria Andreou
- 3P-Medicine Laboratory, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Magdalena Wójcik
- 3P-Medicine Laboratory, Medical University of Gdańsk, Gdańsk, Poland
| | - Hanna Davies
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Ewa Śrutek
- Surgical Oncology, Ludwik Rydygier’s Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
- Department of Tumor Pathology and Pathomorphology, Oncology Center—Prof Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Michał Bieńkowski
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Marek Zdrenka
- Department of Tumor Pathology and Pathomorphology, Oncology Center—Prof Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Aleksandra Ambicka
- Department of Tumor Pathology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Marcin Przewoźnik
- Department of Tumor Pathology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Agnieszka Harazin-Lechowska
- Department of Tumor Pathology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Agnieszka Adamczyk
- Department of Tumor Pathology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Jacek Kowalski
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Dariusz Bała
- Surgical Oncology, Ludwik Rydygier’s Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
- Department of Surgical Oncology, Oncology Center—Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Dorian Wiśniewski
- Department of Surgical Oncology, Oncology Center—Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Karol Tkaczyński
- Department of Surgical Oncology, Oncology Center—Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Krzysztof Kamecki
- Department of Urology, Oncology Center—Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Marta Drzewiecka
- Department of Breast Cancer and Reconstructive Surgery, Oncology Center—Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Paweł Wroński
- Department of Urology, Oncology Center—Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Jerzy Siekiera
- Department of Urology, Oncology Center—Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Izabela Ratnicka
- Department of Plastic Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Jerzy Jankau
- Department of Plastic Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Karol Wierzba
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Jarosław Skokowski
- Department of Surgical Oncology, Medical University of Gdańsk, Gdańsk, Poland
- Department of Medical Laboratory Diagnostics-Biobank, Medical University of Gdańsk, Gdańsk, Poland
| | - Karol Połom
- Department of Surgical Oncology, Medical University of Gdańsk, Gdańsk, Poland
| | - Mikołaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Kraków, Poland
| | - Łukasz Bełch
- Department of Urology, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Chłosta
- Department of Urology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Matuszewski
- Department and Clinic of Urology, Medical University of Gdańsk, Gdańsk, Poland
| | - Krzysztof Okoń
- Department of Pathomorphology, Jagiellonian University Medical College, Kraków, Poland
| | - Olga Rostkowska
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Hellmann
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Karol Sasim
- Clinic of Urology and Oncological Urology, Specialist Hospital of Kościerzyna, Kościerzyna, Poland
| | - Piotr Remiszewski
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Marek Sierżęga
- Department of General, Oncological, and Gastrointestinal Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Hać
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Jarosław Kobiela
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Łukasz Kaska
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Jankowski
- Surgical Oncology, Ludwik Rydygier’s Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
- Department of Surgical Oncology, Oncology Center—Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Diana Hodorowicz-Zaniewska
- Department of General, Oncological, and Gastrointestinal Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Janusz Jaszczyński
- Department of Urology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Wojciech Zegarski
- Surgical Oncology, Ludwik Rydygier’s Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
- Department of Surgical Oncology, Oncology Center—Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Wojciech Makarewicz
- Department of Surgical Oncology, Medical University of Gdańsk, Gdańsk, Poland
- Clinic of General and Oncological Surgery, Specialist Hospital of Kościerzyna, Kościerzyna, Poland
| | - Rafał Pęksa
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Joanna Szpor
- Department of Pathomorphology, Jagiellonian University Medical College, Kraków, Poland
| | - Janusz Ryś
- Department of Tumor Pathology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Łukasz Szylberg
- Department of Tumor Pathology and Pathomorphology, Oncology Center—Prof Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Arkadiusz Piotrowski
- 3P-Medicine Laboratory, Medical University of Gdańsk, Gdańsk, Poland
- Department of Biology and Pharmaceutical Botany, Medical University of Gdańsk, Gdańsk, Poland
| | - Jan P. Dumanski
- 3P-Medicine Laboratory, Medical University of Gdańsk, Gdańsk, Poland
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Biology and Pharmaceutical Botany, Medical University of Gdańsk, Gdańsk, Poland
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8
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Lee JK, Kwon WK, Hong SN, Chang DK, Kim HC, Jang JH, Kim JW. Necessity of Multiplex Ligation Probe Amplification in Genetic Tests: Germline variant analysis of the APC gene in familial adenomatous polyposis patients. Cancer Genet 2022; 262-263:95-101. [DOI: 10.1016/j.cancergen.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/10/2022] [Accepted: 02/09/2022] [Indexed: 11/02/2022]
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9
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Andrés‐Zayas C, Suárez‐González J, Rodríguez‐Macías G, Dorado N, Osorio S, Font P, Carbonell D, Chicano M, Muñiz P, Bastos M, Kwon M, Díez‐Martín JL, Buño I, Martínez‐Laperche C. Clinical utility of targeted next-generation sequencing for the diagnosis of myeloid neoplasms with germline predisposition. Mol Oncol 2021; 15:2273-2284. [PMID: 33533142 PMCID: PMC8410541 DOI: 10.1002/1878-0261.12921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/30/2020] [Accepted: 01/11/2021] [Indexed: 12/30/2022] Open
Abstract
Myeloid neoplasms (MN) with germline predisposition (MNGP) are likely to be more common than currently appreciated. Many of the genes involved in MNGP are also recurrently mutated in sporadic MN. Therefore, routine analysis of gene panels by next-generation sequencing provides an effective approach to detect germline variants with clinical significance in patients with hematological malignancies. Gene panel sequencing was performed in 88 consecutive and five nonconsecutive patients with MN diagnosis. Disease-causing germline mutations in CEBPα, ASXL1, TP53, MPL, GATA2, DDX41, and ETV6 genes were identified in nine patients. Six out of the nine patients with germline variants had a strong family history. These patients presented great heterogeneity in the age of diagnosis and phenotypic characteristics. In our study, there were families in which all the affected members presented the same subtype of disease, whereas members of other families presented various disease phenotypes. This intrafamiliar heterogeneity suggests that the acquisition of particular somatic variants may drive the evolution of the disease. This approach enabled high-throughput detection of MNGP in patients with MN diagnosis, which is of great relevance for both the patients themselves and the asymptomatic mutation carriers within the family. It is crucial to make a proper diagnosis of these patients to provide them with the most suitable treatment, follow-up, and genetic counseling.
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Affiliation(s)
- Cristina Andrés‐Zayas
- Genomics UnitGregorio Marañón General University HospitalGregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
| | - Julia Suárez‐González
- Genomics UnitGregorio Marañón General University HospitalGregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
| | | | - Nieves Dorado
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Department of HematologyGregorio Marañón General University HospitalMadridSpain
| | - Santiago Osorio
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Department of HematologyGregorio Marañón General University HospitalMadridSpain
| | - Patricia Font
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Department of HematologyGregorio Marañón General University HospitalMadridSpain
| | - Diego Carbonell
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Department of HematologyGregorio Marañón General University HospitalMadridSpain
| | - María Chicano
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Department of HematologyGregorio Marañón General University HospitalMadridSpain
| | - Paula Muñiz
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Department of HematologyGregorio Marañón General University HospitalMadridSpain
| | - Mariana Bastos
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Department of HematologyGregorio Marañón General University HospitalMadridSpain
| | - Mi Kwon
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Department of HematologyGregorio Marañón General University HospitalMadridSpain
| | - José Luis Díez‐Martín
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Department of HematologyGregorio Marañón General University HospitalMadridSpain
- Department of MedicineSchool of MedicineComplutense University of MadridSpain
| | - Ismael Buño
- Genomics UnitGregorio Marañón General University HospitalGregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Department of HematologyGregorio Marañón General University HospitalMadridSpain
- Department of Cell BiologySchool of MedicineComplutense University of MadridSpain
| | - Carolina Martínez‐Laperche
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
- Department of HematologyGregorio Marañón General University HospitalMadridSpain
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10
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Disparities in Early-Onset Colorectal Cancer. Cells 2021; 10:cells10051018. [PMID: 33925893 PMCID: PMC8146231 DOI: 10.3390/cells10051018] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence and mortality of early-onset colorectal cancer (CRC) are increasing in the United States (US) and worldwide. In the US, there are notable disparities in early-onset CRC burden by race/ethnicity and geography. African Americans, Hispanic/Latinos, and populations residing in specific regions of the Southern U.S. are disproportionately affected with CRC diagnosed at younger ages, while less is known about disparities in other countries. Reasons for these disparities are likely multi-factorial and potentially implicate differences in health determinants including biology/genetics, diet/environment, individual health behaviors, and access to high-quality health services, as well as social and policy factors. This review summarizes current understanding of early-onset CRC disparities and identifies specific research areas that will inform evidence-based interventions at individual, practice, and policy levels to reduce the global burden of this disease.
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11
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Orlando LA, Wu RR, Myers RA, Neuner J, McCarty C, Haller IV, Harry M, Fulda KG, Dimmock D, Rakhra-Burris T, Buchanan A, Ginsburg GS. At the intersection of precision medicine and population health: an implementation-effectiveness study of family health history based systematic risk assessment in primary care. BMC Health Serv Res 2020; 20:1015. [PMID: 33160339 PMCID: PMC7648301 DOI: 10.1186/s12913-020-05868-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 10/27/2020] [Indexed: 01/27/2023] Open
Abstract
Background Risk assessment is a precision medicine technique that can be used to enhance population health when applied to prevention. Several barriers limit the uptake of risk assessment in health care systems; and little is known about the potential impact that adoption of systematic risk assessment for screening and prevention in the primary care population might have. Here we present results of a first of its kind multi-institutional study of a precision medicine tool for systematic risk assessment. Methods We undertook an implementation-effectiveness trial of systematic risk assessment of primary care patients in 19 primary care clinics at four geographically and culturally diverse healthcare systems. All adult English or Spanish speaking patients were invited to enter personal and family health history data into MeTree, a patient-facing family health history driven risk assessment program, for 27 medical conditions. Risk assessment recommendations followed evidence-based guidelines for identifying and managing those at increased disease risk. Results One thousand eight hundred eighty-nine participants completed MeTree, entering information on N = 25,967 individuals. Mean relatives entered = 13.7 (SD 7.9), range 7–74. N = 1443 (76.4%) participants received increased risk recommendations: 597 (31.6%) for monogenic hereditary conditions, 508 (26.9%) for familial-level risk, and 1056 (56.1%) for risk of a common chronic disease. There were 6617 recommendations given across the 1443 participants. In multivariate analysis, only the total number of relatives entered was significantly associated with receiving a recommendation. Conclusions A significant percentage of the general primary care population meet criteria for more intensive risk management. In particular 46% for monogenic hereditary and familial level disease risk. Adopting strategies to facilitate systematic risk assessment in primary care could have a significant impact on populations within the U.S. and even beyond. Trial registration Clinicaltrials.gov number NCT01956773, registered 10/8/2013.
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Affiliation(s)
- Lori A Orlando
- Department of Medicine, Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, USA.
| | - R Ryanne Wu
- Department of Medicine, Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, USA.,Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Rachel A Myers
- Department of Medicine, Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, USA
| | - Joan Neuner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.,Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, USA
| | | | | | | | - Kimberly G Fulda
- The North Texas Primary care Practice-Based Research Network and Family Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - David Dimmock
- Rady Children's Institute for Genomic Medicine, San Diego, USA
| | - Teji Rakhra-Burris
- Department of Medicine, Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, USA
| | - Adam Buchanan
- Genomic Medicine Institute, Geisinger, Geisinger, USA
| | - Geoffrey S Ginsburg
- Department of Medicine, Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, USA
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12
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Stjernfelt KJ, von Stedingk K, Wiebe T, Hjorth L, Kristoffersson U, Stenmark-Askmalm M, Olsson H, Øra I. Increased Cancer Risk in Families with Pediatric Cancer Is Associated with Gender, Age, Diagnosis, and Degree of Relation to the Child. Cancer Epidemiol Biomarkers Prev 2020; 29:2171-2179. [PMID: 32856606 DOI: 10.1158/1055-9965.epi-20-0322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/07/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Studies of cancer risk among relatives of children with cancer beyond parents and siblings are limited. We have investigated the cancer risk up to the third degree of relation in families with pediatric cancer to reveal patterns of inheritance. METHODS A single-center cohort of 757 patients with pediatric cancer was linked to the Swedish National Population Register, resulting in 16,137 relatives up to the third degree of relation. All relatives were matched to the Swedish Cancer Register, and standard incidence ratios (SIR) were calculated to define relatives at risk. RESULTS Children and adults up to the third degree of relation had increased cancer risk, with SIRs of 1.48 (P = 0.01) and 1.07 (P < 0.01), respectively. The SIRs for first- and third-degree adult relatives were 1.22 and 1.10, respectively, but no increased risk was observed in second-degree relatives. Male relatives had a higher risk than females, especially when related to a girl and when the child had leukemia. The risk was mainly increased for lung, prostate, and gastrointestinal cancer. When excluding 29 families of children with known pathogenic germline variants, the increased risk remained. CONCLUSIONS Relatives to children with cancer up to third degree of relation have an increased cancer risk. Known pathogenic germline variants do not explain this increased risk. IMPACT The overall increased cancer risk among relatives of children with cancer in this population-based cohort strengthens the importance of surveillance programs for families with pediatric cancer.
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Affiliation(s)
- Karl-Johan Stjernfelt
- Department of Pediatrics, Pediatric Oncology and Hematology, Clinical Sciences, Lund University, Lund, Sweden.
| | - Kristoffer von Stedingk
- Department of Pediatrics, Pediatric Oncology and Hematology, Clinical Sciences, Lund University, Lund, Sweden.,Department of Oncogenomics, University Medical Center AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas Wiebe
- Department of Pediatrics, Pediatric Oncology and Hematology, Clinical Sciences, Lund University, Lund, Sweden
| | - Lars Hjorth
- Department of Pediatrics, Pediatric Oncology and Hematology, Clinical Sciences, Lund University, Lund, Sweden
| | - Ulf Kristoffersson
- Department of Laboratory Medicine, Division of Clinical Genetics, Lund University, Lund, Sweden
| | - Marie Stenmark-Askmalm
- Department of Laboratory Medicine, Division of Clinical Genetics, Lund University, Lund, Sweden
| | - Håkan Olsson
- Department of Oncology, Clinical Sciences, Lund University, Lund, Sweden
| | - Ingrid Øra
- Department of Pediatrics, Pediatric Oncology and Hematology, Clinical Sciences, Lund University, Lund, Sweden
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13
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Sengupta D, Banerjee S, Mukhopadhyay P, Guha U, Ganguly K, Bhattacharjee S, Sengupta M. A meta-analysis and in silico analysis of polymorphic variants conferring breast cancer risk in the Indian subcontinent. Future Oncol 2020; 16:2121-2142. [PMID: 32744066 DOI: 10.2217/fon-2020-0333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Genetic association studies on breast cancer on the Indian subcontinent have yielded conflicting results, and the precise effect of these variants on breast cancer pathogenesis is not known. Methods: Genomic variants, as obtained from selected studies from the Indian subcontinent, were subjected to random-effects and fixed-effect meta-analysis. Functional annotation of the relevant variants was done through a tried and tested in silico pipeline. Results: We found rs4646903/CYP1A1, rs1799814/CYP1A1, rs61886492/GCPII, del2/GSTM1, rs4680/COMT and rs1801394/MTRR to be associated with breast cancer. The del2/GSTM1 holds the association in premenopausal women. Conclusions: This is the first study of its kind from the Indian subcontinent analysing the extent of association of variants across populations followed by their functional annotation in the disease pathway.
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Affiliation(s)
- Debmalya Sengupta
- Department of Genetics, University of Calcutta, 35, Ballygunge Circular Road, Kolkata 700019, India
| | - Souradeep Banerjee
- Department of Genetics, University of Calcutta, 35, Ballygunge Circular Road, Kolkata 700019, India
| | - Pramiti Mukhopadhyay
- Department of Genetics, University of Calcutta, 35, Ballygunge Circular Road, Kolkata 700019, India
| | - Udayan Guha
- Department of Genetics, University of Calcutta, 35, Ballygunge Circular Road, Kolkata 700019, India
| | - Kausik Ganguly
- Department of Genetics, University of Calcutta, 35, Ballygunge Circular Road, Kolkata 700019, India
| | - Samsiddhi Bhattacharjee
- National Institute of Biomedical Genomics, Near Netaji Subhas Sanatorium Post Office, Kalyani, West Bengal 741251, India
| | - Mainak Sengupta
- Department of Genetics, University of Calcutta, 35, Ballygunge Circular Road, Kolkata 700019, India
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14
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Qureshi N, Dutton B, Weng S, Sheehan C, Chorley W, Robertson JFR, Kendrick D, Kai J. Improving primary care identification of familial breast cancer risk using proactive invitation and decision support. Fam Cancer 2020; 20:13-21. [PMID: 32524330 PMCID: PMC7870768 DOI: 10.1007/s10689-020-00188-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/18/2020] [Indexed: 01/28/2023]
Abstract
Family history of breast cancer is a key risk factor, accounting for up to 10% of cancers. We evaluated the proactive assessment of familial breast cancer (FBC) risk in primary care. Eligible women (30 to 60 years) were recruited from eight English general practices. Practices were trained on FBC risk assessment. In four randomly-assigned practices, women were invited to complete a validated, postal family history questionnaire, which practice staff inputted into decision support software to determine cancer risk. Those with increased risk were offered specialist referral. Usual care was observed in the other four practices. In intervention practices, 1127/7012 women (16.1%) returned family history questionnaires, comprising 1105 (98%) self-reported white ethnicity and 446 (39.6%) educated to University undergraduate or equivalent qualification, with 119 (10.6%) identified at increased breast cancer risk and offered referral. Sixty-seven (56%) women recommended referral were less than 50 years old. From 66 women attending specialists, 26 (39.4%) were confirmed to have high risk and recommended annual surveillance (40–60 years) and surgical prevention; while 30 (45.5%) were confirmed at moderate risk, with 19 offered annual surveillance (40–50 years). The remaining 10 (15.2%) managed in primary care. None were recommended chemoprevention. In usual care practices, only ten women consulted with concerns about breast cancer family history. This study demonstrated proactive risk assessment in primary care enables accurate identification of women, including many younger women, at increased risk of breast cancer. To improve generalisability across the population, more active methods of engagement need to be explored. Trial registration: CRUK Clinical Trials Database 11779.
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Affiliation(s)
- Nadeem Qureshi
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK.
| | - Brittany Dutton
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
| | - Stephen Weng
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
| | - Christina Sheehan
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
| | - Wendy Chorley
- University Hospitals Derby & Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | | | - Denise Kendrick
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
| | - Joe Kai
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
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15
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Pinheiro M, Lupinacci FCS, Santiago KM, Drigo SA, Marchi FA, Fonseca-Alves CE, Andrade SCDS, Aagaard MM, Basso TR, dos Reis MB, Villacis RAR, Roffé M, Hajj GNM, Jurisica I, Kowalski LP, Achatz MI, Rogatto SR. Germline Mutation in MUS81 Resulting in Impaired Protein Stability is Associated with Familial Breast and Thyroid Cancer. Cancers (Basel) 2020; 12:cancers12051289. [PMID: 32443704 PMCID: PMC7281423 DOI: 10.3390/cancers12051289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 01/10/2023] Open
Abstract
Multiple primary thyroid cancer (TC) and breast cancer (BC) are commonly diagnosed, and the lifetime risk for these cancers is increased in patients with a positive family history of both TC and BC. Although this phenotype is partially explained by TP53 or PTEN mutations, a significant number of patients are negative for these alterations. We judiciously recruited patients diagnosed with BC and/or TC having a family history of these tumors and assessed their whole-exome sequencing. After variant prioritization, we selected MUS81 c.1292G>A (p.R431H) for further investigation. This variant was genotyped in a healthy population and sporadic BC/TC tissues and investigated at the protein level and cellular models. MUS81 c.1292G>A was the most frequent variant (25%) and the strongest candidate due to its function of double-strand break repair. This variant was confirmed in four relatives from two families. MUS81 p.R431H protein exhibited lower expression levels in tumors from patients positive for the germline variant, compared with wild-type BC, and normal breast and thyroid tissues. Using cell line models, we showed that c.1292G>A induced protein instability and affected DNA damage response. We suggest that MUS81 is a novel candidate involved in familial BC/TC based on its low frequency in healthy individuals and proven effect in protein stability.
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Affiliation(s)
- Maisa Pinheiro
- Faculty of Medicine, Sao Paulo State University, UNESP, Botucatu SP 18618-687, Brazil;
- International Research Center, A.C. Camargo Cancer Center, São Paulo SP 01508-010, Brazil; (F.C.S.L.); (K.M.S.); (F.A.M.); (T.R.B.); (M.B.d.R.); (M.R.); (G.N.M.H.); (L.P.K.)
| | - Fernanda Cristina Sulla Lupinacci
- International Research Center, A.C. Camargo Cancer Center, São Paulo SP 01508-010, Brazil; (F.C.S.L.); (K.M.S.); (F.A.M.); (T.R.B.); (M.B.d.R.); (M.R.); (G.N.M.H.); (L.P.K.)
| | - Karina Miranda Santiago
- International Research Center, A.C. Camargo Cancer Center, São Paulo SP 01508-010, Brazil; (F.C.S.L.); (K.M.S.); (F.A.M.); (T.R.B.); (M.B.d.R.); (M.R.); (G.N.M.H.); (L.P.K.)
| | - Sandra Aparecida Drigo
- Department of Surgery and Orthopedics, Experimental Research Unity, Faculty of Medicine, São Paulo State University, UNESP, Botucatu SP 18618-687, Brazil;
| | - Fabio Albuquerque Marchi
- International Research Center, A.C. Camargo Cancer Center, São Paulo SP 01508-010, Brazil; (F.C.S.L.); (K.M.S.); (F.A.M.); (T.R.B.); (M.B.d.R.); (M.R.); (G.N.M.H.); (L.P.K.)
| | - Carlos Eduardo Fonseca-Alves
- Department of Veterinary Surgery and Anesthesiology, São Paulo State University, UNESP, Botucatu SP 18618-681, Brazil;
| | | | - Mads Malik Aagaard
- Department of Clinical Genetics, Vejle University Hospital, 7100 Vejle, Denmark;
| | - Tatiane Ramos Basso
- International Research Center, A.C. Camargo Cancer Center, São Paulo SP 01508-010, Brazil; (F.C.S.L.); (K.M.S.); (F.A.M.); (T.R.B.); (M.B.d.R.); (M.R.); (G.N.M.H.); (L.P.K.)
| | - Mariana Bisarro dos Reis
- International Research Center, A.C. Camargo Cancer Center, São Paulo SP 01508-010, Brazil; (F.C.S.L.); (K.M.S.); (F.A.M.); (T.R.B.); (M.B.d.R.); (M.R.); (G.N.M.H.); (L.P.K.)
| | - Rolando André Rios Villacis
- Department of Genetics and Morphology, Institute of Biological Sciences, University of Brasília, UnB, Brasília DF 70910-900, Brazil;
| | - Martin Roffé
- International Research Center, A.C. Camargo Cancer Center, São Paulo SP 01508-010, Brazil; (F.C.S.L.); (K.M.S.); (F.A.M.); (T.R.B.); (M.B.d.R.); (M.R.); (G.N.M.H.); (L.P.K.)
| | - Glaucia Noeli Maroso Hajj
- International Research Center, A.C. Camargo Cancer Center, São Paulo SP 01508-010, Brazil; (F.C.S.L.); (K.M.S.); (F.A.M.); (T.R.B.); (M.B.d.R.); (M.R.); (G.N.M.H.); (L.P.K.)
| | - Igor Jurisica
- Krembil Research Institute, UHN, University of Toronto, Toronto, ON M5G 2C4, Canada;
- Institute of Neuroimmunology, Slovak Academy of Sciences, 845 10 Bratislava, Slovakia
| | - Luiz Paulo Kowalski
- International Research Center, A.C. Camargo Cancer Center, São Paulo SP 01508-010, Brazil; (F.C.S.L.); (K.M.S.); (F.A.M.); (T.R.B.); (M.B.d.R.); (M.R.); (G.N.M.H.); (L.P.K.)
| | - Maria Isabel Achatz
- Cancer Genetics Unit, Centro de Oncologia, Hospital Sirio Libanês, São Paulo SP 01308-050, Brazil;
| | - Silvia Regina Rogatto
- Department of Clinical Genetics, Vejle University Hospital, Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
- Correspondence:
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16
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Piscitello A, Edwards DK. Estimating the Screening-Eligible Population Size, Ages 45-74, at Average Risk to Develop Colorectal Cancer in the United States. Cancer Prev Res (Phila) 2020; 13:443-448. [PMID: 32029430 DOI: 10.1158/1940-6207.capr-19-0527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/15/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022]
Abstract
Colorectal cancer is a growing burden in adults less than 50 years old. In 2018, the American Cancer Society published a guideline update recommending a reduction in the colorectal cancer screening start age for average-risk individuals from 50 to 45. Implementing these recommendations would have important implications for public health. However, the approximate number of people impacted by this change, the average-risk population ages 45-49, is not well-described in the literature. Here, we provide methodology to conservatively estimate the average-risk and screening-eligible population in the United States, including those who would be impacted by a lowered colorectal cancer screening start age. Using multiple data sources, we estimated the current average-risk population by subtracting individuals with symptomatic colorectal cancer, with a family history of colorectal cancer, and with inflammatory bowel disease and hereditary nonpolyposis colorectal cancer from the total population. Within this population, we estimated the number of screening-eligible individuals by subtracting those with previous colorectal cancer screening (45- to 49-year-old) or up to date with colorectal cancer screening (50- to 74-year-old). The total average-risk population is estimated between 102.1 and 106.5 million people, of whom 43.4-45.2 million people are eligible for colorectal cancer screening. Lowering the screening age would add roughly 19 million people to the average-risk population and increase the current number of screening-eligible individuals on immediate implementation by over 60% (from 27 to 44 million). Estimating the population size impacted by lowering the recommended colorectal cancer screening start age enables more accurate decision-making for policymakers and epidemiologists focused on cancer prevention.
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Del Fiol G, Kohlmann W, Bradshaw RL, Weir CR, Flynn M, Hess R, Schiffman JD, Nanjo C, Kawamoto K. Standards-Based Clinical Decision Support Platform to Manage Patients Who Meet Guideline-Based Criteria for Genetic Evaluation of Familial Cancer. JCO Clin Cancer Inform 2020; 4:1-9. [PMID: 31951474 PMCID: PMC7000231 DOI: 10.1200/cci.19.00120] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The ubiquitous adoption of electronic health records (EHRs) with family health history (FHH) data provides opportunities for tailoring cancer screening strategies to individuals. We aimed to enable a standards-based clinical decision support (CDS) platform for identifying and managing patients who meet guidelines for genetic evaluation of hereditary cancer. METHODS The CDS platform (www.opencds.org) was used to implement algorithms based on the 2018 National Comprehensive Cancer Network guidelines for genetic evaluation of hereditary breast/ovarian and colorectal cancer. The platform was designed to be interfaced with different EHR systems via the Health Level Seven International Fast Healthcare Interoperability Resources standard. The platform was integrated with the Epic EHR and evaluated in a pilot study at an academic health care system. RESULTS The CDS platform was executed against a target population of 143,012 patients; 5,245 (3.7%) met criteria for genetic evaluation based on the FHH recorded in the EHR. In a clinical pilot study, genetic counselors attempted to reach out to 71 of the patients. Of those patients, 25 (35%) scheduled an appointment, 10 (14%) declined, 2 (3%) did not need genetic counseling, 7 (10%) said they would consider it in the future, and 27 (38%) were unreachable. To date, 13 (52%) of the scheduled patients completed visits, and 2 (15%) of those were found to have pathogenic variants in cancer predisposition genes. CONCLUSION A standards-based CDS platform integrated with EHR systems is a promising population-based approach to identify patients who are appropriate candidates for genetic evaluation of hereditary cancers.
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Affiliation(s)
- Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Richard L. Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Charlene R. Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Michael Flynn
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Rachel Hess
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Joshua D. Schiffman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Claude Nanjo
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
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18
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Lee SI, Patel M, Dutton B, Weng S, Luveta J, Qureshi N. Effectiveness of interventions to identify and manage patients with familial cancer risk in primary care: a systematic review. J Community Genet 2020; 11:73-83. [PMID: 31062229 PMCID: PMC6962422 DOI: 10.1007/s12687-019-00419-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/05/2019] [Indexed: 12/15/2022] Open
Abstract
This systematic review evaluated the effectiveness of strategies to identify and manage patients with familial risk of breast, ovarian, colorectal and prostate cancer in primary care to improve clinical outcomes. MEDLINE, EMBASE, CINAHL and Cochrane library were searched from January 1980 to October 2017. We included randomised controlled trials (RCT) and non-randomised studies of interventions (NRSI). Primary outcomes were cancer incidence, cancer-related clinical outcomes or the identification of cancer predisposition; secondary outcomes were the appropriateness of referral, uptake of preventive strategies and cognitive and psychological effect. From 11,842 abstracts, 111 full texts were reviewed and three eligible studies (nine articles) identified. Two were cluster RCTs and one NRSI; all used risk assessment software. No studies identified our primary outcomes, with no consistent outcome across the three studies. In one RCT, intervention improved the proportion of genetic referrals meeting referral guidelines for breast cancer (OR 4.5, 95% CI 1.6 to 13.1). In the other RCT, there was no difference in screening adherence between the intervention and control group. However, there was borderline increased risk perception (OR 1.89, 95% CI 0.99 to 3.59) in the subgroup that under-estimated their colon cancer risk. In the NRSI, there was no change in psychological distress in patients at increased familial breast cancer risk, but population risk patients had reduced anxiety after intervention (state anxiety mean change - 3, 95% CI - 5 to - 2). Future studies should have better-defined comparator groups and longer follow-up and assess outcomes using validated tools.
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Affiliation(s)
- Siang Ing Lee
- Division of Primary Care, School of Medicine, University of Nottingham, 13th Floor, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - Mitesh Patel
- Division of Primary Care, School of Medicine, University of Nottingham, 13th Floor, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - Brittany Dutton
- Division of Primary Care, School of Medicine, University of Nottingham, 13th Floor, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - Stephen Weng
- Division of Primary Care, School of Medicine, University of Nottingham, 13th Floor, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | | | - Nadeem Qureshi
- Division of Primary Care, School of Medicine, University of Nottingham, 13th Floor, Tower Building, University Park, Nottingham, NG7 2RD, UK.
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19
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Using Machine Learning to Uncover Hidden Heterogeneities in Survey Data. Sci Rep 2019; 9:16061. [PMID: 31690743 PMCID: PMC6831673 DOI: 10.1038/s41598-019-51862-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 10/07/2019] [Indexed: 11/20/2022] Open
Abstract
Survey responses in public health surveys are heterogeneous. The quality of a respondent’s answers depends on many factors, including cognitive abilities, interview context, and whether the interview is in person or self-administered. A largely unexplored issue is how the language used for public health survey interviews is associated with the survey response. We introduce a machine learning approach, Fuzzy Forests, which we use for model selection. We use the 2013 California Health Interview Survey (CHIS) as our training sample and the 2014 CHIS as the test sample. We found that non-English language survey responses differ substantially from English responses in reported health outcomes. We also found heterogeneity among the Asian languages suggesting that caution should be used when interpreting results that compare across these languages. The 2013 Fuzzy Forests model also correctly predicted 86% of good health outcomes using 2014 data as the test set. We show that the Fuzzy Forests methodology is potentially useful for screening for and understanding other types of survey response heterogeneity. This is especially true in high-dimensional and complex surveys.
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20
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John EM, Canchola AJ, Sangaramoorthy M, Koo J, Whittemore AS, West DW. Race/Ethnicity and Accuracy of Self-Reported Female First-Degree Family History of Breast and Other Cancers in the Northern California Breast Cancer Family Registry. Cancer Epidemiol Biomarkers Prev 2019; 28:1792-1801. [PMID: 31488412 DOI: 10.1158/1055-9965.epi-19-0444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/18/2019] [Accepted: 08/27/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few studies have evaluated accuracy of self-reported family history of breast and other cancers in racial/ethnic minorities. METHODS We assessed the accuracy of cancer family history reports by women with breast cancer (probands) from the Northern California Breast Cancer Family Registry compared with 2 reference standards: personal cancer history reports by female first-degree relatives and California Cancer Registry records. RESULTS Probands reported breast cancer in first-degree relatives with high accuracy, but accuracy was lower for other cancers. Sensitivity (percentage correctly identifying relatives with cancer) was 93% [95% confidence interval (CI), 89.5-95.4] when compared with the relatives' self-report of breast cancer as the reference standard and varied little by proband race/ethnicity and other demographic factors, except for marginally lower sensitivity for Hispanic white probands (87.3%; 95% CI, 78.0-93.1; P = 0.07) than non-Hispanic white probands (95.1%; 95% CI, 88.9-98.0). Accuracy was also high when compared with cancer registry records as the reference standard, with a sensitivity of 95.5% (95% CI, 93.4-96.9) for breast cancer, but lower sensitivity for Hispanic white probands (91.2%; 95% CI, 84.4-95.2; P = 0.05) and probands with low English language proficiency (80%; 95% CI, 52.8-93.5; P < 0.01). CONCLUSIONS Non-Hispanic white, African American, and Asian American probands reported first-degree breast cancer family history with high accuracy, although sensitivity was lower for Hispanic white probands and those with low English language proficiency. IMPACT Self-reported family history of breast cancer in first-degree relatives is highly accurate and can be used as a reliable standard when other validation methods are not available.
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Affiliation(s)
- Esther M John
- Cancer Prevention Institute of California, Fremont, California. .,Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy (Epidemiology), Stanford University of School of Medicine, Stanford, California.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Alison J Canchola
- Cancer Prevention Institute of California, Fremont, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Meera Sangaramoorthy
- Cancer Prevention Institute of California, Fremont, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Jocelyn Koo
- Cancer Prevention Institute of California, Fremont, California.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Alice S Whittemore
- Department of Health Research and Policy (Epidemiology), Stanford University of School of Medicine, Stanford, California.,Department of Biomedical Data Science, Stanford University of School of Medicine, Stanford, California
| | - Dee W West
- Cancer Prevention Institute of California, Fremont, California.,Department of Health Research and Policy (Epidemiology), Stanford University of School of Medicine, Stanford, California
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21
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Genotype-phenotype relations of the von Hippel-Lindau tumor suppressor inferred from a large-scale analysis of disease mutations and interactors. PLoS Comput Biol 2019; 15:e1006478. [PMID: 30943211 PMCID: PMC6464237 DOI: 10.1371/journal.pcbi.1006478] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 04/15/2019] [Accepted: 02/25/2019] [Indexed: 02/06/2023] Open
Abstract
Familiar cancers represent a privileged point of view for studying the complex cellular events inducing tumor transformation. Von Hippel-Lindau syndrome, a familiar predisposition to develop cancer is a clear example. Here, we present our efforts to decipher the role of von Hippel-Lindau tumor suppressor protein (pVHL) in cancer insurgence. We collected high quality information about both pVHL mutations and interactors to investigate the association between patient phenotypes, mutated protein surface and impaired interactions. Our data suggest that different phenotypes correlate with localized perturbations of the pVHL structure, with specific cell functions associated to different protein surfaces. We propose five different pVHL interfaces to be selectively involved in modulating proteins regulating gene expression, protein homeostasis as well as to address extracellular matrix (ECM) and ciliogenesis associated functions. These data were used to drive molecular docking of pVHL with its interactors and guide Petri net simulations of the most promising alterations. We predict that disruption of pVHL association with certain interactors can trigger tumor transformation, inducing metabolism imbalance and ECM remodeling. Collectively taken, our findings provide novel insights into VHL-associated tumorigenesis. This highly integrated in silico approach may help elucidate novel treatment paradigms for VHL disease. Cancer is generally caused by a series of mutations accumulating over time in a healthy tissue, which becomes re-programmed to proliferate at the expense of the hosting organism. This process is difficult to follow and understand as events in a multitude of different genes can lead to similar outcomes without apparent cause. The von Hippel-Lindau (VHL) tumor suppressor is one of the few genes harboring a familiar cancer syndrome, i.e. VHL mutations are known to cause a predictable series of events leading cancer in the kidneys and a few selected other tissues. This article describes a large-scale analysis to relate known VHL mutations to specific cancer pathways by looking at the molecular interactions. Different cancer types appear to be caused by mutations changing the surface of specific parts of the VHL protein. By looking at the VHL interactors involved, it is therefore possible to identify other candidate genes for mutations leading to very similar cancer types.
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22
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Bermot C, Saint-Martin C, Malhaire C, Sebbag-Sfez D, Mouret-Fourme E, Carton M, Thibault FE. Background parenchymal enhancement and fibroglandular tissue on breast MRI in women with high genetic risk: Are changes before and after risk-reducing salpingo-oophorectomy associated with breast cancer risk? Eur J Radiol 2018; 109:171-177. [PMID: 30527300 DOI: 10.1016/j.ejrad.2018.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/25/2018] [Accepted: 10/30/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Parenchymal enhancement and fibroglandular tissue on breast MRI in women with high genetic risk: are changes before and after risk-reducing salpingo-oophorectomy associated with breast cancer risk? OBJECTIVE To evaluate changes in the level of background parenchymal enhancement (BPE) and amount of fibroglandular tissue (FGT) on breast MRI before and after risk-reducing oophorectomy (RRSO), and to determine whether these changes correlate with ultimate breast cancer risk. MATERIALS AND METHODS The cohort included 146 women with high genetic risk who had undergone pre- and post-RRSO breast MRI. BPE level and FGT amount were retrospectively graded according to BI-RADS classification. Initial values and changes were compared in women with or without later breast cancer after RRSO. Hazard ratios (HR) were estimated using Cox univariate models. RESULTS Patients with initial moderate (BI-RADS C category) BPE had a higher risk of subsequent breast cancer of HR = 3.9 (95% CI [1.1-14.3]; p = 0.04) compared to patients with initial minimal (BI-RADS A) BPE. A categorical BPE decrease after RRSO, versus no change, was associated with a higher cancer risk (HR 2.2, 95% CI [1.04-4.8]; p = 0.04). Initially dense (BI-RADS 3 category) FGT correlated with an increased cancer risk compared to fatty (BI-RADS 1 category) parenchyma (HR 8.3, 95% CI [1.1-64]; p = 0.04). After RRSO, there was a trend for higher cancer risk related to a categorical FGT decrease (HR 2.3, 95% CI [0.9-35.4]; p = 0.06). CONCLUSION Patients in whom BPE decreases after RRSO might be at higher risk of subsequent breast cancer compared to patients with stable BPE. This finding is consistent with the concept of increased risk associated with high initial BPE, which could be of higher clinical relevance than post-RRSO BPE reduction. A similar trend was observed with high initial FGT.
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Affiliation(s)
- Cécile Bermot
- Institut Curie, Département d'Imagerie Médicale, 26 rue d'Ulm, F-75005 Paris, France.
| | - Caroline Saint-Martin
- Institut Curie, PSL Research University, DRCI, Biométrie, 35 Rue Dailly, F-92210, Saint-Cloud, France.
| | - Caroline Malhaire
- Institut Curie, Département d'Imagerie Médicale, 26 rue d'Ulm, F-75005 Paris, France
| | - Delphine Sebbag-Sfez
- Institut Curie, Département d'Imagerie Médicale, 26 rue d'Ulm, F-75005 Paris, France.
| | | | - Matthieu Carton
- Institut Curie, PSL Research University, DRCI, Biométrie, 35 Rue Dailly, F-92210, Saint-Cloud, France.
| | - Fabienne E Thibault
- Institut Curie, Département d'Imagerie Médicale, 26 rue d'Ulm, F-75005 Paris, France.
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23
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Neffa F, Garcia L, Della Valle A, Carusso F, Vergara C, Sanchez D, Sapone M, Silveyra N, Revello AL, Esperon P. Aggressive mutation in a familial adenomatous polyposis syndrome family: when phenotype guides clinical surveillance. J Gastrointest Oncol 2018; 9:553-559. [PMID: 29998021 DOI: 10.21037/jgo.2017.10.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Familial adenomatous polyposis (FAP) is an autosomal dominant genetic condition, caused by mutations in the adenomatous polyposis coli (APC) tumor suppressor gene. Desmoid tumors (DTs) are seen in 15% to 20% of FAP patients. Specific location of mutation serves as a guide to predict colonic and extra colonic manifestations and their aggressiveness. A severe FAP-phenotypic family was registered in a genetic counselling high-risk Uruguayan hereditary cancer clinic. Proband's DNA was analysed by NGS, detecting a pathogenic mutation in APC gene. All willing family members were counselled and encouraged to be tested. Here we report a kindred formed by 16 individuals with a very severe FAP phenotype. A two-base deletion mutation: c.4393_4394delAG in APC gene and a consequent premature stop codon was detected. DTs were diagnosed in 6 individuals, ranging from 2 to 25 years of age. The causes of death were diverse: gastric cancer, rectal cancer and desmoid tumor. The already described genotype-phenotype correlation has proved its worth in this family, as clinical features reflect the mutation location at 3' end of APC gene. The inheritable and lethal nature of the disease needs a tailored follow up approach in order to reduce mortality, optimize local tumor control, and preserve patients' quality of life.
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Affiliation(s)
- Florencia Neffa
- Grupo Colaborativo Uruguayo, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - Lucia Garcia
- Grupo Colaborativo Uruguayo, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - Adriana Della Valle
- Grupo Colaborativo Uruguayo, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - Florencia Carusso
- Grupo Colaborativo Uruguayo, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - Carolina Vergara
- Grupo Colaborativo Uruguayo, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | | | - Marta Sapone
- Grupo Colaborativo Uruguayo, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | | | | | - Patricia Esperon
- Grupo Colaborativo Uruguayo, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay.,Laboratorio de Genética Molecular Facultad de Química, Universidad de la República, Montevideo, Uruguay
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24
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Jastaniah W, Aljefri A, Ayas M, Alharbi M, Alkhayat N, Al-Anzi F, Yassin F, Alkasim F, Alharbi Q, Abdullah S, Abrar MB, Alsultan A. Prevalence of hereditary cancer susceptibility syndromes in children with cancer in a highly consanguineous population. Cancer Epidemiol 2018; 55:88-95. [PMID: 29859499 DOI: 10.1016/j.canep.2018.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/08/2018] [Accepted: 05/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND & AIM Hereditary cancer susceptibility syndromes (HCSS) are reported in up to one-third of children with cancer. Diagnosis of HCSS is crucial for implementation of surveillance protocols. We identified children who fulfilled criteria for HCSS in Saudi Arabia using the American College of Medical Genetics and Genomics (ACMG) guidelines, addressing the utility of these guidelines in a highly consanguineous population. METHODS This multi-center cross-sectional study recruited 1858 children with cancer between January 2011 and December 2014. HCSS criteria were based on the ACMG guidelines. RESULTS Seven hundred and four (40.4%) out of 1742 eligible patients fulfilled criteria for HCSS. Consanguinity was reported in 629 (38%) patients, with 50 (2.9%) first-degree, 535 (30.7%) second-degree, and 272 (15.6%) third-degree relatives affected with cancer. Two hundred and eighty eight (17.4%) leukemia and 87 (5.3%) brain tumour patients fulfilled HCSS criteria, with parental consanguinity being the most frequent criterion in both (leukemia 85.4%, brain tumors 83.9%). However, leukemia was less frequent in patients of consanguineous parents (p = 0.023). CONCLUSION Four out of 10 children with cancer fulfilled criteria for HCSS, most often due to consanguinity. This higher than expected prevalence suggests the need to validate consanguinity as a criterion for HCSS in highly consanguineous populations.
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Affiliation(s)
- Wasil Jastaniah
- Department of Pediatrics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; Chairman Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| | - Abdullah Aljefri
- Consultant Pediatric Hematology/Oncology/BMT, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Consultant Pediatric Hematology/Oncology/BMT, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Musa Alharbi
- Consultant Pediatric Hematology/Oncology/BMT and Chairman of the Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawaf Alkhayat
- Consultant Pediatric Hematology/Oncology/BMT, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Faisal Al-Anzi
- Chief Executive Officer and Consultant Pediatric Hematology/Oncology/BMT, Prince Faisal Bin Bandar Cancer Center, Qaseem, Saudi Arabia
| | - Fawwaz Yassin
- Consultant Pediatric Hematology/Oncology/BMT, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Fawaz Alkasim
- Consultant Pediatric Hematology/Oncology/BMT, King Saud Medical City, Riyadh, Saudi Arabia
| | - Qasim Alharbi
- Consultant Pediatric Hematology/Oncology/BMT, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Shaker Abdullah
- Consultant Pediatric Hematology/Oncology/BMT and Head Section of Pediatric Hematology/Oncology/BMT, Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed Burhan Abrar
- Princess Noorah Oncology Center, King Saud Bin Abdulaziz University and King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Abdulrahman Alsultan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Consultant Pediatric Hematology/Oncology/BMT, Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia
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25
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DiNardo CD, Routbort MJ, Bannon SA, Benton CB, Takahashi K, Kornblau SM, Luthra R, Kanagal-Shamanna R, Medeiros LJ, Garcia-Manero G, M. Kantarjian H, Futreal PA, Meric-Bernstam F, Patel KP. Improving the detection of patients with inherited predispositions to hematologic malignancies using next-generation sequencing-based leukemia prognostication panels. Cancer 2018; 124:2704-2713. [DOI: 10.1002/cncr.31331] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/09/2018] [Accepted: 02/05/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Courtney D. DiNardo
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Mark J. Routbort
- Department of Hematopathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Sarah A. Bannon
- Department of Clinical Cancer Genetics; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Christopher B. Benton
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Koichi Takahashi
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Steve M. Kornblau
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Rajyalakshmi Luthra
- Department of Hematopathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - L. Jeffrey Medeiros
- Department of Hematopathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | | | - Hagop M. Kantarjian
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - P. Andrew Futreal
- Department of Genomic Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Keyur P. Patel
- Department of Hematopathology; The University of Texas MD Anderson Cancer Center; Houston Texas
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26
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Buleje J, Guevara-Fujita M, Acosta O, Huaman FDP, Danos P, Murillo A, Pinto JA, Araujo JM, Aguilar A, Ponce J, Vigil C, Castaneda C, Calderon G, Gomez HL, Fujita R. Mutational analysis of BRCA1 and BRCA2 genes in Peruvian families with hereditary breast and ovarian cancer. Mol Genet Genomic Med 2017; 5:481-494. [PMID: 28944232 PMCID: PMC5606899 DOI: 10.1002/mgg3.301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 12/21/2022] Open
Abstract
Background Breast cancer is one of the most prevalent malignancies in the world. In Peru, breast cancer is the second cause of death among women. Five to ten percent of patients present a high genetic predisposition due to BRCA1 and BRCA2 germline mutations. Methods We performed a comprehensive analysis of BRCA1 and BRCA2 genes by Sanger sequencing and multiplex ligation‐dependent probe amplification (MLPA) to detect large rearrangements in patients from 18 families, which met the criteria for hereditary breast cancer. Results In this series, we found four pathogenic mutations, three previously reported (BRCA1: c.302‐1G>C and c.815_824dup10; BRCA2: c.5946delT) and a duplication of adenines in exon 15 in BRCA1 gene (c.4647_4648dupAA, ClinVar SCV000256598.1). We also found two exonic and four intronic variants of unknown significance and 28 polymorphic variants. Conclusion This is the first report to determine the spectrum of mutations in the BRCA1/BRCA2 genes in Peruvian families selected by clinical and genetic criteria. The alteration rate in BRCA1/BRCA2 with proven pathogenic mutation was 22.2% (4 out 18) and this finding could be influenced by the reduced sample size or clinical criteria. In addition, we found three known BRCA1/BRCA2 mutations and a BRCA1 c.4647_4648dupAA as a novel pathogenic mutation.
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Affiliation(s)
- Jose Buleje
- Centro de Genética y Biología MolecularFacultad de Medicina HumanaUniversidad de San Martín de PorresLimaPerú
| | - Maria Guevara-Fujita
- Centro de Genética y Biología MolecularFacultad de Medicina HumanaUniversidad de San Martín de PorresLimaPerú
| | - Oscar Acosta
- Centro de Genética y Biología MolecularFacultad de Medicina HumanaUniversidad de San Martín de PorresLimaPerú
| | - Francia D P Huaman
- Centro de Genética y Biología MolecularFacultad de Medicina HumanaUniversidad de San Martín de PorresLimaPerú
| | - Pierina Danos
- Centro de Genética y Biología MolecularFacultad de Medicina HumanaUniversidad de San Martín de PorresLimaPerú
| | - Alexis Murillo
- Centro de Genética y Biología MolecularFacultad de Medicina HumanaUniversidad de San Martín de PorresLimaPerú
| | - Joseph A Pinto
- Unidad de Investigación Básica y TraslacionalOncosalud-AUNALimaPerú
| | | | - Alfredo Aguilar
- Unidad de Investigación Básica y TraslacionalOncosalud-AUNALimaPerú
| | | | | | | | | | | | - Ricardo Fujita
- Centro de Genética y Biología MolecularFacultad de Medicina HumanaUniversidad de San Martín de PorresLimaPerú
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Online self-test identifies women at high familial breast cancer risk in population-based breast cancer screening without inducing anxiety or distress. Eur J Cancer 2017; 78:45-52. [PMID: 28412588 DOI: 10.1016/j.ejca.2017.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/02/2017] [Accepted: 03/13/2017] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Identifying high familial breast cancer (FBC) risk improves detection of yet unknown BRCA1/2-mutation carriers, for whom BC risk is both highly likely and potentially preventable. We assessed whether a new online self-test could identify women at high FBC risk in population-based BC screening without inducing anxiety or distress. METHODS After their visit for screening mammography, women were invited by email to take an online self-test for identifying highly increased FBC risk-based on Dutch guidelines. Exclusion criteria were previously diagnosed as increased FBC risk or a personal history of BC. Anxiety (State-Trait Anxiety Inventory Dutch Version), distress (Hospital Anxiety Depression Scale) and BC risk perception were assessed using questionnaires, which were completed immediately before and after taking the online self-test and 2 weeks later. RESULTS Of the 562 women invited by email, 406 (72%) completed the online self-test while 304 also completed questionnaires (response rate 54%). After exclusion criteria, 287 (51%) were included for data analysis. Median age was 56 years (range 50-74). A high or moderate FBC risk was identified in 12 (4%) and three (1%) women, respectively. After completion of the online self-test, anxiety and BC risk perception were decreased while distress scores remained unchanged. Levels were below clinical relevance. Most women (85%) would recommend the self-test; few (3%) would not. CONCLUSION The online self-test identified previously unknown women at high FBC risk (4%), who may carry a BRCA1/2-mutation, without inducing anxiety or distress. We therefore recommend offering this self-test to women who attend population-based screening mammography for the first time.
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Personalized medicine for prevention: can risk stratified screening decrease colorectal cancer mortality at an acceptable cost? Cancer Causes Control 2017; 28:299-308. [DOI: 10.1007/s10552-017-0864-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/01/2017] [Indexed: 12/15/2022]
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Electronic health record interventions at the point of care improve documentation of care processes and decrease orders for genetic tests commonly ordered by nongeneticists. Genet Med 2016; 19:112-120. [PMID: 27362912 DOI: 10.1038/gim.2016.73] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/25/2016] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine whether electronic health record (EHR) tools improve documentation of pre- and postanalytic care processes for genetic tests ordered by nongeneticists. METHODS We conducted a nonrandomized, controlled, pre-/postintervention study of EHR point-of-care tools (informational messages and template report) for three genetic tests. Chart review assessed documentation of genetic testing processes of care, with points assigned for each documented item. Multiple linear and logistic regressions assessed factors associated with documentation. RESULTS Preimplementation, there were no significant site differences (P > 0.05). Postimplementation, mean documentation scores increased (5.9 (2.1) vs. 5.0 (2.2); P = 0.0001) and records with clinically meaningful documentation increased (score >5: 59 vs. 47%; P = 0.02) at the intervention versus the control site. Pre- and postimplementation, a score >5 was positively associated with abnormal test results (OR = 4.0; 95% CI: 1.8-9.2) and trainee provider (OR = 2.3; 95% CI: 1.2-4.6). Postimplementation, a score >5 was also positively associated with intervention site (OR = 2.3; 95% CI: 1.1-5.1) and specialty clinic (OR = 2.0; 95% CI: 1.1-3.6). There were also significantly fewer tests ordered after implementation (264/100,000 vs. 204/100,000; P = 0.03), with no significant change at the control site (280/100,000 vs. 257/100,000; P = 0.50). CONCLUSIONS EHR point-of-care tools improved documentation of genetic testing processes and decreased utilization of genetic tests commonly ordered by nongeneticists.Genet Med 19 1, 112-120.
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Flória-Santos M, Lopes-Júnior LC, Alvarenga LDM, Ribeiro MS, Ferraz VEDF, Nascimento LC, Pereira-da-Silva G. Self-reported cancer family history is a useful tool for identification of individuals at risk of hereditary cancer predisposition syndrome at primary care centers in middle-income settings: a longitudinal study. Genet Mol Biol 2016; 39:178-83. [PMID: 27275666 PMCID: PMC4910551 DOI: 10.1590/1678-4685-gmb-2014-0362] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/11/2016] [Indexed: 11/21/2022] Open
Abstract
Analysis of cancer family history (CFH) offers a low-cost genetic tool to identify
familial cancer predisposition. In middle-income settings, the scarcity of individual
records and database-linked records hinders the assessment of self-reported CFH
consistency as an indicator of familial cancer predisposition. We used self-reported
CFH to identify those families at risk for hereditary cancer syndromes in
community-based primary care centers of a low-income Brazilian area. We also
evaluated the consistency of the information collected by reassessing CFH five years
later. We interviewed 390 families and constructed their pedigrees for genetic cancer
risk assessment. We found 125 families affected by cancer, 35.2% with moderate to
high risk of familial susceptibility to cancer, a number that represents a relatively
high prevalence of potential hereditary cancer syndromes in the overall study sample.
Upon reassessment of CFH in 14/20 families that were previously identified as having
at least one first-degree and one second-degree relative affected by cancer, and
presented moderate to high risk for developing cancer, 90% of initial pedigrees were
confirmed. These results demonstrate the reliability of self-reports as a means of
early identification of healthy individuals at risk, encouraging the wider use of
this method in low- and middle-income primary care settings.
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Affiliation(s)
- Milena Flória-Santos
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Luís Carlos Lopes-Júnior
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Larissa de Melo Alvarenga
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Mayara Segundo Ribeiro
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Lucila Castanheira Nascimento
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Gabriela Pereira-da-Silva
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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de Oliveira CBM, Cardoso-Filho C, Bossi LS, Lourenço GJ, Costa-Gurgel MS, Lima CSP. Association of CYP1A1 A4889G and T6235C polymorphisms with the risk of sporadic breast cancer in Brazilian women. Clinics (Sao Paulo) 2015; 70:680-5. [PMID: 26598080 PMCID: PMC4602382 DOI: 10.6061/clinics/2015(10)04] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 07/21/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We examined the influence of CYP1A1 A4889G and T6235C polymorphisms on the risk of sporadic breast cancer. METHODS DNA from 742 sporadic breast cancer patients and 742 controls was analyzed using the polymerase chain reaction, followed by the restriction fragment length polymorphism technique. RESULTS More patients had the CYP1A1 4889AG+GG genotype compared to controls (29.0% versus 23.2%, p=0.004). The G allele carriers had a 1.50-fold increased risk (95% CI: 1.14-1.97) of sporadic breast cancer compared to the other study participants. The frequency of the 4889AG+GG genotype among the Caucasian patients was higher than in the non-Caucasian patients (30.4% versus 20.2%, p=0.03) and controls (30.4% versus 23.2%, p=0.002). Caucasians and G allele carriers had a 1.61-fold increased risk (95% CI: 1.20-2.15) of sporadic breast cancer compared to other subjects. The CYP1A1 4889AG+GG genotype was more common among patients with a younger median age at first full-term pregnancy than among controls (33.8% versus 23.2%, p=0.001) and subjects whose first full-term pregnancies occurred at an older age (33.8% versus 26.1%, p=0.03). Women with the CYP1A1 4889AG+GG genotype and earlier first full-term pregnancies had a 1.87-fold (95% CI: 1.32-2.67) increased risk of sporadic breast cancer compared to the other study participants. Excess CYP1A1 4889AG+GG (39.8% versus27.1%, p=0.01) and 6235TC+CC (48.4% versus 35.9%, p=0.02) genotypes were also observed in patients with grade I and II tumors compared to patients with grade III tumors and controls (39.8% versus 23.2%, p=0.04; 48.4% versus 38.6%, p=0.04). The G and C allele carriers had a 2.44-fold (95% CI: 1.48-4.02) and 1.67-fold (95% CI: 1.03-2.69) increased risk, respectively, of developing grade I and II tumors compared to other subjects. CONCLUSIONS The CYP1A1 A4889G and T6235C polymorphisms may alter the risk of sporadic breast cancer in Brazilian women.
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Affiliation(s)
- Camila Borges Martins de Oliveira
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Campinas, SP, Brazil
- Corresponding author: E-mail:
| | - Cássio Cardoso-Filho
- Universidade de Campinas, Centro de Assistência Integral à Saúde da Mulher, Campinas, SP, Brazil
| | - Leonardo Silveira Bossi
- Universidade de Campinas, Centro de Assistência Integral à Saúde da Mulher, Campinas, SP, Brazil
| | - Gustavo Jacob Lourenço
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Campinas, SP, Brazil
| | | | - Carmen Silvia Passos Lima
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Campinas, SP, Brazil
- Corresponding author: E-mail:
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Characterization of the Hispanic or latino population in health research: a systematic review. J Immigr Minor Health 2015; 16:429-39. [PMID: 23315046 DOI: 10.1007/s10903-013-9773-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The size and diversity of the Hispanic population in the United States has dramatically increased, with vast implications for health research. We conducted a systematic review of the characterization of the Hispanic population in health research and described its implications. Relevant studies were identified by searches of PubMed, Embase Scopus, and Science/Social Sciences Citation Index from 2000 to 2011. 131 articles met criteria. 56% of the articles reported only "Hispanic" or "Latino" as the characteristic of the Hispanic research population while no other characteristics were reported. 29% of the articles reported language, 27% detailed country of origin and 2% provided the breakdown of race. There is great inconsistency in reported characteristics of Hispanics in health research. The lack of detailed characterization of this population ultimately creates roadblocks in translating evidence into practice when providing care to the large and increasingly diverse Hispanic population in the US.
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Henrikson NB, Webber EM, Goddard KA, Scrol A, Piper M, Williams MS, Zallen DT, Calonge N, Ganiats TG, Janssens ACJW, Zauber A, Lansdorp-Vogelaar I, van Ballegooijen M, Whitlock EP. Family history and the natural history of colorectal cancer: systematic review. Genet Med 2015; 17:702-12. [PMID: 25590981 PMCID: PMC4955831 DOI: 10.1038/gim.2014.188] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/17/2014] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Family history of colorectal cancer (CRC) is a known risk factor for CRC and encompasses both genetic and shared environmental risks. METHODS We conducted a systematic review to estimate the impact of family history on the natural history of CRC and adherence to screening. RESULTS We found high heterogeneity in family-history definitions, the most common definition being one or more first-degree relatives. The prevalence of family history may be lower than the commonly cited 10%, and confirms evidence for increasing levels of risk associated with increasing family-history burden. There is evidence for higher prevalence of adenomas and of multiple adenomas in people with family history of CRC but no evidence for differential adenoma location or adenoma progression by family history. Limited data regarding the natural history of CRC by family history suggest a differential age or stage at cancer diagnosis and mixed evidence with respect to tumor location. Adherence to recommended colonoscopy screening was higher in people with a family history of CRC. CONCLUSION Stratification based on polygenic and/or multifactorial risk assessment may mature to the point of displacing family history-based approaches, but for the foreseeable future, family history may remain a valuable clinical tool for identifying individuals at increased risk for CRC.
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Affiliation(s)
| | | | | | - Aaron Scrol
- Group Health Research Institute, Seattle, Washington, USA
| | - Margaret Piper
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Marc S Williams
- Geisinger Health System, Genomic Medicine Institute, Danville, Pennsylvania, USA
| | | | | | | | | | - Ann Zauber
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Abstract
The hereditary colorectal cancer syndromes comprise a heterogeneous group of conditions with varying cancer risks, gastrointestinal polyp types, nonmalignant findings, and inheritance patterns. Although each one is unique in its own right, these syndromes often have overlapping features, making diagnoses difficult in select cases. Obtaining accurate polyp history (histologic type, number, location, and age of onset), cancer history (location, type, and age of onset), and other nonmalignant features is imperative in determining the likely disease diagnosis and thereby the appropriate genetic tests for precise diagnosis in a timely fashion. This process often necessitates collaboration among surgical oncology team members and genetic counselors.
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Affiliation(s)
- Kory Jasperson
- Department of Internal Medicine, Huntsman Cancer Institute, The University of Utah, 2000 Circle of Hope Drive, Room 1166, Salt Lake City, UT 84112, USA.
| | - Randall W Burt
- Department of Internal Medicine, Huntsman Cancer Institute, The University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
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Koeneman MM, Kruse AJ, Sep SJS, Gubbels CS, Slangen BFM, van Gorp T, Lopes A, Gomez-Garcia E, Kruitwagen RFPM. A family history questionnaire improves detection of women at risk for hereditary gynecologic cancer: a pilot study. Fam Cancer 2015; 13:469-75. [PMID: 24633857 DOI: 10.1007/s10689-014-9711-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pilot study to evaluate whether the use of a standardized questionnaire to document family history of cancer improves identification of women who warrant referral to cancer genetic services (CGS) for increased risk of hereditary cancer, compared to their identification in usual care. Prospective intervention study with historic control group. Gynecology outpatient clinic, Maastricht University Medical Centre, the Netherlands. The prospective intervention group consisted of new outpatients between June 1 and August 1, 2011. The historic control group consisted of new outpatients between May 1, 2009 and April 30, 2010. A standardized questionnaire based on established referral criteria for hereditary breast/ovarian cancer and Lynch syndrome was completed for the intervention group. The referral rate in routine consultation, based on non-standardized family history recording, was determined retrospectively for the control group. The difference in referral rate between intervention and control group, tested by Chi square test. In the control group, 8 of 3,036 women (0.26 %) were referred to CGS. In the intervention group, 209 (42 %) of 500 screening questionnaires were completed. Nineteen women (9, 1 %) met the referral guidelines, of which 5 were newly referred to CGS (2, 4 %). Referral rates differed significantly (p < 0.001) between the two groups. This pilot study shows that the routine use of a screening questionnaire may improve detection and referral rate to CGS of individuals at risk for hereditary cancer. Improving genetic literacy of physicians and use of web-site questionnaires deserve attention in future studies.
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Affiliation(s)
- Margot M Koeneman
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Postbus 5800, 6202 AZ, Maastricht, The Netherlands,
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ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol 2015; 110:223-62; quiz 263. [PMID: 25645574 PMCID: PMC4695986 DOI: 10.1038/ajg.2014.435] [Citation(s) in RCA: 979] [Impact Index Per Article: 108.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023]
Abstract
This guideline presents recommendations for the management of patients with hereditary gastrointestinal cancer syndromes. The initial assessment is the collection of a family history of cancers and premalignant gastrointestinal conditions and should provide enough information to develop a preliminary determination of the risk of a familial predisposition to cancer. Age at diagnosis and lineage (maternal and/or paternal) should be documented for all diagnoses, especially in first- and second-degree relatives. When indicated, genetic testing for a germline mutation should be done on the most informative candidate(s) identified through the family history evaluation and/or tumor analysis to confirm a diagnosis and allow for predictive testing of at-risk relatives. Genetic testing should be conducted in the context of pre- and post-test genetic counseling to ensure the patient's informed decision making. Patients who meet clinical criteria for a syndrome as well as those with identified pathogenic germline mutations should receive appropriate surveillance measures in order to minimize their overall risk of developing syndrome-specific cancers. This guideline specifically discusses genetic testing and management of Lynch syndrome, familial adenomatous polyposis (FAP), attenuated familial adenomatous polyposis (AFAP), MUTYH-associated polyposis (MAP), Peutz-Jeghers syndrome, juvenile polyposis syndrome, Cowden syndrome, serrated (hyperplastic) polyposis syndrome, hereditary pancreatic cancer, and hereditary gastric cancer.
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Etemadi M, Pourian M, Shakib A, Sabokbar T, Peyghanbari V, Shirkoohi R. A registry program for familial gastric cancer patients referred to Cancer Institute of Iran. Asian Pac J Cancer Prev 2014; 15:2141-4. [PMID: 24716947 DOI: 10.7314/apjcp.2014.15.5.2141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastric cancer is the second most common cause of cancer death. It has a poor prognosis with only 5-10% of hereditary etiology. If it is diagnosed, it could be helpful for screening the other susceptible members of a family for preventive procedures. Usually it is identified by symptoms such as presence of cancer in different members of family, some special type of pathology such as diffused adenocarcinoma, having younger age and multiple cancer syndromes. Hence, designing a registry program can be a more practical way to screen high risk families for a preventive program. MATERIALS AND METHODS Based on the inclusion criteria, a questionnaire was prepared. After pilot on a small number of patients, the actual data was collected from 197 patients and processed in SPSS 16.0. RESULTS Totally, 11.8% of the patients were younger than 45 years old. Blood type 'A' was dominant and males had a higher risk behavior with higher consumption of unhealthy food. Adenocarcinoma was reported in majority of cases. 21.8% of the patients had the including criteria for familial gastric cancer (FGC). CONCLUSIONS The high percentage of FGC population compared to the other studies have revealed a need to design an infrastructural diagnostic protocol and screening program for patients with FGC, plus preventive program for family members at risk which could be done by a precise survey related to frequency and founder mutations of FGC in a national registry program.
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Affiliation(s)
- Mehrnoosh Etemadi
- Students Scientific Research Center (SSRC) and Exceptional Talent Development Center (ETDC), Tehran University of Medical Sciences (TUMS), Tehran, Iran E-mail :
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Clinically relevant lessons from Family HealthLink: a cancer and coronary heart disease familial risk assessment tool. Genet Med 2014; 17:493-500. [PMID: 25356968 DOI: 10.1038/gim.2014.136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/28/2014] [Indexed: 01/18/2023] Open
Abstract
PURPOSE A descriptive retrospective study was performed using two separate user cohorts to determine the effectiveness of Family HealthLink as a clinical triage tool. METHODS Cohort 1 consisted of 2,502 users who accessed the public website. Cohort 2 consisted of 194 new patients in a Comprehensive Breast Center setting. For patient users, we assessed documentation of family history and genetics referral. For all users seen in a genetics clinic, the Family HealthLink assessment was compared with that performed by genetic counselors and genetic testing outcomes. RESULTS For general public users, the percentage meeting high-risk criteria were: for cancer only, 22.2%; for coronary heart disease only, 24.3%; and for both diseases, 10.4%. These risk stratification percentages were similar for the patient users. For the patient users, there often was documentation of family history of certain cancer types by oncology professionals, but age of onset and coronary heart disease family history were less complete. Of 142 with high-risk assignments seen in a genetics clinic, 130 (91.5%) of these assignments were corroborated. Forty-two underwent genetic testing and 17 (40.5%) had new molecular diagnoses established. CONCLUSION A significant percentage of individuals are at high familial risk and may require more intensive screening and referral. Interactive family history triage tools can aid this process.Genet Med 17 6, 493-500.
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Bodurtha JN, McClish D, Gyure M, Corona R, Krist AH, Rodríguez VM, Maibauer AM, Borzelleca J, Bowen DJ, Quillin JM. The KinFact intervention - a randomized controlled trial to increase family communication about cancer history. J Womens Health (Larchmt) 2014; 23:806-16. [PMID: 25321314 PMCID: PMC4195404 DOI: 10.1089/jwh.2014.4754] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Knowing family history is important for understanding cancer risk, yet communication within families is suboptimal. Providing strategies to enhance communication may be useful. METHODS Four hundred ninety women were recruited from urban, safety-net, hospital-based primary care women's health clinics. Participants were randomized to receive the KinFact intervention or the control handout on lowering risks for breast/colon cancer and screening recommendations. Cancer family history was reviewed with all participants. The 20-minute KinFact intervention, based in communication and behavior theory, included reviewing individualized breast/colon cancer risks and an interactive presentation about cancer and communication. Study outcomes included whether participants reported collecting family history, shared cancer risk information with relatives, and the frequency of communication with relatives. Data were collected at baseline, 1, 6, and 14 months. RESULTS Overall, intervention participants were significantly more likely to gather family cancer information at follow-up (odds ratio [OR]: 2.73; 95% confidence interval [CI]: 2.01, 3.71) and to share familial cancer information with relatives (OR: 1.85; 95% CI: 1.37, 2.48). Communication frequency (1=not at all; 4=a lot) was significantly increased at follow-up (1.67 vs. 1.54). Differences were not modified by age, race, education, or family history. However, effects were modified by pregnancy status and genetic literacy. Intervention effects for information gathering and frequency were observed for nonpregnant women but not for pregnant women. Additionally, intervention effects were observed for information gathering in women with high genetic literacy, but not in women with low genetic literacy. CONCLUSIONS The KinFact intervention successfully promoted family communication about cancer risk. Educating women to enhance their communication skills surrounding family history may allow them to partner more effectively with their families and ultimately their providers in discussing risks and prevention.
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Affiliation(s)
- Joann N. Bodurtha
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Donna McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Maria Gyure
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Rosalie Corona
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Alexander H. Krist
- Department of Family Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Vivian M. Rodríguez
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Alisa M. Maibauer
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Joseph Borzelleca
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia
| | - Deborah J. Bowen
- Department of Community Health Sciences, Boston University, Boston, Massachusetts
| | - John M. Quillin
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
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Identification of familial clustering for cancer through the family health strategy program in the municipality of Angra dos Reis, Rio de Janeiro, Brazil. J Community Genet 2014; 6:9-16. [PMID: 25063732 DOI: 10.1007/s12687-014-0196-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 07/16/2014] [Indexed: 10/25/2022] Open
Abstract
Identification of families with history of cancer in the municipality of Angra dos Reis, Rio de Janeiro (Brazil), through the Brazilian Unified Primary Health Care System was explored based in the Community Health Agents (CHA) program. This study was divided into two phases: a descriptive one with a cross-sectional epidemiological data of families with history of cancer based on CHA-collected data from home visits in four primary health care units. The second phase consisted in identifying familial clustering of three or more individuals with cancer through construction of a three-generation pedigree and revisited by an itinerant group of medical geneticists. Genetic counseling was carried out with the intent of selecting potential families at risk for hereditary familial cancers. In the first phase of the study, 1,581 families were interviewed by the CHA at their homes. A positive history for cancer was present in 42.3 % of families, comprising 22.3 % with only one case per family, 11.2 % with two cases, and 8.6 % with three or more cases in the family. The informant reported that 15 % of the cases were from the father lineage, 12 % from the mother lineage, and 12.1 % within siblings. In the remaining 60.9 % families, cancer was present in both sides of the family. The types of cancer reported were uterus 8.7 % (n = 137), stomach 7.7 % (n = 122), breast 6.9 % (n = 109), throat 6.8 % (n = 99), prostate 5.4 % (n = 85), lung 5.6 % (n = 88), bowel 3.7 % (n = 59), and unspecified sites in 6.8 % (n = 108) of families. No statistical differences were noted between the data collected on each primary care unit. In the second phase of the study, 136 families (2.9 %) from the total of families interviewed in phase 1 were selected due to the presence of three or more individuals with cancer in the family. Among those, only 73 families attended genetic counseling. Comparison between the data obtained by the CHA and the medical geneticists shows complete agreement in 36 cases (49.3 %), partial agreement in 25 cases (34.2 %) with more detailed information in the CHA sheets, discordance in 4 cases (5.5 %), and not possible to correlate in 8 cases due to identification inconsistency. Risk assessment for cancer was calculated based on the criteria adopted by Scheuner et al. (Genet Med 12(11):726-735, 2010) and revealed that 50.0 % of the families were classified as having a weak risk, 36.1 % a moderate risk, and 13.8 % were considered of high risk. Concerning known hereditary cancer syndromes, we found one family that met the criteria for breast and ovary hereditary cancer (1.4 %) and one family with non-polyposis hereditary colon cancer as revised by Bethesda protocol. Such preliminary results indicated that the Brazilian Primary Health Care system based on the CHA framework can be an effective entrance into the Unified Brazilian Health Care System (SUS-Brazil) for individuals with genetically determined diseases, such as familial cancer. Families with a history of three or more cases of cancer and considered of high risk for familial cancer could be referred to a tertiary health center for proper oncogenetic counseling.
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Waters EA, Muff J, Hamilton JG. Multifactorial beliefs about the role of genetics and behavior in common health conditions: prevalence and associations with participant characteristics and engagement in health behaviors. Genet Med 2014; 16:913-21. [PMID: 24830327 PMCID: PMC4233013 DOI: 10.1038/gim.2014.49] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/09/2014] [Indexed: 01/22/2023] Open
Abstract
Purpose Many common health conditions arise due to a combination of genetic factors and lifestyle-related behaviors. People’s understanding of the multifactorial nature of health conditions has implications for their receptivity to health messages regarding genomics and medicine, and may be related to their adoption of protective health behaviors. Although past work has investigated aspects of either genetic or behavioral causal beliefs, multifactorial beliefs have not been evaluated systematically. Methods Utilizing nationally-representative cross-sectional data from the Health Information National Trends Survey (HINTS), we examined the prevalence of multifactorial beliefs regarding the etiology of cancer, obesity, diabetes, heart disease, and hypertension, as well as associations between such beliefs and demographic, health history, and health behavior variables in the U.S. population. Results Among 3,630 participants, the vast majority (64.2-78.6%) endorsed multifactorial beliefs. The number of statistically significant associations were limited. Trends suggest that endorsement of multifactorial beliefs may differ by demographic and health history characteristics. Beliefs about the multifactorial etiology of cancer were associated with cancer screening behaviors. Multifactorial beliefs about other common health conditions were associated with few health promotion behaviors. Conclusion These findings and recommendations for future research provide preliminary guidance for developing and targeting genomics-related health messages and communications.
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Affiliation(s)
- Erika A Waters
- Department of Surgery, Division of Public Health Sciences, Washington University, St. Louis, Missouri, USA
| | - Jaclyn Muff
- Department of Surgery, Division of Public Health Sciences, Washington University, St. Louis, Missouri, USA
| | - Jada G Hamilton
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Scheuner MT, Hamilton AB, Peredo J, Sale TJ, Austin C, Gilman SC, Bowen MS, Goldzweig CL, Lee M, Mittman BS, Yano EM. A cancer genetics toolkit improves access to genetic services through documentation and use of the family history by primary-care clinicians. Genet Med 2013; 16:60-9. [DOI: 10.1038/gim.2013.75] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 04/16/2013] [Indexed: 02/04/2023] Open
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Shuval K, Chiu CY, Barlow CE, Gabriel KP, Kendzor DE, Businelle MS, Skinner CS, Balasubramanian BA. Family history of chronic disease and meeting public health guidelines for physical activity: the cooper center longitudinal study. Mayo Clin Proc 2013; 88:588-92. [PMID: 23726398 DOI: 10.1016/j.mayocp.2013.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/15/2013] [Accepted: 04/02/2013] [Indexed: 11/30/2022]
Abstract
We aimed to assess whether a family history of coronary heart disease, diabetes, or cancer is linked to meeting public health guidelines for health-promoting physical activity. To achieve this objective, we analyzed data on 29,513 adults who came to the Cooper Clinic (Dallas, Texas) between January 1, 1990, and December 31, 2010, for a preventive medicine visit. Patients completed a comprehensive medical survey including information on family medical history, physical activity, and other lifestyle behaviors. Bivariate and multivariate logistic regression were used to examine the relationship between having a family history of chronic disease and meeting physical activity guidelines. The results indicated that individuals with a family history of disease had reduced odds for meeting or exceeding physical activity guidelines. For example, participants with a family history of 3 diseases were 36% less likely to meet or exceed physical activity guidelines than their counterparts without a family history of disease (odds ratio, 0.64; 95% CI, 0.58-0.72), while controlling for covariates. Among this large sample of adults, those with a family history of chronic disease were less inclined to regularly engage in physical activity. Thus, targeted programs encouraging adoption and maintenance of health-promoting physical activity might be warranted, specifically targeting individuals with familial history of disease.
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Affiliation(s)
- Kerem Shuval
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX 75390, USA.
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Ogino S, Nishihara R, Lochhead P, Imamura Y, Kuchiba A, Morikawa T, Yamauchi M, Liao X, Qian ZR, Sun R, Sato K, Kirkner GJ, Wang M, Spiegelman D, Meyerhardt JA, Schernhammer ES, Chan AT, Giovannucci E, Fuchs CS. Prospective study of family history and colorectal cancer risk by tumor LINE-1 methylation level. J Natl Cancer Inst 2013; 105:130-40. [PMID: 23175808 PMCID: PMC3545905 DOI: 10.1093/jnci/djs482] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/27/2012] [Accepted: 10/18/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Beyond known familial colorectal cancer (CRC) syndromes, the mechanisms underlying the elevated CRC risk associated with CRC family history remain largely unknown. A recent retrospective study suggests familial clustering of CRC with hypomethylation in long interspersed nucleotide element 1 (LINE-1). We tested the hypothesis that CRC family history might confer a higher risk of LINE-1 methylation-low CRC. METHODS Using the Nurses' Health Study and the Health Professionals Follow-up Study, we prospectively examined the association between CRC family history and the risk of rectal and colon cancer (N = 1224) according to tumor LINE-1 methylation level by duplication method Cox proportional hazards regression. We examined microsatellite instability (MSI) status to exclude the influence of Lynch syndrome. All statistical tests were two-sided. RESULTS The association between CRC family history and non-MSI CRC risk differed statistically significantly by LINE-1 methylation level (P (heterogeneity) = .02). CRC family history was associated with a statistically significantly higher risk of LINE-1 methylation-low non-MSI cancer (multivariable hazard ratio [HR] = 1.68, 95% confidence interval [CI] = 1.19 to 2.38 for 1 vs 0 first-degree relatives with CRC; multivariable HR = 3.48, 95% CI = 1.59 to 7.6 for ≥2 vs 0 first-degree relatives with CRC; P (trend) < .001). In contrast, CRC family history was not statistically significantly associated with LINE-1 methylation-high non-MSI cancer (P (trend) = .35). CONCLUSIONS This molecular pathological epidemiology study shows that CRC family history is associated with a higher risk of LINE-1 methylation-low CRC, suggesting previously unrecognized heritable predisposition to epigenetic alterations. Additional studies are needed to evaluate tumor LINE-1 methylation as a molecular biomarker for familial cancer risk assessment.
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Affiliation(s)
- Shuji Ogino
- Center for Molecular Oncologic Pathology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 450 Brookline Ave, Rm JF-215C, Boston, MA 02215, USA.
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Wang C, Sen A, Ruffin MT, Nease DE, Gramling R, Acheson LS, O'Neill SM, Rubinstein WS. Family history assessment: impact on disease risk perceptions. Am J Prev Med 2012; 43:392-8. [PMID: 22992357 PMCID: PMC3448124 DOI: 10.1016/j.amepre.2012.06.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 04/17/2012] [Accepted: 06/06/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Family Healthware™, a tool developed by the CDC, is a self-administered web-based family history tool that assesses familial risk for six diseases (coronary heart disease; stroke; diabetes; and colon, breast, and ovarian cancers) and provides personalized prevention messages based on risk. The Family Healthware Impact Trial (FHITr) set out to examine the clinical utility of presenting personalized preventive messages tailored to family history risk for improving health behaviors. PURPOSE The purpose of this study was to examine the impact of Family Healthware on modifying disease risk perceptions, particularly among those who initially underestimated their risk for certain diseases. DESIGN A total of 3786 patients were enrolled in a cluster-randomized trial to evaluate the clinical utility of Family Healthware. SETTING/PARTICIPANTS Participants were recruited from 41 primary care practices among 13 states between 2005 and 2007. MAIN OUTCOME MEASURES Perceived risk for each disease was assessed at baseline and 6-month follow-up using a single-item comparative risk question. Analyses were completed in March 2012. RESULTS Compared to controls, Family Healthware increased risk perceptions among those who underestimated their risk for heart disease (15% vs 9%, p<0.005); stroke (11% vs 8%, p<0.05); diabetes (18% vs 11%, p<0.05); and colon cancer (17% vs 10%, p=0.05) but not breast or ovarian cancers. The majority of underestimators did not shift in their disease risk perceptions. CONCLUSIONS Family Healthware was effective at increasing disease risk perceptions, particularly for metabolic conditions, among those who underestimated their risk. Results from this study also demonstrate the relatively resistant nature of risk perceptions. TRIAL REGISTRATION This study is registered at clinicaltrials.govNCT00164658.
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Affiliation(s)
- Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA.
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Health behaviors and cancer screening among Californians with a family history of cancer. Genet Med 2012; 15:212-21. [PMID: 23018750 DOI: 10.1038/gim.2012.118] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The purpose of this study was to compare health behaviors and cancer screening among Californians with and without a family history of cancer. METHODS We analyzed data from the 2005 California Health Interview Survey to ascertain cancer screening test use and to estimate the prevalence of health behaviors that may reduce the risk of cancer. We used logistic regression to control for demographic factors and health-care access. RESULTS Women with a family history of breast or ovarian cancer were more likely to be up to date with mammography as compared with women with no family history of cancer (odds ratio = 1.69, 95% confidence interval (1.39, 2.04)); their health behaviors were similar to other women. Men and women with a family history of colorectal cancer were more likely to be up to date with colorectal cancer screening as compared with individuals with no family history of cancer (odds ratio = 2.77, 95% confidence interval (2.20, 3.49)) but were less likely to have a body mass index <25 kg/m(2) (odds ratio = 0.80, 95% confidence interval (0.67, 0.94)). CONCLUSION Innovative methods are needed to encourage those with a moderate-to-strong familial risk for breast cancer and colorectal cancer to increase their physical activity levels, strive to maintain a healthy weight, quit smoking, and reduce alcohol use.Genet Med 2013:15(3):212-221.
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Huang SQ, Liao QJ, Wang XW, Xin DQ, Chen SX, Wu QJ, Ye G. RNAi-mediated knockdown of pituitary tumor- transforming gene-1 (PTTG1) suppresses the proliferation and invasive potential of PC3 human prostate cancer cells. Braz J Med Biol Res 2012; 45:995-1001. [PMID: 22872288 PMCID: PMC3854157 DOI: 10.1590/s0100-879x2012007500126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 07/23/2012] [Indexed: 12/15/2022] Open
Abstract
Pituitary tumor-transforming gene-1 (PTTG1) is a proto-oncogene that promotes tumorigenesis and metastasis in numerous cell types and is overexpressed in a variety of human tumors. We have demonstrated that PTTG1 expression was up-regulated in both human prostate cancer specimens and prostate cancer cell lines. For a more direct assessment of the function of PTTG1 in prostate tumorigenesis, RNAi-mediated knockdown was used to selectively decrease PTTG1 expression in PC3 human prostate tumor cells. After three weeks of selection, colonies stably transfected with PTTG1-targeted RNAi (the knockdown PC3 cell line) or empty vector (the control PC3 cell line) were selected and expanded to investigate the role of PTTG1 expression in PC3 cell growth and invasion. Cell proliferation rate was significantly slower (28%) in the PTTG1 knockdown line after 6 days of growth as indicated by an MTT cell viability assay (P < 0.05). Similarly, a soft agar colony formation assay revealed significantly fewer (66.7%) PTTG1 knockdown PC3 cell colonies than control colonies after three weeks of growth. In addition, PTTG1 knockdown resulted in cell cycle arrest at G1 as indicated by fluorescence-activated cell sorting. The PTTG1 knockdown PC3 cell line also exhibited significantly reduced migration through Matrigel in a transwell assay of invasive potential, and down-regulation of PTTG1 could lead to increased sensitivity of these prostate cancer cells to a commonly used anticancer drug, taxol. Thus, PTTG1 expression is crucial for PC3 cell proliferation and invasion, and could be a promising new target for prostate cancer therapy.
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Affiliation(s)
- S Q Huang
- Department of Urology and Center of Nephrology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Schiffman JD. Hereditary cancer syndromes: if you look, you will find them. Pediatr Blood Cancer 2012; 58:5-6. [PMID: 21953732 DOI: 10.1002/pbc.23336] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 08/10/2011] [Indexed: 11/06/2022]
Affiliation(s)
- Joshua D Schiffman
- High Risk Pediatric Cancer Clinic, Center for Children's Cancer Research (C3R), Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah 84112, USA.
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Xiao XQ, Gong WDA, Wang SZ, Zhang ZD, Rui XP, Wu GZ, Ren F. Polymorphisms of mismatch repair gene hMLH1 and hMSH2 and risk of gastric cancer in a Chinese population. Oncol Lett 2011; 3:591-598. [PMID: 22740958 DOI: 10.3892/ol.2011.517] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 10/04/2011] [Indexed: 12/14/2022] Open
Abstract
The purpose of this study was to determine the genotype and allele frequencies of hMLH1 (-93G>A and I219V) and hMSH2 (-118T>C and IVS12-6T>C) polymorphisms in patients with gastric carcinoma and normal controls, and to evaluate the association between these polymorphisms and the risk of gastric cancer in a hospital-based Chinese population. Genomic DNA was extracted from peripheral blood lymphocytes. A TaqMan assay was used to determine the genotype and allele frequencies of hMLH1 and hMSH2 polymorphisms in data obtained from 554 gastric cancer cases and 592 controls. Unconditional logistic regression was used to assess the association between the four single nucleotide polymorphisms (SNPs) and gastric carcinoma risk. No evidence of an association among any of the four polymorphisms and the risk of gastric cancer was observed. However, when gastric cancer patients were further stratified by age, gender, smoking status, alcohol use and clinicopathological characteristics, and compared with the control populations, the combined variant genotype hMSH2 -118T>C (TC+CC) was not only associated with an increased risk of gastric cancer in subgroups of younger subjects [ages ≤63years; adjusted odds ratio (OR)=1.51, 95% confidence interval (CI), 1.05-2.16], but also with diffuse tumors (adjusted OR=1.41, 95% CI, 1.01-1.96). These data indicate that the polymorphisms of -93G>A, I219V and IVS12-6T>C are not associated with the risk of gastric cancer. However, hMSH2-118T>C combined with variant genotypes (TC+CC) may confer a potential risk of gastric cancer in the Chinese population.
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Affiliation(s)
- Xian-Qiu Xiao
- Department of General Surgery, the 101th Chinese People's Liberation Army Hospital, Jiangsu, P.R. China
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Rubinstein WS, Acheson LS, O'Neill SM, Ruffin MT, Wang C, Beaumont JL, Rothrock N. Clinical utility of family history for cancer screening and referral in primary care: a report from the Family Healthware Impact Trial. Genet Med 2011; 13:956-65. [PMID: 22075527 PMCID: PMC3425444 DOI: 10.1097/gim.0b013e3182241d88] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess the effectiveness of computerized familial risk assessment and tailored messages for identifying individuals for targeted cancer prevention strategies and motivating behavior change. METHODS We conducted a randomized clinical trial in primary care patients aged 35-65 years using Family Healthware, a self-administered, internet-based tool that collects family history for six common diseases including breast cancer, colon cancer, and ovarian cancer, stratifies risk into three tiers, and provides tailored prevention messages. Cancer screening adherence and consultation were measured at baseline and 6-month follow-up. RESULTS Of 3283 participants, 34% were at strong or moderate risk of at least one of the cancers. Family Healthware identified additional participants for whom earlier screening (colon cancer, 4.4%; breast cancer, women ages: 35-39 years, 9%) or genetic assessment (colon cancer, 2.5%; breast cancer, 10%; and ovarian cancer, 4%) may be indicated. Fewer than half were already adherent with risk-based screening. Screening adherence improved for all risk categories with no difference between intervention and control groups. Consultation with specialists did not differ between groups. CONCLUSION Family Healthware identified patients for intensified cancer prevention. Engagement of clinicians and patients, integration with clinical decision support, and inclusion of nonfamilial risk factors may be necessary to achieve the full potential of computerized risk assessment.
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Affiliation(s)
- Wendy S Rubinstein
- Department of Medicine, Division of Genetics, NorthShore University HealthSystem, Evanston, Illinois 60201, USA.
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