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Brent SE, McGee J, Vicus D, Kim R, Eisen A, Wilton AS, Gien LT. Rates of genetic consultation in high-grade serous ovarian cancer patients in the era of PARP inhibitor therapy: A population-based study. Int J Gynaecol Obstet 2024; 166:282-289. [PMID: 38284267 DOI: 10.1002/ijgo.15391] [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: 11/04/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE The American Society of Clinical Oncology recommends all patients with high-grade serous ovarian carcinoma (HGSC) undergo germline genetic testing. Genetic consultation rates in Ontario, Canada, only reached 13.3% in 2011. In 2016, PARP inhibitor maintenance therapy became available in Ontario for BRCA-positive HGSC patients. Given expanding treatment options, we re-examined genetic consultation rates among HGSC patients. METHODS This retrospective cohort study identified patients diagnosed with HGSC between 2012 and 2019 using population-based administrative data from Ontario. Genetics consultations were identified using Ontario Health Insurance Plan billing codes. Consultation rates over time were analyzed using Cochran-Armitage trend test and segmental regression analysis. Multivariable analysis identified factors associated with attending genetics consultation. RESULTS This study included 4645 HGSC patients. The mean age was 64.2 years (±SD 12.3); 56.3% had stage 3-4 disease. Overall, approximately 35% attended genetics consultations. The genetic consultation rate per year increased significantly from 21.6% to 42.6% (P < 0.001). Shorter times between diagnosis and genetics consult were observed after PARP inhibitors became available (68.1 vs 34.1 weeks, P < 0.001). Patients treated at designated cancer centers (odds ratio [OR] 2.11, P < 0.001), diagnosed in later years (OR 1.33, P < 0.001), and from higher income groups (P < 0.05) were more likely to attend genetics consultation; older patients were less likely (OR 0.98, P < 0.001). After PARP inhibitors became available, consultation rates plateaued (P < 0.001). CONCLUSIONS Between 2012 and 2019, genetic consultation rates improved significantly among HGSC patients; however, a large proportion of patients never attended consultation. Further exploration of barriers to care is warranted to improve consultation rates and ensure equitable access to care.
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Affiliation(s)
- Shannon E Brent
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Jacob McGee
- Department of Obstetrics and Gynaecology, Western University, London, Ontario, Canada
| | - Danielle Vicus
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Division of Gynecologic Oncology, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada
| | - Raymond Kim
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrea Eisen
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada
| | | | - Lilian T Gien
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Division of Gynecologic Oncology, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada
- ICES Research, Toronto, Ontario, Canada
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2
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Hayashi T, Konishi I. Molecular Histopathology for Establishing Diagnostic Method and Clinical Therapy for Ovarian Carcinoma. J Clin Med Res 2023; 15:68-75. [PMID: 36895622 PMCID: PMC9990723 DOI: 10.14740/jocmr4853] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/11/2023] [Indexed: 03/04/2023] Open
Abstract
Ovarian carcinoma (OC) is considered the deadliest gynecological malignancy. It is typically diagnosed in the advanced stages of the disease, with metastatic sites widely disseminated within the abdominal cavity. OC treatment is challenging due to the high rate of disease recurrence, which is further complicated by acquired chemoresistance caused by the reversion of the pathological variant. Therefore, more effective treatments are still being sought. Histologically, OC is classified into serous, mucinous, endometrioid, clear cell, and transitional cell carcinomas and malignant Brenner tumor. Recent clinicopathological and molecular biological studies demonstrated that these subtypes differ in histogenesis and anti-tumor agent sensitivity. In Japan, the incidence rates of the histological types of OC, namely, serous carcinoma, mucinous carcinoma, endometrioid carcinoma, and clear cell adenocarcinoma, are 39%, 12%, 16%, and 23%, respectively. Serous carcinoma is classified as high or low grade, with the former accounting for the overwhelming majority. In this study, the molecular pathological classification of OC has been described based on the characteristics of the two types of OC, types 1 and 2. Compared with Europe and the United States, Japan has a higher prevalence of type 1 OC and a lower prevalence of type 2 OC. The prevalence of each type of OC varies by race. It has been elucidated that the prevalence rate of each type of ovarian cancer in Asian countries is similar to that in Japan. Thus, OC is a heterogeneous disease. Furthermore, OC has been attributed to molecular biological mechanisms that vary among tissue subtypes. Therefore, it is necessary to conduct treatment based on accurate diagnoses of each tissue type and establish an optimal treatment strategy, and now is the transition period.
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Affiliation(s)
- Takuma Hayashi
- National Hospital Organization Kyoto Medical Center, Fukakusa Mukaihata-cho, Kyoto 612-8555, Japan
| | - Ikuo Konishi
- National Hospital Organization Kyoto Medical Center, Fukakusa Mukaihata-cho, Kyoto 612-8555, Japan.,Kyoto University, Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan
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3
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McCuaig JM, Stockley TL, Ferguson SE, Vicus D, Brennenstuhl S, Ott K, Kim RH, Metcalfe KA. Patient‐reported outcomes associated with reflex
BRCA1
/2
tumor and subsequent germline panel genetic testing for high‐grade serous ovarian cancer. J Genet Couns 2022; 32:503-513. [PMID: 36478486 DOI: 10.1002/jgc4.1661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
Reflex genetic testing of tumor tissue is being completed to direct cancer treatment; however, the patient impact of this genetic testing model is unknown. This survey study evaluates psychological outcomes following tumor and germline genetic testing in individuals with a new diagnosis of high-grade serous ovarian cancer (HGSOC). Individuals were recruited from two hospitals in Toronto, Canada. Participants completed surveys 1 week after receiving tumor results and 1 week after receiving germline results (which included genetic counseling). Outcomes included cancer-related distress (Impact of Events Scale: IES), genetic testing-related distress (Multidimensional Impact of Cancer Risk Assessment: MICRA), and patient satisfaction. Paired t-tests were used to evaluate differences in outcomes following each genetic test result; Cohen's d was used to evaluate effect size. Subgroup analyses were undertaken according to age at diagnosis (<60 years vs. ≥60 years) and test results (any positive vs. both negative). McNemar's test assessed differences in satisfaction. Fifty-two individuals were included in the analyses. Mean IES scores were similar following disclosure of tumor and germline results (27.39 vs. 26.14; p = 0.481; d = 0.101). Compared to following tumor result disclosure, MICRA scores were significantly lower following receipt of germline results with genetic counseling (27.23 vs. 22.69; p = 0.007; d = 0.435). Decreases in MICRA scores from tumor to germline result disclosure were greater for those diagnosed <60 years or those who received only negative test results. Most individuals were satisfied/highly satisfied following tumor (85.7%) and germline (89.8%) results disclosure (p = 0.774). Reflex tumor, and subsequent germline, genetic testing is a new model of care for cancer patients. In our cohort, genetic testing-related distress decreased significantly following receipt of germline results with genetic counseling, especially for individuals diagnosed under 60 years and those receiving only negative results. Most individuals were satisfied with this model of care.
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Affiliation(s)
- Jeanna M. McCuaig
- University Health Network Toronto Canada
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Canada
- Department of Molecular Genetics University of Toronto Toronto Canada
| | - Tracy L. Stockley
- University Health Network Toronto Canada
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto Canada
| | - Sarah E. Ferguson
- University Health Network Toronto Canada
- Department of Obstetrics and Gynecology University of Toronto Toronto Canada
- Sinai Health Systems Toronto Canada
| | - Danielle Vicus
- Department of Obstetrics and Gynecology University of Toronto Toronto Canada
- Sunnybrook Health Sciences Centre‐ Odette Cancer Centre Toronto Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Canada
| | - Karen Ott
- Sunnybrook Health Sciences Centre‐ Odette Cancer Centre Toronto Canada
| | - Raymond H. Kim
- University Health Network Toronto Canada
- Hospital for Sick Children Toronto Canada
- Department of Medicine University of Toronto Toronto Canada
- Adaptive Oncology Ontario Institute for Cancer Research Toronto Canada
| | - Kelly A. Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Canada
- Women's College Research Institute Toronto Canada
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4
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Winchar K, Lambert P, McManus KJ, Chodirker B, Kean S, Serfas K, Decker K, Nachtigal MW, Altman AD. Referral, Genetic Counselling, and BRCA Testing in the Manitoba High-Grade Serous Ovarian Cancer Population, 2004-2019. Curr Oncol 2022; 29:9365-9376. [PMID: 36547149 PMCID: PMC9777417 DOI: 10.3390/curroncol29120735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022] Open
Abstract
(1) Background: The primary objective of this study was to examine the rate of genetic referral, BRCA testing, and BRCA positivity amongst all patients with high-grade serous ovarian cancers (HGSOC) from 2004-2019. The secondary objective was to analyze secondary factors that may affect the rates of referral and testing. (2) Methods: This population-based cohort study included all women diagnosed with HGSOC using the Manitoba Cancer Registry, CervixCheck registry, Medical Claims database at Manitoba Health, the Hospital Discharge abstract, the Population Registry, and Winnipeg Regional Health Authority genetics data. Data were examined for three different time cohorts (2004-2013, 2014-2016; 2017-2019) correlating to practice pattern changes. (3) Results: A total of 944 patients were diagnosed with HGSOC. The rate of genetic referrals changed over the three timeframes (20.0% → 56.7% → 36.6%) and rate of genetic testing increased over the entire timeframe. Factors found to increase rates of referral and testing included age, histology, history of oral contraceptive use, and family history of ovarian cancer. Prior health care utilization indicators did not affect genetic referral or testing. (4) Conclusion: The rate of genetic referral (2004-2016) and BRCA1/2 testing (2004-2019) for patients with a diagnosis of HGSOC increased over time. A minority of patients received a consultation for genetics counselling, and even fewer received testing for a BRCA1/2. Without a genetic result, it is difficult for clinicians to inform treatment decisions. Additional efforts are needed to increase genetics consultation and testing for Manitoban patients with HGSOC. Effects of routine tumour testing on rates of genetic referral will have to be examined in future studies.
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Affiliation(s)
- Kelcey Winchar
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Pascal Lambert
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Kirk J. McManus
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Bernie Chodirker
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E OV9, Canada
- Pediatrics and Child Health (Section of Genetics and Metabolism), University of Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Sarah Kean
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Kim Serfas
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Kathleen Decker
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Mark W. Nachtigal
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB R3E OV9, Canada
| | - Alon D. Altman
- Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB R3E OV9, Canada
- Correspondence: ; Tel.: +1-204-787-2967
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5
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Goebel EA, Kerkhof J, Dzyubak O, McLachlin CM, McGee J, Sadikovic B. Examining the Diagnostic Yield of Tumour Testing and Qualifying Germline Concordance for Hereditary Cancer Variants in Patients with High-Grade Serous Carcinoma. Genes (Basel) 2022; 13:genes13081398. [PMID: 36011309 PMCID: PMC9407448 DOI: 10.3390/genes13081398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Despite advances in treatment, prognosis for most patients with high-grade serous carcinoma (HGSC) remains poor. Genomic alterations in the homologous recombination (HR) pathway are used for cancer risk assessment and render tumours sensitive to platinum-based chemotherapy and poly (ADP-ribose) polymerase inhibitors (PARPi), which can be associated with more favourable outcomes. In addition to patients with tumours containing BRCA1 or BRCA2 pathologic variants, there is emerging evidence that patients with tumours harbouring pathologic variants in other HR genes may also benefit from PARPi therapy. The objective of this study is to assess the feasibility of primary-tumour testing by examining the concordance of variant detection between germline and tumour-variant status using a custom hereditary cancer gene panel (HCP). From April 2019 to November 2020, HCP variant testing was performed on 146 HGSC formalin-fixed, paraffin-embedded tissue samples using next-generation sequencing. Of those, 78 patients also underwent HCP germline testing using blood samples. A pathogenic variant was detected in 41.1% (60/146) of tumours tested, with 68.3% (41/60) having either a BRCA1 or BRCA2 variant (n = 36), or BRCA1/2 plus a second variant (n = 5), and 31.2% (19/60) carrying a pathogenic variant in another HCP gene. The overall variant rate among the paired germline and tumour samples was 43.6% (34/78), with the remaining 56% (44/78) having no pathogenic variant detected in the germline or tumour. The overall BRCA1/2 variant rate for paired samples was 33.3% (26/78), with germline variants detected in 11.5% (9/78). A non-BRCA1/2 germline variant in another HCP gene was detected in 9.0% (7/78). All germline variants were detected in the tumour, demonstrating 100% concordance. These data provide evidence supporting the feasibility of primary-tumour testing for detecting germline and somatic variants in HCP genes in patients with HGSC, which can be used to guide clinical decision-making, and may provide opportunity for improving patient triage and clinical genetic referral practices.
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Affiliation(s)
- Emily A. Goebel
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5A5, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Correspondence: (E.A.G.); (B.S.)
| | - Jennifer Kerkhof
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Oleksandra Dzyubak
- Department of Obstetrics and Gynecology, London Health Sciences Centre and Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5W9, Canada
| | - C. Meg McLachlin
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5A5, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Jacob McGee
- Department of Obstetrics and Gynecology, London Health Sciences Centre and Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5W9, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON N6A 5W9, Canada
- Correspondence: (E.A.G.); (B.S.)
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6
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Shah S, Cheung A, Kutka M, Sheriff M, Boussios S. Epithelial Ovarian Cancer: Providing Evidence of Predisposition Genes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138113. [PMID: 35805770 PMCID: PMC9265838 DOI: 10.3390/ijerph19138113] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 12/19/2022]
Abstract
Epithelial ovarian cancer (EOC) is one of the cancers most influenced by hereditary factors. A fourth to a fifth of unselected EOC patients carry pathogenic variants (PVs) in a number of genes, the majority of which encode for proteins involved in DNA mismatch repair (MMR) pathways. PVs in BRCA1 and BRCA2 genes are responsible for a substantial fraction of hereditary EOC. In addition, PV genes involved in the MMR pathway account for 10–15% of hereditary EOC. The identification of women with homologous recombination (HR)-deficient EOCs has significant clinical implications, concerning chemotherapy regimen planning and development as well as the use of targeted therapies such as poly(ADP-ribose) polymerase (PARP) inhibitors. With several genes involved, the complexity of genetic testing increases. In this context, next-generation sequencing (NGS) allows testing for multiple genes simultaneously with a rapid turnaround time. In this review, we discuss the EOC risk assessment in the era of NGS.
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Affiliation(s)
- Sidrah Shah
- Department of Palliative Care, Guy’s and St Thomas’ Hospital, London SE1 9RT, UK;
| | - Alison Cheung
- Department of Hematology/Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Kent, Gillingham ME7 5NY, UK; (A.C.); (M.K.)
| | - Mikolaj Kutka
- Department of Hematology/Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Kent, Gillingham ME7 5NY, UK; (A.C.); (M.K.)
| | - Matin Sheriff
- Department of Urology, Medway NHS Foundation Trust, Windmill Road, Kent, Gillingham ME7 5NY, UK;
| | - Stergios Boussios
- Department of Palliative Care, Guy’s and St Thomas’ Hospital, London SE1 9RT, UK;
- King’s College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, London SE1 9RT, UK
- AELIA Organization, 9th Km Thessaloniki-Thermi, 57001 Thessaloniki, Greece
- Correspondence: or or
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7
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Sadinsky MB, Power J, Ambrosio E, Palma L, Zeng X, Foulkes WD, Weber E. Patient Experience with a Gynecologic Oncology-Initiated Genetic Testing Model for Women with Tubo-Ovarian Cancer. Curr Oncol 2022; 29:3565-3575. [PMID: 35621678 PMCID: PMC9139592 DOI: 10.3390/curroncol29050288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/22/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Up to 20% of women diagnosed with tubo-ovarian carcinoma carry a germline pathogenic variant in a cancer-predisposing gene (e.g., BRCA1/BRCA2). Identifying these variants can help to inform eligibility for therapies, guide surveillance and prevention of new primary cancers, and assess risk to family members. The Gynecologic Oncology-Initiated Genetic Testing Model (GOIGT) was initiated at the McGill University Health Centre (MUHC) to streamline universal germline genetic testing for this population, while addressing the limited resources in the public healthcare system. This study aimed to evaluate the patient experience of participating in this model. Methods: Study participants were patients diagnosed with high-grade non-mucinous epithelial tubo-ovarian cancer who underwent genetic testing through the GOIGT model between 1 January 2017 and 31 December 2020. Eligible participants completed the retrospective questionnaires at least one month after result disclosure. Results: A total of 126 patients were tested through the GOIGT model during the study period, of which 56 were invited to participate. Thirty-four participants returned the study questionnaire. Overall, participants did not report decision regret following the genetic testing and were satisfied with the GOIGT model. Participants reported low levels of uncertainty and distress related to the implications of their test results for themselves and their family members. Conclusions: The results of this study support the continued implementation of mainstreamed genetic testing models for women with high-grade non-mucinous tubo-ovarian cancer. Further studies are required to compare experiences for patients with different genetic test results.
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Affiliation(s)
- Michaela Bercovitch Sadinsky
- Department of Human Genetics, McGill University, Montreal, QC H3A0C7, Canada; (L.P.); (W.D.F.); (E.W.)
- Division of Medical Genetics, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada
- Correspondence: ; Tel.: +1-438-401-8300
| | - Joanne Power
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC H4A3J1, Canada; (J.P.); (E.A.); (X.Z.)
| | - Enza Ambrosio
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC H4A3J1, Canada; (J.P.); (E.A.); (X.Z.)
| | - Laura Palma
- Department of Human Genetics, McGill University, Montreal, QC H3A0C7, Canada; (L.P.); (W.D.F.); (E.W.)
- Division of Medical Genetics, McGill University Health Centre, Montreal, QC H4A3J1, Canada
| | - Xing Zeng
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC H4A3J1, Canada; (J.P.); (E.A.); (X.Z.)
| | - William D. Foulkes
- Department of Human Genetics, McGill University, Montreal, QC H3A0C7, Canada; (L.P.); (W.D.F.); (E.W.)
- Division of Medical Genetics, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada
- Division of Medical Genetics, McGill University Health Centre, Montreal, QC H4A3J1, Canada
- Department of Specialized Medicine, Lady David Institute, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada
- Cancer Research Program, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC H4A3J1, Canada
| | - Evan Weber
- Department of Human Genetics, McGill University, Montreal, QC H3A0C7, Canada; (L.P.); (W.D.F.); (E.W.)
- Division of Medical Genetics, McGill University Health Centre, Montreal, QC H4A3J1, Canada
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8
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Virani S, Baiocchi G, Bowtell D, Cabasag CJ, Cho KR, Fortner RT, Fujiwara K, Kim JW, Köbel M, Kurtz JE, Levine DA, Menon U, Norquist BM, Pharoah PDP, Sood AK, Tworoger ST, Wentzensen N, Chanock SJ, Brennan P, Trabert B. Joint IARC/NCI International Cancer Seminar Series Report: expert consensus on future directions for ovarian carcinoma research. Carcinogenesis 2021; 42:785-793. [PMID: 34037709 PMCID: PMC8427725 DOI: 10.1093/carcin/bgab043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
Recently, ovarian cancer research has evolved considerably because of the emerging recognition that rather than a single disease, ovarian carcinomas comprise several different histotypes that vary by etiologic origin, risk factors, molecular profiles, therapeutic approaches and clinical outcome. Despite significant progress in our understanding of the etiologic heterogeneity of ovarian cancer, as well as important clinical advances, it remains the eighth most frequently diagnosed cancer in women worldwide and the most fatal gynecologic cancer. The International Agency for Research on Cancer and the United States National Cancer Institute jointly convened an expert panel on ovarian carcinoma to develop consensus research priorities based on evolving scientific discoveries. Expertise ranged from etiology, prevention, early detection, pathology, model systems, molecular characterization and treatment/clinical management. This report summarizes the current state of knowledge and highlights expert consensus on future directions to continue advancing etiologic, epidemiologic and prognostic research on ovarian carcinoma.
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Affiliation(s)
- Shama Virani
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Glauco Baiocchi
- Department of Gynecology Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - David Bowtell
- Women’s Cancer Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Citadel J Cabasag
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Kathleen R Cho
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Tokyo, Japan
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Emmanuel Kurtz
- Department of Medical and Surgical Oncology and Hematology, Strasbourg Cancer Institute (ICANS-Europe), Strasbourg, France
| | - Douglas A Levine
- Gynecologic Oncology, Laura and Isaac Pearlmutter Cancer Center, New York University Langone Medical Center, New York, NY, USA
| | - Usha Menon
- MRC CTU at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Barbara M Norquist
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Paul D P Pharoah
- Department of Oncology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Anil K Sood
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shelley T Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Paul Brennan
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
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9
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Dragojlovic N, Kopac N, Borle K, Tandun R, Salmasi S, Ellis U, Birch P, Adam S, Friedman JM, Elliott AM, Lynd LD. Utilization and uptake of clinical genetics services in high-income countries: A scoping review. Health Policy 2021; 125:877-887. [PMID: 33962789 DOI: 10.1016/j.healthpol.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 02/11/2021] [Accepted: 04/14/2021] [Indexed: 12/23/2022]
Abstract
Ongoing rapid growth in the need for genetic services has the potential to severely strain the capacity of the clinical genetics workforce to deliver this care. Unfortunately, assessments of the scale of this health policy challenge and potential solutions are hampered by the lack of a consolidated evidence base on the growth in genetic service utilization. To enable health policy research and strategic planning by health systems in this area, we conducted a scoping review of the literature on the utilization and uptake of clinical genetics services in high-income countries published between 2010 and 2018. One-hundred-and-ninety-five unique studies were included in the review. Most focused on cancer (85/195; 44%) and prenatal care (50/195; 26%), which are consistently the two areas with the greatest volume of genetic service utilization in both the United States and other high-income countries. Utilization and uptake rates varied considerably and were influenced by contextual factors including health system characteristics, provider knowledge, and patient preferences. Moreover, growth in genetic service utilization appears to be driven to a significant degree by technological advances and the integration of new tests into clinical care. Our review highlights both the policy challenge posed by the rapid growth in the utilization of genetic services and the variability in this trend across clinical indications and health systems.
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Affiliation(s)
- Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Nicola Kopac
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Kennedy Borle
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Rachel Tandun
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Shahrzad Salmasi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ursula Ellis
- Woodward Library, University of British Columbia, 2198 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Patricia Birch
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Shelin Adam
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Jan M Friedman
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | | | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; BC Women's Hospital Research Institute, H214 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, 588-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6.
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10
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Canadian cost-effectiveness model of BRCA-driven surgical prevention of breast/ovarian cancers compared to treatment if cancer develops. Int J Technol Assess Health Care 2021; 36:104-112. [PMID: 32423520 DOI: 10.1017/s0266462319003519] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the cost effectiveness from a Canadian perspective of index patient germline BRCA testing and then, if positive, family members with subsequent risk-reducing surgery (RRS) in as yet unaffected mutation carriers compared with no testing and treatment of cancer when it develops. METHODS A patient level simulation was developed comparing outcomes between two groups using Canadian data. Group 1: no mutation testing with treatment if cancer developed. Group 2: cascade testing (index patient BRCA tested and first-/second-degree relatives tested if index patient/first-degree relative is positive) with RRS in carriers. End points were the incremental cost-effectiveness ratio (ICER) and budget impact. RESULTS There were 29,102 index patients: 2,786 ovarian cancer and 26,316 breast cancer (BC). Using the base-case assumption of 44 percent and 21 percent of women with a BRCA mutation receiving risk-reducing bilateral salpingo-oophorectomy and risk-reducing mastectomy, respectively, testing was cost effective versus no testing and treatment on cancer development, with an ICER of CAD 14,942 (USD 10,555) per quality-adjusted life-year (QALY), 127 and 104 fewer cases of ovarian and BC, respectively, and twenty-one fewer all-cause deaths. Testing remained cost effective versus no testing at the commonly accepted North American threshold of approximately CAD 100,000 (or USD 100,000) per QALY gained in all scenario analyses, and cost effectiveness improved as RRS uptake rates increased. CONCLUSIONS Prevention via testing and RRS is cost effective at current RRS uptake rates; however, optimization of uptake rates and RRS will increase cost effectiveness and can provide cost savings.
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11
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Care M, McCuaig J, Clarke B, Grenier S, Kim RH, Rouzbahman M, Stickle N, Bernardini M, Stockley TL. Tumor and germline next generation sequencing in high grade serous cancer: experience from a large population-based testing program. Mol Oncol 2020; 15:80-90. [PMID: 33030818 PMCID: PMC7782089 DOI: 10.1002/1878-0261.12817] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/18/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to determine the prevalence of somatic and germline pathogenic variants (PVs) in high‐grade serous cancer (HGSC) and to demonstrate the technical feasibility and effectiveness of a large‐scale, population‐based tumor testing program. It involved a retrospective review of genetic test results in 600 consecutive HGSC tumor samples and a subsequent comparison of germline and tumor results in a subset of 200 individuals. Tumor testing was successful in 95% of samples (570/600) with at least one BRCA1/2 PV identified in 16% (93/570) of cases. Among the 200 paired cases, BRCA1/2 PVs were detected in 38 tumors (19%); 58% were somatic (22/38); and 42% were germline (16/38). There was 100% concordance between germline and tumor test results. This is the largest series of BRCA1/2 testing in HGSC (tumor‐only and paired cohorts), reported to date, and our data show that an effectively designed and validated population‐based tumor testing program can be used to determine both treatment eligibility and hereditary cancer risk.
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Affiliation(s)
- Melanie Care
- Laboratory Medicine Program, Division of Clinical Laboratory Genetics, University Health Network, Toronto, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Jeanna McCuaig
- Department of Molecular Genetics, University of Toronto, Toronto, Canada.,Familial Cancer Clinic, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Blaise Clarke
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Sylvie Grenier
- Laboratory Medicine Program, Division of Clinical Laboratory Genetics, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Raymond H Kim
- Familial Cancer Clinic, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Marjan Rouzbahman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Natalie Stickle
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Marcus Bernardini
- Department of Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - Tracy L Stockley
- Laboratory Medicine Program, Division of Clinical Laboratory Genetics, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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12
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Piedimonte S, Power J, Foulkes WD, Weber E, Palma L, Schiavi A, Ambrosio E, Konci R, Gilbert L, Jardon K, Baret L, Zeng X. BRCA testing in women with high-grade serous ovarian cancer: gynecologic oncologist-initiated testing compared with genetics referral. Int J Gynecol Cancer 2020; 30:1757-1761. [PMID: 32759180 DOI: 10.1136/ijgc-2020-001261] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Up to 15% of patients with high-grade serous ovarian, tubal, or peritoneal carcinoma harbor a mutation in BRCA genes. Early notion of mutation status may facilitate counseling, predict prognosis, and increase access to Parp-inhibitors. The aim of this study was to examine the rate of germline genetic testing in a retrospective cohort of women with high-grade serous ovarian, tubal, or peritoneal carcinoma to determine if a new pilot project of gynecologic oncologist-initiated genetic testing improved the rate of testing, after 1 year of implementation. METHODS Gynecologic oncology-initiated genetic testing was implemented at a single university hospital center with input and collaboration from gynecological oncologists, nurses, and genetic counselors. All patients diagnosed with high-grade serous ovarian, tubal, or peritoneal carcinoma after August 2017 were offered gynecologic oncologist- initiated genetic testing for a panel of 13 hereditary breast and ovarian cancer susceptibility genes. Data from this group was then compared with a historic cohort of patients who received traditional genetic counseling between January 2014 and August 2017 (control group). Patients that had genetic testing through a clinical trial were excluded. The primary outcome was the uptake of genetic testing in both groups. Secondary outcomes included difference in time from diagnosis to genetic result between both cohorts. Data was analyzed using SPSS 25.0 and medians (ranges) were reported. RESULTS A total of 152 women with high-grade serous ovarian, tubal, or peritoneal carcinoma were included in this study. Between January 2014 to July 2017 there were 108 patients with high-grade serous ovarian, tubal, or peritoneal carcinoma, among which 50.9% (n=54) underwent genetic testing following referral to genetics. The prevalence of BRCA pathogenic variants was 25.9% (14/54): 9.2% (5/54) in BRCA1 and 16.7% (9/54) in BRCA2. The median time from diagnosis to genetics referral was 53 days (range; 3-751), and median time from diagnosis to test result disclosure was 186 days (range; 15-938). After 1 year of implementation of the gynecologic oncologist-initiated genetic testing model, among 44 women diagnosed with high-grade serous ovarian, tubal, or peritoneal carcinoma, 86.2% underwent genetic testing. The median time from diagnosis to result disclosure decreased to 58 days, representing a reduction of 128 days, or 4.27 months (P<0.001). Reasons for non-testing included refusal, death, and follow-up at another hospital. The prevalence of germline BRCA1/2 pathogenic variants was 21% (8/38). CONCLUSION Gynecologic oncologist-initiated genetic testing at the time of high-grade serous ovarian, tubal, or peritoneal carcinoma diagnosis leads to increased uptake and decreased delays in testing compared with referral for traditional genetic counseling.
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Affiliation(s)
- Sabrina Piedimonte
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joanne Power
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - William D Foulkes
- Department of Oncology and Human Genetics, Program in Cancer Genetics, McGill University, Montreal, Quebec, Canada
| | - Evan Weber
- Division of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Laura Palma
- Division of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alicia Schiavi
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Enza Ambrosio
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rea Konci
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Lucy Gilbert
- Gynecologic Cancer Services, Cancer Care Mission, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kris Jardon
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Laurence Baret
- Division of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Xing Zeng
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, Quebec, Canada
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13
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Armel SR, Volenik A, Demsky R, Malcolmson J, Maganti M, McCuaig J. Setting a baseline: A 7-year review of referral rates and outcomes for serous ovarian cancer prior to implementation of oncologist mediated genetic testing. Gynecol Oncol 2020; 158:440-445. [PMID: 32505554 DOI: 10.1016/j.ygyno.2020.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Despite guidelines recommending that all women with invasive serous ovarian cancer (SOC) are offered genetic testing, published referral and testing rates have been poor. Many centers have implemented novel genetic counseling service delivery models to increase testing rates. In light of increased awareness and implementation of small process changes at our center, this study aims to establish baseline referral rates and testing outcomes prior to diverging from the traditional model of care. METHODS A list of women diagnosed with SOC at Princess Margaret Cancer Center (PM) between 2010 and 2016 was obtained from the PM Cancer Registry and cross-referenced against the genetics database to determine referral rates and outcomes of genetic testing. RESULTS Of 724 women with SOC, 68% were referred for genetic counseling, with an overall testing rate of 61%. Higher referral rates were seen among women with younger ages at diagnosis and high-grade tumors. Of women tested, 22% were found to have a pathogenic variant in BRCA1/2 and 9% in another cancer gene. Notably, 24% of women with a pathogenic variant reported no family history of breast or ovarian cancer. CONCLUSION Genetic counseling referral and testing rates for women with SOC are higher than previously reported, yet barriers to referral remain. To maximize genetic testing rates and address increasing patient volumes, clinics may be faced with integrating novel genetic counseling delivery models. Findings from this study may serve as a more accurate baseline to which large scale service delivery changes can be compared.
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Affiliation(s)
- Susan Randall Armel
- Familial Cancer Clinic, Princess Margaret Cancer Centre - University Health Network, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada.
| | - Alexandra Volenik
- Familial Cancer Clinic, Princess Margaret Cancer Centre - University Health Network, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Rochelle Demsky
- Familial Cancer Clinic, Princess Margaret Cancer Centre - University Health Network, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Janet Malcolmson
- Familial Cancer Clinic, Princess Margaret Cancer Centre - University Health Network, Toronto, Canada
| | - Manjula Maganti
- Department of Biostatistics, Princess Margaret Cancer Centre - University Health Network, Toronto, Canada
| | - Jeanna McCuaig
- Familial Cancer Clinic, Princess Margaret Cancer Centre - University Health Network, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada
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Rahm AK, Bellcross C, Cragun D, Duquette D, Hampel H, Heald B. Implementing universal cancer screening programs can help sustain genomic medicine programs. Per Med 2019; 17:9-13. [PMID: 31797715 DOI: 10.2217/pme-2019-0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Alanna Kulchak Rahm
- Genomic Medicine Institute, Geisinger, 100 N Academy Ave, Danville, PA 17822, USA
| | - Cecelia Bellcross
- Emory University School of Medicine, Department of Human Genetics, 1462 Clifton Road, Suite 310, Atlanta, GA 30322, USA
| | - Deborah Cragun
- USF Genetic Counseling Program, College of Public Health, University of South Florida, Interdisciplinary Research Building, 3720 Spectrum Blvd, Suite 304, Tampa, FL 33612, USA
| | - Debra Duquette
- Graduate Program in Genetic Counseling, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, Suite 630, Chicago, IL 60611, USA
| | - Heather Hampel
- Division of Human Genetics, Department of Internal Medicine & Comprehensive Cancer Center, The Ohio State University, 2012 Kenny Road, Room 257, Columbus, OH 43221, USA
| | - Brandie Heald
- Sanford R Weiss, MD, Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
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15
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Challenges in Managing Patients with Hereditary Cancer at Gynecological Services. Obstet Gynecol Int 2019; 2019:4365754. [PMID: 31263500 PMCID: PMC6556775 DOI: 10.1155/2019/4365754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/08/2019] [Indexed: 11/17/2022] Open
Abstract
Aim To reveal current problems and challenges faced by our gynecologic services department in managing patients with hereditary cancers. Methods We collected clinical data of patients with hereditary cancers, identified via genetic testing (or clinically diagnosed in cases of Cowden syndrome or Peutz–Jeghers syndrome), and treated in our gynecological department from 2012 to 2018. Results Fifteen patients had hereditary breast and ovarian cancer (HBOC), 6 had Lynch syndrome, 2 had Cowden syndrome, and 2 had Peutz–Jeghers syndrome. Five patients diagnosed with HBOC were younger than 40 years at diagnosis. Risk-reducing salpingo-oophorectomy (RRSO) was performed on 1 patient with a BRCA1 mutation at age 38 years. Seven patients overall underwent RRSO, and none had malignancies on pathological examinations. Peritoneal washing cytology (PWC) was suspicious for malignancy in one patient; however, subsequent PWC at 6 months after RRSO was negative. A patient with endometrial cancer and Lynch syndrome and a patient with atypical endometrial hyperplasia (AEH) and Cowden syndrome strongly desired fertility preservation. They achieved remission after medroxyprogesterone acetate treatment and multiple dilations and curettages, respectively. One patient with Lynch syndrome developed AEH after 11 years of surveillance. Laparotomy revealed adjacent low-grade and high-grade serous ovarian cancer with positive ascites cytology. She had no recurrence during 7-year follow-up after laparotomy. Conclusion Managing patients with hereditary cancer, positive or false-positive ascites cytology discovered during RRSO, and desired preservation of fertility is highly challenging.
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McGee J, Peart TM, Foley N, Bertrand M, Prefontaine M, Sugimoto A, Ettler H, Welch S, Panabaker K. Direct Genetics Referral Pathway for High-Grade Serous Ovarian Cancer Patients: The "Opt-Out" Process. JOURNAL OF ONCOLOGY 2019; 2019:6029097. [PMID: 31061661 PMCID: PMC6466895 DOI: 10.1155/2019/6029097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/18/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE In order to meet a clinical need for better pathways to access genetic testing for ovarian cancer patients, we implemented and reviewed an opt-out referral process for genetic consultation whereby a referral is automatically sent to genetics following a pathological diagnosis of HGSC. METHODS Following implementation of the opt-out referral process, each month a list of new cases of HGSC was generated from the synoptic pathology report and forwarded directly to the Cancer Genetics clinic. Using an advanced directive, patients were automatically referred for genetic counselling two months after surgery. If the patient declined genetic counselling (opted-out) after discussion with their surgeon within the two months after surgery, the Genetic Counsellor was informed and the patient was removed from the referral process. RESULTS Between January 1, 2015, and December 31, 2017, 168 women were diagnosed with HGSC, of whom 167 received a referral for genetic consultation. In only one case the referral was cancelled by the surgeon, resulting in a referral rate of 99.4%. By the end of the study period, 133 women attended a genetics consultation appointment and 125 (94%) agreed to proceed with genetic testing. Among those who completed genetic testing, 15% tested positive for a BRCA1 or BRCA2 gene mutation. Of the women who tested positive for a BRCA1/2 mutation, 56% had no family history of breast or ovarian cancer. CONCLUSIONS The opt-out referral process described in this study is s a feasible, effective, and patient-centred approach to increase access to BRCA1/2 testing for patients with ovarian cancer.
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Affiliation(s)
- Jacob McGee
- Department of Obstetrics & Gynecology, London Health Sciences Centre, London, Canada
| | - Teresa M. Peart
- Department of Obstetrics & Gynecology, London Health Sciences Centre, London, Canada
| | - Norine Foley
- Department of Aging, Rehabilitation & Geriatric Care Program, Division of Stroke Rehabilitation and Assistive Technologies, Lawson Health Research Institute, London, Canada
| | - Monique Bertrand
- Department of Obstetrics & Gynecology, London Health Sciences Centre, London, Canada
| | - Michel Prefontaine
- Department of Obstetrics & Gynecology, London Health Sciences Centre, London, Canada
| | - Akira Sugimoto
- Department of Obstetrics & Gynecology, London Health Sciences Centre, London, Canada
| | - Helen Ettler
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Canada
| | - Stephen Welch
- Department of Medical Oncology, London Health Sciences Centre, London, Canada
| | - Karen Panabaker
- Department of Medical Genetics, London Health Sciences Centre, London, Canada
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Next-Generation Service Delivery: A Scoping Review of Patient Outcomes Associated with Alternative Models of Genetic Counseling and Genetic Testing for Hereditary Cancer. Cancers (Basel) 2018; 10:cancers10110435. [PMID: 30428547 PMCID: PMC6266465 DOI: 10.3390/cancers10110435] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 01/19/2023] Open
Abstract
The combination of increased referral for genetic testing and the current shortage of genetic counselors has necessitated the development and implementation of alternative models of genetic counseling and testing for hereditary cancer assessment. The purpose of this scoping review is to provide an overview of the patient outcomes that are associated with alternative models of genetic testing and genetic counseling for hereditary cancer, including germline-only and tumor testing models. Seven databases were searched, selecting studies that were: (1) full-text articles published ≥2007 or conference abstracts published ≥2015, and (2) assessing patient outcomes of an alternative model of genetic counseling or testing. A total of 79 publications were included for review and synthesis. Data-charting was completed using a data-charting form that was developed by the study team for this review. Seven alternative models were identified, including four models that involved a genetic counselor: telephone, telegenic, group, and embedded genetic counseling models; and three models that did not: mainstreaming, direct, and tumor-first genetic testing models. Overall, these models may be an acceptable alternative to traditional models on knowledge, patient satisfaction, psychosocial measures, and the uptake of genetic testing; however, particular populations may be better served by traditional in-person genetic counseling. As precision medicine initiatives continue to advance, institutions should consider the implementation of new models of genetic service delivery, utilizing a model that will best serve the needs of their unique patient populations.
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Chen Y, Wang G, Wang Y, Gao X, Wang K, Li J, Xue F. Capn4 regulates migration and invasion of ovarian carcinoma cells via targeting osteopontin-mediated PI3K/AKT signaling pathway. Oncol Lett 2018; 17:564-570. [PMID: 30655802 DOI: 10.3892/ol.2018.9524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 08/15/2018] [Indexed: 01/06/2023] Open
Abstract
Previous studies have demonstrated that calpain small subunit 4 (Capn4) is able to regulate the viability and metastasis of cancer cells. However, the regulatory effects and underlying molecular mechanism of Capn4 in ovarian carcinoma cells are not well understood. The purpose of the present study was to investigate the role of Capn4 in ovarian carcinoma cells and analyze the possible mechanism mediated by Capn4. The expression levels of Capn4 and osteopontin (OPN) were determined and the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway was analyzed in ovarian carcinoma cells. The results of the present study revealed that Capn4 and OPN were overexpressed in clinical ovarian carcinoma tissues and ovarian carcinoma cells. Capn4 silencing downregulated OPN expression, and suppressed ovarian carcinoma cell viability and migration. Capn4 silencing enhanced apoptosis of ovarian carcinoma cells by increasing activity of the capase-3 apoptosis signaling pathway. Capn4 promoted the metastasis of ovarian carcinoma cells by interacting with the PI3K/AKT signaling pathway via upregulation of OPN expression. In conclusion, the results of the present study indicate that Capn4 may be a potential therapeutic target for the treatment of ovarian carcinoma.
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Affiliation(s)
- Yuanyuan Chen
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Gang Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Yingmei Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Xiaoli Gao
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Kan Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Jie Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
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Inadequate Rates of BRCA Testing with its Negative Consequences for Women with Epithelial Ovarian Cancer and their Families: an Overview of the Literature. Clin Oncol (R Coll Radiol) 2018; 30:472-483. [DOI: 10.1016/j.clon.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/18/2018] [Indexed: 12/19/2022]
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20
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McCuaig JM, Stockley TL, Shaw P, Fung-Kee-Fung M, Altman AD, Bentley J, Bernardini MQ, Cormier B, Hirte H, Kieser K, MacMillan A, Meschino WS, Panabaker K, Perrier R, Provencher D, Schrader KA, Serfas K, Tomiak E, Wong N, Young SS, Gotlieb WH, Hoskins P, Kim RH. Evolution of genetic assessment for BRCA-associated gynaecologic malignancies: a Canadian multisociety roadmap. J Med Genet 2018; 55:571-577. [PMID: 30042185 PMCID: PMC6119348 DOI: 10.1136/jmedgenet-2018-105472] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/18/2018] [Accepted: 07/02/2018] [Indexed: 01/21/2023]
Abstract
The landscape of genetic testing in ovarian cancer patients has changed dramatically in recent years. The therapeutic benefits of poly ADP-ribose polymerase (PARP) inhibitors in treatment of BRCA1/2-related ovarian cancers has resulted in an increased demand and urgency for genetic testing results, while technological developments have led to widespread use of multi-gene cancer panels and development of tumour testing protocols. Traditional genetic counselling models are no longer sustainable and must evolve to match the rapid evolution of genetic testing technologies and developments in personalized medicine. Recently, representatives from oncology, clinical genetics, molecular genetics, pathology, and patient advocacy came together to create a national multi-disciplinary Canadian consortium. By aligning stakeholder interests, the BRCA Testing to Treatment (BRCA TtoT) Community of Practice aims to develop a national strategy for tumour and germline BRCA1/2 testing and genetic counselling in women with ovarian cancer. This article serves to provide an overview of the recent evolution of genetic assessment for BRCA1/2-associated gynecologic malignancies and outline a Canadian roadmap to facilitate change, improve genetic testing rates, and ultimately improve outcomes for hereditary ovarian cancer patients and their families.
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Affiliation(s)
- Jeanna M McCuaig
- Familial Breast & Ovarian Cancer Clinic, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Tracy L Stockley
- Division of Clinical Laboratory Genetics and Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Shaw
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Michael Fung-Kee-Fung
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alon D Altman
- Department of Gynecologic Oncology, University of Manitoba, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - James Bentley
- Department of Obstetrics and Gynecology, Nova Scotia Health Authority, Halifix, Nova Scotia, Canada
| | - Marcus Q Bernardini
- Department of Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Beatrice Cormier
- Department of Obstetrics and Gynecology, Université de Montreal, Montreal, Quebec, Canada
| | - Hal Hirte
- Department of Gynecologic Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Katharina Kieser
- Department of Gynecologic Oncology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Andree MacMillan
- Provincial Medical Genetics Program, Eastern Health, St John's, Newfoundland and Labrador, Canada
| | - Wendy S Meschino
- Department of Genetics, North York General Hospital, Toronto, Ontario, Canada
| | - Karen Panabaker
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Renee Perrier
- Department of Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Diane Provencher
- Department of Obstetrics and Gynecology, Université de Montreal, Montreal, Quebec, Canada
| | - Kasmintan A Schrader
- Hereditary Cancer Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Kimberly Serfas
- Department of Genetics and Metabolism, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Eva Tomiak
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nora Wong
- Department of Medical Genetics, CIUSSS West-Central Montreal Jewish General Hospital, Montreal, Canada
| | - Sean S Young
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Walter Henri Gotlieb
- Department of Gynecologic Oncology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Paul Hoskins
- Department of Gynecologic Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Raymond H Kim
- Familial Breast & Ovarian Cancer Clinic, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Hoskins PJ, Gotlieb WH. Missed therapeutic and prevention opportunities in women with BRCA-mutated epithelial ovarian cancer and their families due to low referral rates for genetic counseling and BRCA testing: A review of the literature. CA Cancer J Clin 2017; 67:493-506. [PMID: 28881380 DOI: 10.3322/caac.21408] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 12/24/2022] Open
Abstract
Answer questions and earn CME/CNE Fifteen percent of women with epithelial ovarian cancer have inherited mutations in the BRCA breast cancer susceptibility genes. Knowledge of her BRCA status has value both for the woman and for her family. A therapeutic benefit exists for the woman with cancer, because a new family of oral drugs, the poly ADP-ribose polymerase (PARP) inhibitors, has recently been approved, and these drugs have the greatest efficacy in women who carry the mutation. For her family, there is the potential to prevent ovarian cancer in those carrying the mutation by using risk-reducing surgery. Such surgery significantly reduces the chance of developing this, for the most part, incurable cancer. Despite these potential benefits, referral rates for genetic counseling and subsequent BRCA testing are low, ranging from 10% to 30%, indicating that these therapeutic and prevention opportunities are being missed. The authors have reviewed the relevant available literature. Topics discussed are BRCA and its relation to ovarian cancer, the rates of referral for genetic counseling/BRCA testing, reasons for these low rates, potential strategies to improve on those rates, lack of effectiveness of current screening strategies, the pros and cons of risk-reducing surgery, other prevention options, and the role and value of PARP inhibitors. CA Cancer J Clin 2017;67:493-506. © 2017 American Cancer Society.
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Affiliation(s)
- Paul J Hoskins
- Medical Oncologist and Past President, Society of Gynecologic Oncology Canada, British Columbia Cancer Agency, Vancouver Center, BC, Canada
| | - Walter H Gotlieb
- Gynecologic Oncologist and President, Society of Gynecologic Oncology Canada, McGill University, Jewish General Hospital, Montreal, QC, Canada
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Yurgelun MB. Germline Testing for Individuals With Pancreatic Cancer: The Benefits and Challenges to Casting a Wider Net. J Clin Oncol 2017; 35:3375-3377. [DOI: 10.1200/jco.2017.74.7535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Matthew B. Yurgelun
- Matthew B. Yurgelun, Dana-Farber Cancer Institute; Brigham & Women’s Hospital; and Harvard Medical School, Boston, MA
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