1
|
Chodick G, Silverman BG, Keinan-Boker L. The Use of National Cancer Registry Data for Breast Cancer Family History Assessment in Premenopausal Women. J Clin Med 2024; 13:4473. [PMID: 39124739 PMCID: PMC11313154 DOI: 10.3390/jcm13154473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Population-based cancer registries are the best source of information to measure cancer burden. However, little is done to use this information for individual cancer risk assessment. In this study, we aimed at identifying women at high risk of breast and ovarian cancer using data on family history of cancer from the Israel national cancer registry. Methods: We used the family history assessment tool (FHAT) to score all females, 26 to 45 years of age, in a 2.6-million-member health provider in Israel (Maccabi Healthcare Services). Data on breast, ovarian, prostate, and pancreatic cancer history among the participants and their parents (identified using the national census) were retrieved from the national cancer registry. These data were used to calculate individual FHAT scores. Results: A total of 377,931 eligible women were included in the analysis. A relevant family history of cancer was detected in 20,386 (5.4%), with FHAT scores ranging from 1 to 16. FHAT score was higher in older women and among those with a history of breast cancer. Among women aged 35-39, an FHAT score of 10 or above was associated with an OR of 15.23 (95%CI: 7.41-28.19) for breast cancer compared to women with an FHAT of 0. Conclusions: Using individual-level data from national cancer registries may assist in detecting women with a relevant family history of cancer.
Collapse
Affiliation(s)
- Gabriel Chodick
- School of Public Health, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel;
- Israel National Cancer Registry, Israel Center for Disease Control, Ministry of Health, Tel-Hashomer, Ramat Gan 5262000, Israel;
| | - Barbara G. Silverman
- School of Public Health, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel;
- Israel National Cancer Registry, Israel Center for Disease Control, Ministry of Health, Tel-Hashomer, Ramat Gan 5262000, Israel;
| | - Lital Keinan-Boker
- Israel National Cancer Registry, Israel Center for Disease Control, Ministry of Health, Tel-Hashomer, Ramat Gan 5262000, Israel;
- School of Public Health, University of Haifa, Haifa 3498838, Israel
| |
Collapse
|
2
|
Williams A, Blake AK, Williamson Dean L, Lepard Tassin T. Does the amount of family history matter? Perspectives of adult adoptees. J Genet Couns 2024; 33:643-652. [PMID: 37632167 DOI: 10.1002/jgc4.1770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Family history is considered the gold standard for risk assessment of inherited conditions and is often used to inform preventative care. There are currently no provider guidelines that address caring for patients with a lack of family history, and adoptees report inconsistent care because of this. Through this qualitative study, we explored (1) how the amount of family history impacts adoptees' perceptions of healthcare and (2) adoptees' suggestions for improvement of their healthcare. Fourteen adult adoptees participated in semi-structured interviews via telephone or Zoom audio. Transcripts were analyzed using thematic analysis and interpretive phenomenology. Results revealed five themes: adoptees should have access to their family health history; several factors influence the importance of family history (reproduction, identity formation, age, and health concerns); many adoptees use direct-to-consumer testing to gain information about health risks or to find family members; completing history forms or being asked about family health history invokes negative emotions in adoptees; experiences with healthcare providers are variable for adoptees. These results show that unknown family health history can contribute to a negative perception of healthcare. Adoptees perceive family health history as important to know, and not having this information brings up complex emotions in the healthcare setting. To help mitigate the disparities and the negative emotions that adoptees feel, genetic counselors should consider acknowledging the complex emotions, reassuring adoptees with available preventative care, and revising preclinical paperwork, such as family health history questionnaires, to be more inclusive of those who lack this information. These changes have the potential to significantly improve healthcare experiences for adoptees. Healthcare providers, especially genetic counselors, need to continue to learn about and advocate for this population.
Collapse
Affiliation(s)
- Alyssa Williams
- Genetic Counseling Department, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Avera Cancer Institute, Sioux Falls, South Dakota, USA
| | - Alise K Blake
- Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Lori Williamson Dean
- Genetic Counseling Department, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Tiffany Lepard Tassin
- Genetic Counseling Department, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
3
|
Grassi J, Pessanha RM, Grippa WR, Dell’Antonio LS, Dell’Antonio CSDS, Faure L, Clavel J, Lopes-Júnior LC. Temporal Trends in the Completeness of Epidemiological Variables in a Hospital-Based Cancer Registry of a Pediatric Oncology Center in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:200. [PMID: 38397690 PMCID: PMC10888061 DOI: 10.3390/ijerph21020200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/27/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
This ecological time series study aimed to examine the temporal trends in the completeness of epidemiological variables from a hospital-based cancer registry (HbCR) of a reference center for pediatric oncology in Brazil from 2010 to 2016. Completeness categories were based on the percentage of missing data, with the categories excellent (<5%), good (5-10%), regular (11-20%), poor (21-50%), and very poor (>50%). Descriptive and bivariate analyses were performed using R.4.1.0; a Mann-Kendall trend test was performed to examine the temporal trends. Variables with the highest incompleteness included race/color (17.24% in 2016), level of education (51.40% in 2015), TNM (56.88% in 2012), disease status at the end of the first treatment (12.09% in 2013), cancer family history (79.12% in 2013), history of alcoholic consumption (39.25% in 2015), history of tobacco consumption (38.32% in 2015), and type of admission clinic (10.28% in 2015). Nevertheless, most variables achieved 100% completeness and were classified as excellent across the time series. A significant trend was observed for race/color, TNM, and history of tobacco consumption. While most variables maintained excellent completeness, the increasing incompleteness trend in race/color and decreasing trend in TNM underscore the importance of reliable and complete HbCRs for personalized cancer care, for planning public policies, and for conducting research on cancer control.
Collapse
Affiliation(s)
- Jonathan Grassi
- Graduate Program in Public Health, Universidade Federal do Espírito Santo (Ufes), Vitoria 29047-105, ES, Brazil; (J.G.); (R.M.P.); (W.R.G.)
| | - Raphael Manhães Pessanha
- Graduate Program in Public Health, Universidade Federal do Espírito Santo (Ufes), Vitoria 29047-105, ES, Brazil; (J.G.); (R.M.P.); (W.R.G.)
| | - Wesley Rocha Grippa
- Graduate Program in Public Health, Universidade Federal do Espírito Santo (Ufes), Vitoria 29047-105, ES, Brazil; (J.G.); (R.M.P.); (W.R.G.)
| | - Larissa Soares Dell’Antonio
- Espírito Santo State Health Department, Special Center for Epidemiological Surveillance, Vitoria 29047-105, ES, Brazil; (L.S.D.); (C.S.d.S.D.)
| | | | - Laure Faure
- Centre de Recherche en Epidémiologie et Statistiques (CRESS), Institut National de la Santé et de la Recherche Médicale—INSERM, Université Paris-Cité, 75013 Paris, France; (L.F.); (J.C.)
| | - Jacqueline Clavel
- Centre de Recherche en Epidémiologie et Statistiques (CRESS), Institut National de la Santé et de la Recherche Médicale—INSERM, Université Paris-Cité, 75013 Paris, France; (L.F.); (J.C.)
| | - Luís Carlos Lopes-Júnior
- Graduate Program in Public Health, Universidade Federal do Espírito Santo (Ufes), Vitoria 29047-105, ES, Brazil; (J.G.); (R.M.P.); (W.R.G.)
| |
Collapse
|
4
|
dos Santos JTT, Rosa RCA, Pereira ALE, Assunção-Luiz AV, Bacalá BT, Ferraz VEDF, Flória M. Risk for Hereditary Neoplastic Syndromes in Women with Mismatch Repair-Proficient Endometrial Cancer. Genes (Basel) 2023; 14:1999. [PMID: 38002942 PMCID: PMC10671603 DOI: 10.3390/genes14111999] [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: 10/02/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023] Open
Abstract
Endometrial cancer (EC) is a prevalent malignancy in women, and those who are proficient in the DNA mismatch repair (pMMR) pathway may have a family history (FH) that meets the criteria for a hereditary neoplastic condition (HNS). This study aimed to estimate the risk of HNS in women with pMMR endometrial tumors by analyzing their FH. To achieve this, we collaborated with a primary study and collected FH information by telephone. The final sample comprised 42 women who responded to the Primary Screening Questionnaire. Their family pedigrees were drawn and categorized according to internationally standardized criteria for the risk of HNS. Results showed that 26 women (61%) were found to be at risk for HNS, with Bethesda criteria being met by 23%, Amsterdam criteria by 15%, and 4% met the attenuated familial adenomatous polyposis criteria. Our results emphasize the importance of FH and the need to encourage healthcare professionals to collect and document FH more frequently, even if it is self-reported. By identifying individuals with HNS, we can improve their outcomes and reduce the burden of cancer in families with a predisposition to cancer.
Collapse
Affiliation(s)
| | - Reginaldo Cruz Alves Rosa
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-901, SP, Brazil; (R.C.A.R.); (A.L.E.P.); (V.E.d.F.F.)
| | - Alison Luis Eburneo Pereira
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-901, SP, Brazil; (R.C.A.R.); (A.L.E.P.); (V.E.d.F.F.)
| | - Alan Vinicius Assunção-Luiz
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-901, SP, Brazil; (J.T.T.d.S.); (A.V.A.-L.); (B.T.B.)
| | - Bruna Tavares Bacalá
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-901, SP, Brazil; (J.T.T.d.S.); (A.V.A.-L.); (B.T.B.)
| | - Victor Evangelista de Faria Ferraz
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-901, SP, Brazil; (R.C.A.R.); (A.L.E.P.); (V.E.d.F.F.)
| | - Milena Flória
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-901, SP, Brazil; (J.T.T.d.S.); (A.V.A.-L.); (B.T.B.)
| |
Collapse
|
5
|
Matalon DR, Zepeda-Mendoza CJ, Aarabi M, Brown K, Fullerton SM, Kaur S, Quintero-Rivera F, Vatta M. Clinical, technical, and environmental biases influencing equitable access to clinical genetics/genomics testing: A points to consider statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2023; 25:100812. [PMID: 37058144 DOI: 10.1016/j.gim.2023.100812] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 04/15/2023] Open
Affiliation(s)
- Dena R Matalon
- Division of Medical Genetics, Department of Pediatrics, Stanford Medicine, Stanford University, Stanford, CA
| | - Cinthya J Zepeda-Mendoza
- Divisions of Hematopathology and Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Mahmoud Aarabi
- UPMC Medical Genetics and Genomics Laboratories, UPMC Magee-Womens Hospital, Pittsburgh, PA; Departments of Pathology and Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Stephanie M Fullerton
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Department of Bioethics & Humanities, University of Washington School of Medicine, Seattle, WA
| | - Shagun Kaur
- Department of Child Health, Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Fabiola Quintero-Rivera
- Division of Genetic and Genomic Medicine, Departments of Pathology, Laboratory Medicine, and Pediatrics, University of California Irvine, Irvine, CA
| | | |
Collapse
|
6
|
Clark NM, Roberts EA, Fedorenko C, Sun Q, Dubard-Gault M, Handford C, Yung R, Cheng HH, Sham JG, Norquist BM, Flanagan MR. Genetic Testing Among Patients with High-Risk Breast, Ovarian, Pancreatic, and Prostate Cancers. Ann Surg Oncol 2023; 30:1312-1326. [PMID: 36335273 DOI: 10.1245/s10434-022-12755-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The National Comprehensive Cancer Network recommends genetic testing in patients with potentially hereditary breast, ovarian, pancreatic, and prostate cancers (HBOPP). Knowledge of genetic mutations impacts decisions about screening and treatment. METHODS A retrospective cohort study of 28,586 HBOPP patients diagnosed from 2013 to 2019 was conducted using a linked administrative-cancer database in the Seattle-Puget Sound SEER area. Guideline-concordant testing (GCT) was assessed annually according to guideline updates. Frequency of testing according to patient/cancer characteristics was evaluated using chi-squared tests, and factors associated with receipt of genetic testing were identified using multivariable logistic regression. RESULTS Testing occurred in 17% of HBOPP patients, increasing from 9% in 2013 to 21% in 2019 (p < 0.001). Ovarian cancer had the highest testing (40%) and prostate cancer the lowest (4%). Age < 50, female sex, non-Hispanic White race, commercial insurance, urban location, family history of HBOPP, and triple negative breast cancer (TNBC) were associated with increased testing (all p < 0.05). GCT increased from 38% in 2013 to 44% in 2019, and was highest for early age at breast cancer diagnosis, TNBC, male breast cancer, and breast cancer with family history of HBOPP (all > 70% in 2019), and lowest for metastatic prostate cancer (6%). CONCLUSIONS The frequency of genetic testing for HBOPP cancer has increased over time. Though GCT is high for breast cancer, there are gaps in concordance among patients with other cancers. Increasing provider and patient education, genetic counseling, and insurance coverage for testing among HBOPP patients may improve guideline adherence.
Collapse
Affiliation(s)
- Nina M Clark
- Department of Surgery, University of Washington, Seattle, USA
| | - Emma A Roberts
- University of Washington School of Medicine, Seattle, USA
| | - Catherine Fedorenko
- Hutchinson Institute for Cancer Outcomes Research Fred Hutchinson Cancer Center, Seattle, USA
| | - Qin Sun
- Hutchinson Institute for Cancer Outcomes Research Fred Hutchinson Cancer Center, Seattle, USA
| | - Marianne Dubard-Gault
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, USA.,Fred Hutchinson Cancer Center, Seattle, USA
| | | | - Rachel Yung
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.,Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, USA
| | - Heather H Cheng
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.,Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, USA
| | - Jonathan G Sham
- Department of Surgery, University of Washington, Seattle, USA.,Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, USA
| | - Barbara M Norquist
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
| | - Meghan R Flanagan
- Department of Surgery, University of Washington, Seattle, USA. .,Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, USA.
| |
Collapse
|
7
|
Lee SS, Rajeev P, Finning S, Oh C, Pothuri B. Missed opportunities in the real-world genetic testing in BRCA gene variant carriers with cancers meeting NCCN criteria. Gynecol Oncol 2023; 170:32-37. [PMID: 36610379 DOI: 10.1016/j.ygyno.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The objective of this study was to determine the proportion of patients meeting the National Comprehensive Cancer Network (NCCN)'s BRCA genetic testing criteria prior to a diagnosis of a BRCA-related cancer. METHODS This was a cross-sectional study of patients with BRCA pathogenic variants and a diagnosis of a BRCA-related cancer. Patients were included if they had known dates of genetic testing and cancer diagnosis. NCCN criteria (version 2.2021) were applied to determine if patients met criteria for testing before a BRCA-related cancer diagnosis. The outcome of interest was the proportion of patients undergoing genetic testing following a diagnosis of a BRCA-related cancer who qualified for genetic testing based on NCCN criteria. Chi-square, Mann-Whitney U test, and logistic regression were performed with significance at p < 0.05. RESULTS Of 270 patients with a BRCA-related cancer, 229 (85%) underwent genetic testing after a cancer diagnosis. Most patients (97%) met at least one NCCN criteria for BRCA testing; 166 (73%) of patients who were tested following a BRCA-related cancer diagnosis also met the criteria for testing by family history. Publicly insured or uninsured patients were three times more likely to undergo BRCA testing after a diagnosis of cancer (odds ratio [OR] 3.03, 95% confidence interval [CI] 1.09-8.40). Patients with a family history of pathogenic variants were more likely to undergo testing before a cancer diagnosis (OR 0.10, 95% CI 0.05-0.23). CONCLUSION Most patients with BRCA-associated cancers undergo genetic testing after their cancer diagnosis. Increased education on genetic testing criteria and novel methods to improve testing are desperately needed.
Collapse
Affiliation(s)
- Sarah S Lee
- New York University Langone Health, Department of Obstetrics and Gynecology, New York, NY, USA; New York University Langone Health, Department of Medicine, New York, NY, USA
| | - Pournami Rajeev
- New York University Grossman School of Medicine, New York, NY, USA
| | - Skyler Finning
- New York University Langone Health, Department of Obstetrics and Gynecology, New York, NY, USA
| | - Cheongeun Oh
- New York University Langone Health, Department of Population Health, New York, NY, USA
| | - Bhavana Pothuri
- New York University Langone Health, Department of Obstetrics and Gynecology, New York, NY, USA; New York University Langone Health, Department of Medicine, New York, NY, USA.
| |
Collapse
|
8
|
Wang F, Fan L, Zhao Q, Liu Y, Zhang Z, Wang D, Zhao X, Li Y, Tan B. Family history of malignant tumor is a predictor of gastric cancer prognosis: Incorporation into a nomogram. Medicine (Baltimore) 2022; 101:e30141. [PMID: 36107576 PMCID: PMC9439747 DOI: 10.1097/md.0000000000030141] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to investigate the impact of a family history of malignant tumor on the prognosis of patients with gastric cancer and develop a nomogram that incorporates a family history of malignant tumor to predict overall survival (OS) in patients with gastric cancer to aid clinicians and patients in decision making. Four hundred eighty-eight patients with gastric cancer undergoing radical gastrectomy in our center were included and randomly split into a training set (n = 350) and a validation set (n = 138) at a ratio of 7:3. Cox univariate regression analysis was used to evaluate the influence of clinicopathological characteristics and family history of malignant tumors on their prognosis, and variables were screened by multivariate Cox regression analysis and consensus on clinical evidence. A nomogram was constructed for OS based on the filtered variables, and the C-index, receiver operating characteristic curve (ROC curve), and calibration curve were used to validate the nomogram and decision curve analysis curve (DCA curve) was used for clinical practicality assessment. Six variables related to OS, including the pathological differentiation degree, Lauren type, infiltration depth, lymph node metastasis, tumor deposit, and family history of malignant tumor, were screened to construct a nomogram. The nomogram developed in this study performed well in the training set and the validation set, with C-index of 0.776 and 0.757, and the area under the ROC curve(AUC) for predicting 1-, 3-, and 5-year survival rates are 0.838, 0.850, 0.820 and 0.754, 0.789, 0.808, respectively. The calibration curve shows that the estimated death risk of the nomogram in the 2 data sets is very close to the actual death risk. The net benefits of nomogram-guided prediction of patient survival at 1-, 3-, and 5 years were demonstrated by the DCA curves, which showed high clinical practicability. Family history of malignant tumors is an independent risk factor affecting the prognosis of patients with gastric cancer. The nomogram developed in this research can be used as an important tool to predict the prognosis of gastric cancer patients with family history data.
Collapse
Affiliation(s)
- Fanke Wang
- Department of Gastrointestinal Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Liqiao Fan
- Department of Gastrointestinal Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Qun Zhao
- Department of Gastrointestinal Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Yu Liu
- Department of Gastrointestinal Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Zhidong Zhang
- Department of Gastrointestinal Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Dong Wang
- Department of Gastrointestinal Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Xuefeng Zhao
- Department of Gastrointestinal Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Yong Li
- Department of Gastrointestinal Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
- *Correspondence: Yong Li, Department of Gastrointestinal Surgery, The Fourth Hospital of Hebei Medical University, No. 12, Jiankang Road, Shijiazhuang 050011, P.R. China. (e-mail: )
| | - Bibo Tan
- Department of Gastrointestinal Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| |
Collapse
|
9
|
Li K, Yin R, Li L, Wang D, Li L, Ma C, Ren Q, Wang G, Fan Y, Zhou H, Liu Z, Li T, Luo K, Kui D, Wang J. Diagnosis and treatment of uterine sarcoma: A multicenter, real-world study in western China. Medicine (Baltimore) 2021; 100:e28220. [PMID: 34941084 PMCID: PMC8702065 DOI: 10.1097/md.0000000000028220] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/24/2021] [Indexed: 01/05/2023] Open
Abstract
A detailed understanding of the diagnosis and treatment of uterine sarcoma in the real world is required due to its low incidence, high malignancy, lack of specific symptoms, and lack of high-level evidence supporting its clinical diagnosis and treatment. This study aimed to provide a basis for the standardized diagnosis and treatment of uterine sarcoma. It retrospectively analyzed the real-world data on the diagnosis, treatment, and prognosis of uterine sarcoma in western China.The clinical and pathological data of patients with uterine sarcoma diagnosed and treated between January 2009 and January 2019 in 13 medical centers from 4 western provinces of China, Sichuan, Guangxi, Shaanxi, and Xinjiang, were collected and further examined by univariate and multivariate analyses to find possible risk factors affecting the prognosis of uterine sarcoma.A total of 299 patients with various pathological types of uterine sarcoma were included, with an average age of 47.7 ± 11.1 years. The univariate and multivariate analyses showed that age (P = .0081), family history (P = .0358), and chemotherapy regimen (P = .0005) significantly correlated with progression-free survival; while age (P = .0393) and International Federation of Gynecology and Obstetrics staging (P = .0141) significantly correlated with overall survival.As age increased, the risk of death in patients with uterine sarcoma increased; The disease tended to progress faster in lower-age patients. A family history of tumors had an impact on disease progression; however, the way in which it affected needs further exploration. Different chemotherapy regimens affected the patient's disease progression. This study suggested that the anthracycline chemotherapy regimen was slightly better.
Collapse
Affiliation(s)
- Kemin Li
- The Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Rutie Yin
- The Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Li Li
- Hospital Affiliated to Guangxi Medical University, Nanling, China
| | - Danqing Wang
- The Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Li Li
- Tumor Hospital Affiliated to Xinjiang Medical University, Xingjiang, China
| | - Cailing Ma
- The First Affiliated Hospital of Xinjiang Medical University, Xingjiang, China
| | - Qianchuan Ren
- The Affiliated Hospital of Southwest Medical University, Luozhou, China
| | - Guqing Wang
- Shaanxi Provincial Cancer Hospital, Xian, China
| | - Yang Fan
- NingXia people's Hospital, Yinchuan, China
| | - Honggui Zhou
- Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Zi Liu
- The First Affiliated Hospital of Xi’an Jiaotong University, Xian, China
| | - Tao Li
- The Third People‘s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Kunrong Luo
- The Second Hospital of Liangshan Yi State, Sichuan Province, Sichuan, China
| | - Dingqing Kui
- Dazhou Central Hospital, Sichuan Province, Sichuan, China
| | - Jingyi Wang
- Department of Obstetric and Gynecology, The Second Affiliate Hospital of Chengdu Medical College, China National Corporation 416 Hospital, Sichuan, China
| |
Collapse
|
10
|
Awareness of Breast Cancer Screening among the Medical and General Population of the North Region of Cameroon. Int J Breast Cancer 2021; 2021:6663195. [PMID: 34354843 PMCID: PMC8331314 DOI: 10.1155/2021/6663195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 07/08/2021] [Indexed: 01/02/2023] Open
Abstract
Breast cancer has become a real public health problem in Cameroon, particularly in rural areas due to late diagnosis, resulting partly from the absence of national screening programs. This work is aimed at assessing breast cancer awareness in the North Region of Cameroon. Participants were selected in six health centers surrounding the rural area of Garoua, North Region, Cameroon, and administered a questionnaire aimed at assessing their awareness about breast cancer risk factors and screening. Out of the 475 women (including 37 medical personnel) interviewed, 45.5% attended at least secondary school; 91.3% were aware of the disease with the main sources of information from those around them (64.8%), media (46.5%), and health professionals in health facilities (42.7%). 23.3% had misconceptions and myth-based ideas on the origin of the disease. Ignorance was the main reason preventing the performance of breast self-examination, and the high cost prevents individuals from going for mammography. The highest awareness rate was observed in employed women with higher level of education. Our study highlights the need to raise awareness among the populations in North Region, Cameroon, about the risk factors and clinical signs of breast cancer and the importance of screening practice for early diagnosis of breast cancer.
Collapse
|
11
|
Lovejoy LA, Turner CE, Shriver CD, Ellsworth RE. Cancer Previvors in an Active Duty Service Women Population: An Opportunity for Prevention and Increased Force Readiness. Mil Med 2021; 186:e737-e742. [PMID: 33206196 PMCID: PMC8246613 DOI: 10.1093/milmed/usaa485] [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: 08/31/2020] [Revised: 10/12/2020] [Accepted: 10/28/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The majority of active duty service women (ADS) are young, have access to healthcare, and meet fitness standards set by the U.S. military, suggesting that ADS represent a healthy population at low risk of cancer. Breast cancer is, however, the most common cancer in ADS and may have a significant effect on troop readiness with lengthy absence during treatment and inability to return to duty after the treatment. The identification of unaffected ADS who carry germline mutations in cancer predisposition genes ("previvors") would provide the opportunity to prevent or detect cancer at an early stage, thus minimizing effects on troop readiness. In this study, we determined (1) how many high-risk ADS without cancer pursued genetic testing, (2) how many previvors employed risk-reducing strategies, and (3) the number of undiagnosed previvors within an ADS population. METHODS The Clinical Breast Care Project (protocol WRNMMC IRB #20704) database of the Murtha Cancer Center/Walter Reed National Military Medical Center was queried to identify all ADS with no current or previous history of cancer. Classification as high genetic risk was calculated using National Comprehensive Cancer Network 2019 guidelines for genetic testing for breast, ovary, colon, and gastric cancer. The history of clinical genetic testing and risk-reducing strategies was extracted from the database. Genomic DNA from ADS with blood specimens available for research purposes were subjected to next-generation sequencing technologies using a cancer predisposition gene panel. RESULTS Of the 336 cancer-free ADS enrolled in the Clinical Breast Care Project, 77 had a family history that met National Comprehensive Cancer Network criteria for genetic testing for BRCA1/2 and 2 had a family history of colon cancer meeting the criteria for genetic testing for Lynch syndrome. Of the 28 (35%) high-risk women who underwent clinical genetic testing, 11 had pathogenic mutations in the breast cancer genes BRCA1 (n = 5), BRCA2 (n = 5), or CHEK2 (n = 1). Five of the six ADS who had a relative with a known pathogenic mutation were carriers of the tested mutation. All of the women who had pathogenic mutations detected through clinical genetic testing underwent prophylactic double mastectomy, and three also had risk-reducing salpingo-oophorectomy. Two (6%) of the 33 high-risk ADS tested only in the research setting had a family history of breast/ovarian cancer and carried pathogenic mutations: one carried a BRCA2 mutation, whereas the other carried a mutation in the colon cancer predisposition gene PMS2. No mutations were detected in the 177 low-risk women tested in the research setting. DISCUSSION Within this unaffected cohort of ADS, 23% were classified as high risk. Although all of the previvors engaged in risk-reduction strategies, only one-third of the high-risk women sought genetic testing. These data suggest that detailed family histories of cancer should be collected in ADS and genetic testing should be encouraged in those at high risk. The identification of previvors and concomitant use of risk-reduction strategies may improve health in the ADS and optimize military readiness by decreasing cancer incidence.
Collapse
Affiliation(s)
- Leann A Lovejoy
- Clinical Breast Care Project, Chan Soon-Shiong Institute for Molecular Medicine at Windber, Windber, PA 15963, USA
| | - Clesson E Turner
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Craig D Shriver
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Rachel E Ellsworth
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Clinical Breast Care Project, Henry M. Jackson Foundation for the Advancement of Military Medicine, Windber, PA 15963, USA
| |
Collapse
|
12
|
Association of Family History with the Development of Breast Cancer: A Cohort Study of 129,374 Women in KoGES Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126409. [PMID: 34199253 PMCID: PMC8296242 DOI: 10.3390/ijerph18126409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022]
Abstract
Background: Breast cancer is the most common cancer among women. The Korean Genome and Epidemiology Study (KoGES) is a large cohort study that is available to the public. Using this large cohort study, we aimed to unravel the relationship between breast cancer development and a family history of breast cancer in Korea. Methods: This cohort study relied on data from the KoGES from 2001 through 2013. A total of 211,725 participants were screened. Of these, 129,374 women were evaluated. They were divided into two groups, including participants with and without breast cancer. A logistic regression model was used to retrospectively analyze the odds ratio of breast cancer history in families of women with and without breast cancer. Results: Of 129,374 women, 981 had breast cancer. The breast cancer group had more mothers and siblings with histories of breast cancer (p < 0.001). A history of breast cancer in the participant’s mother resulted in an odds ratio of 3.12 (1.75–5.59), and a history of breast cancer in the participant’s sibling resulted in an odds ratio of 2.63 (1.85–3.74). There was no interaction between the history of maternal breast cancer and the history of sibling breast cancer. Based on the subgroup analysis, family history was a stronger factor in premenopausal women than in menopausal and postmenopausal women. Conclusions: A family history of breast cancer is a significant risk factor for breast cancer in Korea. Premenopausal women with a maternal history of breast cancer are of particular concern. Intensive screening and risk-reducing strategies should be considered for this vulnerable subpopulation.
Collapse
|
13
|
Abstract
Among women, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death in the world. The purpose of this article is to review the evidence regarding breast cancer screening for average-risk women. The review primarily focuses on mammographic screening but also reviews clinical breast examinations, emerging screening technologies, and opportunities to build consensus. Wherever possible, the review relies on published systematic reviews, meta-analyses, and guidelines from three major societies (US Preventive Services Task Force, American College of Radiology, and the American Cancer Society) to reflect a range of evidence-based perspectives regarding mammographic screening.
Collapse
Affiliation(s)
- Anand K Narayan
- Radiology, Massachusetts General Hospital, 55 Fruit Street, Wang 240, Boston, MA 02114, USA. https://twitter.com/AnandKNarayan
| | - Christoph I Lee
- Department of Radiology, Department of Health Services, Northwest Screening and Cancer Outcomes Research Enterprise, University of Washington, 1144 Eastlake Avenue East, LG-212, Seattle, WA 98109, USA
| | - Constance D Lehman
- Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang Building, Suite 219L, Boston, MA 02114, USA
| |
Collapse
|