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Iwai Y, Toumbou K, Zuze T, Morgan JS, Simwinga L, Wright ST, Fedoriw Y, Oladeru OT, Balogun OD, Roberson ML, Olopade OI, Tomoka T, Elmore SN. Breast Cancer Germline Genetic Counseling and Testing for Populations of African Heritage Globally: A Scoping Review on Research, Practice, and Bioethical Considerations. JCO Glob Oncol 2023; 9:e2300154. [PMID: 37944088 PMCID: PMC10645409 DOI: 10.1200/go.23.00154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/05/2023] [Accepted: 09/05/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Despite the disproportionately high risk of breast cancer among women of African heritage, little is known about the facilitators and barriers to implementing germline genetic testing and counseling (GT/C). METHODS This scoping review followed guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Published manuscripts from database inception through 2021 were sourced from PubMed, Cumulative Index to Nursing and Allied Health Literature via EBSCO, Embase, Cochrane Library, and Scopus. Search terms were used to retrieve articles addressing (1) African heritage, (2) breast cancer, and (3) GT or GC. The screening involved abstract and title review and full-text review. Data were extracted for all articles meeting the inclusion criteria. RESULTS A total of 154 studies were included. Most studies that took place were conducted in the United States (71.4%), and most first authors (76.9%) were from the United States. GT was conducted in 73 (49.7%) studies. BRCA1/BRCA2 were the most commonly studied genes for germline mutations. GC was conducted in 49 studies (33.3%), and perspectives on GC were evaluated in 43 (29.3%). The use of racial/ethnic categories varied broadly, although African American was most common (40.1%). Racism was mentioned in three studies (2.0%). CONCLUSION There is a growing body of literature on GT/C for breast cancer in women of African heritage. Future studies on GT/C of African populations should consider increased clarity around racial/ethnic categorizations, continued community engagement, and intentional processes for informed consent.
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Affiliation(s)
- Yoshiko Iwai
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Jenny S. Morgan
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
- Department of Clinical Medicine, Indiana University School of Medicine, Indianapolis, IN
- Department of Global Health, Indiana University School of Medicine, Indianapolis, IN
| | | | - Sarah T. Wright
- UNC Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Oluwadamilola T. Oladeru
- Department of Radiation Oncology, University of Florida, Gainesville, FL
- Department of Radiation Oncology, Mayo Clinic in Florida, Jacksonville, FL
| | | | - Mya L. Roberson
- Department of Health Policy, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | | | | | - Shekinah N.C. Elmore
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
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Rice SM, McLaren RA, Mustafa HJ, Dugoff L, Al-Kouatly HB. Connecting the dots: Carrier screening and the Genetic Information Nondiscrimination Act in the United States. Prenat Diagn 2023; 43:1142-1149. [PMID: 37392371 DOI: 10.1002/pd.6405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/17/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To highlight the possibility of genetic discrimination in the United States with respect to carrier screening under limitations of the Genetic Information Nondiscrimination Act (GINA) and to encourage providers to educate patients about this possibility during pretest counseling. METHODS Review of current professional guidelines and practice resources regarding the necessary components of pretest counseling for carrier screening in the context of GINA's limitations and the potential impact of carrier screening results on life, long-term care and disability insurance. RESULTS Current practice resources advise that patients in the United States should be informed that their employer or health insurance company generally cannot use their genetic information during the underwriting process. However, these resources do not elaborate on GINA's limitations or explain why there may be adverse consequences to patients regarding these limitations. Studies have demonstrated significant gaps in provider knowledge of GINA, especially for those without formal genetic training. CONCLUSION Enhanced education and provision of GINA educational resources for providers and patients will help ensure that patients have the opportunity to prioritize their insurance needs prior to undergoing carrier screening.
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Affiliation(s)
- Stephanie M Rice
- Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Rodney A McLaren
- Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Hiba J Mustafa
- Division of Maternal-Fetal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Fetal Center, Riley Children's Health, Indiana University Health, Indianapolis, Indiana, USA
| | - Lorraine Dugoff
- Division of Reproductive Genetics, Division of Maternal-Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Huda B Al-Kouatly
- Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Sorscher S. Is It Time to Expand Our Definition of "Clinical Utility"? Cancer Control 2023; 30:10732748231170483. [PMID: 37057688 PMCID: PMC10108406 DOI: 10.1177/10732748231170483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 04/15/2023] Open
Abstract
Currently, genetic tests that predict cancer risk or risk of recurrence in patients who have had their cancer treated with curative intent must have proven "clinical utility" to be recommended by the organizations responsible for publishing the standard-of-care guidelines for cancer care.Based on the current definition of clinical utility, most patients are denied testing for cancer-predisposing genes or pathogenic germline variants even though germline testing has been proven as highly accurate in identifying pathogenic germline variant carriers, there are measures recommended to prevent and diagnose early cancers associated with particular PGVs, and disparities in patient access to genetic tests are well described.Similarly, despite dozens of studies demonstrating that detected circulating tumor DNA (ctDNA) after curative intention therapy of different cancer types is a highly accurate biomarker that predicts recurrence, the major organizations that publish guidelines for cancer monitoring after curative intention therapy recommend against using ctDNA assays to detect minimal residual disease and thereby predict recurrence for all solid tumor malignancies.Here, the primary reasons that these genetic tests are considered to lack proven clinical utility and the primary evidence suggesting that a broader definition of clinical utility should be considered are discussed. By expanding the definition of clinical utility, many patients will benefit from the information gained from having these genetic tests.
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Kühn F, Karsten MM, Kendel F, Feufel MA, Speiser D. Training courses on hereditary breast and ovarian cancer to strengthen cross-sectoral care in underserved areas. PATIENT EDUCATION AND COUNSELING 2021; 104:1431-1437. [PMID: 33162275 DOI: 10.1016/j.pec.2020.10.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/08/2020] [Accepted: 10/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To strengthen cross-sectoral care by disseminating specialized knowledge about hereditary breast and ovarian cancer across underserved areas. METHODS We report on a training course about genetic counseling and testing of hereditary breast and ovarian cancer patients for gynecologists from certified cancer centers. In total, 50 gynecologists attended the course which was offered once annually between 2017 and 2019. Before and after the course, participants were asked to answer a self-assessment questionnaire and completed the training with a multiple-choice test. The results of the self-assessments and knowledge tests were analyzed to steadily improve the training. RESULTS The self-assessments imply a perceived increase in certainty regarding the inclusion criteria for specialized genetic counseling, pedigree analysis, and contents of the initial consultation. Both the knowledge tests and self-assessments showed that participants had difficulties in interpreting and differentiating between age-specific and lifetime risks. CONCLUSION The courses successfully conveyed knowledge necessary to identify patients at risk and to provide timely genetic analyses even in rural areas. PRACTICE IMPLICATIONS The results are a promising basis for creating additional training courses addressing specialists in hospitals and gynecological practices. Further education of physicians might improve cross-sectoral cooperation and thereby enable specialized care supply in rural areas.
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Affiliation(s)
- Friedrich Kühn
- Charité - Universitätsmedizin Berlin, Department of Gynecology, Berlin, Germany
| | | | - Friederike Kendel
- Charité - Universitätsmedizin Berlin, Department of Gender in Medicine, Berlin, Germany
| | - Markus A Feufel
- Technische Universität Berlin, Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Berlin, Germany
| | - Dorothee Speiser
- Charité - Universitätsmedizin Berlin, Department of Gynecology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Hereditary Breast and Ovarian Cancer Center, Berlin, Germany.
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DiNardo CD, Korde LA, Yurgelun MB. A Case-Based Approach to Understanding Complex Genetic Information in an Evolving Landscape. Am Soc Clin Oncol Educ Book 2021; 41:1-11. [PMID: 34010053 DOI: 10.1200/edbk_321041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The rapid integration of highly sensitive next-generation sequencing technologies into clinical oncology care has led to unparalleled progress, and yet these technological advances have also made genetic information considerably more complex. For instance, accurate interpretation of genetic testing for germline/inherited cancer predisposition syndromes and somatic/acquired pathogenic variants now requires a more nuanced understanding of the presence and incidence of clonal hematopoiesis and circulating tumor cells, with careful evaluation of pathogenic variants occurring at low variant allele frequency required. The interplay between somatic and germline pathogenic variants and awareness of distinct genotype-phenotype manifestations in various inherited cancer syndromes are now increasingly appreciated and can impact patient management. Through a case-based approach, we focus on three areas of particular relevance to the treating clinician oncologist: (1) understanding clonal hematopoiesis and somatic mosaicism, which can be detected on germline sequencing and lead to considerable confusion in clinical interpretation; (2) implications of the detection of a potentially germline pathogenic variant in a high-penetrance cancer susceptibility gene during routine tumor testing; and (3) a review of gene-specific risks and surveillance recommendations in Lynch syndrome. A discussion on the availability and difficulties often associated with direct-to-consumer genetic testing is also provided.
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Affiliation(s)
- Courtney D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Matthew B Yurgelun
- Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
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Stenehjem DD, Telford C, Unni SK, Bauer H, Sainski A, Deka R, Schauerhamer MB, Ye X, Tak CR, Ma J, Dalvi TB, Gutierrez L, Kaye JA, Tyczynski JE, Brixner DI, Biskupiak JE. BRCA testing and outcomes in women with breast cancer. Breast Cancer Res Treat 2021; 186:839-850. [PMID: 33389410 DOI: 10.1007/s10549-020-06038-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/25/2020] [Indexed: 12/27/2022]
Abstract
MAIN PURPOSE Germline BRCA mutations (BRCAm) strongly influence the risk of developing breast cancer. This study aimed to understand the role of BRCAm testing in affected individuals and to assess its impact on the outcome of BRCAm carriers compared to non-carriers (BRCAwt) with breast cancer. RESEARCH QUESTION The research question is "Does standard of care testing for BRCAm improve survival outcomes of breast cancer patients?" METHODS In a single institution observational cohort study, demographic and clinical characteristics were compared between breast cancer patients with and without BRCAm. Frequency of BRCA testing was assessed. Survival outcomes were assessed by initial treatment setting stratified by BRCA status. RESULTS Of 5712 identified women with breast cancer, 14.6% (n = 835) were tested for a BRCA mutation and had a documented result. The total number and proportion of women tested for a BRCAm increased between 2000 and 2014, resulting in an increased number of BRCAm carriers identified. However, the proportion of women who underwent testing and had a BRCAm decreased during the study period from 27.5% in 2000-2004 to 13.3% in 2010-2014. Disease-free survival was similar in the adjuvant and neoadjuvant treatment settings between BRCAm and BRCAwt patients. Progression-free survival on first line treatment and overall survival for patients with metastatic disease was also similar between BRCAm and BRCAwt patients. CONCLUSIONS The proportion of women tested and the number of BRCAm identified increased during the study period despite a decreasing proportion of positive results among women tested.
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Affiliation(s)
- David D Stenehjem
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA. .,Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, 1110 Kirby Drive, 232 Life Science, Duluth, MN, 55812, USA.
| | - Claire Telford
- AstraZeneca Pharmaceuticals, Gaithersburg, MD, USA.,GlaxoSmithKline, 5 Moore Drive, Research Triangle Park, NC, 27709, USA
| | - Sudhir K Unni
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,Daiichi-Sankyo, Basking Ridge, NJ, USA
| | - Hillevi Bauer
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Amy Sainski
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,Truven Health, Ann Arbor, MN, USA
| | - Rishi Deka
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,University of Southern California, San Diego, CA, USA
| | - Marisa B Schauerhamer
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Xiangyang Ye
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Casey R Tak
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Junjie Ma
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,Amgen Inc, Thousand Oaks, CA, 91320, USA
| | | | | | | | - Jerzy E Tyczynski
- AstraZeneca Pharmaceuticals, Gaithersburg, MD, USA.,AbbVie Inc, Pharmacovigilance and Patient Safety, North Chicago, IL, USA
| | - Diana I Brixner
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Joseph E Biskupiak
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
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