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Patel MM, Adrada BE. Hereditary Breast Cancer: BRCA Mutations and Beyond. Radiol Clin North Am 2024; 62:627-642. [PMID: 38777539 DOI: 10.1016/j.rcl.2023.12.014] [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] [Indexed: 05/25/2024]
Abstract
Hereditary breast cancers are manifested by pathogenic and likely pathogenic genetic mutations. Penetrance expresses the breast cancer risk associated with these genetic mutations. Although BRCA1/2 are the most widely known genetic mutations associated with breast cancer, numerous additional genes demonstrate high and moderate penetrance for breast cancer. This review describes current genetic testing, details the specific high and moderate penetrance genes for breast cancer and reviews the current approach to screening for breast cancer in patients with these genetic mutations.
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Affiliation(s)
- Miral M Patel
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, CPB5.3208, Houston, TX 77030, USA.
| | - Beatriz Elena Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, CPB5.3208, Houston, TX 77030, USA
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Afroze T, Iyer A, Faisal H, Manaf H, Bahul R. Knowledge and Attitudes Regarding Breast Cancer Screening and Mammograms Among Women Aged 40 Years and Older in the United Arab Emirates. Cureus 2024; 16:e59766. [PMID: 38846223 PMCID: PMC11153839 DOI: 10.7759/cureus.59766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVES To assess the knowledge and attitude regarding breast cancer screening and mammograms among 40 years and older females in the United Arab Emirates. METHODS A cross-sectional questionnaire-based study was conducted on women faculty, staff, and female patients attending our hospital. The inclusion criteria were women ≥ 40 years old who agreed to participate. The exclusion criteria were women < 40 and those ≥ 40 years who refused to participate. A signed informed consent was taken. A p-value of < 0.5 was considered significant. RESULTS Among the 460 women enrolled, 420 completed the survey (response rate 91%). The mean age was 48.4 ± 8.2 years. A total of 63.4% of the participants were < 50 years of age. A total of 53.3% were never screened before. About 98% believed that screening is beneficial in early detection. Social media (52.2%) and health professionals (46%) played a vital role in creating awareness. The majority of women were aware of self-breast examinations (73.3%), followed by mammography (68.6%). About 84% and 68.3%, of the participants had incorrect knowledge of the timing and frequency of mammograms, respectively. Only 16.3% of the participants were recommended by their physician, while the rest (83.7%) performed screening based on their awareness. No significant association was found between nutritional status (p=0.252), age at first pregnancy (p=0.409), or having children (p= 0.377) with mammogram uptake. There was a significant association between the perceived benefit of screening and mammogram uptake (p=0.033). There was a positive association between radiation therapy to the chest area and mammogram uptake (p<0.024). A statistically significant association was found between the correct timing of mammograms with family history of cancer (p = 0.037) and previous exposure to radiation therapy to the chest (p = 0.002). CONCLUSION There is a need to increase knowledge and awareness regarding breast cancer screening and mammograms among women in UAE. Specifically, breast self-examination should be encouraged and recommended.
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Affiliation(s)
- Tazeen Afroze
- Family Medicine Department, Nad Al Hamar Health Center, Dubai, ARE
| | - Aashka Iyer
- Community Medicine Department, Gulf Medical University, Ajman, ARE
| | - Hana Faisal
- Community Medicine Department, Gulf Medical University, Ajman, ARE
| | - Hiba Manaf
- Community Medicine Department, Gulf Medical University, Ajman, ARE
| | - Radha Bahul
- Community Medicine Department, Gulf Medical University, Ajman, ARE
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3
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Kubota K, Nakashima K, Nakashima K, Kataoka M, Inoue K, Goto M, Kanbayashi C, Hirokaga K, Yamaguchi K, Suzuki A. The Japanese breast cancer society clinical practice guidelines for breast cancer screening and diagnosis, 2022 edition. Breast Cancer 2024; 31:157-164. [PMID: 37973686 PMCID: PMC10901949 DOI: 10.1007/s12282-023-01521-x] [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: 09/12/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
This article provides updates to readers based on the newly published Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2022 Edition. These guidelines incorporate the latest evaluation of evidence from studies of diagnostic accuracy. For each clinical question, outcomes for benefits and harms were established, and qualitative or quantitative systematic reviews were conducted. Recommendations were determined through voting by a multidisciplinary group, and guidelines were documented to facilitate shared decision-making among patients and medical professionals. The guidelines address screening, surveillance, and pre- and postoperative diagnosis of breast cancer. In an environment that demands an integrated approach, decisions are needed on how to utilize modalities, such as mammography, ultrasound, MRI, and PET/CT. Additionally, it is vital to understand the appropriate use of new technologies, such as tomosynthesis, elastography, and contrast-enhanced ultrasound, and to consider how best to adapt these methods for individual patients.
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Affiliation(s)
- Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-koshigaya, Koshigaya, Saitama, 343-8555, Japan.
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan.
| | - Kazutaka Nakashima
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Kazuaki Nakashima
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Division of Breast Imaging and Breast Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masako Kataoka
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenich Inoue
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Breast Cancer Center, Shonan Memorial Hospital, Kanagawa, Japan
| | - Mariko Goto
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chizuko Kanbayashi
- The Japanese Breast Cancer Society Clinical Practice Guidelines Breast Cancer Screening and Diagnosis Subcommittee, Tokyo, Japan
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Koichi Hirokaga
- Department of Breast Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Ken Yamaguchi
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Akihiko Suzuki
- Division of Breast and Endocrine Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Coffey K, Mango V. Revisiting Screening in Women With a Family History of Breast Cancer. JOURNAL OF BREAST IMAGING 2023; 5:635-645. [PMID: 38141237 DOI: 10.1093/jbi/wbad069] [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: 05/31/2023] [Indexed: 12/25/2023]
Abstract
Women with a family history (FH) of breast cancer and without known genetic susceptibility represent a unique population whose lifetime probability of developing breast cancer varies widely depending on familial factors, breast density, and the risk assessment tool used. Recently updated guidelines from the American College of Radiology recommend supplemental annual screening with contrast-enhanced MRI or contrast-enhanced mammography for women with an FH who are high risk (≥20% lifetime risk) or have dense breasts. To date, most screening studies addressing outcomes in women with FH have largely included those also with confirmed or suspected gene mutations, in whom the lifetime risk is highest, with limited data for women at average to intermediate risk who are not known to be genetically susceptible and may not benefit as much from the same screening approaches. Further research focusing specifically on women with FH as the only breast cancer risk factor is warranted to refine risk assessment and optimize a multimodality personalized screening approach.
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Affiliation(s)
- Kristen Coffey
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY, USA
| | - Victoria Mango
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY, USA
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van Barele M, Akdeniz D, Heemskerk-Gerritsen BAM, Andrieu N, Noguès C, van Asperen CJ, Wevers M, Ausems MGEM, de Bock GH, Dommering CJ, Gómez-García EB, van Leeuwen FE, Mooij TM, Easton DF, Antoniou AC, Evans DG, Izatt L, Tischkowitz M, Frost D, Brewer C, Olah E, Simard J, Singer CF, Thomassen M, Kast K, Rhiem K, Engel C, de la Hoya M, Foretová L, Jakubowska A, Jager A, Sattler MGA, Schmidt MK, Hooning MJ. Contralateral breast cancer risk in patients with breast cancer and a germline-BRCA1/2 pathogenic variant undergoing radiation. J Natl Cancer Inst 2023; 115:1318-1328. [PMID: 37369040 PMCID: PMC10637040 DOI: 10.1093/jnci/djad116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/06/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Radiation-induced secondary breast cancer (BC) may be a concern after radiation therapy (RT) for primary breast cancer (PBC), especially in young patients with germline (g)BRCA-associated BC who already have high contralateral BC (CBC) risk and potentially increased genetic susceptibility to radiation. We sought to investigate whether adjuvant RT for PBC increases the risk of CBC in patients with gBRCA1/2-associated BC. METHODS The gBRCA1/2 pathogenic variant carriers diagnosed with PBC were selected from the prospective International BRCA1/2 Carrier Cohort Study. We used multivariable Cox proportional hazards models to investigate the association between RT (yes vs no) and CBC risk. We further stratified for BRCA status and age at PBC diagnosis (<40 and >40 years). Statistical significance tests were 2-sided. RESULTS Of 3602 eligible patients, 2297 (64%) received adjuvant RT. Median follow-up was 9.6 years. The RT group had more patients with stage III PBC than the non-RT group (15% vs 3%, P < .001), received chemotherapy more often (81% vs 70%, P < .001), and received endocrine therapy more often (50% vs 35%, P < .001). The RT group had an increased CBC risk compared with the non-RT group (adjusted hazard ratio [HR] = 1.44; 95% confidence interval [CI] = 1.12 to 1.86). Statistical significance was observed in gBRCA2 (HR = 1.77; 95% CI = 1.13 to 2.77) but not in gBRCA1 pathogenic variant carriers (HR = 1.29; 95% CI = 0.93 to 1.77; P = .39 for interaction). In the combined gBRCA1/2 group, patients irradiated when they were younger than or older than 40 years of age at PBC diagnosis showed similar risks (HR = 1.38; 95% CI = 0.93 to 2.04 and HR = 1.56; 95% CI = 1.11 to 2.19, respectively). CONCLUSIONS RT regimens minimizing contralateral breast dose should be considered in gBRCA1/2 pathogenic variant carriers.
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Affiliation(s)
- Mark van Barele
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Delal Akdeniz
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - Genepso
- Département d’Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli-Calmettes, Marseille, France
| | - Nadine Andrieu
- INSERM, U900, Paris, France
- Institut Curie, Paris, France
- PSL Research University, Paris, France
- Mines ParisTech, Fontainebleau, France
| | - Catherine Noguès
- Département d’Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli-Calmettes, Marseille, France
- Institut Paoli-Calmettes & Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - HEBON
- The Hereditary Breast and Ovarian Cancer Research Group Netherlands (HEBON), Coordinating Center, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Marijke Wevers
- Department for Clinical Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Margreet G E M Ausems
- Division of Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Charlotte J Dommering
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Thea M Mooij
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - EMBRACE
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - D Gareth Evans
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Genomic Medicine, Division of Evolution and Genomic Sciences, The University of Manchester, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie, University of Manchester, Manchester, UK
| | - Louise Izatt
- Department of Clinical Genetics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
- Program in Cancer Genetics, Departments of Human Genetics and Oncology, McGill University, Montréal, QC, Canada
| | - Debra Frost
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Carole Brewer
- Department of Clinical Genetics, Royal Devon & Exeter Hospital, Exeter, UK
| | - Edit Olah
- Department of Molecular Genetics, National Institute of Oncology, Budapest, Hungary
| | - Jacques Simard
- Genomics Center, Centre Hospitalier Universitaire de Québec, Université Laval Research Center, Quebec City, QC, Canada
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Personalized Response Monitoring in Oncology (PREMIO), Odense University Hospital, Odense, Denmark
| | - Karin Kast
- Center of Familial Breast and Ovarian Cancer and Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Kerstin Rhiem
- Center of Familial Breast and Ovarian Cancer and Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Miguel de la Hoya
- Molecular Oncology Laboratory, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Lenka Foretová
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
- Independent Laboratory of Molecular Biology and Genetic Diagnostics, Pomeranian Medical University, Szczecin, Poland
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Margriet G A Sattler
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marjanka K Schmidt
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Division of Molecular Pathology, The Netherlands Cancer Institute–Antoni Van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Wilding M, Fleming J, Moore K, Crook A, Reddy R, Choi S, Schlub TE, Field M, Thiyagarajan L, Thompson J, Berman Y. Clinical and imaging modality factors impacting radiological interpretation of breast screening in young women with neurofibromatosis type 1. Fam Cancer 2023; 22:499-511. [PMID: 37335380 DOI: 10.1007/s10689-023-00340-5] [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: 11/20/2022] [Accepted: 05/28/2023] [Indexed: 06/21/2023]
Abstract
Young women with Neurofibromatosis type 1 (NF1) have a high risk of developing breast cancer and poorer survival following breast cancer diagnosis. International guidelines recommend commencing breast screening between 30 and 35 years; however, the optimal screening modality is unestablished, and previous reports suggest that breast imaging may be complicated by the presence of intramammary and cutaneous neurofibromas (cNFs). The aim of this study was to explore potential barriers to implementation of breast screening for young women with NF1.Twenty-seven women (30-47 years) with NF1 completed breast screening with breast MRI, mammogram and breast ultrasound. Nineteen probably benign/suspicious lesions were detected across 14 women. Despite the presence of breast cNFs, initial biopsy rate for participants with NF1 (37%), were comparable to a BRCA pathogenic variant (PV) cohort (25%) (P = 0.311). No cancers or intramammary neurofibromas were identified. Most participants (89%) returned for second round screening.The presence of cNF did not affect clinician confidence in 3D mammogram interpretation, although increasing breast density, frequently seen in young women, impeded confidence for 2D and 3D mammogram. Moderate or marked background parenchymal enhancement on MRI was higher in the NF1 cohort (70.4%) than BRCA PV carriers (47.3%), which is an independent risk factor for breast cancer.Breast MRI was the preferred mode of screening over mammogram, as the majority (85%) with NF1 demonstrated breast density (BI-RADS 3C/4D), which hinders mammogram interpretation. For those with high breast density and high cNF breast coverage, 3D rather than 2D mammogram is preferred, if MRI is unavailable.
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Affiliation(s)
- Mathilda Wilding
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Jane Fleming
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Katrina Moore
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ashley Crook
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ranjani Reddy
- North Shore Radiology & Nuclear Medicine, Pacific Highway, Sydney, NSW, Australia
| | - Sarah Choi
- North Shore Radiology & Nuclear Medicine, Pacific Highway, Sydney, NSW, Australia
| | - Timothy E Schlub
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michael Field
- NSLHD Familial Cancer Service, Department of Cancer Services, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lavvina Thiyagarajan
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jeff Thompson
- Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Yemima Berman
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
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Takahashi K, Takeda Y, Ono Y, Isomoto H, Mizukami Y. Current status of molecular diagnostic approaches using liquid biopsy. J Gastroenterol 2023; 58:834-847. [PMID: 37470859 PMCID: PMC10423147 DOI: 10.1007/s00535-023-02024-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/08/2023] [Indexed: 07/21/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive and lethal cancers, and developing an efficient and reliable approach for its early-stage diagnosis is urgently needed. Precancerous lesions of PDAC, such as pancreatic intraepithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasms (IPMN), arise through multiple steps of driver gene alterations in KRAS, TP53, CDKN2A, SMAD4, or GNAS. Hallmark mutations play a role in tumor initiation and progression, and their detection in bodily fluids is crucial for diagnosis. Recently, liquid biopsy has gained attention as an approach to complement pathological diagnosis, and in addition to mutation signatures in cell-free DNA, cell-free RNA, and extracellular vesicles have been investigated as potential diagnostic and prognostic markers. Integrating such molecular information to revise the diagnostic criteria for pancreatic cancer can enable a better understanding of the pathogenesis underlying inter-patient heterogeneity, such as sensitivity to chemotherapy and disease outcomes. This review discusses the current diagnostic approaches and clinical applications of genetic analysis in pancreatic cancer and diagnostic attempts by liquid biopsy and molecular analyses using pancreatic juice, duodenal fluid, and blood samples. Emerging knowledge in the rapidly advancing liquid biopsy field is promising for molecular profiling and diagnosing pancreatic diseases with significant diversity.
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Affiliation(s)
- Kenji Takahashi
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Yohei Takeda
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yusuke Ono
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Hajime Isomoto
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yusuke Mizukami
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka Higashi, Asahikawa, Hokkaido, 078-8510, Japan
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
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Monticciolo DL, Newell MS, Moy L, Lee CS, Destounis SV. Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR. J Am Coll Radiol 2023; 20:902-914. [PMID: 37150275 DOI: 10.1016/j.jacr.2023.04.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/26/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023]
Abstract
Early detection decreases breast cancer death. The ACR recommends annual screening beginning at age 40 for women of average risk and earlier and/or more intensive screening for women at higher-than-average risk. For most women at higher-than-average risk, the supplemental screening method of choice is breast MRI. Women with genetics-based increased risk, those with a calculated lifetime risk of 20% or more, and those exposed to chest radiation at young ages are recommended to undergo MRI surveillance starting at ages 25 to 30 and annual mammography (with a variable starting age between 25 and 40, depending on the type of risk). Mutation carriers can delay mammographic screening until age 40 if annual screening breast MRI is performed as recommended. Women diagnosed with breast cancer before age 50 or with personal histories of breast cancer and dense breasts should undergo annual supplemental breast MRI. Others with personal histories, and those with atypia at biopsy, should strongly consider MRI screening, especially if other risk factors are present. For women with dense breasts who desire supplemental screening, breast MRI is recommended. For those who qualify for but cannot undergo breast MRI, contrast-enhanced mammography or ultrasound could be considered. All women should undergo risk assessment by age 25, especially Black women and women of Ashkenazi Jewish heritage, so that those at higher-than-average risk can be identified and appropriate screening initiated.
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Affiliation(s)
- Debra L Monticciolo
- Division Chief, Breast Imaging, Massachusetts General Hospital, Boston, Massachusetts.
| | - Mary S Newell
- Interim Division Chief, Breast Imaging, Emory University, Atlanta, Georgia
| | - Linda Moy
- Associate Chair for Faculty Mentoring, New York University Grossman School of Medicine, New York, New York; Editor-in-Chief, Radiology
| | - Cindy S Lee
- New York University Grossman School of Medicine, New York, New York
| | - Stamatia V Destounis
- Elizabeth Wende Breast Care, Rochester, New York; Chair, ACR Commission on Breast Imaging
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9
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Bergmann LL, Ackman JB, Starekova J, Moeller A, Reeder S, Nagle SK, Schiebler ML. MR Angiography of Pulmonary Vasculature. Magn Reson Imaging Clin N Am 2023; 31:475-491. [PMID: 37414473 DOI: 10.1016/j.mric.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Pulmonary MR angiography (MRA) is a useful alternative to computed tomographic angiography (CTA) for the study of the pulmonary vasculature. For pulmonary hypertension and partial anomalous pulmonary venous return, a cardiac MR imaging and the pulmonary MRA are useful for flow quantification and planning treatment. For the diagnosis of pulmonary embolism (PE), MRA-PE has been shown to have non-inferior outcomes at 6 months when compared with CTA-PE. Over the last 15 years, pulmonary MRA has become a routine and reliable examination for the workup of pulmonary hypertension and the primary diagnosis of PE at the University of Wisconsin.
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Affiliation(s)
- Liisa L Bergmann
- Department of Radiology, University of Kentucky College of Medicine, 800 Rose Street, HX332E, Lexington, KY 40536-0293, USA; Department of Medicine, University of Kentucky College of Medicine, 800 Rose Street, HX332E, Lexington, KY 40536-0293, USA.
| | - Jeanne B Ackman
- Massachusetts General Hospital, Department of Radiology, Division of Thoracic Imaging and Intervention Austin Building 202, 55 Fruit Street, Boston, MA 02114, USA
| | - Jitka Starekova
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Alexander Moeller
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Scott Reeder
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Scott K Nagle
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA.
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Hurley L, Alashban Y, Albeshan S, England A, McEntee MF. The effect of breast shielding outside the field of view on breast entrance surface dose in axial X-ray examinations: a phantom study. Diagn Interv Radiol 2023; 29:555-560. [PMID: 37129301 PMCID: PMC10679606 DOI: 10.4274/dir.2023.232126] [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: 01/20/2023] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the effect of outside-field-of-view (FOV) lead shielding on the entrance surface dose (ESD) of the breast on an anthropomorphic X-ray phantom for a variety of axial skeleton X-ray examinations. METHODS Using an anthropomorphic phantom and radiation dosimeter, the ESD of the breast was measured with and without outside-FOV shielding in anterior-posterior (AP) abdomen, AP cervical spine, occipitomental 30° (OM30) facial bones, AP lumbar spine, and lateral lumbar spine radiography. The effect of several exposure parameters, including a low milliampere-seconds technique, grid use, automatic exposure control use, wraparound lead (WAL) use, trolley use, and X-ray table use, on the ESD of the breast with and without outside-FOV shielding was investigated. The mean ESD (μSv) and standard deviation for each radiographic protocol were calculated. A one-tailed Student's t-test was carried out to evaluate whether ESD to the breast was reduced with the use of outside-FOV shielding. RESULTS A total of 920 breast ESD measurements were recorded across the different protocol parameters. The largest decrease in mean ESD of the breast with outside-FOV shielding was 0.002 μSv (P = 0.084), recorded in the AP abdomen on the table with a grid, OM30 on the table with a grid, OM30 standard protocol on the trolley, and OM30 on the trolley with WAL protocols. This decrease was found to be statistically non-significant. CONCLUSION This study found no significant decrease in the ESD of the breast with the use of outside-FOV shielding for the AP abdomen, AP cervical spine, OM30 facial bones, AP lumbar spine, or lateral lumbar spine radiography across a range of protocols.
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Affiliation(s)
- Lauren Hurley
- Department of Medical Imaging and Radiation Therapy, University College Cork, School of Medicine, Brookfield Health Sciences, Munster, Ireland
| | - Yazeed Alashban
- Department of Radiological Sciences, King Saud University, College of Applied Medical Sciences, Riyadh, Saudi Arabia
| | - Salman Albeshan
- Department of Radiological Sciences, King Saud University, College of Applied Medical Sciences, Riyadh, Saudi Arabia
| | - Andrew England
- Department of Medical Imaging and Radiation Therapy, University College Cork, School of Medicine, Brookfield Health Sciences, Munster, Ireland
| | - Mark F. McEntee
- Department of Medical Imaging and Radiation Therapy, University College Cork, School of Medicine, Brookfield Health Sciences, Munster, Ireland
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11
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Ding W, Fan Z, Xu Y, Wei C, Li Z, Lin Y, Zhu J, Ruan G. Magnetic resonance imaging in screening women at high risk of breast cancer: A meta-analysis. Medicine (Baltimore) 2023; 102:e33146. [PMID: 36897691 PMCID: PMC9997824 DOI: 10.1097/md.0000000000033146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is more accurate than mammography in screening for breast cancer. Exposure to ionizing radiation from repeated diagnostic X-rays may be a cause of breast cancer. METHODS We conducted systematic searches on PubMed, Cochrane and Embase to identify studies on women who underwent mammography or MRI screening. A meta-analysis was performed to compare the detection rate of breast cancer by mammography, MRI or both. RESULTS A total of 18 diagnostic publications were identified and included in the meta-analysis. Among the 1000 screened women, MRI alone increased the detection rate of breast cancer by 8 compared with mammography alone (RR 0.48, 95% CI 0.42-0.54), and MRI plus mammography increased the detection rate of breast cancer by 1 compared with MRI alone (RR 0.86, 95% CI 0.78-0.96). Subgroup analysis demonstrated that the diagnostic efficacy of MRI plus mammography in breast was obviously better than that of MRI alone or mammography alone. CONCLUSIONS Screening with MRI alone might be the best choice for women at high risk of breast cancer.
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Affiliation(s)
- Wu Ding
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
- Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, China
| | - Zaiwei Fan
- Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, China
| | - Yuehuai Xu
- Department of Clinical Medicine, School of Medicine, Shaoxing University, Shaoxing, China
| | - Chunshou Wei
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
| | - Zhian Li
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
| | - Yingli Lin
- Department of Early Childhood Education, Shaoxing Vocational and Technical College, Shaoxing, China
| | - Jianming Zhu
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
| | - Guodong Ruan
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, China
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12
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Duque G, Manterola C, Otzen T, Arias C, Palacios D, Mora M, Galindo B, Holguín JP, Albarracín L. Cancer Biomarkers in Liquid Biopsy for Early Detection of Breast
Cancer: A Systematic Review. Clin Med Insights Oncol 2022; 16:11795549221134831. [PMCID: PMC9634213 DOI: 10.1177/11795549221134831] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Breast cancer (BC) is the most common neoplasm in women worldwide. Liquid
biopsy (LB) is a non-invasive diagnostic technique that allows the analysis
of biomarkers in different body fluids, particularly in peripheral blood and
also in urine, saliva, nipple discharge, volatile respiratory fluids, nasal
secretions, breast milk, and tears. The objective was to analyze the
available evidence related to the use of biomarkers obtained by LB for the
early diagnosis of BC. Methods: Articles related to the use of biomarkers for the early diagnosis of BC due
to LB, published between 2010 and 2022, from the databases (WoS, EMBASE,
PubMed, and SCOPUS) were included. The MInCir diagnostic scale was applied
in the articles to determine their methodological quality (MQ). Descriptive
statistics were used, as well as determination of weighted averages of each
variable, to analyze the extracted data. Sensitivity, specificity, and area
under the curve values for specific biomarkers (individual or in panels) are
described. Results: In this systematic review (SR), 136 articles met the selection criteria,
representing 17 709 patients with BC. However, 95.6% were case-control
studies. In 96.3% of cases, LB was performed in peripheral blood samples.
Most of the articles were based on microRNA (miRNA) analysis. The mean MQ
score was 25/45 points. Sensitivity, specificity, and area under the curve
values for specific biomarkers (individual or in panels) have been
found. Conclusions: The determination of biomarkers through LB is a useful mechanism for the
diagnosis of BC. The analysis of miRNA in peripheral blood is the most
studied methodology. Our results indicate that LB has a high sensitivity and
specificity for the diagnosis of BC, especially in early stages.
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Affiliation(s)
- Galo Duque
- Medical Sciences PhD Program,
Universidad de La Frontera, Temuco, Chile,Faculty of Medicine, Universidad del
Azuay, Cuenca, Ecuador,Galo Duque, Faculty of Medicine,
Universidad del Azuay. Postal address: Av. 24 de Mayo y Hernán Malo, Cuenca,
Ecuador 010107.
| | - Carlos Manterola
- Medical Sciences PhD Program,
Universidad de La Frontera, Temuco, Chile,Center of Excellence in Morphological
and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco, Chile
| | - Tamara Otzen
- Medical Sciences PhD Program,
Universidad de La Frontera, Temuco, Chile,Center of Excellence in Morphological
and Surgical Studies (CEMyQ), Universidad de La Frontera, Temuco, Chile
| | - Cristina Arias
- Faculty of Medicine, Universidad del
Azuay, Cuenca, Ecuador
| | | | - Miriann Mora
- Medical Sciences PhD Program,
Universidad de La Frontera, Temuco, Chile,Faculty of Medicine, Universidad del
Azuay, Cuenca, Ecuador
| | - Bryan Galindo
- Faculty of Medicine, Universidad del
Azuay, Cuenca, Ecuador
| | - Juan Pablo Holguín
- Medical Sciences PhD Program,
Universidad de La Frontera, Temuco, Chile,Faculty of Medicine, Universidad del
Azuay, Cuenca, Ecuador
| | - Lorena Albarracín
- Medical Sciences PhD Program,
Universidad de La Frontera, Temuco, Chile
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13
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Mighton C, Shickh S, Aguda V, Krishnapillai S, Adi-Wauran E, Bombard Y. From the patient to the population: Use of genomics for population screening. Front Genet 2022; 13:893832. [PMID: 36353115 PMCID: PMC9637971 DOI: 10.3389/fgene.2022.893832] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/26/2022] [Indexed: 10/22/2023] Open
Abstract
Genomic medicine is expanding from a focus on diagnosis at the patient level to prevention at the population level given the ongoing under-ascertainment of high-risk and actionable genetic conditions using current strategies, particularly hereditary breast and ovarian cancer (HBOC), Lynch Syndrome (LS) and familial hypercholesterolemia (FH). The availability of large-scale next-generation sequencing strategies and preventive options for these conditions makes it increasingly feasible to screen pre-symptomatic individuals through public health-based approaches, rather than restricting testing to high-risk groups. This raises anew, and with urgency, questions about the limits of screening as well as the moral authority and capacity to screen for genetic conditions at a population level. We aimed to answer some of these critical questions by using the WHO Wilson and Jungner criteria to guide a synthesis of current evidence on population genomic screening for HBOC, LS, and FH.
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Affiliation(s)
- Chloe Mighton
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Salma Shickh
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Vernie Aguda
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Suvetha Krishnapillai
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ella Adi-Wauran
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Yvonne Bombard
- Genomics Health Services Research Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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14
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Canet M, Harbron R, Thierry-Chef I, Cardis E. Cancer Effects of Low to Moderate Doses of Ionizing Radiation in Young People with Cancer-Predisposing Conditions: A Systematic Review. Cancer Epidemiol Biomarkers Prev 2022; 31:1871-1889. [PMID: 35861626 PMCID: PMC9530642 DOI: 10.1158/1055-9965.epi-22-0393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 01/07/2023] Open
Abstract
Moderate to high doses of ionizing radiation (IR) are known to increase the risk of cancer, particularly following childhood exposure. Concerns remain regarding risks from lower doses and the role of cancer-predisposing factors (CPF; genetic disorders, immunodeficiency, mutations/variants in DNA damage detection or repair genes) on radiation-induced cancer (RIC) risk. We conducted a systematic review of evidence that CPFs modify RIC risk in young people. Searches were performed in PubMed, Scopus, Web of Science, and EMBASE for epidemiologic studies of cancer risk in humans (<25 years) with a CPF, exposed to low-moderate IR. Risk of bias was considered. Fifteen articles focusing on leukemia, lymphoma, breast, brain, and thyroid cancers were included. We found inadequate evidence that CPFs modify the risk of radiation-induced leukemia, lymphoma, brain/central nervous system, and thyroid cancers and limited evidence that BRCA mutations modify radiation-induced breast cancer risk. Heterogeneity was observed across studies regarding exposure measures, and the numbers of subjects with CPFs other than BRCA mutations were very small. Further studies with more appropriate study designs are needed to elucidate the impact of CPFs on RIC. They should focus either on populations of carriers of specific gene mutations or on common susceptible variants using polygenic risk scores.
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Affiliation(s)
- Maelle Canet
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,University Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Richard Harbron
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,University Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Isabelle Thierry-Chef
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,University Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Elisabeth Cardis
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,University Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiologia y Salud Pública, Madrid, Spain.,Corresponding Author: Elisabeth Cardis, Institut de Salut Global de Barcelona - Campus MAR, Parc de Recerca Biomèdica de Barcelona (PRBB), Doctor Aiguader, 88, 08003 Barcelona, Spain. Phone: 349-3214-7312; E-mail:
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15
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Nakamura Y, Kubota J, Nishimura Y, Nagata K, Nishimura M, Daino K, Ishikawa A, Kaneko T, Mashimo T, Kokubo T, Takabatake M, Inoue K, Fukushi M, Arai M, Saito M, Shimada Y, Kakinuma S, Imaoka T.
Brca1
L63X
/+
rat is a novel model of human
BRCA1
deficiency displaying susceptibility to radiation‐induced mammary cancer. Cancer Sci 2022; 113:3362-3375. [PMID: 35851737 PMCID: PMC9530872 DOI: 10.1111/cas.15485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/14/2022] [Accepted: 07/03/2022] [Indexed: 11/30/2022] Open
Abstract
Women who are heterozygous for deleterious BRCA1 germline mutations harbor a high risk of hereditary breast cancer. Previous Brca1‐heterozygous animal models do not recapitulate the breast cancer phenotype, and thus all currently used knockout models adopt conditional, mammary‐specific homozygous Brca1 loss or addition of Trp53 deficiency. Herein, we report the creation and characterization of a novel Brca1 mutant rat model harboring the germline L63X mutation, which mimics a founder mutation in Japan, through CRISPR‐Cas9–based genome editing. Homozygotes (Brca1L63X/L63X) were embryonic lethal, whereas heterozygotes (Brca1L63X/+) showed apparently normal development. Without carcinogen exposure, heterozygotes developed mammary carcinoma at a comparable incidence rate with their wild‐type (WT) littermates during their lifetime. Intraperitoneal injection of 1‐methyl‐1‐nitrosourea (25 or 50 mg/kg) at 7 weeks of age induced mammary carcinogenesis at comparable levels among the heterozygotes and their littermates. After exposure to ionizing radiation (0.1–2 Gy) at 7 weeks of age, the heterozygotes, but not WT littermates, displayed dose‐dependent mammary carcinogenesis with 0.8 Gy−1 excess in hazard ratio during their middle age; the relative susceptibility of the heterozygotes was more prominent when rats were irradiated at 3 weeks of age. The heterozygotes had tumors with a lower estrogen receptor α immunopositivity and no evidence of somatic mutations of the WT allele. The Brca1L63X/+ rats thus offer the first single‐mutation, heterozygous model of BRCA1‐associated breast cancer, especially with exposure to a DNA break‐inducing carcinogen. This implies that such carcinogens are causative and a key to breast cancer prevention in individuals who carry high‐risk BRCA1 mutations.
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Affiliation(s)
- Yuzuki Nakamura
- Department of Radiation Effects Research National Institute of Radiological Sciences Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba 263‐8555 Japan
- Department of Radiological Sciences, Graduate School of Human Health Sciences Tokyo Metropolitan University 116‐8551 Tokyo Japan
| | - Jo Kubota
- Department of Radiation Effects Research National Institute of Radiological Sciences Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba 263‐8555 Japan
- Department of Radiological Sciences, Graduate School of Human Health Sciences Tokyo Metropolitan University 116‐8551 Tokyo Japan
| | - Yukiko Nishimura
- Department of Radiation Effects Research National Institute of Radiological Sciences Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba 263‐8555 Japan
| | - Kento Nagata
- Department of Radiation Effects Research National Institute of Radiological Sciences Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba 263‐8555 Japan
| | - Mayumi Nishimura
- Department of Radiation Effects Research National Institute of Radiological Sciences Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba 263‐8555 Japan
| | - Kazuhiro Daino
- Department of Radiation Effects Research National Institute of Radiological Sciences Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba 263‐8555 Japan
| | - Atsuko Ishikawa
- Department of Radiation Effects Research National Institute of Radiological Sciences Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba 263‐8555 Japan
| | - Takehito Kaneko
- Division of Fundamental and Applied Sciences, Graduate School of Science and Engineering Iwate University Morioka Japan
- Institute of Laboratory Animals, Graduate School of Medicine Kyoto University 606‐8303 Kyoto Japan
| | - Tomoji Mashimo
- Institute of Laboratory Animals, Graduate School of Medicine Kyoto University 606‐8303 Kyoto Japan
- Laboratory Animal Research Center, Institute of Medical Science The University of Tokyo 108‐8639 Tokyo Japan
| | - Toshiaki Kokubo
- Laboratory Animal and Genome Sciences Section, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology 263‐8555 Chiba Japan
| | - Masaru Takabatake
- Department of Radiation Effects Research National Institute of Radiological Sciences Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba 263‐8555 Japan
- Department of Radiological Sciences, Graduate School of Human Health Sciences Tokyo Metropolitan University 116‐8551 Tokyo Japan
| | - Kazumasa Inoue
- Department of Radiological Sciences, Graduate School of Human Health Sciences Tokyo Metropolitan University 116‐8551 Tokyo Japan
| | - Masahiro Fukushi
- Department of Radiological Sciences, Graduate School of Human Health Sciences Tokyo Metropolitan University 116‐8551 Tokyo Japan
| | - Masami Arai
- Department of Clinical Genetics, Graduate School of Medicine Juntendo University 113‐8421 Tokyo Japan
| | - Mitsue Saito
- Department of Breast Oncology, Graduate School of Medicine Juntendo University 113‐8421 Tokyo Japan
| | - Yoshiya Shimada
- Department of Radiation Effects Research National Institute of Radiological Sciences Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba 263‐8555 Japan
- Department of Radiological Sciences, Graduate School of Human Health Sciences Tokyo Metropolitan University 116‐8551 Tokyo Japan
| | - Shizuko Kakinuma
- Department of Radiation Effects Research National Institute of Radiological Sciences Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba 263‐8555 Japan
- Department of Radiological Sciences, Graduate School of Human Health Sciences Tokyo Metropolitan University 116‐8551 Tokyo Japan
| | - Tatsuhiko Imaoka
- Department of Radiation Effects Research National Institute of Radiological Sciences Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba 263‐8555 Japan
- Department of Radiological Sciences, Graduate School of Human Health Sciences Tokyo Metropolitan University 116‐8551 Tokyo Japan
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16
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An Overview on Radiation Sensitivity in Hereditary Breast and Ovarian Cancer Syndrome. Cancers (Basel) 2022; 14:cancers14133254. [PMID: 35805026 PMCID: PMC9265704 DOI: 10.3390/cancers14133254] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Individuals with hereditary breast and ovarian cancer (HBOC) syndrome are more likely to develop several types of cancer compared to the general population. They are regularly subjected to diagnostic exams and therapeutic options that use ionizing radiation, making it important to understand the effects that this can induce. Thus, several studies have been carried out to understand whether the exposure of individuals with HBOC to ionizing radiation may be associated with the onset of cancer. However, the results are inconsistent. Abstract Hereditary breast and ovarian cancer (HBOC) syndrome is a condition in which individuals have an increased risk of developing different types of cancer when compared to the general population. BRCA1 repair associated (BRCA1) and BRCA2 repair associated (BRCA2) genes are tumor suppressor genes that play a crucial role in cell, by repairing DNA damage. Mutations in these genes are responsible for 25% of HBOC cases. Individuals with this syndrome are often subjected to diagnostic imaging techniques, as well as therapeutic options, that use ionizing radiation, so it is crucial to understand whether these individuals may present higher radiosensitivity and, therefore, its consequences. Several studies have been carried out to understand if the exposure to different ionizing radiation doses can induce cancer in individuals with HBOC. Some of these studies have shown that individuals with HBOC are hypersensitive to the ionizing radiation and, therefore, have neoplasms resulting from mutations in genes that are important in maintaining genomic stability. When mutated, genes no longer guarantee this stability and promote the induction of carcinogenesis. Oppositely, other studies show that there is no association between exposure to ionizing radiation and an increased risk of developing cancer. Thus, the results are inconsistent, and there is a great need to clarify this relationship. In this review, we present the characteristics of HBOC syndrome and the effects that ionizing radiation can induce in individuals who have it. In addition, we review the studies that have already been carried out on this subject.
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17
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Maughan BC, Marin M, Han J, Gibbins KJ, Brixey AG, Caughey AB, Kline JA, Jarman AF. Venous Thromboembolism During Pregnancy and the Postpartum Period: Risk Factors, Diagnostic Testing, and Treatment. Obstet Gynecol Surv 2022; 77:433-444. [PMID: 35792687 PMCID: PMC10042329 DOI: 10.1097/ogx.0000000000001043] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance The risk of venous thromboembolism (VTE) increases during pregnancy and the postpartum period. Deep vein thrombosis is the most common VTE during pregnancy, but pulmonary embolism is typically of greater concern as it contributes to far higher morbidity and mortality. Diagnosis and treatment of VTE during pregnancy differ substantially from the general nonpregnant population. Objective This review describes the epidemiology, risk factors, clinical presentation, diagnosis, and treatment of VTE during pregnancy and the postpartum period. Evidence Acquisition First, we reviewed the VTE guidelines from professional societies in obstetrics, cardiology, hematology, emergency medicine, pulmonology, and critical care. Second, we examined references from these documents and used PubMed to identify recent articles that cited the guidelines. Finally, we searched PubMed and Google Scholar for articles published since 2018 that included terms for pregnancy and the epidemiology, risk factors, diagnostic imaging, or treatment of VTE. Results Venous thromboembolism risk increases throughout pregnancy and peaks shortly after delivery. More than half of pregnancy-related VTE are associated with thrombophilia; other major risks include cesarean delivery, postpartum infection, and the combination of obesity with immobilization. Most VTE can be treated with low molecular weight heparin, but cases of limb- or life-threatening VTE require consideration of thrombolysis and other reperfusion therapies. Conclusions and Relevance Venous thromboembolism is far more frequent in antepartum and postpartum women than age-matched controls, and clinical suspicion for VTE in this population should incorporate pregnancy-specific risks. Treatment of limb- or life-threatening antepartum or postpartum VTE requires multispecialty coordination to optimize maternal and fetal outcomes.
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Affiliation(s)
- Brandon C Maughan
- Assistant Professor, Department of Emergency Medicine, Oregon Health & Science University School of Medicine, Portland, OR
| | - Maria Marin
- Medical Student, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA
| | - Justin Han
- Medical Student, College of Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Karen J Gibbins
- Assistant Professor, Division of Perinatology, Department of Obstetrics and Gynecology
| | - Anupama G Brixey
- Assistant Professor, Section of Cardiothoracic Imaging, Department of Diagnostic Radiology
| | - Aaron B Caughey
- Professor and Chair, Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, OR
| | - Jeffrey A Kline
- Professor and Associate Chair of Research, Department of Emergency Medicine, Wayne State University, Detroit, MI
| | - Angela F Jarman
- Assistant Professor, Department of Emergency Medicine, University of California Davis, Davis, CA
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18
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Priyadarshini P, Sarath S, Hemavathy V. Breast cancer awareness package on knowledge, attitude and practice towards breast self examination to prevent breast cancer among women in adopted communities – a pilot analysis. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.22.471483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Breast health is extremely important for all women. However, the breast is another region of the human body that is susceptible to cancer. Breast cancer is becoming increasingly common these days, and it is now one of the leading causes of mortality globally. According to the World Health Organization, breast cancer is the most common disease among women worldwide, claiming the lives of hundreds of thousands of women each year and impacting nations at all stages of development. In fact, it is the most common cancer in women, with a significant incidence observed among those aged 30 to 50. The goal of the World Health Organization’s Worldwide Breast Cancer Initiative (GBCI) is to reduce global breast cancer mortality by 2.5 percent each year; As a result, 2.5 million breast cancer deaths will be avoided globally between 2020 and 2040. To achieve these goals, three pillars must be in place: health endorsement for early detection, suitable identification at the right time, and comprehensive breast cancer management. Because of advances in early detection and care, the incidence of women dying of breast cancer has decreased by 41% from 1989 to 2018. During that time, more than 403,000 breast cancer deaths were prevented.
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19
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GATE/GEANT4 simulation of radiation risk induced cancer from mammographic screening. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2021.109929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Radiation Dose of Contrast-Enhanced Mammography: A Two-Center Prospective Comparison. Cancers (Basel) 2022; 14:cancers14071774. [PMID: 35406546 PMCID: PMC8997084 DOI: 10.3390/cancers14071774] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
The radiation dose associated with contrast-enhanced mammography (CEM) has been investigated only by single-center studies. In this retrospective study, we aimed to compare the radiation dose between two centers performing CEM within two prospective studies, using the same type of equipment. The CEM mean glandular dose (MGD) was computed for low energy (LE) and high energy (HE) images and their sum was calculated for each view. MGD and related parameters (entrance dose, breast thickness, compression, and density) were compared between the two centers using the Mann−Whitney test. Finally, per-patient MGD was calculated by pooling the two datasets and determining the contribution of LE and HE images. A total of 348 CEM examinations were analyzed (228 from Center 1 and 120 from Center 2). The median total MGD per view was 2.33 mGy (interquartile range 2.19−2.51 mGy) at Center 1 and 2.46 mGy (interquartile range 2.32−2.70 mGy) at Center 2, with a 0.15 mGy median difference (p < 0.001) equal to 6.2%. LE-images contributed between 64% and 77% to the total patient dose in CEM, with the remaining 23−36% being associated with HE images. The mean radiation dose for a two-view bilateral CEM exam was 4.90 mGy, about 30% higher than for digital mammography.
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21
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Devic C, Bodgi L, Sonzogni L, Pilleul F, Ribot H, Charry CD, Le Moigne F, Paul D, Carbillet F, Munier M, Foray N. Influence of cellular models and individual factor in the biological response to chest CT scan exams. Eur Radiol Exp 2022; 6:14. [PMID: 35301607 PMCID: PMC8931147 DOI: 10.1186/s41747-022-00266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background While computed tomography (CT) exams are the major cause of medical exposure to ionising radiation, there is increasing evidence that the potential radiation-induced risks must be documented. We investigated the impact of cellular models and individual factor on the deoxyribonucleic acid double-strand breaks (DSB) recognition and repair in human fibroblasts and mammary epithelial cells exposed to current chest CT scan conditions. Method Twelve human primary fibroblasts and four primary human mammary epithelial cell lines with different levels of radiosensitivity/susceptibility were exposed to a standard chest CT scan exam using adapted phantoms. Cells were exposed to a single helical irradiation (14.4 mGy) or to a topogram followed, after 1 min, by one single helical examination (1.1 mGy + 14.4 mGy). DSB signalling and repair was assessed through anti-γH2AX and anti-pATM immunofluorescence. Results Chest CT scan induced a significant number of γH2AX and pATM foci. The kinetics of both biomarkers were found strongly dependent on the individual factor. The topogram may also influence the biological response of radiosensitive/susceptible fibroblasts to irradiation. Altogether, our findings show that a chest CT scan exam may result in 2 to 3 times more unrepaired DSB in cells from radiosensitive/susceptible patients. Conclusions Both individual and tissue factors in the recognition and repair of DSB after current CT scan exams are important. Further investigations are needed to better define the radiosensitivity/susceptibility of individual humans. Supplementary Information The online version contains supplementary material available at 10.1186/s41747-022-00266-0.
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Affiliation(s)
- Clément Devic
- Institut National de la Santé et de la Recherche Médicale, U1296, « Radiations: Defense, Health and Environment », Bât Cheney A 28 Rue Laennec Centre Léon-Bérard, 69008, Lyon, France.,Fibermetrix™ SAS, 7 Allée de l'Europe, 67960, Entzheim, France
| | - Larry Bodgi
- Radiation Oncology Department, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon
| | - Laurène Sonzogni
- Institut National de la Santé et de la Recherche Médicale, U1296, « Radiations: Defense, Health and Environment », Bât Cheney A 28 Rue Laennec Centre Léon-Bérard, 69008, Lyon, France
| | - Frank Pilleul
- Département de Radiologie, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France
| | - Hervé Ribot
- Service de Radiologie, Hôpital d'Instruction des Armées « Desgenettes », Boulevard Pinel, 69003, Lyon, France
| | - Charlotte De Charry
- Service de Radiologie, Hôpital d'Instruction des Armées « Desgenettes », Boulevard Pinel, 69003, Lyon, France
| | - François Le Moigne
- Service de Radiologie, Hôpital d'Instruction des Armées « Desgenettes », Boulevard Pinel, 69003, Lyon, France
| | - Didier Paul
- Institut National de la Santé et de la Recherche Médicale, U1296, « Radiations: Defense, Health and Environment », Bât Cheney A 28 Rue Laennec Centre Léon-Bérard, 69008, Lyon, France
| | - Fanny Carbillet
- Institut National de la Santé et de la Recherche Médicale, U1296, « Radiations: Defense, Health and Environment », Bât Cheney A 28 Rue Laennec Centre Léon-Bérard, 69008, Lyon, France.,ALARA Expertise SAS, 7 Allée de l'Europe, 67960, Entzheim, France
| | - Mélodie Munier
- Institut National de la Santé et de la Recherche Médicale, U1296, « Radiations: Defense, Health and Environment », Bât Cheney A 28 Rue Laennec Centre Léon-Bérard, 69008, Lyon, France.,Fibermetrix™ SAS, 7 Allée de l'Europe, 67960, Entzheim, France
| | - Nicolas Foray
- Institut National de la Santé et de la Recherche Médicale, U1296, « Radiations: Defense, Health and Environment », Bât Cheney A 28 Rue Laennec Centre Léon-Bérard, 69008, Lyon, France.
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22
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BRCA 1–2 Incidence in Synchronous and Metachronous Breast Cancer: a Tertiary Center Study. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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23
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Lyons MJ, Fernandez Poole S, Brownson RC, Lyn R. Place Is Power: Investing in Communities as a Systemic Leverage Point to Reduce Breast Cancer Disparities by Race. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020632. [PMID: 35055453 PMCID: PMC8775540 DOI: 10.3390/ijerph19020632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 02/01/2023]
Abstract
Racial disparities in breast cancer present a vexing and complex challenge for public health. A diverse array of factors contributes to disparities in breast cancer incidence and outcomes, and, thus far, efforts to improve racial equity have yielded mixed results. Systems theory offers a model that is well-suited to addressing complex issues. In particular, the concept of a systemic leverage point offers a clue that may assist researchers, policymakers, and interventionists in formulating innovative and comprehensive approaches to eliminating racial disparities in breast cancer. Naming systemic racism as a fundamental cause of disparities, we use systems theory to identify residential segregation as a key leverage point and a driver of racial inequities across the social, economic, and environmental determinants of health. We call on researchers, policymakers, and interventionists to use a systems-informed, community-based participatory approach, aimed at harnessing the power of place, to engage directly with community stakeholders in coordinating efforts to prevent breast cancer, and work toward eliminating disparities in communities of color.
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Affiliation(s)
- Matthew Jay Lyons
- WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, GA 30144, USA;
| | - Senaida Fernandez Poole
- Office of the President, California Breast Cancer Research Program, University of California, Oakland, CA 94607, USA;
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA;
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University, St. Louis, MO 63110, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rodney Lyn
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
- Correspondence: ; Tel.: +1-(404)-413-1133
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24
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Yoshida R. Hereditary breast and ovarian cancer (HBOC): review of its molecular characteristics, screening, treatment, and prognosis. Breast Cancer 2021; 28:1167-1180. [PMID: 32862296 PMCID: PMC8514387 DOI: 10.1007/s12282-020-01148-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022]
Abstract
Breast cancer is a common cancer affecting a large number of patients. Notably, 5-10% of all breast cancer patients are genetically predisposed to cancers. Although the most common breast cancer susceptibility genes are BRCA1 and BRCA2, which are also associated with the risk of developing ovarian and pancreatic cancer, advances in next-generation sequencing (NGS) analysis technology enabled the discovery of several non-BRCA genes responsible for breast and ovarian cancers. Studies on hereditary breast and ovarian cancer (HBOC) involve not only determining the predisposition to developing cancer, but also considering the current treatment for breast cancer, prevention of next cancer, risk diagnosis, and adoption of protective measures for relatives. We present a comprehensive review of HBOC, which will be a useful resource in the clinical setting. Many hereditary tumors, including HBOC, are syndromes characterized by the development of different types of cancer in succession. Taking advantage of knowing predisposition of susceptibility to cancer, it is important to continue and update cancer management protocols, which includes the adoption of preventive measures, countermeasures, and treatments, to accurately assess and prevent the impact of cancer on the quality of life of the next generation of patients.
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Affiliation(s)
- Reiko Yoshida
- Showa University Advanced Cancer Translational Research Institute, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
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25
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Zhu Y, O'Connell AM, Ma Y, Liu A, Li H, Zhang Y, Zhang X, Ye Z. Dedicated breast CT: state of the art-Part II. Clinical application and future outlook. Eur Radiol 2021; 32:2286-2300. [PMID: 34476564 DOI: 10.1007/s00330-021-08178-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/19/2021] [Accepted: 06/29/2021] [Indexed: 12/17/2022]
Abstract
Dedicated breast CT is being increasingly used for breast imaging. This technique provides images with no compression, removal of tissue overlap, rapid acquisition, and available simultaneous assessment of microcalcifications and contrast enhancement. In this second installment in a 2-part review, the current status of clinical applications and ongoing efforts to develop new imaging systems are discussed, with particular emphasis on how to achieve optimized practice including lesion detection and characterization, response to therapy monitoring, density assessment, intervention, and implant evaluation. The potential for future screening with breast CT is also addressed. KEY POINTS: • Dedicated breast CT is an emerging modality with enormous potential in the future of breast imaging by addressing numerous clinical needs from diagnosis to treatment. • Breast CT shows either noninferiority or superiority with mammography and numerical comparability to MRI after contrast administration in diagnostic statistics, demonstrates excellent performance in lesion characterization, density assessment, and intervention, and exhibits promise in implant evaluation, while potential application to breast cancer screening is still controversial. • New imaging modalities such as phase-contrast breast CT, spectral breast CT, and hybrid imaging are in the progress of R & D.
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Affiliation(s)
- Yueqiang Zhu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, 300060, Tianjin, China
| | - Avice M O'Connell
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY, 14642, USA
| | - Yue Ma
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, 300060, Tianjin, China
| | - Aidi Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, 300060, Tianjin, China
| | - Haijie Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, 300060, Tianjin, China
| | - Yuwei Zhang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, 300060, Tianjin, China
| | - Xiaohua Zhang
- Koning Corporation, Lennox Tech Enterprise Center, 150 Lucius Gordon Drive, Suite 112, West Henrietta, NY, 14586, USA
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, 300060, Tianjin, China.
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26
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Ribeiro Guerra M, Coignard J, Eon-Marchais S, Dondon MG, Le Gal D, Beauvallet J, Mebirouk N, Belotti M, Caron O, Gauthier-Villars M, Coupier I, Buecher B, Lortholary A, Fricker JP, Gesta P, Noguès C, Faivre L, Berthet P, Luporsi E, Delnatte C, Bonadona V, Maugard CM, Pujol P, Lasset C, Longy M, Bignon YJ, Adenis-Lavignasse C, Venat-Bouvet L, Dreyfus H, Gladieff L, Mortemousque I, Audebert-Bellanger S, Soubrier F, Giraud S, Lejeune-Dumoulin S, Limacher JM, Chiesa J, Fajac A, Floquet A, Eisinger F, Tinat J, Fert-Ferrer S, Colas C, Frebourg T, Damiola F, Barjhoux L, Cavaciuti E, Mazoyer S, Tardivon A, Lesueur F, Stoppa-Lyonnet D, Andrieu N. Diagnostic chest X-rays and breast cancer risk among women with a hereditary predisposition to breast cancer unexplained by a BRCA1 or BRCA2 mutation. Breast Cancer Res 2021; 23:79. [PMID: 34344426 PMCID: PMC8336294 DOI: 10.1186/s13058-021-01456-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background Diagnostic ionizing radiation is a risk factor for breast cancer (BC). BC risk increases with increased dose to the chest and decreases with increased age at exposure, with possible effect modification related to familial or genetic predisposition. While chest X-rays increase the BC risk of BRCA1/2 mutation carriers compared to non-carriers, little is known for women with a hereditary predisposition to BC but who tested negative for a BRCA1 or BRCA2 (BRCA1/2) mutation. Methods We evaluated the effect of chest X-rays from diagnostic medical procedures in a dataset composed of 1552 BC cases identified through French family cancer clinics and 1363 unrelated controls. Participants reported their history of X-ray exposures in a detailed questionnaire and were tested for 113 DNA repair genes. Logistic regression and multinomial logistic regression models were used to assess the association with BC. Results Chest X-ray exposure doubled BC risk. A 3% increased BC risk per additional exposure was observed. Being 20 years old or younger at first exposure or being exposed before first full-term pregnancy did not seem to modify this risk. Birth after 1960 or carrying a rare likely deleterious coding variant in a DNA repair gene other than BRCA1/2 modified the effect of chest X-ray exposure. Conclusion Ever/never chest X-ray exposure increases BC risk 2-fold regardless of age at first exposure and, by up to 5-fold when carrying 3 or more rare variants in a DNA repair gene. Further studies are needed to evaluate other DNA repair genes or variants to identify those which could modify radiation sensitivity. Identification of subpopulations that are more or less susceptible to ionizing radiation is important and potentially clinically relevant. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-021-01456-1.
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Affiliation(s)
- Maximiliano Ribeiro Guerra
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France.,Department of Public Health, Faculty of Medicine, Federal University of Juiz de Fora - UFJF, Minas Gerais, Brazil
| | - Juliette Coignard
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Séverine Eon-Marchais
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Marie-Gabrielle Dondon
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Dorothée Le Gal
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Juana Beauvallet
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Noura Mebirouk
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | | | - Olivier Caron
- Gustave Roussy, Département de Médecine Oncologique, Université Paris-Saclay, Villejuif, France
| | | | - Isabelle Coupier
- Hôpital Arnaud de Villeneuve, CHU Montpellier, Service de Génétique Médicale et Oncogénétique, Montpellier, France.,INSERM 896, CRCM Val d'Aurelle, Montpellier, France
| | | | - Alain Lortholary
- Centre Catherine de Sienne, Service d'Oncologie Médicale, Nantes, France
| | | | - Paul Gesta
- CH Georges Renon, Service d'Oncogénétique Régional Poitou-Charentes, Niort, France
| | - Catherine Noguès
- Département d'Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli Calmettes, Marseille, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - Laurence Faivre
- Institut GIMI, CHU de Dijon, Hôpital d'Enfants, Dijon, France.,Centre de Lutte contre le Cancer Georges François Leclerc, Dijon, France
| | - Pascaline Berthet
- Centre François Baclesse, Unité de pathologie gynécologique, Caen, France
| | - Elisabeth Luporsi
- Service de Génétique UF4128 CHR Metz-Thionville, Hôpital de Mercy, Metz, France
| | - Capucine Delnatte
- Centre René Gauducheau, Unité d'Oncogénétique, Nantes, Saint Herblain, France
| | - Valérie Bonadona
- Université Claude Bernard Lyon 1, Villeurbanne, France.,CNRS UMR 5558, Lyon, France.,Centre Léon Bérard, Unité de Prévention et Epidémiologie Génétique, Lyon, France
| | - Christine M Maugard
- Génétique Oncologique moléculaire, UF1422, Département d'Oncobiologie, LBBM, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,UF6948 Génétique Oncologique Clinique, Evaluation familiale et suivi, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pascal Pujol
- Hôpital Arnaud de Villeneuve, CHU Montpellier, Service de Génétique Médicale et Oncogénétique, Montpellier, France.,INSERM 896, CRCM Val d'Aurelle, Montpellier, France
| | - Christine Lasset
- Université Claude Bernard Lyon 1, Villeurbanne, France.,CNRS UMR 5558, Lyon, France.,Centre Léon Bérard, Unité de Prévention et Epidémiologie Génétique, Lyon, France
| | | | - Yves-Jean Bignon
- Département d'oncogénétique, Centre Jean Perrin, Université Clermont Auvergne, UMR INSERM 1240, Clermont Ferrand, France
| | | | | | - Hélène Dreyfus
- Clinique Sainte Catherine, Avignon, France.,Hôpital Couple-Enfant, Département de Génétique, CHU de Grenoble, Grenoble, France
| | - Laurence Gladieff
- Institut Claudius Regaud - IUCT-Oncopole, Service d'Oncologie Médicale, Toulouse, France
| | | | | | | | - Sophie Giraud
- Hospices Civils de Lyon, Service de Génétique, Groupement Hospitalier EST, Bron, France
| | | | | | - Jean Chiesa
- Service d'Oncologie Médicale, CHRU Hôpital Caremeau, Nîmes, France
| | - Anne Fajac
- Service d'Oncogénétique, Hôpital Tenon, Paris, France
| | | | - François Eisinger
- Département d'Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli Calmettes, Marseille, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - Julie Tinat
- Groupe Hospitalier Pellegrin, Service de génétique médicale, CHU De Bordeaux, Bordeaux, France
| | | | - Chrystelle Colas
- Institut Curie, Service de Génétique, Paris, France.,Institut Curie, Hopital René Huguenin, Saint-Cloud, France
| | - Thierry Frebourg
- Département de Génétique, Hopital Universitaire de Rouen, Rouen, France
| | - Francesca Damiola
- Department of Biopathology, Pathology Research platform, Centre Léon Bérard, Lyon, France
| | - Laure Barjhoux
- GCS AURAGEN, Plateforme de Génétique, Hôpital Edouart Herriot, Lyon, France
| | - Eve Cavaciuti
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Sylvie Mazoyer
- Centre de Recherche en Neurosciences de Lyon, INSERM U1028, CNRS UMR5292, Université Lyon 1, Université Saint Etienne, Lyon, France
| | - Anne Tardivon
- Service de Radiologie, Institut Curie, Paris, France
| | - Fabienne Lesueur
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Dominique Stoppa-Lyonnet
- Institut Curie, Service de Génétique, Paris, France.,INSERM, U830, Paris, France.,Université Paris-Descartes, Paris, France
| | - Nadine Andrieu
- INSERM, U900, Paris, France. .,Institut Curie, Paris, France. .,Mines ParisTech, Fontainebleau, France. .,PSL Research University, Paris, France.
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27
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Wang LJ, Wong YC, Hwang YS, Pang ST, Chuang CK, Chang YH. Split-bolus computed tomography urography (CTU) achieves more than half of radiation dose reduction in females and overweight patients than conventional single-bolus computed tomography urography. Transl Oncol 2021; 14:101151. [PMID: 34111709 PMCID: PMC8193142 DOI: 10.1016/j.tranon.2021.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/06/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare radiation dose between single-bolus and split-bolus computed tomography urography (CTU). MATERIALS AND METHODS We prospectively enrolled patients undergoing single-bolus and split-bolus CTU from 2019 June to 2020 June. The age, sex and body mass index (BMI) of each patient was recorded and categorized into BMI classes. The radiation dose indices including volumetric computed dose index, size-specific dose estimate, dose length product and effective dose of each patient were compared between 2 CTU groups with calculation of dose reduction proportions (DRPs). RESULTS Seventy-six patients underwent single-bolus (n = 39) and split-bolus (n = 37) CTU. Single-bolus CTU had higher radiation doses than split-bolus CTU and there were statistically significant differences of all radiation dose indices between two CTU groups without and with stratification by sex and BMI classes. The DRPs of volumetric computed dose index, size-specific dose estimate, dose length product and effective dose using split-bolus CTU were 49%, 49%. 50%, and 45%, respectively. Multiple linear regression with an effect size (f2) as 2.24 showed females (p = 0.027) and higher BMI classes (p = 2.38 *10-9) were associated with higher effective doses; and split-bolus CTU, lower effective doses (p = 5.40 *10-15). Using split-bolus CTU, females had consistently higher DRP of all radiation dose indices than males (54-55% versus 40-42%). Overweight patients had the largest DRP as 55% of effective dose. CONCLUSIONS Split-bolus CTU could be preferred by its significant radiation dose reduction effect in regard to single-bolus CTU, which was most profound in females and overweight patients.
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Affiliation(s)
- Li-Jen Wang
- Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, Chang Gung Medical foundation, New Taipei City, Tucheng District, No. 6, Section 2, Jincheng Road, Taiwan; Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Yon-Cheong Wong
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Shuan Hwang
- Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, Chang Gung Medical foundation, New Taipei City, Tucheng District, No. 6, Section 2, Jincheng Road, Taiwan; Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - See-Tong Pang
- Department of Urology, Linkou Chang Gung Memorial Hospital, College of Medicine, Taoyuan, Taiwan
| | - Cheng-Keng Chuang
- Department of Urology, Linkou Chang Gung Memorial Hospital, College of Medicine, Taoyuan, Taiwan
| | - Ying-Hsu Chang
- Department of Urology, Linkou Chang Gung Memorial Hospital, College of Medicine, Taoyuan, Taiwan; Department of Urology, New Taipei Municipal Tucheng Hospital, Chang Gung Medical foundation, New Taipei City, Taiwan
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28
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Jiao Y, Lesueur F, Azencott CA, Laurent M, Mebirouk N, Laborde L, Beauvallet J, Dondon MG, Eon-Marchais S, Laugé A, Noguès C, Andrieu N, Stoppa-Lyonnet D, Caputo SM. A new hybrid record linkage process to make epidemiological databases interoperable: application to the GEMO and GENEPSO studies involving BRCA1 and BRCA2 mutation carriers. BMC Med Res Methodol 2021; 21:155. [PMID: 34325649 PMCID: PMC8320036 DOI: 10.1186/s12874-021-01299-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Linking independent sources of data describing the same individuals enable innovative epidemiological and health studies but require a robust record linkage approach. We describe a hybrid record linkage process to link databases from two independent ongoing French national studies, GEMO (Genetic Modifiers of BRCA1 and BRCA2), which focuses on the identification of genetic factors modifying cancer risk of BRCA1 and BRCA2 mutation carriers, and GENEPSO (prospective cohort of BRCAx mutation carriers), which focuses on environmental and lifestyle risk factors. METHODS To identify as many as possible of the individuals participating in the two studies but not registered by a shared identifier, we combined probabilistic record linkage (PRL) and supervised machine learning (ML). This approach (named "PRL + ML") combined together the candidate matches identified by both approaches. We built the ML model using the gold standard on a first version of the two databases as a training dataset. This gold standard was obtained from PRL-derived matches verified by an exhaustive manual review. Results The Random Forest (RF) algorithm showed a highest recall (0.985) among six widely used ML algorithms: RF, Bagged trees, AdaBoost, Support Vector Machine, Neural Network. Therefore, RF was selected to build the ML model since our goal was to identify the maximum number of true matches. Our combined linkage PRL + ML showed a higher recall (range 0.988-0.992) than either PRL (range 0.916-0.991) or ML (0.981) alone. It identified 1995 individuals participating in both GEMO (6375 participants) and GENEPSO (4925 participants). CONCLUSIONS Our hybrid linkage process represents an efficient tool for linking GEMO and GENEPSO. It may be generalizable to other epidemiological studies involving other databases and registries.
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Affiliation(s)
- Yue Jiao
- Department of Genetics, Institut Curie, PSL Research University, Paris, France.,Inserm, U900, Paris, France.,Institut Curie, PSL Research University, Mines ParisTech, Paris, France
| | - Fabienne Lesueur
- Inserm, U900, Paris, France.,Institut Curie, PSL Research University, Mines ParisTech, Paris, France
| | - Chloé-Agathe Azencott
- Inserm, U900, Paris, France.,Mines ParisTech, PSL Research University, CBIO-Centre for Computational Biology, Paris, France
| | - Maïté Laurent
- Department of Genetics, Institut Curie, PSL Research University, Paris, France
| | - Noura Mebirouk
- Inserm, U900, Paris, France.,Institut Curie, PSL Research University, Mines ParisTech, Paris, France
| | - Lilian Laborde
- Institut Paoli-Calmettes, Centre de Traitement des Données IPC-PACA, Département de la Recherche Clinique et de l'Innovation, Marseille, France
| | - Juana Beauvallet
- Inserm, U900, Paris, France.,Institut Curie, PSL Research University, Mines ParisTech, Paris, France
| | - Marie-Gabrielle Dondon
- Inserm, U900, Paris, France.,Institut Curie, PSL Research University, Mines ParisTech, Paris, France
| | - Séverine Eon-Marchais
- Inserm, U900, Paris, France.,Institut Curie, PSL Research University, Mines ParisTech, Paris, France
| | - Anthony Laugé
- Department of Genetics, Institut Curie, PSL Research University, Paris, France
| | | | | | - Catherine Noguès
- Institut Paoli-Calmettes, Département d'Anticipation et de Suivi du Cancer, Oncogénétique clinique, Marseille France Inserm, U830, Université Paris Descartes, Paris, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Nadine Andrieu
- Inserm, U900, Paris, France.,Institut Curie, PSL Research University, Mines ParisTech, Paris, France
| | - Dominique Stoppa-Lyonnet
- Department of Genetics, Institut Curie, PSL Research University, Paris, France.,Paris University, Paris, France.,Inserm, U830, Paris, France
| | - Sandrine M Caputo
- Department of Genetics, Institut Curie, PSL Research University, Paris, France.
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Musey PI, Bellolio F, Upadhye S, Chang AM, Diercks DB, Gottlieb M, Hess EP, Kontos MC, Mumma BE, Probst MA, Stahl JH, Stopyra JP, Kline JA, Carpenter CR. Guidelines for reasonable and appropriate care in the emergency department (GRACE): Recurrent, low-risk chest pain in the emergency department. Acad Emerg Med 2021; 28:718-744. [PMID: 34228849 DOI: 10.1111/acem.14296] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/21/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022]
Abstract
This first Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE-1) from the Society for Academic Emergency Medicine is on the topic: Recurrent, Low-risk Chest Pain in the Emergency Department. The multidisciplinary guideline panel used The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding eight priority questions for adult patients with recurrent, low-risk chest pain and have derived the following evidence based recommendations: (1) for those >3 h chest pain duration we suggest a single, high-sensitivity troponin below a validated threshold to reasonably exclude acute coronary syndrome (ACS) within 30 days; (2) for those with a normal stress test within the previous 12 months, we do not recommend repeat routine stress testing as a means to decrease rates of major adverse cardiac events at 30 days; (3) insufficient evidence to recommend hospitalization (either standard inpatient admission or observation stay) versus discharge as a strategy to mitigate major adverse cardiac events within 30 days; (4) for those with non-obstructive (<50% stenosis) coronary artery disease (CAD) on prior angiography within 5 years, we suggest referral for expedited outpatient testing as warranted rather than admission for inpatient evaluation; (5) for those with no occlusive CAD (0% stenosis) on prior angiography within 5 years, we recommend referral for expedited outpatient testing as warranted rather than admission for inpatient evaluation; (6) for those with a prior coronary computed tomographic angiography within the past 2 years with no coronary stenosis, we suggest no further diagnostic testing other than a single, normal high-sensitivity troponin below a validated threshold to exclude ACS within that 2 year time frame; (7) we suggest the use of depression and anxiety screening tools as these might have an effect on healthcare use and return emergency department (ED) visits; and (8) we suggest referral for anxiety or depression management, as this might have an impact on healthcare use and return ED visits.
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Affiliation(s)
- Paul I. Musey
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN USA
| | | | - Suneel Upadhye
- Division of Emergency Medicine McMaster University Hamilton Canada
| | - Anna Marie Chang
- Department of Emergency Medicine Thomas Jefferson University Philadelphia PA USA
| | - Deborah B. Diercks
- Department of Emergency Medicine UT Southwestern Medical Center Dallas TX USA
| | - Michael Gottlieb
- Department of Emergency Medicine Rush Medical Center Chicago IL USA
| | - Erik P. Hess
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN USA
| | - Michael C. Kontos
- Department of Internal Medicine Virginia Commonwealth University Richmond VA USA
| | - Bryn E. Mumma
- Department of Emergency Medicine UC Davis School of Medicine Sacramento CA USA
| | - Marc A. Probst
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York NY USA
| | | | - Jason P. Stopyra
- Department of Emergency Medicine Wake Forest School of Medicine Winston‐SalemNC USA
| | - Jeffrey A. Kline
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN USA
| | - Christopher R. Carpenter
- Department of Emergency Medicine and Emergency Care Research Core Washington University School of Medicine St. Louis MO USA
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30
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Lazzari G, Buono G, Zannino B, Silvano G. Breast Cancer Adjuvant Radiotherapy in BRCA1/2, TP53, ATM Genes Mutations: Are There Solved Issues? BREAST CANCER-TARGETS AND THERAPY 2021; 13:299-310. [PMID: 34012291 PMCID: PMC8126701 DOI: 10.2147/bctt.s306075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/21/2021] [Indexed: 01/08/2023]
Abstract
BRCA1, BRCA2, TP53 and ATM gene mutations are the most studied tumour suppressor genes (TSGs) influencing the loco-regional approach to breast cancer (BC). Due to altered radio sensitivity of mutated cancer cells, mastectomy has always been advised in most patients with BC linked to TSGs mutations in order to avoid or minimize the use of adjuvant radiotherapy (ART). Whether ART is safe or not in these carriers is still debated. As a result, this issue has been widely discussed in the recent ASTRO and ASCO papers, yielding important and useful recommendations on the use of ART according to the mutational status. In this review, we have highlighted the impact of these mutations on local control, toxicities, second tumors, and contralateral breast cancers (CBCs) after ART to solve remaining doubts and encourage the safe use of ART when indicated.
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Affiliation(s)
- Grazia Lazzari
- Radiation Oncology Unit, San Giuseppe Moscati Hospital, Taranto, 74100, Italy
| | - Giuseppe Buono
- Medical Oncology Unit, San Rocco Hospital, Sessa Aurunca, Caserta, 81037, Italy
| | - Benedetto Zannino
- Medical Oncology Unit, San Rocco Hospital, Sessa Aurunca, Caserta, 81037, Italy
| | - Giovanni Silvano
- Radiation Oncology Unit, San Giuseppe Moscati Hospital, Taranto, 74100, Italy
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31
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Cai Y, Li J, Gao Y, Yang K, He J, Li N, Tian J. A systematic review of recommendations on screening strategies for breast cancer due to hereditary predisposition: Who, When, and How? Cancer Med 2021; 10:3437-3448. [PMID: 33932123 PMCID: PMC8124106 DOI: 10.1002/cam4.3898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/27/2021] [Accepted: 02/27/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Breast cancer is a global health problem that cannot be underestimated. Many studies have shown that breast cancer is related to pathogenic mutations in hereditary predisposition genes. Clinical practice guidelines play a vital role in guiding the selection of breast cancer screening. Little is known about the quality and consistency of guidelines' recommendations and their changes over these years. METHODS We reviewed the existing screening guidelines for genetic susceptibility to breast cancer and assessed the methodological quality, and summarized the recommendations to aid clinicians to make decisions. We conducted a systematic search in PubMed, Embase, Web of Science, and guideline-specific databases, aiming to find the guidelines of breast cancer due to hereditary predisposition. The necessary information was exacted by Excel. We also summarized different evidence grading systems. The qualities of the guidelines were assessed by the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument. RESULTS A total of 54 recommendations from 13 guidelines were extracted. Generally speaking, the recommendations were consistent, mainly focusing on mammography and MRI. CONCLUSIONS The recommendations differ in details. Moreover, different guidelines are based on different grading systems, and some guidelines are not divided for age limits, which may limit the promotion and implementation of the guidelines. It is suggested that improvement can be made in this regard in the future.
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Affiliation(s)
- Yitong Cai
- Evidence‐Based CenterLanzhou UniversityLanzhouChina
| | - Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ya Gao
- Evidence‐Based Medicine CenterSchool of Basic Medical SciencesLanzhou UniversityLanzhouChina
| | - Kelu Yang
- Evidence‐Based CenterLanzhou UniversityLanzhouChina
| | - Jie He
- National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ni Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jinhui Tian
- Evidence‐Based Medicine CenterSchool of Basic Medical SciencesLanzhou UniversityLanzhouChina
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32
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Eskreis-Winkler S, Simon K, Reichman M, Spincemaille P, Nguyen TD, Christos PJ, Drotman M, Prince MR, Pinker K, Sutton EJ, Morris EA, Wang Y. Multispectral Imaging for Metallic Biopsy Marker Detection During MRI-Guided Breast Biopsy: A Feasibility Study for Clinical Translation. Front Oncol 2021; 11:605014. [PMID: 33828972 PMCID: PMC8020905 DOI: 10.3389/fonc.2021.605014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/04/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the feasibility and diagnostic accuracy of multispectral MRI (MSI) in the detection and localization of biopsy markers during MRI-guided breast biopsy. Methods This prospective study included 20 patients undergoing MR-guided breast biopsy. In 10 patients (Group 1), MSI was acquired following tissue sampling and biopsy marker deployment. In the other 10 patients (Group 2), MSI was acquired following tissue sampling but before biopsy marker deployment (to simulate deployment failure). All patients received post-procedure mammograms. Group 1 and Group 2 designations, in combination with the post-procedure mammogram, served as the reference standard. The diagnostic performance of MSI for biopsy marker identification was independently evaluated by two readers using two-spectral-bin MR and one-spectral-bin MR. The κ statistic was used to assess inter-rater agreement for biopsy marker identification. Results The sensitivity, specificity, and accuracy of biopsy marker detection for readers 1 and 2 using 2-bin MSI were 90.0% (9/10) and 90.0% (9/10), 100.0% (10/10) and 100.0% (10/10), 95.0% (19/20) and 95.0% (19/20); and using 1-bin MSI were 70.0% (7/10) and 80.0% (8/10), 100.0% (8/8) and 100.0% (10/10), 85.0% (17/20) and 90.0% (18/20). Positive predictive value was 100% for both readers for all numbers of bins. Inter-rater agreement was excellent: κ was 1.0 for 2-bin MSI and 0.81 for 1-bin MSI. Conclusion MSI is a feasible, diagnostically accurate technique for identifying metallic biopsy markers during MRI-guided breast biopsy and may eliminate the need for a post-procedure mammogram.
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Affiliation(s)
- Sarah Eskreis-Winkler
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Katherine Simon
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Melissa Reichman
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Pascal Spincemaille
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, United States
| | - Michele Drotman
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Katja Pinker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elizabeth J Sutton
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Yi Wang
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
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33
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Koterov AN, Ushenkova LN, Biryukov AP. Hill’s Temporality Criterion: Reverse Causation and Its Radiation Aspect. BIOL BULL+ 2021. [DOI: 10.1134/s1062359020120031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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34
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Prophylactic Surgery in the BRCA+ Patient: Do Women Develop Breast Cancer While Waiting? ACTA ACUST UNITED AC 2021; 28:702-715. [PMID: 33504079 PMCID: PMC7924380 DOI: 10.3390/curroncol28010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/07/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022]
Abstract
Breast cancer susceptibility gene (BRCA) mutation carriers have an increased risk of breast cancer. Mitigation of this risk can be achieved via surveillance or prophylactic mastectomy with or without breast reconstruction. Those that choose surgery expect to reduce their chance of developing cancer. The purpose of this study was to determine the incidence of patients developing breast cancer prior to surgery and to identify modifiable contributing factors within the patient journey. This is a historical cohort study of all BRCA mutation carriers identified through the British Columbia Cancer Hereditary Cancer Program between 2000 and 2012. Patients were divided into two groups: surveillance (S) and prophylactic mastectomy with immediate breast reconstruction (PM/IBR). The incidence of cancer, time to PM/IBR and patient journeys were analyzed. A total of 333 women were identified. The time to surgery from mutation disclosure was a median of 31 (5.3, 75.7) months. During this period, 6% of patients developed breast cancer compared with a 14% incidence of breast cancer in patients choosing surveillance. The majority of time to surgery was attributed to the period between mutation disclosure and the decision to proceed with surgery. Strategies to facilitate decision-making as well as wait list prioritization and dedicated operative time should be targeted to this population to decrease the number of women developing an interval cancer prior to surgery.
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35
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Terra L, Hooning MJ, Heemskerk-Gerritsen BAM, van Beurden M, Roeters van Lennep JE, van Doorn HC, de Hullu JA, Mom C, van Dorst EBL, Mourits MJE, Slangen BFM, Gaarenstroom KN, Zillikens MC, Leiner T, van der Kolk L, Collee M, Wevers M, Ausems MGEM, van Engelen K, Berger LP, van Asperen CJ, Gomez-Garcia EB, van de Beek I, Rookus MA, Hauptmann M, Bleiker EM, Schagen SB, Aaronson NK, Maas AHEM, van Leeuwen FE. Long-Term Morbidity and Health After Early Menopause Due to Oophorectomy in Women at Increased Risk of Ovarian Cancer: Protocol for a Nationwide Cross-Sectional Study With Prospective Follow-Up (HARMOny Study). JMIR Res Protoc 2021; 10:e24414. [PMID: 33480862 PMCID: PMC7864779 DOI: 10.2196/24414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 01/24/2023] Open
Abstract
Background BRCA1/2 mutation carriers are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) at 35 to 45 years of age. RRSO substantially decreases ovarian cancer risk, but at the cost of immediate menopause. Knowledge about the potential adverse effects of premenopausal RRSO, such as increased risk of cardiovascular disease, osteoporosis, cognitive dysfunction, and reduced health-related quality of life (HRQoL), is limited. Objective The aim of this study is to assess the long-term health effects of premenopausal RRSO on cardiovascular disease, bone health, cognitive functioning, urological complaints, sexual functioning, and HRQoL in women with high familial risk of breast or ovarian cancer. Methods We will conduct a multicenter cross-sectional study with prospective follow-up, nested in a nationwide cohort of women at high familial risk of breast or ovarian cancer. A total of 500 women who have undergone RRSO before 45 years of age, with a follow-up period of at least 10 years, will be compared with 250 women (frequency matched on current age) who have not undergone RRSO or who have undergone RRSO at over 55 years of age. Participants will complete an online questionnaire on lifestyle, medical history, cardiovascular risk factors, osteoporosis, cognitive function, urological complaints, and HRQoL. A full cardiovascular assessment and assessment of bone mineral density will be performed. Blood samples will be obtained for marker analysis. Cognitive functioning will be assessed objectively with an online neuropsychological test battery. Results This study was approved by the institutional review board in July 2018. In February 2019, we included our first participant. As of November 2020, we had enrolled 364 participants in our study. Conclusions Knowledge from this study will contribute to counseling women with a high familial risk of breast/ovarian cancer about the long-term health effects of premenopausal RRSO. The results can also be used to offer health recommendations after RRSO. Trial Registration ClinicalTrials.gov NCT03835793; https://clinicaltrials.gov/ct2/show/NCT03835793. International Registered Report Identifier (IRRID) DERR1-10.2196/24414
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Affiliation(s)
- Lara Terra
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Marc van Beurden
- Department of Gynaecology, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | | | - Helena C van Doorn
- Department for Gynaecologic Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joanne A de Hullu
- Department for Gynaecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Constantijne Mom
- Department of Gynaecology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Eleonora B L van Dorst
- Department for Gynaecologic Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marian J E Mourits
- Department for Gynaecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Brigitte F M Slangen
- Department for Gynaecology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Katja N Gaarenstroom
- Department of Gynaecology, Leiden University Medical Center, Leiden, Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Tim Leiner
- Department Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lizet van der Kolk
- Family Cancer Clinic, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Margriet Collee
- Department for Clinical Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marijke Wevers
- Department for Clinical Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Margreet G E M Ausems
- Division of Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Klaartje van Engelen
- Department for Clinical Genetics, Amsterdam University Medical Centers, Vrije University Amsterdam, Amsterdam, Netherlands
| | - Lieke Pv Berger
- Department of Genetics, University Medical Center Groningen, Groningen, Netherlands
| | - Christi J van Asperen
- Department for Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Irma van de Beek
- Department for Clinical Genetics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Matti A Rookus
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Michael Hauptmann
- Brandenburg Medical School Theodor Fontane, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - Eveline M Bleiker
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Sanne B Schagen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Neil K Aaronson
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Flora E van Leeuwen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
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36
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Daly MB, Pal T, Berry MP, Buys SS, Dickson P, Domchek SM, Elkhanany A, Friedman S, Goggins M, Hutton ML, Karlan BY, Khan S, Klein C, Kohlmann W, Kurian AW, Laronga C, Litton JK, Mak JS, Menendez CS, Merajver SD, Norquist BS, Offit K, Pederson HJ, Reiser G, Senter-Jamieson L, Shannon KM, Shatsky R, Visvanathan K, Weitzel JN, Wick MJ, Wisinski KB, Yurgelun MB, Darlow SD, Dwyer MA. Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:77-102. [DOI: 10.6004/jnccn.2021.0001] [Citation(s) in RCA: 211] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic focus primarily on assessment of pathogenic or likely pathogenic variants associated with increased risk of breast, ovarian, and pancreatic cancer and recommended approaches to genetic testing/counseling and management strategies in individuals with these pathogenic or likely pathogenic variants. This manuscript focuses on cancer risk and risk management for BRCA-related breast/ovarian cancer syndrome and Li-Fraumeni syndrome. Carriers of a BRCA1/2 pathogenic or likely pathogenic variant have an excessive risk for both breast and ovarian cancer that warrants consideration of more intensive screening and preventive strategies. There is also evidence that risks of prostate cancer and pancreatic cancer are elevated in these carriers. Li-Fraumeni syndrome is a highly penetrant cancer syndrome associated with a high lifetime risk for cancer, including soft tissue sarcomas, osteosarcomas, premenopausal breast cancer, colon cancer, gastric cancer, adrenocortical carcinoma, and brain tumors.
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Affiliation(s)
| | - Tuya Pal
- 2Vanderbilt-Ingram Cancer Center
| | - Michael P. Berry
- 3St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | - Patricia Dickson
- 5Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Michael Goggins
- 9The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | - Seema Khan
- 12Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | | | | | - Holly J. Pederson
- 22Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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37
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Eidemüller M, Holmberg E, Lundell M, Karlsson P. Evidence for Increased Susceptibility to Breast Cancer From Exposure to Ionizing Radiation Due to a Familial History of Breast Cancer: Results From the Swedish Hemangioma Cohort. Am J Epidemiol 2021; 190:76-84. [PMID: 32735015 PMCID: PMC7784527 DOI: 10.1093/aje/kwaa163] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
Abstract
Women with a history of breast cancer among family members are at increased risk for breast cancer. However, it is unknown whether a familial breast cancer history (FBCH) also increases individual susceptibility to breast cancer from radiation exposure. In this cohort study, 17,200 female Swedish hemangioma patients with 1,079 breast cancer cases diagnosed between 1958 and 2013, exposed to ionizing radiation in infancy, were linked to their first-degree relatives. The association between FBCH and radiation-induced breast cancer risk was assessed. Further, the relevance for breast cancer radiotherapy and mammography screening was evaluated. On average, the radiation-induced excess relative risk and excess absolute risk of breast cancer at age 50 years were 0.51 Gy-1 (95% confidence interval (CI): 0.33, 0.71) and 10.8 cases/10,000 person-years/Gy (95% CI: 7.0, 14.6), respectively. Radiation risk was higher by a factor of 2.7 (95% CI: 1.0, 4.8; P = 0.05) if 1 first-degree relative was affected by breast cancer. For whole-breast standard radiotherapy at age 40 years with a contralateral breast dose of 0.72 Gy, the 20-year radiation-related excess risk of contralateral breast cancer was estimated to increase from 0.6% for women without FBCH to 1.7% for women with FBCH. In a biennial mammography screening program at ages 40-74 years, radiation risk up to age 80 years would increase from 0.11% for women without FBCH to 0.29% for women with FBCH.
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Affiliation(s)
- Markus Eidemüller
- Correspondence to Dr. Markus Eidemüller, Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Radiation Medicine, Ingolstädter Landstrasse 1, 85764 Neuherberg, Germany (e-mail: ). † Deceased
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38
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Nagpal P, Priya S, Eskandari A, Mullan A, Aggarwal T, Narayanasamy S, Parashar K, Bhat AP, Sieren JC. Factors Affecting Radiation Dose in Computed Tomography Angiograms for Pulmonary Embolism: A Retrospective Cohort Study. J Clin Imaging Sci 2020; 10:74. [PMID: 33274118 PMCID: PMC7708960 DOI: 10.25259/jcis_168_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/02/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives Computed tomography pulmonary angiogram (CTPA) is one of the most commonly ordered and frequently overused tests. The purpose of this study was to evaluate the mean radiation dose to patients getting CTPA and to identify factors that are associated with higher dose. Material and Methods This institutionally approved retrospective study included all patients who had a CTPA to rule out acute pulmonary embolism between 2016 and 2018 in a tertiary care center. Patient data (age, sex, body mass index [BMI], and patient location), CT scanner type, image reconstruction methodology, and radiation dose parameters (dose-length product [DLP]) were recorded. Effective dose estimates were obtained by multiplying DLP by conversion coefficient (0.014 mSv•mGy-1•cm-1). Multivariate logistic regression analysis was performed to determine the factors affecting the radiation dose. Results There were 2342 patients (1099 men and 1243 women) with a mean age of 58.1 years (range 0.2-104.4 years) and BMI of 31.3 kg/m2 (range 12-91.5 kg/m2). The mean effective radiation dose was 5.512 mSv (median - 4.27 mSv; range 0.1-43.0 mSv). Patient factors, including BMI >25 kg/m2, male sex, age >18 years, and intensive care unit (ICU) location, were associated with significantly higher dose (P < 0.05). CT scanning using third generation dual-source scanner with model-based iterative reconstruction (IR) had significantly lower dose (mean: 4.90 mSv) versus single-source (64-slice) scanner with filtered back projection (mean: 9.29 mSv, P < 0.001). Conclusion Patients with high BMI and ICU referrals are associated with high CT radiation dose. They are most likely to benefit by scanning on newer generation scanner using advance model-based IR techniques.
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Affiliation(s)
- Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, United State
| | - Sarv Priya
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, United State
| | - Ali Eskandari
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, United State
| | - Aidan Mullan
- Department of Statistics, University of California, Berkeley, California, United State
| | - Tanya Aggarwal
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, United State
| | - Sabarish Narayanasamy
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, United State
| | - Kamesh Parashar
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, United State
| | - Ambarish P Bhat
- Department of Radiology, Interventional Radiology, University of Missouri, Columbia, Missouri, United State
| | - Jessica C Sieren
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, United State.,Department of Biomedical Engineering, University of Iowa and Carver College of Medicine, Iowa City, United State
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Breast cancer screening for women at high risk: review of current guidelines from leading specialty societies. Breast Cancer 2020; 28:1195-1211. [PMID: 32959120 DOI: 10.1007/s12282-020-01157-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022]
Abstract
The purpose of this article is to overview the existing breast cancer screening guidelines for women at high risk from world-leading specialty societies. Accumulation of evidence and development of accessible genetic testing strategies have changed the idea of breast cancer screening for high-risk women. Personalized tailor-made screening adjusted for risk factors has been conducted in accordance with guidelines. The use of imaging modalities other than mammography including contrast-enhanced MRI and other various strategies for improving screening are discussed. The present review also mentions the existing challenges in high-risk screening and the latest information based on two large-scale studies.
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Rybchenko LA, Poluben LO, Bychkova GM, Stephanovych GV, Klymenko SV. MUTATIONS OF GENES BRCA1 AND BRCA2 IN WOMEN WITH OVARIAN CANCER EXPOSED TO FACTORS OF CHORNOBYL NUCLEAR ACCIDENT. PROBLEMY RADIAT︠S︡IĬNOÏ MEDYT︠S︡YNY TA RADIOBIOLOHIÏ 2020; 24:455-464. [PMID: 31841487 DOI: 10.33145/2304-8336-2019-24-455-464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE to determine a frequency of germline mutations 185delAG, 5382insC in BRCA1 gene and 6174delT in BRCA2 gene in Ukrainian patients with OC including women who were exposed to the factors of Chornobyl nuclear accident. MATERIAL AND METHODS In the study we enrolled 306 OC patients of different age who were tested for the presence of the major BRCA1 and BRCA2 gene mutations using allele specific multiplex polymerase chain reaction. RESULTS The mutation frequency in patients exposed to IR with OC (main group) was 5.3 % (2 from 38). Among unexposed patients (control group) 11,2 % (30 from 268) of cases with mutation were identified. However, the dif- ference between the groups was not significant (p = 0.39). It was shown that the BRCA1/2 mutations frequency in the patient of both groups was 10,4 % (32 from 306). The mutation BRCA1 5382insC was positive in 87.5 % (28 from 32) of cases, nevertheless nobody was identified with the allelic variant BRCA2 6174delT among both groups. There was a tendency toward an earlier age of the OC manifestation in the patients exposed to IR due to Chornobyl nuclear accident compared to BRCA-positive women of the control group (р = 0.06). When comparing BRCA-positive and BRCA-negative patients with OC of the main group, there was a statistical significance regarding the earlier age of the disease manifestation in the patients with mutations (р = 0.04). However, such difference was not observed in the control group (р = 0.22). CONCLUSIONS The frequency of the mutations in exposed to IR and unexposed patients with OC does not differ and depends on a spectrum of studied BRCA1/2 gene mutations, level of DNA amplification and sample number. The allel- ic variant BRCA1 5382insC is dominant and accounts for 87.5 % of the total number of the found mutations. Due to the radiation factor the OC in the BRCA1-positive individuals is realized at the earlier age than in patients negative for these mutations. The incidence of OC after the Chornobyl accident was observed 27-38 years later in a cohort of women who were from 4 to 40 years old at the moment of the nuclear explosion.
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Affiliation(s)
- L A Rybchenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka St., Kyiv, 04050, Ukraine
| | - L O Poluben
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka St., Kyiv, 04050, Ukraine
| | - G M Bychkova
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka St., Kyiv, 04050, Ukraine
| | - G V Stephanovych
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka St., Kyiv, 04050, Ukraine
| | - S V Klymenko
- State Institution «National Research Center for Radiation Medicine of the National Academy of MedicalSciences of Ukraine», 53 Yuriia Illienka St., Kyiv, 04050, Ukraine
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41
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Collins JM, Isaacs C. Management of breast cancer risk in BRCA1/2 mutation carriers who are unaffected with cancer. Breast J 2020; 26:1520-1527. [PMID: 32652823 DOI: 10.1111/tbj.13970] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 11/30/2022]
Abstract
Pathogenic mutations in BRCA1 and BRCA2 genes markedly increase the risk of breast cancer and other cancers such as ovarian/fallopian tube, pancreatic, prostate, and melanoma. Patients with BRCA1 mutations have a slightly higher lifetime risk of breast cancer than BRCA2 mutation carriers, and both BRCA1 and BRCA2 carriers tend to develop breast cancer at an earlier age than the general population. In this review, we will discuss management recommendations to reduce breast cancer risk for BRCA1/2 mutation carriers including special populations of carriers such as pregnant or lactating patients and men. Breast cancer screening, including clinical breast examination, mammogram, and breast MRI, is important for detecting breast cancer at an early and likely curable stage. In addition to screening, counseling on risk-reducing surgeries is strongly recommended for BRCA1/2 carriers. Risk-reducing mastectomy decreases the risk of breast cancer development, and risk-reducing salpingo-oophorectomy decreases ovarian cancer-specific as well as overall mortality, but controversy exists regarding its impact on breast cancer-specific mortality. Given the effectiveness of screening for breast cancer, further management should be carried out on an individual basis taking into account quality of life and psychosocial factors, and recommendations should be readdressed periodically as science progresses and patients' goals may change.
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Affiliation(s)
- Julie M Collins
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
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Dullens B, de Putter R, Lambertini M, Toss A, Han S, Van Nieuwenhuysen E, Van Gorp T, Vanderstichele A, Van Ongeval C, Keupers M, Prevos R, Celis V, Dekervel J, Everaerts W, Wildiers H, Nevelsteen I, Neven P, Timmerman D, Smeets A, Denayer E, Van Buggenhout G, Legius E, Punie K. Cancer Surveillance in Healthy Carriers of Germline Pathogenic Variants in BRCA1/2: A Review of Secondary Prevention Guidelines. JOURNAL OF ONCOLOGY 2020; 2020:9873954. [PMID: 32655641 PMCID: PMC7322604 DOI: 10.1155/2020/9873954] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023]
Abstract
Germline pathogenic alterations in the breast cancer susceptibility genes 1 (BRCA1) and 2 (BRCA2) are the most prevalent causes of hereditary breast and ovarian cancer. The increasing trend in proportion of cancer patients undergoing genetic testing, followed by predictive testing in families of new index patients, results in a significant increase of healthy germline BRCA1/2 mutation carriers who are at increased risk for breast, ovarian, and other BRCA-related cancers. This review aims to give an overview of available screening guidelines for female and male carriers of pathogenic or likely pathogenic germline BRCA1/2 variants per cancer type, incorporating malignancies that are more or less recently well correlated with BRCA1/2. We selected guidelines from national/international organizations and/or professional associations that were published or updated between January 1, 2015, and February 1, 2020. In total, 12 guidelines were included. This review reveals several significant discordances between the different guidelines. Optimal surveillance strategies depend on accurate age-specific cancer risk estimates, which are not reliably available for all BRCA-related cancers. Up-to-date national or international consensus guidelines are of utmost importance to harmonize counseling and proposed surveillance strategies for BRCA1/2 carriers.
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Affiliation(s)
- Boudewijn Dullens
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
| | - Robin de Putter
- Department of Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C Clinica di Oncologia Médica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Angela Toss
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Sileny Han
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Els Van Nieuwenhuysen
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Toon Van Gorp
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Adriaan Vanderstichele
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Chantal Van Ongeval
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Machteld Keupers
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Renate Prevos
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Valerie Celis
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Dekervel
- Digestive Oncology, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
| | - Ines Nevelsteen
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Timmerman
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Ellen Denayer
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Griet Van Buggenhout
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Eric Legius
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Kevin Punie
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
- Multidisciplinary Breast Centre, UZ-KU Leuven Cancer Institute (LKI), University Hospitals Leuven, Leuven, Belgium
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Francies FZ, Hull R, Khanyile R, Dlamini Z. Breast cancer in low-middle income countries: abnormality in splicing and lack of targeted treatment options. Am J Cancer Res 2020; 10:1568-1591. [PMID: 32509398 PMCID: PMC7269781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023] Open
Abstract
Breast cancer is a common malignancy among women worldwide. Regardless of the economic status of a country, breast cancer poses a burden in prevention, diagnosis and treatment. Developed countries such as the U.S. have high incidence and mortality rates of breast cancer. Although low incidence rates are observed in developing countries, the mortality rate is on the rise implying that low- to middle-income countries lack the resources for preventative screening for early detection and adequate treatment resources. The differences in incidence between countries can be attributed to changes in exposure to environmental risk factors, behaviour and lifestyle factors of the different population groups. Genomic modifications are an important factor that significantly alters the risk profile of breast tumourigenesis. The incidence of early-onset breast cancer is increasing and evidence shows that early onset of breast cancer is far more aggressive than late onset of the disease; possibly due to the difference in genetic alterations or tumour biology. Alternative splicing is a pivotal factor in the progressions of breast cancer. It plays a significant role in tumour prognosis, survival and drug resistance; hence, it offers a valuable option as a therapeutic target. In this review, the differences in breast cancer incidence and mortality rates in developed countries will be compared to low- to middle-income countries. The review will also discuss environmental and lifestyle risk factors, and the underlying molecular mechanisms, genetic variations or mutations and alternative splicing that may contribute to the development and novel drug targets for breast cancer.
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Affiliation(s)
- Flavia Zita Francies
- SA-MRC/UP Precision Prevention & Novel Drug Targets for HIV-Associated Cancers (PPNDTHAC) Extramural Unit, Pan African Cancer Research Institute (PACRI), University of Pretoria, Faculty of Health Sciences Hatfield, 0028, South Africa
| | - Rodney Hull
- SA-MRC/UP Precision Prevention & Novel Drug Targets for HIV-Associated Cancers (PPNDTHAC) Extramural Unit, Pan African Cancer Research Institute (PACRI), University of Pretoria, Faculty of Health Sciences Hatfield, 0028, South Africa
| | - Richard Khanyile
- SA-MRC/UP Precision Prevention & Novel Drug Targets for HIV-Associated Cancers (PPNDTHAC) Extramural Unit, Pan African Cancer Research Institute (PACRI), University of Pretoria, Faculty of Health Sciences Hatfield, 0028, South Africa
| | - Zodwa Dlamini
- SA-MRC/UP Precision Prevention & Novel Drug Targets for HIV-Associated Cancers (PPNDTHAC) Extramural Unit, Pan African Cancer Research Institute (PACRI), University of Pretoria, Faculty of Health Sciences Hatfield, 0028, South Africa
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Helm JS, Rudel RA. Adverse outcome pathways for ionizing radiation and breast cancer involve direct and indirect DNA damage, oxidative stress, inflammation, genomic instability, and interaction with hormonal regulation of the breast. Arch Toxicol 2020. [PMID: 32399610 DOI: 10.1007/s00204-020-02752-z)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Knowledge about established breast carcinogens can support improved and modernized toxicological testing methods by identifying key mechanistic events. Ionizing radiation (IR) increases the risk of breast cancer, especially for women and for exposure at younger ages, and evidence overall supports a linear dose-response relationship. We used the Adverse Outcome Pathway (AOP) framework to outline and evaluate the evidence linking ionizing radiation with breast cancer from molecular initiating events to the adverse outcome through intermediate key events, creating a qualitative AOP. We identified key events based on review articles, searched PubMed for recent literature on key events and IR, and identified additional papers using references. We manually curated publications and evaluated data quality. Ionizing radiation directly and indirectly causes DNA damage and increases production of reactive oxygen and nitrogen species (RONS). RONS lead to DNA damage and epigenetic changes leading to mutations and genomic instability (GI). Proliferation amplifies the effects of DNA damage and mutations leading to the AO of breast cancer. Separately, RONS and DNA damage also increase inflammation. Inflammation contributes to direct and indirect effects (effects in cells not directly reached by IR) via positive feedback to RONS and DNA damage, and separately increases proliferation and breast cancer through pro-carcinogenic effects on cells and tissue. For example, gene expression changes alter inflammatory mediators, resulting in improved survival and growth of cancer cells and a more hospitable tissue environment. All of these events overlap at multiple points with events characteristic of "background" induction of breast carcinogenesis, including hormone-responsive proliferation, oxidative activity, and DNA damage. These overlaps make the breast particularly susceptible to ionizing radiation and reinforce that these biological activities are important characteristics of carcinogens. Agents that increase these biological processes should be considered potential breast carcinogens, and predictive methods are needed to identify chemicals that increase these processes. Techniques are available to measure RONS, DNA damage and mutation, cell proliferation, and some inflammatory proteins or processes. Improved assays are needed to measure GI and chronic inflammation, as well as the interaction with hormonally driven development and proliferation. Several methods measure diverse epigenetic changes, but it is not clear which changes are relevant to breast cancer. In addition, most toxicological assays are not conducted in mammary tissue, and so it is a priority to evaluate if results from other tissues are generalizable to breast, or to conduct assays in breast tissue. Developing and applying these assays to identify exposures of concern will facilitate efforts to reduce subsequent breast cancer risk.
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Affiliation(s)
- Jessica S Helm
- Silent Spring Institute, 320 Nevada Street, Suite 302, Newton, MA, 02460, USA
| | - Ruthann A Rudel
- Silent Spring Institute, 320 Nevada Street, Suite 302, Newton, MA, 02460, USA.
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45
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Helm JS, Rudel RA. Adverse outcome pathways for ionizing radiation and breast cancer involve direct and indirect DNA damage, oxidative stress, inflammation, genomic instability, and interaction with hormonal regulation of the breast. Arch Toxicol 2020; 94:1511-1549. [PMID: 32399610 PMCID: PMC7261741 DOI: 10.1007/s00204-020-02752-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/16/2020] [Indexed: 12/15/2022]
Abstract
Knowledge about established breast carcinogens can support improved and modernized toxicological testing methods by identifying key mechanistic events. Ionizing radiation (IR) increases the risk of breast cancer, especially for women and for exposure at younger ages, and evidence overall supports a linear dose-response relationship. We used the Adverse Outcome Pathway (AOP) framework to outline and evaluate the evidence linking ionizing radiation with breast cancer from molecular initiating events to the adverse outcome through intermediate key events, creating a qualitative AOP. We identified key events based on review articles, searched PubMed for recent literature on key events and IR, and identified additional papers using references. We manually curated publications and evaluated data quality. Ionizing radiation directly and indirectly causes DNA damage and increases production of reactive oxygen and nitrogen species (RONS). RONS lead to DNA damage and epigenetic changes leading to mutations and genomic instability (GI). Proliferation amplifies the effects of DNA damage and mutations leading to the AO of breast cancer. Separately, RONS and DNA damage also increase inflammation. Inflammation contributes to direct and indirect effects (effects in cells not directly reached by IR) via positive feedback to RONS and DNA damage, and separately increases proliferation and breast cancer through pro-carcinogenic effects on cells and tissue. For example, gene expression changes alter inflammatory mediators, resulting in improved survival and growth of cancer cells and a more hospitable tissue environment. All of these events overlap at multiple points with events characteristic of "background" induction of breast carcinogenesis, including hormone-responsive proliferation, oxidative activity, and DNA damage. These overlaps make the breast particularly susceptible to ionizing radiation and reinforce that these biological activities are important characteristics of carcinogens. Agents that increase these biological processes should be considered potential breast carcinogens, and predictive methods are needed to identify chemicals that increase these processes. Techniques are available to measure RONS, DNA damage and mutation, cell proliferation, and some inflammatory proteins or processes. Improved assays are needed to measure GI and chronic inflammation, as well as the interaction with hormonally driven development and proliferation. Several methods measure diverse epigenetic changes, but it is not clear which changes are relevant to breast cancer. In addition, most toxicological assays are not conducted in mammary tissue, and so it is a priority to evaluate if results from other tissues are generalizable to breast, or to conduct assays in breast tissue. Developing and applying these assays to identify exposures of concern will facilitate efforts to reduce subsequent breast cancer risk.
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Affiliation(s)
- Jessica S Helm
- Silent Spring Institute, 320 Nevada Street, Suite 302, Newton, MA, 02460, USA
| | - Ruthann A Rudel
- Silent Spring Institute, 320 Nevada Street, Suite 302, Newton, MA, 02460, USA.
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Obdeijn IM, Mann RM, Loo CCE, Lobbes M, Voormolen EMC, van Deurzen CHM, de Bock G, Hooning MJ. The supplemental value of mammographic screening over breast MRI alone in BRCA2 mutation carriers. Breast Cancer Res Treat 2020; 181:581-588. [PMID: 32333294 PMCID: PMC7220868 DOI: 10.1007/s10549-020-05642-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/10/2020] [Indexed: 01/17/2023]
Abstract
Purpose BRCA2 mutation carriers are offered annual breast screening with MRI and mammography. The aim of this study was to investigate the supplemental value of mammographic screening over MRI screening alone. Methods In this multicenter study, proven BRCA2 mutation carriers, who developed breast cancer during screening using both digital mammography and state-of-art breast MRI, were identified. Clinical data were reviewed to classify cases in screen-detected and interval cancers. Imaging was reviewed to assess the diagnostic value of mammography and MRI, using the Breast Imaging and Data System (BI-RADS) classification allocated at the time of diagnosis. Results From January 2003 till March 2019, 62 invasive breast cancers and 23 ductal carcinomas in situ were diagnosed in 83 BRCA2 mutation carriers under surveillance. Overall screening sensitivity was 95.2% (81/85). Four interval cancers occurred (4.7% (4/85)). MRI detected 73 of 85 breast cancers (sensitivity 85.8%) and 42 mammography (sensitivity 49.9%) (p < 0.001). Eight mammography-only lesions occurred. In 1 of 17 women younger than 40 years, a 6-mm grade 3 DCIS, retrospectively visible on MRI, was detected with mammography only in a 38-year-old woman. The other 7 mammography-only breast cancers were diagnosed in women aged 50 years and older, increasing sensitivity in this subgroup from 79.5% (35/44) to 95.5% (42/44) (p ≤ 0.001). Conclusions In BRCA2 mutation carriers younger than 40 years, the benefit of mammographic screening over MRI was very small. In carriers of 50 years and older, mammographic screening contributed significantly. Hence, we propose to postpone mammographic screening in BRCA2 mutation carriers to at least age 40.
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Affiliation(s)
- Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Claudette C E Loo
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marc Lobbes
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands.,Department of Radiology and Nuclear Medicine, University Medical Center, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Eleonora M C Voormolen
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Geertruida de Bock
- Department of Epidemiology, University Medical Center, Groningen, The Netherlands
| | | | - Maartje J Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Jatoi I. Breast Cancer Screening: a Paradigm Change Is Needed-the PB Desai Oration. Indian J Surg Oncol 2020; 11:19-22. [PMID: 32205963 PMCID: PMC7064690 DOI: 10.1007/s13193-019-01017-1] [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: 09/03/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022] Open
Abstract
This editorial summarizes the key points of the PB Desai Oration, delivered by the author at the National Conference of the Indian Association of Surgical Oncology in Kolkata, India, on September 21, 2019.
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Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology and Endocrine Surgery, University of Texas Health and Science Center, 7703 Floyd Curl Drive, Mail Code 7738, San Antonio, TX 78229 USA
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Achatz MI, Caleffi M, Guindalini R, Marques RM, Nogueira-Rodrigues A, Ashton-Prolla P. Recommendations for Advancing the Diagnosis and Management of Hereditary Breast and Ovarian Cancer in Brazil. JCO Glob Oncol 2020; 6:439-452. [PMID: 32155091 PMCID: PMC7113069 DOI: 10.1200/jgo.19.00170] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The objective of this review was to address the barriers limiting access to genetic cancer risk assessment and genetic testing for individuals with suspected hereditary breast and ovarian cancer (HBOC) through a review of the diagnosis and management steps of HBOC. METHODS A selected panel of Brazilian experts in fields related to HBOC was provided with a series of relevant questions to address before the multiday conference. During this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion, until a consensus was achieved. RESULTS The authors propose specific and realistic recommendations for improving access to early diagnosis, risk management, and cancer care of HBOC specific to Brazil. Moreover, in creating these recommendations, the authors strived to address all the barriers and impediments mentioned in this article. CONCLUSION There is a great need to expand hereditary cancer testing and counseling in Brazil, and changing current policies is essential to accomplishing this goal. Increased knowledge and awareness, together with regulatory actions to increase access to this technology, have the potential to improve patient care and prevention and treatment efforts for patients with cancer across the country.
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Affiliation(s)
| | - Maira Caleffi
- Nucleo Mama Porto Alegre and Associação Hospitalar Moinhos de Vento, Porto Alegre, Brazil
| | - Rodrigo Guindalini
- Oncologia D’or, Rede D’or São Luiz, Brazil
- Centro de Investigação Translacional em Oncologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Renato Moretti Marques
- Programa da Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Centro de Oncologia e Hematologia, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Angelica Nogueira-Rodrigues
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Grupo Brasileiro de Oncologia Ginecológica, Belo Horizonte, Brazil
- DOM Oncologia, Minas Gerais, Brazil
| | - Patricia Ashton-Prolla
- Departmento de Genética, Universidade Federal do Rio Grande do Sul
- Laboratório de Medicina Genômica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Glandular dose indices using a glandular dose to air kerma volume histogram in mammography. Med Phys 2020; 47:1340-1348. [DOI: 10.1002/mp.13981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/19/2019] [Accepted: 12/13/2019] [Indexed: 01/25/2023] Open
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Saccarelli CR, Bitencourt AGV, Morris EA. Breast Cancer Screening in High-Risk Women: Is MRI Alone Enough? J Natl Cancer Inst 2020; 112:121-122. [PMID: 31233125 PMCID: PMC7019094 DOI: 10.1093/jnci/djz130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carolina Rossi Saccarelli
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY
- Department of Radiology, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Almir G V Bitencourt
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY
- Department of Imaging, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY
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