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Espinoza-Moya ME, Guertin JR, Floret A, Dorval M, Lapointe J, Chiquette J, Bouchard K, Nabi H, Laberge M. Mapping inter-professional collaboration in oncogenetics: Results from a scoping review. Crit Rev Oncol Hematol 2024; 199:104364. [PMID: 38729319 DOI: 10.1016/j.critrevonc.2024.104364] [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: 02/26/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Inter-professional collaboration could improve timely access and quality of oncogenetic services. Here, we present the results of a scoping review conducted to systematically identify collaborative models available, unpack the nature and extent of collaboration proposed, synthesize evidence on their implementation and evaluation, and identify areas where additional research is needed. A comprehensive search was conducted in four journal indexing databases on June 13th, 2022, and complemented with searches of the grey literature and citations. Screening was conducted by two independent reviewers. Eligible documents included those describing either the theory of change, planning, implementation and/or evaluation of collaborative oncogenetic models. 165 publications were identified, describing 136 unique interventions/studies on oncogenetic models with somewhat overlapping collaborative features. Collaboration appears to be mostly inter-professional in nature, often taking place during risk assessment and pre-testing genetic counseling. Yet, most publications provide very limited information on their collaborative features, and only a few studies have set out to formally evaluate them. Better quality research is needed to comprehensively examine and make conclusions regarding the value of collaboration in this oncogenetics. We propose a definition, logic model, and typology of collaborative oncogenetic models to strengthen future planning, implementation, and evaluation in this field.
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Affiliation(s)
- Maria-Eugenia Espinoza-Moya
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Jason Robert Guertin
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Arthur Floret
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Michel Dorval
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; Centre de Recherche CISSS Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1, Canada; Faculty of Pharmacy, Université Laval, 1050 Av de la Médecine, Québec, QC G1V 0A6, Canada
| | - Julie Lapointe
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada
| | - Jocelyne Chiquette
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; Centre des maladies du sein, CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada
| | - Karine Bouchard
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada
| | - Hermann Nabi
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Maude Laberge
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Université Laval, Québec, QC G1V 0A6, Canada; Vitam, Centre de recherche en santé durable, Université Laval, 2525, Chemin de la Canardière, Québec, QC G1J 0A4, Canada.
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Wong RWC, Cheung ANY. Predictive and prognostic biomarkers in female genital tract tumours: an update highlighting their clinical relevance and practical issues. Pathology 2024; 56:214-227. [PMID: 38212229 DOI: 10.1016/j.pathol.2023.10.013] [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: 08/31/2023] [Revised: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 01/13/2024]
Abstract
The evaluation of biomarkers by molecular techniques and immunohistochemistry has become increasingly relevant to the treatment of female genital tract tumours as a consequence of the greater availability of therapeutic options and updated disease classifications. For ovarian cancer, mutation testing for BRCA1/2 is the standard predictive biomarker for poly(ADP-ribose) polymerase inhibitor therapy, while homologous recombination deficiency testing may allow the identification of eligible patients among cases without demonstrable BRCA1/2 mutations. Clinical recommendations are available which specify how these predictive biomarkers should be applied. Mismatch repair (MMR) protein and folate receptor alpha immunohistochemistry may also be used to guide treatment in ovarian cancer. In endometrial cancer, MMR immunohistochemistry is the preferred test for predicting benefit from immune checkpoint inhibitor (ICI) therapy, but molecular testing for microsatellite instability may have a supplementary role. HER2 testing by immunohistochemistry and in situ hybridisation is applicable to endometrial serous carcinomas to assess trastuzumab eligibility. Immunohistochemistry for oestrogen receptor and progesterone receptor expression may be used for prognostication in endometrial cancer, but its predictive value for hormonal therapy is not yet proven. POLE mutation testing and p53 immunohistochemistry (as a surrogate for TP53 mutation status) serve as prognostic markers for favourable and adverse outcomes, respectively, in endometrial cancer, especially when combined with MMR testing for molecular subtype designation. For cervical cancer, programmed death ligand 1 immunohistochemistry may be used to predict benefit from ICI therapy although its predictive value is under debate. In vulvar cancer, p16 and p53 immunohistochemistry has established prognostic value, stratifying patients into three groups based on the human papillomavirus and TP53 mutation status of the tumour. Awareness of the variety and pitfalls of expression patterns for p16 and p53 in vulvar carcinomas is crucial for accurate designation. It is hoped that collaborative efforts in standardising and optimising biomarker testing for gynaecological tumours will contribute to evidence-based therapeutic decisions.
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Affiliation(s)
- Richard Wing-Cheuk Wong
- Department of Pathology, United Christian Hospital, Kwun Tong, Hong Kong Special Administrative Region of China.
| | - Annie N Y Cheung
- Department of Pathology, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region of China
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Brent SE, McGee J, Vicus D, Kim R, Eisen A, Wilton AS, Gien LT. Rates of genetic consultation in high-grade serous ovarian cancer patients in the era of PARP inhibitor therapy: A population-based study. Int J Gynaecol Obstet 2024. [PMID: 38284267 DOI: 10.1002/ijgo.15391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE The American Society of Clinical Oncology recommends all patients with high-grade serous ovarian carcinoma (HGSC) undergo germline genetic testing. Genetic consultation rates in Ontario, Canada, only reached 13.3% in 2011. In 2016, PARP inhibitor maintenance therapy became available in Ontario for BRCA-positive HGSC patients. Given expanding treatment options, we re-examined genetic consultation rates among HGSC patients. METHODS This retrospective cohort study identified patients diagnosed with HGSC between 2012 and 2019 using population-based administrative data from Ontario. Genetics consultations were identified using Ontario Health Insurance Plan billing codes. Consultation rates over time were analyzed using Cochran-Armitage trend test and segmental regression analysis. Multivariable analysis identified factors associated with attending genetics consultation. RESULTS This study included 4645 HGSC patients. The mean age was 64.2 years (±SD 12.3); 56.3% had stage 3-4 disease. Overall, approximately 35% attended genetics consultations. The genetic consultation rate per year increased significantly from 21.6% to 42.6% (P < 0.001). Shorter times between diagnosis and genetics consult were observed after PARP inhibitors became available (68.1 vs 34.1 weeks, P < 0.001). Patients treated at designated cancer centers (odds ratio [OR] 2.11, P < 0.001), diagnosed in later years (OR 1.33, P < 0.001), and from higher income groups (P < 0.05) were more likely to attend genetics consultation; older patients were less likely (OR 0.98, P < 0.001). After PARP inhibitors became available, consultation rates plateaued (P < 0.001). CONCLUSIONS Between 2012 and 2019, genetic consultation rates improved significantly among HGSC patients; however, a large proportion of patients never attended consultation. Further exploration of barriers to care is warranted to improve consultation rates and ensure equitable access to care.
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Affiliation(s)
- Shannon E Brent
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Jacob McGee
- Department of Obstetrics and Gynaecology, Western University, London, Ontario, Canada
| | - Danielle Vicus
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Division of Gynecologic Oncology, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada
| | - Raymond Kim
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrea Eisen
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada
| | | | - Lilian T Gien
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Division of Gynecologic Oncology, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada
- ICES Research, Toronto, Ontario, Canada
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Mir ZM, Fei LYN, McKeown S, Dinchong R, Cofie N, Dalgarno N, Rusnak A, Cheifetz RE, Merchant SJ. Knowledge, perceptions, attitudes, and barriers pertaining to genetic literacy among surgeons: a scoping review. Can J Surg 2024; 67:E118-E127. [PMID: 38503461 PMCID: PMC10959449 DOI: 10.1503/cjs.001523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The rapid evolution of genetic technologies and utilization of genetic information for clinical decision-making has necessitated increased surgeon participation in genetic counselling, testing, and appropriate referral of patients for genetic services, without formal training in genetics. We performed a scoping review to describe surgeons' knowledge, perceptions, attitudes, and barriers pertaining to genetic literacy in the management of patients who had confirmed cancer or who were potentially genetically at risk. METHODS We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews checklist. We performed a comprehensive literature search, and 2 reviewers independently screened studies for inclusion. These studies included surgeons involved in the care of patients with confirmed gastrointestinal, breast, and endocrine and neuroendocrine cancers, or patients who were potentially genetically at risk for these cancers. RESULTS We analyzed 17 studies, all of which used survey or interview-based formats. Many surgeons engaged in genetic counselling, testing, and referral, but reported low confidence and comfort in doing so. Knowledge assessments showed lower confidence in identifying genetic inheritance patterns and hereditary cancer syndromes, but awareness was higher among surgeons with greater clinical volume or subspecialty training in oncology. Surgeons felt responsible for facilitating these services and explicitly requested educational support in genetics. Barriers to genetic literacy were identified and catalogued at patient, surgeon, and system levels. CONCLUSION Surgeons frequently engage in genetics-related tasks despite a lack of formal genetics training, and often report low knowledge, comfort, and confidence in providing such services. We have identified several barriers to genetic literacy that can be used to develop interventions to enhance genetic literacy among surgeons.
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Affiliation(s)
- Zuhaib M Mir
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Linda Y N Fei
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Sandra McKeown
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Rachelle Dinchong
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Nicholas Cofie
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Nancy Dalgarno
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Alison Rusnak
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Rona E Cheifetz
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Shaila J Merchant
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
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Romagnoli KM, Kulchak Rahm A, Jonas MC, Schwiter R, Klinger T, Ladd I, Salvati Z, DiNucci A, Blasi PR, Sheridan L, Scrol A, Henrikson NB. Human-Centered Design Study to Inform Traceback Cascade Genetic Testing Programs at Three Integrated Health Systems. Public Health Genomics 2023; 26:45-57. [PMID: 36871550 PMCID: PMC10475143 DOI: 10.1159/000529852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION A traceback genetic testing program for ovarian cancer has the potential to identify individuals with hereditary breast and ovarian cancer and their relatives. Successful implementation depends on understanding and addressing the experiences, barriers, and preferences of the people served. METHODS We conducted a remote, human-centered design research study of people with ovarian, fallopian tube, or peritoneal cancer (probands) and people with a family history of ovarian cancer (relatives) at three integrated health systems between May and September 2021. Participants completed activities to elicit their preferences about ovarian cancer genetic testing messaging and to design their ideal experience receiving an invitation to participate in genetic testing. Interview data were analyzed using a rapid thematic analysis approach. RESULTS We interviewed 70 participants and identified five preferred experiences for a traceback program. Participants strongly prefer discussing genetic testing with their doctor but are comfortable discussing with other clinicians. The most highly preferred experience for both probands and relatives was to discuss with a knowledgeable clinician who could answer questions, followed by directed (sent directly to specific people) or passive (shared in a public area) communication. Repeated contact was acceptable for reminders. CONCLUSION Participants were open to receiving information about traceback genetic testing and recognized its value. Participants preferred discussing genetic testing with a trusted clinician. Directed communication was preferable to passive communication. Other valued information included how genetic tests help their family and the cost of genetic testing. These findings are informing traceback cascade genetic testing programs at all three sites.
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Affiliation(s)
- Katrina M Romagnoli
- Department of Health System Sciences, Geisinger Health System, Danville, Pennsylvania, USA
| | - Alanna Kulchak Rahm
- Department of Genomic Health, Geisinger Health System, Danville, Pennsylvania, USA
| | - Mary Cabell Jonas
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, Maryland, USA
| | - Rachel Schwiter
- Department of Genomic Health, Geisinger Health System, Danville, Pennsylvania, USA
| | - Tracey Klinger
- Department of Genomic Health, Geisinger Health System, Danville, Pennsylvania, USA,
| | - Ilene Ladd
- Department of Genomic Health, Geisinger Health System, Danville, Pennsylvania, USA
| | - Zachary Salvati
- Department of Genomic Health, Geisinger Health System, Danville, Pennsylvania, USA
| | - Anna DiNucci
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, Maryland, USA
| | - Paula Rae Blasi
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente, Seattle, Washington, USA
| | - Leigh Sheridan
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente, Seattle, Washington, USA
| | - Aaron Scrol
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente, Seattle, Washington, USA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente, Seattle, Washington, USA
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Barnhardt L, Nathoo FS, Rauw JM. Improving Rates of Germline BRCA Mutation Testing for Patients With Ovarian Cancer in Vancouver Island, British Columbia, Canada. JCO Oncol Pract 2023; 19:e470-e475. [PMID: 36867837 DOI: 10.1200/op.22.00341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
PURPOSE Despite more than a decade of endorsement from multiple international cancer authorities advocating all women with ovarian cancer be offered germline breast cancer (BRCA) gene testing, British Columbia Cancer Victoria was not meeting this target. A quality improvement project was undertaken with the aim of increasing completed BRCA testing rates for all eligible patients seen at British Columbia Cancer Victoria to > 90% by 1 year from April 2016. METHODS A current state analysis was completed, and multiple change ideas were developed, including education of medical oncologists, referral process update, initiating a group consenting seminar, and engagement of a nurse practitioner to lead the seminar. We used a retrospective chart audit from December 2014 to February 2018. On April 15, 2016, we initiated our Plan, Do, Study, Act (PDSA) cycles and completed them on February 28, 2018. We evaluated sustainability through an additional retrospective chart audit from January 2021 to August 2021. RESULTS Patients with completed germline BRCA genetic testing climbed from an average of 58%-89% per month. Before our project, patients waited on average 243 days (± 214) for their genetic test results. After implementation, patients received results within 118 days (± 98). This was sustained with an average of 83% of patients per month having completed germline BRCA testing almost 3 years after project completion. CONCLUSION Our quality improvement initiative resulted in a sustained increase in germline BRCA test completion for eligible patients with ovarian cancer.
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Affiliation(s)
- Laurie Barnhardt
- BCCancer, Nursing, Victoria, Canada.,University of Victoria, Victoria, Canada
| | - Farouk S Nathoo
- Mathematics and Statistics, University of Victoria, Victoria, Canada
| | - Jennifer M Rauw
- BCCancer, Medical Oncology, Victoria, Canada.,UBC, Internal Medicine, Vancouver, Canada
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Bisgin A, Sag SO, Dogan ME, Yildirim MS, Gumus AA, Akkus N, Balasar O, Durmaz CD, Eroz R, Altiner S, Alemdar A, Aliyeva L, Boga I, Cam FS, Dogan B, Esbah O, Hanta A, Mujde C, Ornek C, Ozer S, Rencuzogullari C, Sonmezler O, Bozdogan ST, Dundar M, Temel SG. Germline landscape of BRCAs by 7-site collaborations as a BRCA consortium in Turkey. Breast 2022; 65:15-22. [PMID: 35753294 PMCID: PMC9249944 DOI: 10.1016/j.breast.2022.06.005] [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: 01/19/2022] [Revised: 05/26/2022] [Accepted: 06/17/2022] [Indexed: 11/12/2022] Open
Abstract
BRCA1/2 mutations play a significant role in cancer pathogenesis and predisposition particularly in breast, ovarian and prostate cancers. Thus, germline analysis of BRCA1 and BRCA2 is essential for clinical management strategies aiming at the identification of recurrent and novel mutations that could be used as a first screening approach. We analyzed germline variants of BRCA1/2 genes for 2168 individuals who had cancer diagnosis or high risk assessment due to BRCAs related cancers, referred to 10 health care centers distributed across 7 regions covering the Turkish landscape. Overall, 68 and 157 distinct mutations were identified in BRCA1 and BRCA2, respectively. Twenty-two novel variants were reported from both genes while BRCA2 showed higher mutational heterogeneity. We herein report the collective data as BRCA Turkish consortium that confirm the molecular heterogeneity in BRCAs among Turkish population, and also as the first study presenting the both geographical, demographical and gene based landscape of all recurrent and novel mutations which some might be a founder effect in comparison to global databases. This wider perspective leads to the most accurate variant interpretations which pave the way for the more precise and efficient management affecting the clinical and molecular aspects. A similar percentage of clinically unaffected individuals were also identified with potentially pathogenic variants. Based on the geographic examinations, Eastern Anatolian and the Mediterranean region had the lowest positivity rates. The Southeastern Anatolian region showed the lowest density of both patients and clinically relevant genetic changes.
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Goebel EA, Kerkhof J, Dzyubak O, McLachlin CM, McGee J, Sadikovic B. Examining the Diagnostic Yield of Tumour Testing and Qualifying Germline Concordance for Hereditary Cancer Variants in Patients with High-Grade Serous Carcinoma. Genes (Basel) 2022; 13:genes13081398. [PMID: 36011309 PMCID: PMC9407448 DOI: 10.3390/genes13081398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Despite advances in treatment, prognosis for most patients with high-grade serous carcinoma (HGSC) remains poor. Genomic alterations in the homologous recombination (HR) pathway are used for cancer risk assessment and render tumours sensitive to platinum-based chemotherapy and poly (ADP-ribose) polymerase inhibitors (PARPi), which can be associated with more favourable outcomes. In addition to patients with tumours containing BRCA1 or BRCA2 pathologic variants, there is emerging evidence that patients with tumours harbouring pathologic variants in other HR genes may also benefit from PARPi therapy. The objective of this study is to assess the feasibility of primary-tumour testing by examining the concordance of variant detection between germline and tumour-variant status using a custom hereditary cancer gene panel (HCP). From April 2019 to November 2020, HCP variant testing was performed on 146 HGSC formalin-fixed, paraffin-embedded tissue samples using next-generation sequencing. Of those, 78 patients also underwent HCP germline testing using blood samples. A pathogenic variant was detected in 41.1% (60/146) of tumours tested, with 68.3% (41/60) having either a BRCA1 or BRCA2 variant (n = 36), or BRCA1/2 plus a second variant (n = 5), and 31.2% (19/60) carrying a pathogenic variant in another HCP gene. The overall variant rate among the paired germline and tumour samples was 43.6% (34/78), with the remaining 56% (44/78) having no pathogenic variant detected in the germline or tumour. The overall BRCA1/2 variant rate for paired samples was 33.3% (26/78), with germline variants detected in 11.5% (9/78). A non-BRCA1/2 germline variant in another HCP gene was detected in 9.0% (7/78). All germline variants were detected in the tumour, demonstrating 100% concordance. These data provide evidence supporting the feasibility of primary-tumour testing for detecting germline and somatic variants in HCP genes in patients with HGSC, which can be used to guide clinical decision-making, and may provide opportunity for improving patient triage and clinical genetic referral practices.
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Affiliation(s)
- Emily A. Goebel
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5A5, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Correspondence: (E.A.G.); (B.S.)
| | - Jennifer Kerkhof
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Oleksandra Dzyubak
- Department of Obstetrics and Gynecology, London Health Sciences Centre and Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5W9, Canada
| | - C. Meg McLachlin
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5A5, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Jacob McGee
- Department of Obstetrics and Gynecology, London Health Sciences Centre and Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5W9, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, ON N6A 5W9, Canada
- Correspondence: (E.A.G.); (B.S.)
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Page SC, Bernard J, Mehros W, Gregoire J, Sebastianelli A, Renaud MC, Douville P, Langlais EL, Plante M. Low BRCA1/2 germline mutation rate in a French-Canadian population with a diagnosis of epithelial tubo-ovarian carcinoma. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1054-1060. [DOI: 10.1016/j.jogc.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 10/15/2022]
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10
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Shah S, Cheung A, Kutka M, Sheriff M, Boussios S. Epithelial Ovarian Cancer: Providing Evidence of Predisposition Genes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138113. [PMID: 35805770 PMCID: PMC9265838 DOI: 10.3390/ijerph19138113] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 12/19/2022]
Abstract
Epithelial ovarian cancer (EOC) is one of the cancers most influenced by hereditary factors. A fourth to a fifth of unselected EOC patients carry pathogenic variants (PVs) in a number of genes, the majority of which encode for proteins involved in DNA mismatch repair (MMR) pathways. PVs in BRCA1 and BRCA2 genes are responsible for a substantial fraction of hereditary EOC. In addition, PV genes involved in the MMR pathway account for 10–15% of hereditary EOC. The identification of women with homologous recombination (HR)-deficient EOCs has significant clinical implications, concerning chemotherapy regimen planning and development as well as the use of targeted therapies such as poly(ADP-ribose) polymerase (PARP) inhibitors. With several genes involved, the complexity of genetic testing increases. In this context, next-generation sequencing (NGS) allows testing for multiple genes simultaneously with a rapid turnaround time. In this review, we discuss the EOC risk assessment in the era of NGS.
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Affiliation(s)
- Sidrah Shah
- Department of Palliative Care, Guy’s and St Thomas’ Hospital, London SE1 9RT, UK;
| | - Alison Cheung
- Department of Hematology/Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Kent, Gillingham ME7 5NY, UK; (A.C.); (M.K.)
| | - Mikolaj Kutka
- Department of Hematology/Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Kent, Gillingham ME7 5NY, UK; (A.C.); (M.K.)
| | - Matin Sheriff
- Department of Urology, Medway NHS Foundation Trust, Windmill Road, Kent, Gillingham ME7 5NY, UK;
| | - Stergios Boussios
- Department of Palliative Care, Guy’s and St Thomas’ Hospital, London SE1 9RT, UK;
- King’s College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, London SE1 9RT, UK
- AELIA Organization, 9th Km Thessaloniki-Thermi, 57001 Thessaloniki, Greece
- Correspondence: or or
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11
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Low BRCA1/2 germline mutation rate in a French-Canadian population with a diagnosis of epithelial tubo-ovarian carcinoma. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1047-1053. [PMID: 35779836 DOI: 10.1016/j.jogc.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/20/2022]
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12
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An appraisal of genetic testing for prostate cancer susceptibility. NPJ Precis Oncol 2022; 6:43. [PMID: 35732815 PMCID: PMC9217944 DOI: 10.1038/s41698-022-00282-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/13/2022] [Indexed: 11/09/2022] Open
Abstract
Most criteria for genetic testing for prostate cancer susceptibility require a prior diagnosis of prostate cancer, in particular cases with metastatic disease are selected. Advances in the field are expected to improve outcomes through tailored treatments for men with advanced prostate cancer with germline pathogenic variants, although these are not currently offered in the curative setting. A better understanding of the value of genetic testing for prostate cancer susceptibility in screening, for early detection and prevention is necessary. We review and summarize the literature describing germline pathogenic variants in genes associated with increased prostate cancer risk and aggressivity. Important questions include: what is our ability to screen for and prevent prostate cancer in a man with a germline pathogenic variant and how does knowledge of a germline pathogenic variant influence treatment of men with nonmetastatic disease, with hormone-resistant disease and with metastatic disease? The frequency of germline pathogenic variants in prostate cancer is well described, according to personal and family history of cancer and by stage and grade of disease. The role of these genes in aggressive prostate cancer is also discussed. It is timely to consider whether or not genetic testing should be offered to all men with prostate cancer. The goals of testing are to facilitate screening for early cancers in unaffected high-risk men and to prevent advanced disease in men with cancer.
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13
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Tinker AV, Altman AD, Bernardini MQ, Ghatage P, Gien LT, Provencher D, Salvador S, Doucette S, Oza AM. A Pan-Canadian Consensus Statement on First-Line PARP Inhibitor Maintenance for Advanced, High-Grade Serous and Endometrioid Tubal, Ovarian, and Primary Peritoneal Cancers. Curr Oncol 2022; 29:4354-4369. [PMID: 35735457 PMCID: PMC9221681 DOI: 10.3390/curroncol29060348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
The majority of patients with advanced, high-grade epithelial-tubo ovarian cancer (EOC) respond well to initial treatment with platinum-based chemotherapy; however, up to 80% of patients will experience a recurrence. Poly(ADP-ribose) Polymerase (PARP) inhibitors have been established as a standard of care maintenance therapy to prolong remission and prevent relapse following a response to first-line platinum-chemotherapy. Olaparib and niraparib are the PARP inhibitors currently approved for use in the first-line maintenance setting in Canada. Selection of maintenance therapy requires consideration of patient and tumour factors, presence of germline and somatic mutations, expected drug toxicity profile, and treatment access. This paper discusses the current clinical evidence for first-line PARP inhibitor maintenance therapy in patients with advanced, high-grade EOC and presents consensus statements and a treatment algorithm to aid Canadian oncologists on the selection and use of PARP inhibitors within the Canadian EOC treatment landscape.
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Affiliation(s)
- Anna V. Tinker
- Division of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, Canada;
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Alon D. Altman
- Division of Gynecologic Oncology, Cancer Care Manitoba, Winnipeg, MB R3E 0V9, Canada;
- Department of Obstetrics Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Marcus Q. Bernardini
- Division of Gynecologic Oncology, Princess Margaret Cancer Center, University Health Network, Sinai Health System, Toronto, ON M5B 2M9, Canada;
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1X8, Canada;
| | - Prafull Ghatage
- Department of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada;
- Department of Gynecological Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Lilian T. Gien
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1X8, Canada;
- Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Diane Provencher
- Institut du Cancer de Montréal, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 0A9, Canada;
- Division of Gynecologic Oncology, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Shannon Salvador
- Department of Obstetrics and Gynecology, McGill University Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | | | - Amit M. Oza
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1X8, Canada;
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
- Correspondence:
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14
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Sadinsky MB, Power J, Ambrosio E, Palma L, Zeng X, Foulkes WD, Weber E. Patient Experience with a Gynecologic Oncology-Initiated Genetic Testing Model for Women with Tubo-Ovarian Cancer. Curr Oncol 2022; 29:3565-3575. [PMID: 35621678 PMCID: PMC9139592 DOI: 10.3390/curroncol29050288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/22/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Up to 20% of women diagnosed with tubo-ovarian carcinoma carry a germline pathogenic variant in a cancer-predisposing gene (e.g., BRCA1/BRCA2). Identifying these variants can help to inform eligibility for therapies, guide surveillance and prevention of new primary cancers, and assess risk to family members. The Gynecologic Oncology-Initiated Genetic Testing Model (GOIGT) was initiated at the McGill University Health Centre (MUHC) to streamline universal germline genetic testing for this population, while addressing the limited resources in the public healthcare system. This study aimed to evaluate the patient experience of participating in this model. Methods: Study participants were patients diagnosed with high-grade non-mucinous epithelial tubo-ovarian cancer who underwent genetic testing through the GOIGT model between 1 January 2017 and 31 December 2020. Eligible participants completed the retrospective questionnaires at least one month after result disclosure. Results: A total of 126 patients were tested through the GOIGT model during the study period, of which 56 were invited to participate. Thirty-four participants returned the study questionnaire. Overall, participants did not report decision regret following the genetic testing and were satisfied with the GOIGT model. Participants reported low levels of uncertainty and distress related to the implications of their test results for themselves and their family members. Conclusions: The results of this study support the continued implementation of mainstreamed genetic testing models for women with high-grade non-mucinous tubo-ovarian cancer. Further studies are required to compare experiences for patients with different genetic test results.
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Affiliation(s)
- Michaela Bercovitch Sadinsky
- Department of Human Genetics, McGill University, Montreal, QC H3A0C7, Canada; (L.P.); (W.D.F.); (E.W.)
- Division of Medical Genetics, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada
- Correspondence: ; Tel.: +1-438-401-8300
| | - Joanne Power
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC H4A3J1, Canada; (J.P.); (E.A.); (X.Z.)
| | - Enza Ambrosio
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC H4A3J1, Canada; (J.P.); (E.A.); (X.Z.)
| | - Laura Palma
- Department of Human Genetics, McGill University, Montreal, QC H3A0C7, Canada; (L.P.); (W.D.F.); (E.W.)
- Division of Medical Genetics, McGill University Health Centre, Montreal, QC H4A3J1, Canada
| | - Xing Zeng
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC H4A3J1, Canada; (J.P.); (E.A.); (X.Z.)
| | - William D. Foulkes
- Department of Human Genetics, McGill University, Montreal, QC H3A0C7, Canada; (L.P.); (W.D.F.); (E.W.)
- Division of Medical Genetics, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada
- Division of Medical Genetics, McGill University Health Centre, Montreal, QC H4A3J1, Canada
- Department of Specialized Medicine, Lady David Institute, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada
- Cancer Research Program, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC H4A3J1, Canada
| | - Evan Weber
- Department of Human Genetics, McGill University, Montreal, QC H3A0C7, Canada; (L.P.); (W.D.F.); (E.W.)
- Division of Medical Genetics, McGill University Health Centre, Montreal, QC H4A3J1, Canada
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15
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Grafodatskaya D, O'Rielly DD, Bedard K, Butcher DT, Howlett CJ, Lytwyn A, McCready E, Parboosingh J, Spriggs EL, Vaags AK, Stockley TL. Practice guidelines for BRCA1/2 tumour testing in ovarian cancer. J Med Genet 2022; 59:727-736. [PMID: 35393334 PMCID: PMC9340048 DOI: 10.1136/jmedgenet-2021-108238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Abstract
The purpose of this document is to provide pre-analytical, analytical and post-analytical considerations and recommendations to Canadian clinical laboratories developing, validating and offering next-generation sequencing (NGS)-based BRCA1 and BRCA2 (BRCA1/2) tumour testing in ovarian cancers. This document was drafted by the members of the Canadian College of Medical Geneticists (CCMG) somatic BRCA Ad Hoc Working Group, and representatives from the Canadian Association of Pathologists. The document was circulated to the CCMG members for comment. Following incorporation of feedback, this document has been approved by the CCMG board of directors. The CCMG is a Canadian organisation responsible for certifying medical geneticists and clinical laboratory geneticists, and for establishing professional and ethical standards for clinical genetics services in Canada. The current CCMG Practice Guidelines were developed as a resource for clinical laboratories in Canada; however, they are not inclusive of all information laboratories should consider in the validation and use of NGS for BRCA1/2 tumour testing in ovarian cancers.
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Affiliation(s)
- Daria Grafodatskaya
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.,Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Darren D O'Rielly
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.,Centre for Translational Genomes & Division of Genetics, Eastern Regional Health Authority, St. John's, Newfoundland, Canada
| | - Karine Bedard
- Département de Pathologie et Biologie cellulaire, Université de Montréal, Montreal, Québec, Canada.,Laboratoire de Diagnostic Moléculaire, Centre hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Darci T Butcher
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.,Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Christopher J Howlett
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Wester University, London, Ontario, Canada
| | - Alice Lytwyn
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.,Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Elizabeth McCready
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.,Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jillian Parboosingh
- Department of Medical Genetics, Alberta Children's Hospital Research Institute for Child and Maternal Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Genetics and Genomics, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - Elizabeth L Spriggs
- Genomics, Diagnostic Services, Shared Health Manitoba, Winnipeg, Manitoba, Canada.,Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrea K Vaags
- Laboratory Medicine and Genetics, Trillium Health Partners, Mississauga, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Tracy L Stockley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada .,Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
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16
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Lin Y, Zhou X, Peng W, Wu J, Wu X, Chen Y, Cui Z. Expression and clinical implications of basic leucine zipper ATF-like transcription factor 2 in breast cancer. BMC Cancer 2021; 21:1062. [PMID: 34565331 PMCID: PMC8474811 DOI: 10.1186/s12885-021-08785-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 09/15/2021] [Indexed: 12/28/2022] Open
Abstract
Background Basic leucine zipper ATF-like transcription factor 2 (BATF2) has been reported to participate in the occurrence and development of some malignancies. Herein, we aimed to explore the expression pattern and clinical implications of BATF2 in breast cancer (BC). Methods We assessed the differences in BATF2 mRNA expression between cancerous and noncancerous tissues in BC using GEPIA and UALCAN data and in BATF2 protein expression pattern using Human Protein Atlas (HPA) data. BATF2 co-expression networks were analyzed in Coexpedia. The association between the differentially expressed BATF2 mRNA and BC prognosis was assessed using UALCAN, OSbrca, and GEPIA databases. In external validations, BATF2 protein expression in BC tissues was quantitated using a tissue microarray and immunohistochemistry (IHC) analysis, and BATF2 mRNA expression in serum and serum-derived exosomes of BC patients using real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). Results No difference in the BATF2 mRNA expression level was found between cancerous and noncancerous tissues in BC based on databases. There were low-to-moderate levels of increases in BATF2 protein expressions in BC cases from the HPA cohort. BATF2 mRNA expression was negatively correlated with androgen receptor (AR) and positively correlated with BRCA2 DNA repair associated (BRCA2), marker of proliferation Ki-67 (Mki67), and tumor protein p53 (TP53) expressions. Generally, BATF2 mRNA exhibited a non-significant association with BC prognosis; yet the subgroup analyses showed that triple-negative breast cancer (TNBC) patients with high BATF2 mRNA expressions had a longer overall survival (OS). Our IHC analysis revealed a positive rate of BATF2 protein expression of 46.90%, mainly located in the nucleus of cancer cells in BC, and the OS of BC patients with high BATF2 protein expressions was prolonged. The positive rates of BATF2 mRNA expressions in the serum and exosomes were 45.00 and 41.67%, respectively. Besides, the AUCs of serum and exosomal BATF2 mRNA for BC diagnosis were 0.8929 and 0.8869, respectively. Conclusions BC patients exhibit low-to-moderate expressions in BATF2 mRNA expression levels in cancerous tissues. The high BATF2 protein expression can be a potential indicator of a better BC prognosis. Serum and exosomal BATF2 mRNA levels also serve as promising noninvasive biomarkers for BC diagnosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08785-6.
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Affiliation(s)
- Yingying Lin
- Laboratory of Biochemistry and Molecular Biology Research, Department of Clinical Laboratory, Fujian Medical University Cancer Hospital, No. 420 Fuma Road, Jin'an District, Fuzhou, 350014, Fujian Province, China
| | - Xusheng Zhou
- Laboratory of Biochemistry and Molecular Biology Research, Department of Clinical Laboratory, Fujian Medical University Cancer Hospital, No. 420 Fuma Road, Jin'an District, Fuzhou, 350014, Fujian Province, China
| | - Wei Peng
- Laboratory of Biochemistry and Molecular Biology Research, Department of Clinical Laboratory, Fujian Medical University Cancer Hospital, No. 420 Fuma Road, Jin'an District, Fuzhou, 350014, Fujian Province, China
| | - Jing Wu
- Laboratory of Biochemistry and Molecular Biology Research, Department of Clinical Laboratory, Fujian Medical University Cancer Hospital, No. 420 Fuma Road, Jin'an District, Fuzhou, 350014, Fujian Province, China
| | - Xiufeng Wu
- Department of Breast Surgical Oncology, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China.
| | - Yan Chen
- Laboratory of Biochemistry and Molecular Biology Research, Department of Clinical Laboratory, Fujian Medical University Cancer Hospital, No. 420 Fuma Road, Jin'an District, Fuzhou, 350014, Fujian Province, China.
| | - Zhaolei Cui
- Laboratory of Biochemistry and Molecular Biology Research, Department of Clinical Laboratory, Fujian Medical University Cancer Hospital, No. 420 Fuma Road, Jin'an District, Fuzhou, 350014, Fujian Province, China.
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17
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Lapointe J, Dorval M, Chiquette J, Joly Y, Guertin JR, Laberge M, Gekas J, Hébert J, Pomey MP, Cruz-Marino T, Touhami O, Blanchet Saint-Pierre A, Gagnon S, Bouchard K, Rhéaume J, Boisvert K, Brousseau C, Castonguay L, Fortier S, Gosselin I, Lachapelle P, Lavoie S, Poirier B, Renaud MC, Ruizmangas MG, Sebastianelli A, Roy S, Côté M, Racine MM, Roy MC, Côté N, Brisson C, Charette N, Faucher V, Leblanc J, Dubeau MÈ, Plante M, Desbiens C, Beaumont M, Simard J, Nabi H. A Collaborative Model to Implement Flexible, Accessible and Efficient Oncogenetic Services for Hereditary Breast and Ovarian Cancer: The C-MOnGene Study. Cancers (Basel) 2021; 13:cancers13112729. [PMID: 34072979 PMCID: PMC8198545 DOI: 10.3390/cancers13112729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/12/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary We recently developed an oncogenetic model to overcome the unprecedented demand for genetic counseling and testing for hereditary breast and ovarian cancer. Quality and performance indicators showed that the implementation of this model improved access to genetic counseling and minimized delays for genetic tests for patients, who reported to be overwhelmingly satisfied with the process. However, it remains unknown whether this model is robust and sustainable or requires adjustments. In addition, whether the model could be deployed elsewhere remains also to be elucidated. The C-MOnGene study was therefore designed to gain an in-depth understanding of the context in which the model was developed and implemented, and document the lessons that can be learned to optimize oncogenetic services delivery in other settings. Abstract Medical genetic services are facing an unprecedented demand for counseling and testing for hereditary breast and ovarian cancer (HBOC) in a context of limited resources. To help resolve this issue, a collaborative oncogenetic model was recently developed and implemented at the CHU de Québec-Université Laval; Quebec; Canada. Here, we present the protocol of the C-MOnGene (Collaborative Model in OncoGenetics) study, funded to examine the context in which the model was implemented and document the lessons that can be learned to optimize the delivery of oncogenetic services. Within three years of implementation, the model allowed researchers to double the annual number of patients seen in genetic counseling. The average number of days between genetic counseling and disclosure of test results significantly decreased. Group counseling sessions improved participants’ understanding of breast cancer risk and increased knowledge of breast cancer and genetics and a large majority of them reported to be overwhelmingly satisfied with the process. These quality and performance indicators suggest this oncogenetic model offers a flexible, patient-centered and efficient genetic counseling and testing for HBOC. By identifying the critical facilitating factors and barriers, our study will provide an evidence base for organizations interested in transitioning to an oncogenetic model integrated into oncology care; including teams that are not specialized but are trained in genetics.
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Affiliation(s)
- Julie Lapointe
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Local J0-01, Québec, QC G1S 4L8, Canada; (J.L.); (M.D.); (J.C.); (J.R.G.); (M.L.); (K.B.); (J.S.)
| | - Michel Dorval
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Local J0-01, Québec, QC G1S 4L8, Canada; (J.L.); (M.D.); (J.C.); (J.R.G.); (M.L.); (K.B.); (J.S.)
- Centre de Recherche CISSS Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1, Canada;
- Faculté de Pharmacie, Université Laval, 1050 Av de la Médecine, Québec, QC G1V 0A6, Canada
| | - Jocelyne Chiquette
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Local J0-01, Québec, QC G1S 4L8, Canada; (J.L.); (M.D.); (J.C.); (J.R.G.); (M.L.); (K.B.); (J.S.)
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Yann Joly
- Institut de Recherche du Centre Universitaire de Santé McGill, 2155 Rue Guy, 5e étage, Montréal, QC H3H 2R9, Canada;
- Département de Génétique Humaine et Unité de Bioéthique, Faculté de Médecine, Université McGill, 3605 Rue de la Montagne Montréal, Montréal, QC H3G 2M1, Canada
| | - Jason Robert Guertin
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Local J0-01, Québec, QC G1S 4L8, Canada; (J.L.); (M.D.); (J.C.); (J.R.G.); (M.L.); (K.B.); (J.S.)
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, 1050 Avenue de la Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Maude Laberge
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Local J0-01, Québec, QC G1S 4L8, Canada; (J.L.); (M.D.); (J.C.); (J.R.G.); (M.L.); (K.B.); (J.S.)
- Vitam, Centre de Recherche en Santé Durable, Université Laval, 2525, Chemin de la Canardière, Québec, QC G1J 0A4, Canada
- Département des Opérations et Systèmes de Décision, Faculté des Sciences de l’Administration, Université Laval, 2325 Rue de la Terrasse Université Laval, Québec, QC G1V 0A6, Canada
| | - Jean Gekas
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Johanne Hébert
- Centre de Recherche CISSS Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1, Canada;
- Département des Sciences Infirmières, Université du Québec à Rimouski (UQAR), Campus de Lévis, 1595 Boulevard Alphonse-Desjardins, Lévis, QC G6V 0A6, Canada
| | - Marie-Pascale Pomey
- Centre de Recherche du CHUM, 900, Rue Saint-Denis, Montréal, QC H2X 0A9, Canada;
- Département de Gestion, Évaluation et Politique de Santé, Faculté de Médecine, Université de Montréal, 7101 Avenue du Parc, 3e Étage, Montréal, QC H3N 1X9, Canada
| | - Tania Cruz-Marino
- CIUSSS Saguenay Lac-St-Jean, 930 Rue Jacques-Cartier Est, Chicoutimi, QC G7H 7K9, Canada; (T.C.-M.); (O.T.); (S.G.); (V.F.); (J.L.); (M.-È.D.)
| | - Omar Touhami
- CIUSSS Saguenay Lac-St-Jean, 930 Rue Jacques-Cartier Est, Chicoutimi, QC G7H 7K9, Canada; (T.C.-M.); (O.T.); (S.G.); (V.F.); (J.L.); (M.-È.D.)
| | - Arnaud Blanchet Saint-Pierre
- CISSS Bas St-Laurent, 150 Av Rouleau, Rimouski, QC G5L 5T1, Canada; (A.B.S.-P.); (M.-C.R.); (N.C.); (C.B.); (N.C.)
| | - Sylvain Gagnon
- CIUSSS Saguenay Lac-St-Jean, 930 Rue Jacques-Cartier Est, Chicoutimi, QC G7H 7K9, Canada; (T.C.-M.); (O.T.); (S.G.); (V.F.); (J.L.); (M.-È.D.)
| | - Karine Bouchard
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Local J0-01, Québec, QC G1S 4L8, Canada; (J.L.); (M.D.); (J.C.); (J.R.G.); (M.L.); (K.B.); (J.S.)
| | - Josée Rhéaume
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Karine Boisvert
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Claire Brousseau
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Lysanne Castonguay
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Sylvain Fortier
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Isabelle Gosselin
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Philippe Lachapelle
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Sabrina Lavoie
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Brigitte Poirier
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Marie-Claude Renaud
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Maria-Gabriela Ruizmangas
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Alexandra Sebastianelli
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Stéphane Roy
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Madeleine Côté
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | | | - Marie-Claude Roy
- CISSS Bas St-Laurent, 150 Av Rouleau, Rimouski, QC G5L 5T1, Canada; (A.B.S.-P.); (M.-C.R.); (N.C.); (C.B.); (N.C.)
| | - Nathalie Côté
- CISSS Bas St-Laurent, 150 Av Rouleau, Rimouski, QC G5L 5T1, Canada; (A.B.S.-P.); (M.-C.R.); (N.C.); (C.B.); (N.C.)
| | - Carmen Brisson
- CISSS Bas St-Laurent, 150 Av Rouleau, Rimouski, QC G5L 5T1, Canada; (A.B.S.-P.); (M.-C.R.); (N.C.); (C.B.); (N.C.)
| | - Nelson Charette
- CISSS Bas St-Laurent, 150 Av Rouleau, Rimouski, QC G5L 5T1, Canada; (A.B.S.-P.); (M.-C.R.); (N.C.); (C.B.); (N.C.)
| | - Valérie Faucher
- CIUSSS Saguenay Lac-St-Jean, 930 Rue Jacques-Cartier Est, Chicoutimi, QC G7H 7K9, Canada; (T.C.-M.); (O.T.); (S.G.); (V.F.); (J.L.); (M.-È.D.)
| | - Josianne Leblanc
- CIUSSS Saguenay Lac-St-Jean, 930 Rue Jacques-Cartier Est, Chicoutimi, QC G7H 7K9, Canada; (T.C.-M.); (O.T.); (S.G.); (V.F.); (J.L.); (M.-È.D.)
| | - Marie-Ève Dubeau
- CIUSSS Saguenay Lac-St-Jean, 930 Rue Jacques-Cartier Est, Chicoutimi, QC G7H 7K9, Canada; (T.C.-M.); (O.T.); (S.G.); (V.F.); (J.L.); (M.-È.D.)
| | - Marie Plante
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Christine Desbiens
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Martin Beaumont
- CHU de Québec-Université Laval, 1050, Chemin Ste-Foy, Québec, QC G1S 4L8, Canada; (J.G.); (J.R.); (K.B.); (C.B.); (L.C.); (S.F.); (I.G.); (P.L.); (S.L.); (B.P.); (M.-C.R.); (M.-G.R.); (A.S.); (S.R.); (M.C.); (M.P.); (C.D.); (M.B.)
| | - Jacques Simard
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Local J0-01, Québec, QC G1S 4L8, Canada; (J.L.); (M.D.); (J.C.); (J.R.G.); (M.L.); (K.B.); (J.S.)
- Département de Médecine moléculaire, Faculté de Médecine, Université Laval, 1050 Avenue de la Médecine, Québec, QC G1V 0A6, Canada
| | - Hermann Nabi
- Centre de Recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Local J0-01, Québec, QC G1S 4L8, Canada; (J.L.); (M.D.); (J.C.); (J.R.G.); (M.L.); (K.B.); (J.S.)
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, 1050 Avenue de la Médecine, Université Laval, Québec, QC G1V 0A6, Canada
- Correspondence: ; Tel.: +1-418-525-4444 (ext. 82800)
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Vriend J, Nachtigal MW. Ubiquitin Proteasome Pathway Transcriptome in Epithelial Ovarian Cancer. Cancers (Basel) 2021; 13:cancers13112659. [PMID: 34071321 PMCID: PMC8198060 DOI: 10.3390/cancers13112659] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
In this article, we reviewed the transcription of genes coding for components of the ubiquitin proteasome pathway in publicly available datasets of epithelial ovarian cancer (EOC). KEGG analysis was used to identify the major pathways distinguishing EOC of low malignant potential (LMP) from invasive high-grade serous ovarian carcinomas (HGSOC), and to identify the components of the ubiquitin proteasome system that contributed to these pathways. We identified elevated transcription of several genes encoding ubiquitin conjugases associated with HGSOC. Fifty-eight genes coding for ubiquitin ligases and more than 100 genes encoding ubiquitin ligase adaptors that were differentially expressed between LMP and HGSOC were also identified. Many differentially expressed genes encoding E3 ligase adaptors were Cullin Ring Ligase (CRL) adaptors, and 64 of them belonged to the Cullin 4 DCX/DWD family of CRLs. The data suggest that CRLs play a role in HGSOC and that some of these proteins may be novel therapeutic targets. Differential expression of genes encoding deubiquitinases and proteasome subunits was also noted.
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Affiliation(s)
- Jerry Vriend
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Correspondence: ; Tel.: +1-204-789-3732
| | - Mark W. Nachtigal
- Department of Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada;
- Department of Obstetrics, Gynecology & Reproductive Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- CancerCare Manitoba Research Institute, Winnipeg, MB R3E 0V9, Canada
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19
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Tone AA, McCuaig JM, Ricker N, Boghosian T, Romagnuolo T, Stickle N, Virtanen C, Zhang T, Kim RH, Ferguson SE, May T, Laframboise S, Armel S, Demsky R, Volenik A, Stuart-McEwan T, Shaw P, Oza A, Kamel-Reid S, Stockley T, Bernardini MQ. The Prevent Ovarian Cancer Program (POCP): Identification of women at risk for ovarian cancer using complementary recruitment approaches. Gynecol Oncol 2021; 162:97-106. [PMID: 33858678 DOI: 10.1016/j.ygyno.2021.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Up to 20% of high-grade serous ovarian carcinomas (HGSOC) are hereditary; however, historical uptake of genetic testing is low. We used a unique combination of approaches to identify women in Ontario, Canada, with a first-degree relative (FDR) who died from HGSOC without prior genetic testing, and offer them multi-gene panel testing. METHODS From May 2015-Sept 2019, genetic counseling and testing was provided to eligible participants. Two recruitment strategies were employed, including self-identification in response to an outreach campaign and direct targeting of FDRs of deceased HGSOC patients treated at our institution. The rate of pathogenic variants (PV) in established/potential ovarian cancer risk genes and the benefits/challenges of each approach were assessed. RESULTS A total of 564 women enrolled in response to our outreach campaign (n = 473) or direct recruitment (n = 91). Mean age at consent was 52 years and 96% did not meet provincial testing criteria. Genetic results were provided to 528 individuals from 458 families. The rate of PVs in ovarian cancer risk genes was highest when FDRs were diagnosed with HGSOC <60 years (9.4% vs. 3.9% ≥ 60y, p = 0.0160). Participants in the outreach vs. direct recruitment cohort had a similar rate of PVs; however, uptake of genetic testing (97% vs. 89%; p = 0.0036) and study completion (95% vs. 87%; p = 0.0062) rates were higher in the former. Eleven participants with pathogenic variants have completed risk-reducing gynecologic surgery, with one stage I HGSOC and two breast cancers identified. CONCLUSION Overall PV rates in this large cohort were lower than expected; however, we provide evidence that genetic testing criteria in Ontario should include individuals with a deceased FDR diagnosed with HGSOC <60 years of age.
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Affiliation(s)
- Alicia A Tone
- Gynecologic Oncology, The University Health Network, Toronto, Canada; Ovarian Cancer Canada, Toronto, Canada
| | - Jeanna M McCuaig
- Gynecologic Oncology, The University Health Network, Toronto, Canada; Familial Cancer Clinic, The University Health Network, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Nicole Ricker
- Gynecologic Oncology, The University Health Network, Toronto, Canada
| | - Talin Boghosian
- Gynecologic Oncology, The University Health Network, Toronto, Canada
| | - Tina Romagnuolo
- Gynecologic Oncology, The University Health Network, Toronto, Canada
| | - Natalie Stickle
- Bioinformatics and HPC Core, The University Health Network, Toronto, Canada
| | - Carl Virtanen
- Bioinformatics and HPC Core, The University Health Network, Toronto, Canada
| | - Tong Zhang
- Advanced Molecular Diagnostics Laboratory, The University Health Network, Toronto, Canada
| | - Raymond H Kim
- Familial Cancer Clinic, The University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Medical Oncology, The University Health Network, Toronto, Canada
| | - Sarah E Ferguson
- Gynecologic Oncology, The University Health Network, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Taymaa May
- Gynecologic Oncology, The University Health Network, Toronto, Canada
| | | | - Susan Armel
- Familial Cancer Clinic, The University Health Network, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Rochelle Demsky
- Familial Cancer Clinic, The University Health Network, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Alexandra Volenik
- Familial Cancer Clinic, The University Health Network, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | | | - Patricia Shaw
- Gynecologic Pathology, The University Health Network, Toronto, Canada
| | - Amit Oza
- Medical Oncology, The University Health Network, Toronto, Canada
| | - Suzanne Kamel-Reid
- Advanced Molecular Diagnostics Laboratory, The University Health Network, Toronto, Canada; Clinical Laboratory Genetics, The University Health Network, Toronto, Canada
| | - Tracy Stockley
- Advanced Molecular Diagnostics Laboratory, The University Health Network, Toronto, Canada; Clinical Laboratory Genetics, The University Health Network, Toronto, Canada
| | - Marcus Q Bernardini
- Gynecologic Oncology, The University Health Network, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.
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20
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Kim SR, Tone A, Kim RH, Cesari M, Clarke BA, Eiriksson L, Hart T, Aronson M, Holter S, Lytwyn A, Maganti M, Oldfield L, Gallinger S, Bernardini MQ, Oza AM, Djordjevic B, Lerner‐Ellis J, Van de Laar E, Vicus D, Pugh TJ, Pollett A, Ferguson SE. Performance characteristics of screening strategies to identify Lynch syndrome in women with ovarian cancer. Cancer 2020; 126:4886-4894. [PMID: 32809219 PMCID: PMC7693219 DOI: 10.1002/cncr.33144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND For women with ovarian cancer (OC), the optimal screening strategy to identify Lynch syndrome (LS) has not been determined. In the current study, the authors compared the performance characteristics of various strategies combining mismatch repair (MMR) immunohistochemistry (IHC), microsatellite instability testing (MSI), and family history for the detection of LS. METHODS Women with nonserous and/or nonmucinous ovarian cancer were recruited prospectively from 3 cancer centers in Ontario, Canada. All underwent germline testing for LS and completed a family history assessment. Tumors were assessed using MMR IHC and MSI. The sensitivity, specificity, and positive and negative predictive values of screening strategies were compared with the gold standard of a germline result. RESULTS Of 215 women, germline data were available for 189 (88%); 13 women (7%) had pathogenic germline variants with 7 women with mutS homolog 6 (MSH6); 3 women with mutL homolog 1 (MLH1); 2 women with PMS1 homolog 2, mismatch repair system component (PMS2); and 1 woman with mutS homolog 2 (MSH2). A total of 28 women had MMR-deficient tumors (13%); of these, 11 had pathogenic variants (39%). Sequential IHC (with MLH1 promoter methylation analysis on MLH1-deficient tumors) followed by MSI for nonmethylated and/or MMR-intact patients was the most sensitive (92.3%; 95% confidence interval, 64%-99.8%) and specific (97.7%; 95% confidence interval, 94.2%-99.4%) approach, missing 1 case of LS. IHC with MLH1 promoter methylation analysis missed 2 patients of LS. Family history was found to have the lowest sensitivity at 55%. CONCLUSIONS Sequential IHC (with MLH1 promoter methylation analysis) followed by MSI was found to be most sensitive. However, IHC with MLH1 promoter methylation analysis also performed well and is likely more cost-effective and efficient in the clinical setting. The pretest probability of LS is high in patients with MMR deficiency and warrants universal screening for LS.
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Affiliation(s)
- Soyoun Rachel Kim
- Division of Gynecologic OncologyPrincess Margaret Cancer Centre, University Health NetworkSinai Health SystemsTorontoOntarioCanada
- Department of Obstetrics and GynaecologyUniversity of TorontoTorontoOntarioCanada
| | - Alicia Tone
- Division of Gynecologic OncologyPrincess Margaret Cancer Centre, University Health NetworkSinai Health SystemsTorontoOntarioCanada
| | - Raymond H. Kim
- Fred A. Litwin Family Centre for Genetic MedicineUniversity Health NetworkTorontoOntarioCanada
- Zane Cohen Centre for Digestive Diseases, Familial Gastrointestinal Cancer RegistryMount Sinai HospitalTorontoOntarioCanada
- Division of Medical Oncology and HematologyPrincess Margaret Cancer Centre, University Health NetworkSinai Health SystemsTorontoOntarioCanada
| | - Matthew Cesari
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Blaise A. Clarke
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Lua Eiriksson
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyJuravinski Cancer Centre, McMaster UniversityHamiltonOntarioCanada
| | - Tae Hart
- Zane Cohen Centre for Digestive Diseases, Familial Gastrointestinal Cancer RegistryMount Sinai HospitalTorontoOntarioCanada
- Department of PsychologyRyerson UniversityTorontoOntarioCanada
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Familial Gastrointestinal Cancer RegistryMount Sinai HospitalTorontoOntarioCanada
| | - Spring Holter
- Zane Cohen Centre for Digestive Diseases, Familial Gastrointestinal Cancer RegistryMount Sinai HospitalTorontoOntarioCanada
| | - Alice Lytwyn
- Division of Anatomical PathologyDepartment of Pathology and Molecular MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Manjula Maganti
- Department of BiostatisticsPrincess Margaret Cancer Centre, University Health NetworkUniversity of TorontoTorontoOntarioCanada
| | - Leslie Oldfield
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
| | - Steven Gallinger
- Division of General SurgeryPrincess Margaret Cancer Centre, University Health NetworkSinai Health SystemsTorontoOntarioCanada
| | - Marcus Q. Bernardini
- Division of Gynecologic OncologyPrincess Margaret Cancer Centre, University Health NetworkSinai Health SystemsTorontoOntarioCanada
- Department of Obstetrics and GynaecologyUniversity of TorontoTorontoOntarioCanada
| | - Amit M. Oza
- Division of Medical Oncology and HematologyPrincess Margaret Cancer Centre, University Health NetworkSinai Health SystemsTorontoOntarioCanada
| | - Bojana Djordjevic
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Jordan Lerner‐Ellis
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
| | - Emily Van de Laar
- Division of Gynecologic OncologyPrincess Margaret Cancer Centre, University Health NetworkSinai Health SystemsTorontoOntarioCanada
| | - Danielle Vicus
- Department of Obstetrics and GynaecologyUniversity of TorontoTorontoOntarioCanada
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologySunnybrook Health Sciences Centre, University of TorontoTorontoOntarioCanada
| | - Trevor J. Pugh
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Ontario Institute for Cancer ResearchUniversity Health NetworkTorontoOntarioCanada
- Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Aaron Pollett
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
- Pathology and Laboratory MedicineMount Sinai HospitalTorontoOntarioCanada
| | - Sarah E. Ferguson
- Division of Gynecologic OncologyPrincess Margaret Cancer Centre, University Health NetworkSinai Health SystemsTorontoOntarioCanada
- Department of Obstetrics and GynaecologyUniversity of TorontoTorontoOntarioCanada
- Zane Cohen Centre for Digestive Diseases, Familial Gastrointestinal Cancer RegistryMount Sinai HospitalTorontoOntarioCanada
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21
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Care M, McCuaig J, Clarke B, Grenier S, Kim RH, Rouzbahman M, Stickle N, Bernardini M, Stockley TL. Tumor and germline next generation sequencing in high grade serous cancer: experience from a large population-based testing program. Mol Oncol 2020; 15:80-90. [PMID: 33030818 PMCID: PMC7782089 DOI: 10.1002/1878-0261.12817] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/18/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to determine the prevalence of somatic and germline pathogenic variants (PVs) in high‐grade serous cancer (HGSC) and to demonstrate the technical feasibility and effectiveness of a large‐scale, population‐based tumor testing program. It involved a retrospective review of genetic test results in 600 consecutive HGSC tumor samples and a subsequent comparison of germline and tumor results in a subset of 200 individuals. Tumor testing was successful in 95% of samples (570/600) with at least one BRCA1/2 PV identified in 16% (93/570) of cases. Among the 200 paired cases, BRCA1/2 PVs were detected in 38 tumors (19%); 58% were somatic (22/38); and 42% were germline (16/38). There was 100% concordance between germline and tumor test results. This is the largest series of BRCA1/2 testing in HGSC (tumor‐only and paired cohorts), reported to date, and our data show that an effectively designed and validated population‐based tumor testing program can be used to determine both treatment eligibility and hereditary cancer risk.
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Affiliation(s)
- Melanie Care
- Laboratory Medicine Program, Division of Clinical Laboratory Genetics, University Health Network, Toronto, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Jeanna McCuaig
- Department of Molecular Genetics, University of Toronto, Toronto, Canada.,Familial Cancer Clinic, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Blaise Clarke
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Sylvie Grenier
- Laboratory Medicine Program, Division of Clinical Laboratory Genetics, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Raymond H Kim
- Familial Cancer Clinic, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Marjan Rouzbahman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Natalie Stickle
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Marcus Bernardini
- Department of Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - Tracy L Stockley
- Laboratory Medicine Program, Division of Clinical Laboratory Genetics, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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22
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Fadda M, Chappuis PO, Katapodi MC, Pagani O, Monnerat C, Membrez V, Unger S, Caiata Zufferey M. Physicians communicating with women at genetic risk of breast and ovarian cancer: Are we in the middle of the ford between contradictory messages and unshared decision making? PLoS One 2020; 15:e0240054. [PMID: 33031463 PMCID: PMC7544052 DOI: 10.1371/journal.pone.0240054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022] Open
Abstract
BRCA1/2 genetic testing offers tremendous opportunities for prevention, diagnosis and treatment of breast and ovarian cancer. Women acquire valuable information that can help them to make informed decisions about their health. However, knowing one's susceptibility to developing cancer may be burdensome for several women, as this risk needs to be managed over time through a continuous dialogue with multiple healthcare professionals. We explored how communication between physicians and unaffected women carrying BRCA1/2 germline pathogenic variants was experienced by women in relation to their genetic risk. Data came from qualitative interviews conducted in Switzerland with 32 unaffected women carrying BRCA1/2 pathogenic variants and aware of their genetic status for at least 3 years. We identified three different types of message as conveyed by physicians to women: (1) a normative message, (2) an over-empowering message, and (3) a minimizing message. On one hand, we found that women are exposed to contradictory messages, often simultaneously, in their interactions with healthcare professionals during their post-genetic testing journey. On the other hand, women's reports highlighted the absence of shared decision-making in such interactions. The combination of these two findings resulted in a strong sense of disorientation, frustration, and powerlessness among participants. Healthcare professionals interacting with high cancer risk women are urged to align in favor of a both concerted and shared decision-making approach when discussing options for managing genetic risk.
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Affiliation(s)
- Marta Fadda
- Faculty of Biomedical Sciences, Institute of Public Health, Università della Svizzera italiana, Italiana, Switzerland
| | - Pierre O. Chappuis
- Division of Genetic Medicine and Division of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Maria C. Katapodi
- Faculty of Medicine, Department of Clinical Research, University of Basel, Basel, Switzerland
| | | | | | - Véronique Membrez
- Division of Medical Genetics, Hôpital du Valais, Institut Central (ICH), Sion, Switzerland
| | - Sheila Unger
- Service of Medical Genetics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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23
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Hodgson A, Turashvili G. Pathology of Hereditary Breast and Ovarian Cancer. Front Oncol 2020; 10:531790. [PMID: 33117676 PMCID: PMC7550871 DOI: 10.3389/fonc.2020.531790] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Hereditary breast and ovarian cancer (HBOC) syndrome is most commonly characterized by deleterious germline mutations in BRCA1 and BRCA2. HBOC patients are prone to the development of malignant neoplasms in multiple organs including the breast, ovary, and fallopian tube. From a pathological perspective, a number of morphological features have been described in BRCA-associated breast and tubo-ovarian cancers. For example, breast cancers diagnosed in BRCA1-mutation carriers are frequently of a high Nottingham grade and display medullary morphology and a triple-negative and/or a basal-like immunophenotype. In contrast, breast cancers in BRCA2-mutation carriers are similar to sporadic luminal-type tumors that are positive for hormone receptors and lack expression of human epidermal growth factor receptor 2. Cancers arising in the fallopian tube and ovary are almost exclusively of a high-grade serous histotype with frequent Solid, pseudo-Endometrioid, and Transitional cell carcinoma-like morphology (“SET features”), marked nuclear atypia, high mitotic index, abundant tumor infiltrating lymphocytes, and necrosis. In addition, pushing or infiltrative micropapillary patterns of invasion have been described in BRCA-associated metastases of tubo-ovarian high-grade serous carcinomas. Besides BRCA1 and BRCA2 mutations, alterations in a number of other homologous recombination genes with moderate penetrance, including PALB2, RAD51C, RAD51D, BRIP1, and others, have also been described in HBOC patients with varying frequency; however, distinct morphological characteristics of these tumors have not been well characterized to date. In this review, the above pathological features are discussed in detail and a focus is placed on how accurate pathologic interpretation plays an important role in allowing HBOC patients to receive the best possible management.
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Affiliation(s)
- Anjelica Hodgson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Gulisa Turashvili
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
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24
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Vos JR, Fakkert IE, de Hullu JA, van Altena AM, Sie AS, Ouchene H, Willems RW, Nagtegaal ID, Jongmans MCJ, Mensenkamp AR, Woldringh GH, Bulten J, Leter EM, Kets CM, Simons M, Ligtenberg MJL, Hoogerbrugge N. Universal Tumor DNA BRCA1/2 Testing of Ovarian Cancer: Prescreening PARPi Treatment and Genetic Predisposition. J Natl Cancer Inst 2020; 112:161-169. [PMID: 31076742 PMCID: PMC7019087 DOI: 10.1093/jnci/djz080] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 04/29/2019] [Indexed: 12/23/2022] Open
Abstract
Background Women with epithelial ovarian cancer (OC) have a higher chance to benefit from poly (ADP-ribose) polymerase inhibitor (PARPi) therapy if their tumor has a somatic or hereditary BRCA1/2 pathogenic variant. Current guidelines advise BRCA1/2 genetic predisposition testing for all OC patients, though this does not detect somatic variants. We assessed the feasibility of a workflow for universal tumor DNA BRCA1/2 testing of all newly diagnosed OC patients as a prescreen for PARPi treatment and cancer predisposition testing. Methods Formalin-fixed paraffin-embedded tissue was obtained from OC patients in seven hospitals immediately after diagnosis or primary surgery. DNA was extracted, and universal tumor BRCA1/2 testing was then performed in a single site. Diagnostic yield, uptake, referral rates for genetic predisposition testing, and experiences of patients and gynecologists were evaluated. Results Tumor BRCA1/2 testing was performed for 315 (77.6%) of the 406 eligible OC samples, of which 305 (96.8%) were successful. In 51 of these patients, pathogenic variants were detected (16.7%). Most patients (88.2%) went on to have a genetic predisposition test. BRCA1/2 pathogenic variants were shown to be hereditary in 56.8% and somatic in 43.2% of patients. Participating gynecologists and patients were overwhelmingly positive about the workflow. Conclusions Universal tumor BRCA1/2 testing in all newly diagnosed OC patients is feasible, effective, and appreciated by patients and gynecologists. Because many variants cannot be detected in DNA from blood, testing tumor DNA as the first step can double the identification rate of patients who stand to benefit most from PARP inhibitors.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Edward M Leter
- Radboud University Medical Center, Nijmegen, the Netherlands. Department of Clinical Genetics (EML), Maastricht University Medical Center, Maastricht, the Netherlands
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25
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Piedimonte S, Power J, Foulkes WD, Weber E, Palma L, Schiavi A, Ambrosio E, Konci R, Gilbert L, Jardon K, Baret L, Zeng X. BRCA testing in women with high-grade serous ovarian cancer: gynecologic oncologist-initiated testing compared with genetics referral. Int J Gynecol Cancer 2020; 30:1757-1761. [PMID: 32759180 DOI: 10.1136/ijgc-2020-001261] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Up to 15% of patients with high-grade serous ovarian, tubal, or peritoneal carcinoma harbor a mutation in BRCA genes. Early notion of mutation status may facilitate counseling, predict prognosis, and increase access to Parp-inhibitors. The aim of this study was to examine the rate of germline genetic testing in a retrospective cohort of women with high-grade serous ovarian, tubal, or peritoneal carcinoma to determine if a new pilot project of gynecologic oncologist-initiated genetic testing improved the rate of testing, after 1 year of implementation. METHODS Gynecologic oncology-initiated genetic testing was implemented at a single university hospital center with input and collaboration from gynecological oncologists, nurses, and genetic counselors. All patients diagnosed with high-grade serous ovarian, tubal, or peritoneal carcinoma after August 2017 were offered gynecologic oncologist- initiated genetic testing for a panel of 13 hereditary breast and ovarian cancer susceptibility genes. Data from this group was then compared with a historic cohort of patients who received traditional genetic counseling between January 2014 and August 2017 (control group). Patients that had genetic testing through a clinical trial were excluded. The primary outcome was the uptake of genetic testing in both groups. Secondary outcomes included difference in time from diagnosis to genetic result between both cohorts. Data was analyzed using SPSS 25.0 and medians (ranges) were reported. RESULTS A total of 152 women with high-grade serous ovarian, tubal, or peritoneal carcinoma were included in this study. Between January 2014 to July 2017 there were 108 patients with high-grade serous ovarian, tubal, or peritoneal carcinoma, among which 50.9% (n=54) underwent genetic testing following referral to genetics. The prevalence of BRCA pathogenic variants was 25.9% (14/54): 9.2% (5/54) in BRCA1 and 16.7% (9/54) in BRCA2. The median time from diagnosis to genetics referral was 53 days (range; 3-751), and median time from diagnosis to test result disclosure was 186 days (range; 15-938). After 1 year of implementation of the gynecologic oncologist-initiated genetic testing model, among 44 women diagnosed with high-grade serous ovarian, tubal, or peritoneal carcinoma, 86.2% underwent genetic testing. The median time from diagnosis to result disclosure decreased to 58 days, representing a reduction of 128 days, or 4.27 months (P<0.001). Reasons for non-testing included refusal, death, and follow-up at another hospital. The prevalence of germline BRCA1/2 pathogenic variants was 21% (8/38). CONCLUSION Gynecologic oncologist-initiated genetic testing at the time of high-grade serous ovarian, tubal, or peritoneal carcinoma diagnosis leads to increased uptake and decreased delays in testing compared with referral for traditional genetic counseling.
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Affiliation(s)
- Sabrina Piedimonte
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joanne Power
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - William D Foulkes
- Department of Oncology and Human Genetics, Program in Cancer Genetics, McGill University, Montreal, Quebec, Canada
| | - Evan Weber
- Division of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Laura Palma
- Division of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alicia Schiavi
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Enza Ambrosio
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rea Konci
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Lucy Gilbert
- Gynecologic Cancer Services, Cancer Care Mission, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kris Jardon
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Laurence Baret
- Division of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Xing Zeng
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, Quebec, Canada
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26
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McCuaig JM, Care M, Ferguson SE, Kim RH, Stockley TL, Metcalfe KA. Year 1: Experiences of a tertiary cancer centre following implementation of reflex BRCA1 and BRCA2 tumor testing for all high-grade serous ovarian cancers in a universal healthcare system. Gynecol Oncol 2020; 158:747-753. [PMID: 32674931 DOI: 10.1016/j.ygyno.2020.06.507] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study compares the rate and time to genetic referral, and patient uptake of germline genetic services, before and after implementation of reflex BRCA1/2 tumor testing for high-grade serous ovarian cancer (HGSOC) in a universal healthcare system. METHODS A retrospective chart review of HSGOC patients diagnosed in the year before (PRE) and after (POST) implementation of reflex BRCA1/2 tumor testing was conducted. Clinical information (date/age at diagnosis, personal/family history of breast/ovarian cancer, cancer stage, primary treatment, tumor results) and dates of genetics referral, counseling, and germline testing were obtained. Incident rate ratios (IRR) and 95% CI were calculated using negative binomial regression. Time to referral was evaluated using Kaplan-Meier survival analysis. Fisher Exact tests were used to evaluate uptake of genetic services. RESULTS 175 HGSOC patients were identified (81 PRE; 94 POST). Post-implementation of tumor testing, there was a higher rate of genetics referral (12.88 versus 7.10/1000 person-days; IRR = 1.60, 95% CI: 1.07-2.42) and a shorter median time from diagnosis to referral (59 days PRE, 33 days POST; p = .04). In the POST cohort, most patients were referred prior to receiving their tumor results (n = 63/77; 81.8%). Once referred, most patients attended genetic counseling (94.5% PRE, 97.6% POST; p = .418) and pursue germline testing (98.6% PRE; 100% POST; p = .455). CONCLUSIONS Following implementation of reflex BRCA1/2 tumor testing for HGSOC, significant improvements to the rate and time to genetics referral were identified. Additional studies are needed to evaluate physician referral practices and the long-term impact of reflex tumor testing.
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Affiliation(s)
- Jeanna M McCuaig
- Familial Cancer Clinic, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada; Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada.
| | - Melanie Care
- Department of Molecular Genetics, University of Toronto, 27 King's College Circle, Toronto5, ON M5S 1A8, Canada; Division of Clinical Laboratory Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Sarah E Ferguson
- Division of Gynecologic Oncology, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada; Department of Obstetrics and Gynecology, University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Raymond H Kim
- Familial Cancer Clinic, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada; Division of Medical Oncology, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Tracy L Stockley
- Division of Clinical Laboratory Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Kelly A Metcalfe
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada; Women's College Research Institute, 72 Grenville Street, Toronto, ON M5S 1B2, Canada
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27
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McMullen M, Karakasis K, Madariaga A, Oza AM. Overcoming Platinum and PARP-Inhibitor Resistance in Ovarian Cancer. Cancers (Basel) 2020; 12:cancers12061607. [PMID: 32560564 PMCID: PMC7352566 DOI: 10.3390/cancers12061607] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022] Open
Abstract
Platinum chemotherapy remains the cornerstone of treatment for epithelial ovarian cancer (OC) and Poly (ADP-ribose) polymerase inhibitors (PARPi) now have an established role as maintenance therapy. The mechanisms of action of these agents is, in many ways, complementary, and crucially reliant on the intracellular DNA Damage Repair (DDR) response. Here, we review mechanisms of primary and acquired resistance to treatment with platinum and PARPi, examining the interplay between both classes of agents. A key resistance mechanism appears to be the restoration of the Homologous Recombination (HR) repair pathway, through BRCA reversion mutations and epigenetic upregulation of BRCA1. Alterations in non-homologous end-joint (NHEJ) repair, replication fork protection, upregulation of cellular drug efflux pumps, reduction in PARP1 activity and alterations to the tumour microenvironment have also been described. These resistance mechanisms reveal molecular vulnerabilities, which may be targeted to re-sensitise OC to platinum or PARPi treatment. Promising therapeutic strategies include ATR inhibition, epigenetic re-sensitisation through DNMT inhibition, cell cycle checkpoint inhibition, combination with anti-angiogenic therapy, BET inhibition and G-quadruplex stabilisation. Translational studies to elucidate mechanisms of treatment resistance should be incorporated into future clinical trials, as understanding these biologic mechanisms is crucial to developing new and effective therapeutic approaches in advanced OC.
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Affiliation(s)
| | | | | | - Amit M. Oza
- Correspondence: ; Tel.: +1-416-946-4450; Fax: +1-416-946-4467
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28
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Armel SR, Volenik A, Demsky R, Malcolmson J, Maganti M, McCuaig J. Setting a baseline: A 7-year review of referral rates and outcomes for serous ovarian cancer prior to implementation of oncologist mediated genetic testing. Gynecol Oncol 2020; 158:440-445. [PMID: 32505554 DOI: 10.1016/j.ygyno.2020.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Despite guidelines recommending that all women with invasive serous ovarian cancer (SOC) are offered genetic testing, published referral and testing rates have been poor. Many centers have implemented novel genetic counseling service delivery models to increase testing rates. In light of increased awareness and implementation of small process changes at our center, this study aims to establish baseline referral rates and testing outcomes prior to diverging from the traditional model of care. METHODS A list of women diagnosed with SOC at Princess Margaret Cancer Center (PM) between 2010 and 2016 was obtained from the PM Cancer Registry and cross-referenced against the genetics database to determine referral rates and outcomes of genetic testing. RESULTS Of 724 women with SOC, 68% were referred for genetic counseling, with an overall testing rate of 61%. Higher referral rates were seen among women with younger ages at diagnosis and high-grade tumors. Of women tested, 22% were found to have a pathogenic variant in BRCA1/2 and 9% in another cancer gene. Notably, 24% of women with a pathogenic variant reported no family history of breast or ovarian cancer. CONCLUSION Genetic counseling referral and testing rates for women with SOC are higher than previously reported, yet barriers to referral remain. To maximize genetic testing rates and address increasing patient volumes, clinics may be faced with integrating novel genetic counseling delivery models. Findings from this study may serve as a more accurate baseline to which large scale service delivery changes can be compared.
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Affiliation(s)
- Susan Randall Armel
- Familial Cancer Clinic, Princess Margaret Cancer Centre - University Health Network, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada.
| | - Alexandra Volenik
- Familial Cancer Clinic, Princess Margaret Cancer Centre - University Health Network, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Rochelle Demsky
- Familial Cancer Clinic, Princess Margaret Cancer Centre - University Health Network, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Janet Malcolmson
- Familial Cancer Clinic, Princess Margaret Cancer Centre - University Health Network, Toronto, Canada
| | - Manjula Maganti
- Department of Biostatistics, Princess Margaret Cancer Centre - University Health Network, Toronto, Canada
| | - Jeanna McCuaig
- Familial Cancer Clinic, Princess Margaret Cancer Centre - University Health Network, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada
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29
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Vos JR, Ligtenberg MJL, Hoogerbrugge N. Response to Tomao, Panici, and Tomao. J Natl Cancer Inst 2020; 112:425. [PMID: 31287552 PMCID: PMC7156924 DOI: 10.1093/jnci/djz140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/04/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Janet R Vos
- Department of Human Genetics, Nijmegen, the Netherlands
| | - Marjolijn J L Ligtenberg
- Department of Human Genetics, Nijmegen, the Netherlands.,Department of Pathology, Nijmegen, the Netherlands, Radboud University Medical Center, Nijmegen, the Netherlands
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30
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Unim B, De Vito C, Hagan J, Villari P, Knoppers BM, Zawati M. The Provision of Genetic Testing and Related Services in Quebec, Canada. Front Genet 2020; 11:127. [PMID: 32194621 PMCID: PMC7064617 DOI: 10.3389/fgene.2020.00127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background Research in the field of genomics and genetics has evolved in recent years and so has the demand of consumers who are increasingly interested in genomic prediction of diseases and various traits. The aim of this study is to identify genetic service delivery models, policies governing the use of genomics medicine, and measures to evaluate genetic services in the province of Quebec, Canada. Methods An ad hoc questionnaire was designed and administered online in 2017 to healthcare workers with good knowledge or experience in the provision of BReast CAncer genes 1 and 2 (BRCA1/2), Lynch syndrome, familial hypercholesterolemia, inherited thrombophilia genetic tests, engaged in policy planning or evaluation of genetic services. A quali-quantitative analysis of the survey results was performed. Results Thirty professionals participated in the study. The delivery models are classified in five categories according to the leading role of healthcare professionals in patient care pathways: i) the geneticist model; ii) the primary care model; iii) the medical specialist model; iv) the population screening program model; and v) the direct-to-consumer model. Barriers to genetic services are the coverage of genetic tests by the publicly funded healthcare system, the availability of qualified personnel, and the number of genetic centers. Regulatory oversight concerning the provision of genetic services appears to be insufficient. Conclusions Integration between genetics and the overall healthcare system in Quebec is in an early phase. Current models of genetic services require good level of genetic knowledge by all medical specialists, collaboration among different healthcare personnel, and work redistribution. The proper implementation of genomics into healthcare can be achieved through education and training, proper regulatory oversight, genomic policies, and public awareness.
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Affiliation(s)
- Brigid Unim
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Julie Hagan
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Ma'n Zawati
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
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31
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Lheureux S, Mirza M, Coleman R. The DNA Repair Pathway as a Target for Novel Drugs in Gynecologic Cancers. J Clin Oncol 2019; 37:2449-2459. [PMID: 31403862 DOI: 10.1200/jco.19.00347] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | | | - Robert Coleman
- The University of Texas MD Anderson Cancer Center, Houston, TX
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32
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Paradiso AV, Digennaro M, Patruno M, De Summa S, Tommasi S, Berindan-Neagoe I. BRCA germline mutation test for all woman with ovarian cancer? BMC Cancer 2019; 19:641. [PMID: 31253107 PMCID: PMC6599356 DOI: 10.1186/s12885-019-5829-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 06/12/2019] [Indexed: 01/09/2023] Open
Abstract
Background Delivering widespread BRCA testing to patients with ovarian cancer has been suggested by several scientists, recommended by professional societies and solicited by patients organizations. However, based on the lack of studies clearly demonstrating the cost-effectiveness of such approach compared to standard practice, we evaluated the possibility to better select subgroups of ovarian cancer (OC) patients with higher probability to be a BRCA mutation carrier’. Methods We analyzed the database of 2222 germline BRCA analyses from OC patients recently published by Song et al. (Song 2014) by applying multivariate and conditional inference regression tree-analyses. Results Overall, 178/2192 (8.1%) evaluable OC women showed pathogenic germline mutations in BRCA genes (84 BRCA1;94 BRCA2). BRCA mutations resulted significantly more frequent in Epithelial tumors (10.7%), less differentiated tumours (11.0%) and younger subjects (13.4%). Regression tree analysis permitted to individualize a subset of 66% OC patients with particularly low risk (3.5%) to carry a BRCA mutation vs a subgroup (24% of the series), with a probability higher than 17% to carry a pathogenic mutation. Younger age, OC and Breast Cancer family history were confirmed powerful factors in selecting subgroups of patients with significantly different BRCA mutation probability. Conclusions Our regression tree-analysis can represent an innovative approach taking into consideration all main clinical pathological information to select OC patients to be candidated for BRCA test.
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Affiliation(s)
- A V Paradiso
- Experimental Oncology - Center for Study of Heredo-Familial Tumors, IRCCS-Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65, 70124, Bari, Italy. .,Centro Studi Tumori Eredo-Familiari, Istituto Tumori G Paolo II IRCCS National Cancer Research Centre, Via O Flacco, 65, 70124, Bari, Italy.
| | - M Digennaro
- Experimental Oncology - Center for Study of Heredo-Familial Tumors, IRCCS-Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65, 70124, Bari, Italy
| | - M Patruno
- Experimental Oncology - Center for Study of Heredo-Familial Tumors, IRCCS-Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65, 70124, Bari, Italy
| | - S De Summa
- Molecular and Pharmacogenetics Diagnostic Laboratory, IRCCS-Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65, 70124, Bari, Italy
| | - S Tommasi
- Molecular and Pharmacogenetics Diagnostic Laboratory, IRCCS-Istituto Tumori "Giovanni Paolo II", viale Orazio Flacco, 65, 70124, Bari, Italy
| | - I Berindan-Neagoe
- Department of Functional Genomics and Experimental Pathology, The Oncology Institute "Prof. Dr. Ion Chiricuta", University of Medicine and Pharmacy Iuliu Hatieganu- Center for Functional Genomics and Center for Advanced Medicine Medfuture, Republicii 34th street; Marinescu 23, Pasteur 4-6, 400015, Cluj-Napoca, Romania
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33
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Beitsch PD, Whitworth PW, Hughes K, Patel R, Rosen B, Compagnoni G, Baron P, Simmons R, Smith LA, Grady I, Kinney M, Coomer C, Barbosa K, Holmes DR, Brown E, Gold L, Clark P, Riley L, Lyons S, Ruiz A, Kahn S, MacDonald H, Curcio L, Hardwick MK, Yang S, Esplin ED, Nussbaum RL. Underdiagnosis of Hereditary Breast Cancer: Are Genetic Testing Guidelines a Tool or an Obstacle? J Clin Oncol 2019; 37:453-460. [PMID: 30526229 PMCID: PMC6380523 DOI: 10.1200/jco.18.01631] [Citation(s) in RCA: 225] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE An estimated 10% of breast and ovarian cancers result from hereditary causes. Current testing guidelines for germ line susceptibility genes in patients with breast carcinoma were developed to identify carriers of BRCA1/ 2 variants and have evolved in the panel-testing era. We evaluated the capability of the National Comprehensive Cancer Network (NCCN) guidelines to identify patients with breast cancer with pathogenic variants in expanded panel testing. METHODS An institutional review board-approved multicenter prospective registry was initiated with 20 community and academic sites experienced in cancer genetic testing and counseling. Eligibility criteria included patients with a previously or newly diagnosed breast cancer who had not undergone either single- or multigene testing. Consecutive patients 18 to 90 years of age were consented and underwent an 80-gene panel test. Health Insurance Portability and Accountability Act-compliant electronic case report forms collected information on patient demographics, diagnoses, phenotypes, and test results. RESULTS More than 1,000 patients were enrolled, and data records for 959 patients were analyzed; 49.95% met NCCN criteria, and 50.05% did not. Overall, 8.65% of patients had a pathogenic/likely pathogenic (P/LP) variant. Of patients who met NCCN guidelines with test results, 9.39% had a P/LP variant. Of patients who did not meet guidelines, 7.9% had a P/LP variant. The difference in positive results between these groups was not statistically significant (Fisher's exact test P = .4241). CONCLUSION Our results indicate that nearly half of patients with breast cancer with a P/LP variant with clinically actionable and/or management guidelines in development are missed by current testing guidelines. We recommend that all patients with a diagnosis of breast cancer undergo expanded panel testing.
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Affiliation(s)
| | | | | | - Rakesh Patel
- Good Samaritan Hospital–TME/Breast Care Network, Los Gatos, CA
| | - Barry Rosen
- Advanced Surgical Care of Northern Illinois, Barrington, IL
| | - Gia Compagnoni
- Advanced Surgical Care of Northern Illinois, Barrington, IL
| | - Paul Baron
- Roper St Francis Healthcare, Charleston, SC
| | | | | | - Ian Grady
- North Valley Breast Clinic, Redding, CA
| | | | - Cynara Coomer
- Staten Island University Hospital, Staten Island, NY
| | | | | | | | | | | | - Lee Riley
- St Luke’s University Health Network, Easton, PA
| | | | - Antonio Ruiz
- Chesapeake Regional Medical Center, Chesapeake, VA
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Next-Generation Service Delivery: A Scoping Review of Patient Outcomes Associated with Alternative Models of Genetic Counseling and Genetic Testing for Hereditary Cancer. Cancers (Basel) 2018; 10:cancers10110435. [PMID: 30428547 PMCID: PMC6266465 DOI: 10.3390/cancers10110435] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 01/19/2023] Open
Abstract
The combination of increased referral for genetic testing and the current shortage of genetic counselors has necessitated the development and implementation of alternative models of genetic counseling and testing for hereditary cancer assessment. The purpose of this scoping review is to provide an overview of the patient outcomes that are associated with alternative models of genetic testing and genetic counseling for hereditary cancer, including germline-only and tumor testing models. Seven databases were searched, selecting studies that were: (1) full-text articles published ≥2007 or conference abstracts published ≥2015, and (2) assessing patient outcomes of an alternative model of genetic counseling or testing. A total of 79 publications were included for review and synthesis. Data-charting was completed using a data-charting form that was developed by the study team for this review. Seven alternative models were identified, including four models that involved a genetic counselor: telephone, telegenic, group, and embedded genetic counseling models; and three models that did not: mainstreaming, direct, and tumor-first genetic testing models. Overall, these models may be an acceptable alternative to traditional models on knowledge, patient satisfaction, psychosocial measures, and the uptake of genetic testing; however, particular populations may be better served by traditional in-person genetic counseling. As precision medicine initiatives continue to advance, institutions should consider the implementation of new models of genetic service delivery, utilizing a model that will best serve the needs of their unique patient populations.
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