1
|
Vlaming M, Ausems MGEM, Schijven G, van Oort IM, Kets CM, Komdeur FL, van der Kolk LE, Oldenburg RA, Sijmons RH, Kiemeney LALM, Bleiker EMA. Men with metastatic prostate cancer carrying a pathogenic germline variant in breast cancer genes: disclosure of genetic test results to relatives. Fam Cancer 2024; 23:165-175. [PMID: 38722431 PMCID: PMC11153271 DOI: 10.1007/s10689-024-00377-0] [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: 12/15/2023] [Accepted: 03/14/2024] [Indexed: 06/06/2024]
Abstract
Some patients with metastatic prostate cancer carry a pathogenic germline variant (PV) in a gene, that is mainly associated with an increased risk of breast cancer in women. If they test positive for such a PV, prostate cancer patients are encouraged to disclose the genetic test result to relatives who are at risk in case the carrier status changes the relatives' medical care. Our study aimed to investigate how men who learned they carry a PV in BRCA1, BRCA2, PALB2, CHEK2 or ATM disclosed their carrier status to at-risk relatives and to assess the possible psychological burden for the carrier and their perception of the burden for relatives. In total, 23 men with metastatic prostate cancer carrying a PV completed the IRI questionnaire about family communication; 14 also participated in a semi-structured interview. Patients felt highly confident in discussing the genetic test result with relatives. The diagnosis of prostate cancer was experienced as a burden, whereas being informed about genetic testing results did in most cases not add to this burden. Two patients encountered negative experiences with family communication, as they considered the genetic test result to be more urgent than their relatives. This mixed-methods study shows that metastatic prostate cancer patients with a PV in genes mainly associated with increased risk of breast cancer feel well-equipped to communicate about this predisposition in their families. Carriers felt motivated to disclose their genetic test result to relatives. Most of them indicated that the disclosure was not experienced as a psychological burden.
Collapse
Affiliation(s)
- Michiel Vlaming
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, 3584, The Netherlands
| | - Margreet G E M Ausems
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, 3584, The Netherlands
| | - Gina Schijven
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Heidelberglaan 100, CX Utrecht, 3584, The Netherlands
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, GA Nijmegen, 6525, The Netherlands
| | - C Marleen Kets
- Department of Human Genetics, Radboud University Medical Center, Geert Grooteplein Zuid 10, GA Nijmegen, 6525, The Netherlands
| | - Fenne L Komdeur
- Department of Human Genetics, Amsterdam University Medical Centers, Meibergdreef 9, AZ Amsterdam, 1105, The Netherlands
| | - Lizet E van der Kolk
- Department of Clinical Genetics, the Netherlands Cancer Institute, Plesmanlaan 121, CX Amsterdam, 1066, The Netherlands
| | - Rogier A Oldenburg
- Department of Clinical Genetics, Erasmus Medical Center, Dr. Molewaterplein 40, GD Rotterdam, 3015, The Netherlands
| | - Rolf H Sijmons
- Department of Genetics, University Medical Center Groningen, Hanzeplein 1, GZ Groningen, 9713, The Netherlands
| | - Lambertus A L M Kiemeney
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, GA Nijmegen, 6525, The Netherlands
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein Zuid 10, GA Nijmegen, 6525, The Netherlands
| | - Eveline M A Bleiker
- Department of Clinical Genetics, the Netherlands Cancer Institute, Plesmanlaan 121, CX Amsterdam, 1066, The Netherlands.
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, CX Amsterdam, 1066, The Netherlands.
- Department of Clinical Genetics, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, 2333, The Netherlands.
| |
Collapse
|
2
|
Ficarino H, Cage B, Osula JP, Heatherly A, Chu D, Reddy S, Bhatia S, Hollis R. Deficiencies in germline genetic testing in young-onset colorectal cancer patients. Am J Surg 2024; 232:126-130. [PMID: 38302366 PMCID: PMC11090699 DOI: 10.1016/j.amjsurg.2024.01.022] [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: 12/14/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Young-onset colorectal cancer (YO-CRC) patients have high rates of pathologic genetic variants on germline testing, however it is unclear what factors are associated with genetic testing completion. METHODS We performed a retrospective review of YO-CRC patients aged ≤50 years between 2014 and 2021 who received the entirety of their cancer care at a single institution. The primary outcome was completion of germline multigene panel testing. Variables were examined for association with germline multigene panel testing. RESULTS Among 100 YO-CRC patients, only 31 % (n = 31) completed genetic testing. Testing rates did not differ by colorectal cancer stage but were significantly higher among patients who received chemotherapy (39.8 % vs 5.9 %; p = 0.01) and in patients with increasing number of relatives with a family history of cancer (p < 0.01). CONCLUSIONS Only one-third of YO-CRC patients completed genetic testing. Patients seen by oncology or with increasingly strong family cancer history were more likely to complete genetic testing.
Collapse
Affiliation(s)
- Hannah Ficarino
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Ben Cage
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jean Paul Osula
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Alexis Heatherly
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Daniel Chu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sushanth Reddy
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Robert Hollis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.
| |
Collapse
|
3
|
Wang X, Waldman L, Silberman Y, Wang M, Tackey C, Hanna L, Vesprini D, Emmenegger U, Eisen A, Smoragiewicz M. Mainstream Model of Genetic Testing for Prostate Cancer at a Large Tertiary Cancer Centre. Clin Genitourin Cancer 2024:102052. [PMID: 38461085 DOI: 10.1016/j.clgc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND An estimated 20% to 30% of men with advanced prostate cancer carry a mutation in DNA damage repair genes, of which half are estimated to be germline. Eligibility criteria for germline genetic testing expanded significantly for Ontario patients in May 2021 and many centers adopted a "mainstream" model, defined as oncologist-initiated genetic testing. METHODS We conducted a retrospective chart review to report on the first-year mainstream experience of a large tertiary oncologic center, the Sunnybrook Odette Cancer Centre. All patients who underwent mainstream at the discretion of their treating physician were included. A subset underwent somatic profiling as part of clinical trial screening. Descriptive statistics were used to report baseline clinicopathologic characteristics and treatments received. RESULTS Between May 1, 2021, and May 30, 2022, 174 patients with prostate cancer underwent mainstream germline genetic testing with a 19-gene panel. Median age was 75 (IQR 68-80), and 82% of patients were diagnosed with either de novo metastatic or high-risk localized prostate adenocarcinoma. Fourteen patients (8%; 95% CI 4%-12%) were found to have a deleterious germline mutation, including pathogenic or likely pathogenic variants in BRCA1/2, ATM, CHEK2, PMS2, RAD51C, HOXB13, and BRIP1. Forty-nine patients (28%; 95% CI 21%-35%) were found to have a variant of uncertain significance. Thirty-four patients also had next-generation sequencing (NGS) of their somatic tissue. Among this subset, 8 of 34 (23%) had an alteration in homologous recombination repair (HRR) genes. Of the 14 patients with a germline mutation, none had a prior personal history of malignancy and 6 (43%) did not have any first- or second-degree relatives with history of prostate, pancreatic, breast, or ovarian cancer. CONCLUSION We report on the real-world characteristics of prostate cancer patients who underwent mainstream germline genetic testing. Personal history and family history of cancer cannot reliably stratify patients for the presence of pathogenic germline variants.
Collapse
Affiliation(s)
- Xin Wang
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Larissa Waldman
- Cancer Genetics and High-Risk Program, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yael Silberman
- Cancer Genetics and High-Risk Program, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Michael Wang
- Department of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Department of Bio-Medical Science, Guelph University, Guelph, Ontario, Canada
| | - Caleb Tackey
- Department of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Lilian Hanna
- Department of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Danny Vesprini
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Urban Emmenegger
- Department of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Andrea Eisen
- Cancer Genetics and High-Risk Program, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Department of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Martin Smoragiewicz
- Department of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
| |
Collapse
|
4
|
Koster R, Schipper LJ, Giesbertz NAA, van Beek D, Mendeville M, Samsom KG, Rosenberg EH, Hogervorst FBL, Roepman P, Boelens MC, Bosch LJW, van den Berg JG, Meijer GA, Voest EE, Cuppen E, Ruijs MWG, van Wezel T, van der Kolk L, Monkhorst K. Impact of genetic counseling strategy on diagnostic yield and workload for genome-sequencing-based tumor diagnostics. Genet Med 2024; 26:101032. [PMID: 38006283 DOI: 10.1016/j.gim.2023.101032] [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: 07/17/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE Genome sequencing (GS) enables comprehensive molecular analysis of tumors and identification of hereditary cancer predisposition. According to guidelines, directly determining pathogenic germline variants (PGVs) requires pretest genetic counseling, which is cost-ineffective. Referral for genetic counseling based on tumor variants alone could miss relevant PGVs and/or result in unnecessary referrals. METHODS We validated GS for detection of germline variants and simulated 3 strategies using paired tumor-normal GS data of 937 metastatic patients. In strategy-1, genetic counseling before tumor testing allowed direct PGV analysis. In strategy-2 and -3, germline testing and referral for post-test genetic counseling is based on tumor variants using Dutch (strategy-2) or Europen Society for Medical Oncology (ESMO) Precision Medicine Working Group (strategy-3) guidelines. RESULTS In strategy-1, PGVs would be detected in 50 patients (number-needed-to counsel; NTC = 18.7). In strategy-2, 86 patients would have been referred for genetic counseling and 43 would have PGVs (NTC = 2). In strategy-3, 94 patients would have been referred for genetic counseling and 32 would have PGVs (NTC = 2.9). Hence, 43 and 62 patients, respectively, were unnecessarily referred based on a somatic variant. CONCLUSION Both post-tumor test counseling strategies (2 and 3) had significantly lower NTC, and strategy-2 had the highest PGV yield. Combining pre-tumor test mainstreaming and post-tumor test counseling may maximize the clinically relevant PGV yield and minimize unnecessary referrals.
Collapse
Affiliation(s)
- Roelof Koster
- The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Luuk J Schipper
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | | | - Kris G Samsom
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Paul Roepman
- Hartwig Medical Foundation, Amsterdam, The Netherlands
| | | | - Linda J W Bosch
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Gerrit A Meijer
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Emile E Voest
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Edwin Cuppen
- Hartwig Medical Foundation, Amsterdam, The Netherlands
| | | | - Tom van Wezel
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Kim Monkhorst
- The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| |
Collapse
|