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Curran MG, Larkin MA. "The Bird effect"-positive impact of celebrity health disclosure on public awareness and soaring interest in motor neurone disease. Ir J Med Sci 2024; 193:973-974. [PMID: 37845581 DOI: 10.1007/s11845-023-03552-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Michael G Curran
- University of Galway School of Medicine, Clinical Science Institute, University Hospital Galway, Costello Road, Co. Galway, Ireland.
- Milford Care Centre, Plassey Park Road, Castletroy, Co. Limerick, Ireland.
| | - Mary Ann Larkin
- Milford Care Centre, Plassey Park Road, Castletroy, Co. Limerick, Ireland
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2
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Nobakht N, Kamgar M, Tavanaei M, Bilder RM, Nobakht E. Music and Medicine: Promoting Harmony for Health. Am J Med 2024; 137:92-98. [PMID: 37871734 DOI: 10.1016/j.amjmed.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023]
Abstract
A multitude of clinical trials measuring hemodynamic and psychological parameters have shown the beneficial effects of music on health. However, there are no clear instructions on how to utilize the potential benefits of music to improve health outcomes. Moreover, whether the effect of music is transient or enduring has yet to be determined. To address the effect of music on vital parameters and emotional well-being of patients we provide an overview of methods and findings of some studies that have evaluated the physiological or psychological impacts of music. This review puts forward a proposed model for fostering an individualized approach that can examine the therapeutic effects of music.
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Affiliation(s)
- Niloofar Nobakht
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles.
| | - Mohammad Kamgar
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles
| | - Maryam Tavanaei
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles
| | - Robert M Bilder
- Jane & Terry Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles
| | - Ehsan Nobakht
- Division of Renal Diseases and Hypertension, George Washington University School of Medicine & Health Sciences
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3
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Steers MLN, Strowger M, Tanygin AB, Ward RM. Do you 'like' problems? The linkage between college students' interactions with alcohol-related content on social media and their alcohol-related problems. Drug Alcohol Rev 2024; 43:75-85. [PMID: 37539618 PMCID: PMC10838370 DOI: 10.1111/dar.13729] [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: 09/30/2022] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Alcohol-related content (ARC) on social media and drinking motives impact college students' drinking. Most studies have examined peer-generated ARC on drinking outcomes but have yet to extend this relationship to other sources of influence. The current study explores the link between drinking motives, alcohol company ARC, celebrity ARC, and alcohol-related problems among college students. METHODS Students (N = 454) from two US universities completed a cross-sectional online survey assessing demographics; drinking motives (Drinking Motives Questionnaire-Revised; Cooper, Psychol Assess. 1994;6:117-28); following/awareness of alcohol company ARC; engagement with celebrity ARC; peak drinks (most drinks consumed on one occasion); and alcohol-related problems (e.g., passed out). RESULTS Greater celebrity ARC was linked to coping, enhancement, and conformity motives, and peak drinks. Frequent engagement with celebrity ARC was associated with higher problems. Positive indirect effects were observed from celebrity ARC to problems through coping and conformity motives, and peak drinks. After having adjusted for the influence of celebrity ARC, no significant pathways were found between alcohol company ARC and any of the drinking motives, peak drinks or problems, nor were there any indirect effects between alcohol company ARC and problems. DISCUSSION AND CONCLUSIONS Results revealed that a possible explanation for why students who engaged with celebrity ARC experience problems was due to coping and conformity motives as well as peak drinks. Interventions targeting alcohol cognitions might assess engagement with and exposure to different sources of ARC given their potential to influence problems.
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Affiliation(s)
| | - Megan Strowger
- Old Dominion University College of Sciences, Norfolf, USA
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4
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Alkhatib KY, Filipas DK, Briggs L, Frego N, Koelker M, Lipsitz SR, Pierorazio PM, Rebbeck T, Kilbridge K, Kibel AS, Trinh QD, Rana HQ, Cole AP. Racial differences in knowledge, attitudes, and sources of information about germline cancer genetic testing in the U.S.A.: An analysis of the health information National Trends Survey System. Prev Med 2024; 178:107779. [PMID: 37967620 DOI: 10.1016/j.ypmed.2023.107779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE To understand racial disparities in germline cancer genetic testing and the role of prior knowledge, attitudes, and sources of information. METHODS A cross-sectional analysis of the Health Information National Trends Survey 5 (HINTS 5) was conducted between February 24th and June 15th, 2020. The study aimed to investigate knowledge and receipt of genetic testing, attitudes toward the importance of genetic testing in preventing, detecting, and treating cancer, and information sources of genetic testing in the United States of America. RESULTS Non-Hispanic Black (NHB) and Hispanic race/ethnicity were associated with lower odds of being informed about genetic testing, whereas those of NHB race were more likely to endorse the importance of genetic testing in cancer prevention and treatment. Regarding sources of information about genetic testing: Non-Hispanic Asians were less likely to be informed about genetic testing from television (Mean Predicted Probability (MPP) 0.38 95%CI; 0.21-0.55, (Adjusted Risk Difference) ARD vs. Non-Hispanic White (NHW); -0.228, p = 0.01), NHB were less likely to report being informed about genetic testing from social media (MPP 0.27 95%CI; 0.20-0.34, ARD vs. NHW; -0.139, p < 0.01). CONCLUSIONS NHB and Hispanic groups face unequal access to information about genetic testing. There are significant race-based differences in information sources. These differences could be used to promote equitable access to cancer genetic testing.
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Affiliation(s)
- Khalid Y Alkhatib
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics (Penn LDI), Wharton, University of Pennsylvania, Philadelphia, PA, USA.
| | - Dejan K Filipas
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Logan Briggs
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urologic Surgery, Mayo Clinic, Phoenix, AZ.
| | - Nicola Frego
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy.
| | - Mara Koelker
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Stuart R Lipsitz
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Phillip M Pierorazio
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics (Penn LDI), Wharton, University of Pennsylvania, Philadelphia, PA, USA.
| | - Tim Rebbeck
- Division of Cancer Genetics and Prevention and Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Kerry Kilbridge
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Department of Urology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Adam S Kibel
- Department of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Quoc-Dien Trinh
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Huma Q Rana
- Division of Cancer Genetics and Prevention and Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Alexander P Cole
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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5
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Zhu J, Min N, Zhang Y, Wu H, Hong C, Geng R, Wei Y, Guan Q, Zheng Y, Li X. Contralateral prophylactic mastectomy for unilateral breast cancer in Chinese female population: a retrospective cohort study. Gland Surg 2023; 12:1668-1685. [PMID: 38229836 PMCID: PMC10788567 DOI: 10.21037/gs-23-384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/09/2023] [Indexed: 01/18/2024]
Abstract
Background Due to differences in socioeconomic and cultural backgrounds, the characteristics and prognosis of Asian female patients choosing contralateral prophylactic mastectomy (CPM) are likely to be different from Western patients. To fill the research gap of CPM in Asian populations, this study aims to explore the application trend, survival benefits, decision-making factors, and satisfaction of CPM based on the Chinese patients undergoing CPM. Methods The 0-III stage unilateral breast cancer (UBC) patients who received breast surgery in the Chinese PLA General Hospital from 2005 to 2017 were selected. The surgical procedures included simple mastectomy (SM), nipple-sparing mastectomy (NSM), breast conserving surgery (BCS), and CPM. Cox proportional regression analyses and Kaplan-Meier (KM) curve were performed to compare the overall survival (OS) and disease-free survival (DFS) rates between CPM group and unilateral mastectomy (UM) group. Proportional propensity score matching (PSM) with a 1:1 ratio was used to match the two groups and secondary survival analysis was performed. Logistic regression models were used to test predictive factors related to patients' CPM surgical decision-making. Results Four thousand two hundred and seventy-six patients were included in the study, with 73 patients receiving CPM, 3,567 receiving SM, 151 receiving NSM, and 485 receiving BCS. CPM surgery was first used in 2007, with a peak application rate of 3.02% in 2016. Three thousand seven hundred and ninety-one patients were included in the survival analysis, with a median follow-up time of 66.60 months. Compared to UM patients, neither the KM survival curve nor Cox regression hazard analyses of CPM showed better OS (P=0.963; P=0.834). After PSM, CPM also did not exhibit significant survival benefits in OS (P=0.335) and DFS (P=0.409). The logistic regression analyses showed that NSM surgery and lower tumor-node-metastasis (TNM) stage were independent factors to promote the CPM decision-making of patients. The CPM group showed high overall satisfaction (84.9%) and relatively low appearance satisfaction (69.9%). Conclusions CPM was practiced for the first time since 2007 in our hospital. CPM does not provide any OS and DFS benefits compared to UM and the appearance satisfaction procedure was relatively low. Therefore, clinicians should fully communicate with patients before surgery and be more cautious in giving CPM recommendations.
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Affiliation(s)
- Jingjin Zhu
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ningning Min
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanjun Zhang
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Huan Wu
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Chenyan Hong
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rui Geng
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yufan Wei
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qingyu Guan
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yiqiong Zheng
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiru Li
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Grandjean B, Scherz A, Rabaglio M. Eleven Years of Oncogenetic Consultations in a Swiss Center: Patient and Testing Characteristics. Appl Clin Genet 2023; 16:205-213. [PMID: 37965626 PMCID: PMC10642386 DOI: 10.2147/tacg.s410261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Oncogenetic counseling has been provided at the University Hospital of Bern since 2004. Since the public announcement by Ms. Angelina Jolie in 2013 that she had undergone bilateral prophylactic mastectomy, other oncogenetic centers have reported an increase in consultations. We conducted a retrospective review of the oncogenetic consultations at our center to evaluate the presence and the consequences of a potential "Angelina Jolie effect" and to characterize this patient population over a decade. Methods All initial oncogenetic consultations between 2005 and 2015 were collected, using electronic records. Demographics, cancer type, testing, and mutation results, as well as consultation rates, were recorded. The yearly trends were analyzed using Joinpoint regression analysis (JPA). Results In total, 823 patient cases were included, mostly women (84%), half of them with a positive personal cancer history. A hereditary breast and ovarian cancer (HBOC) risk was the main reason for consultation (72%). Moreover, 22% of patients had a previously detected familial mutation. Two-thirds underwent testing, which yielded a positive test result in 31% of the cases. According to JPA, the consultation rate increased throughout the decade, with a significant upward trend from 2013. Rates of testing and positive results remained stable over time. Most patients (86%) fulfilled the referral criteria of published guidelines. Discussion At our center, we found retrospectively a disproportionate growth in the referral rate for HBOC cases compared to other oncological cases after the year 2013, but overall, no change in testing rates was detected.
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Affiliation(s)
- Bastien Grandjean
- Department of Medical Oncology, Inselspital University Hospital, Bern, Switzerland
| | - Amina Scherz
- Department of Medical Oncology, Inselspital University Hospital, Bern, Switzerland
| | - Manuela Rabaglio
- Department of Medical Oncology, Inselspital University Hospital, Bern, Switzerland
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Wellman ML, Holton AE, Kaphingst KA. Previvorship Posting: Why Breast Cancer Previvors Share Their Stories on Social Media. HEALTH COMMUNICATION 2023; 38:2441-2449. [PMID: 35582752 DOI: 10.1080/10410236.2022.2074780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Research on previvors, individuals with a genetic predisposition to develop hereditary breast and ovarian cancer but who have not yet been diagnosed with breast or other cancers, examines online information gathering and community support to alleviate uncertainty. However, research exploring online content published by previvors themselves is limited. We examined content published to Instagram and TikTok to explore how breast cancer previvors discussed their lived experience which included, but was not limited to, genetic testing, diagnosis with a BRCA1/2 pathogenic (i.e. risk-increasing) variant, the decision to undergo preventative measures like surgery and/or reconstruction, and how they cope after diagnosis and surgical procedures. In the findings, we explicate how many previvors feel a responsibility to share their authentic experience on social media in order to help others and mitigate their own feelings of uncertainty. This study offers a snapshot of how women are sharing breast cancer previvorship and building social connections with each other online.
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Ward MS, Feldman MJ, Ward BN, Ong V, Brown NJ, Shahrestani S, Yi Yang C, Abraham ME, Paskhover B, Nanda A. Characterizing internet search patterns for neurologic and neurosurgical conditions following celebrity diagnosis. J Neurosurg Sci 2023; 67:523-528. [PMID: 34763394 DOI: 10.23736/s0390-5616.21.05569-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Social media and internet platforms have become significant drivers of mass-information. Highly publicized events, such as John McCain's announcement of his glioblastoma diagnosis, often drive national public interest in medical topics. Improved understanding of the temporality of interest spikes as well as the nature of the information that garners attention from outside the medical community can help inform ways in which the medical community can boost awareness of (and interest in) the field of neurosurgery. We utilized the "explore topics" feature on Google Trends to obtain web, news, and YouTube search data from May 1, 2015, to May 1, 2019 for the terms "glioblastoma," "brain tumor," "stroke," and "multiple sclerosis" to identify periods of visibly increased search interest. Search results for "glioblastoma" showed significantly elevated average interest during the period of July 3-23, 2017, as compared to that generated since this specific time period (42.6 vs. 8.73, P<0.001). This increased search activity therefore directly correlated with John McCain's public announcement of his glioblastoma diagnosis, and a similar search interest spike was evident using the search term "brain tumor" (87.3 vs. 64.2, P<0.001). Search results for "multiple sclerosis" showed - as a result of the online buzz created by Selma Blair's battle with the disease - significantly elevated average interest from October 8, 2018, to October 28, 2018, and February 11, 2019, to March 3, 2019, when compared to the average interest of the remaining time (59 vs. 40.16, P<0.001 and 69 vs. 40.16, P<0.001). Finally, there were no corresponding elevations in YouTube search interest for any of the terms associated with increased interest on Google Trends. Following major events related to the neurological disease of public figures there is an expected rise in Google search interest relevant to these topics. Our findings suggest that there is an optimal window of approximately 2 weeks following each of these events for activist and clinical groups to publicize their desired message, and for the field of neurosurgery and neurological science to increase public awareness regarding specific diseases, with a regression to baseline interest by 4 months following the event.
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Affiliation(s)
- Max S Ward
- Zucker School of Medicine at Hofstra/Northwell, Unit of Neurological Surgery, Manhasset, NY, USA -
| | - Michael J Feldman
- Unit Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Vera Ong
- John H. Burns Medical School, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, Orange, CA, USA
| | - Shane Shahrestani
- Keck School of Medicine of USC, Department of Neurological Surgery, Los Angeles, CA, USA
- California Institute of Technology, Pasadena, CA, USA
| | - Chen Yi Yang
- Department of Neurological Surgery, University of California, Orange, CA, USA
| | - Mickey E Abraham
- Unit of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Boris Paskhover
- Rutgers New Jersey Medical School, Unit of Otolaryngology, Head and Neck Surgery, Newark, NJ, USA
| | - Anil Nanda
- Rutgers New Jersey Medical School, Neurological Surgery, Newark, NJ, USA
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Bednar EM, Chen M, Walsh MT, Eppolito AL, Klein MH, Teed K, Hodge B, Hunter J, Chao HG, Davis D, Serchion W, Yobbi C, Krukenberg R, Jenkinson SB, Moore JJ, Garcia C, Gonzalez F, Murray T, Nielsen LD, Ho B, Haas M, Greenzweig SB, Anderson A, Johnson C, Morman NA, Bowdish E, Wise E, Cooper JN, Russ PK, Tondo-Steele K, de Gracia BF, Levin B, Mattie K, Zarnawski K, Kalasinski M, Stone J, O'Brien C, Bream A, Kennedy AM, Paul RA, Bilbao M, Romero M, Carr RL, Siettmann JM, Vercruyssen AK, Leon K, Arun BK, Grainger AV, Warshal DP, Bowman E, Goedde TA, Halaharvi D, Rath K, Grana G, Mina L, Lu KH. Outcomes of the "BRCA Quality Improvement Dissemination Program": An initiative to improve patient receipt of cancer genetics services at five health systems. Gynecol Oncol 2023; 172:106-114. [PMID: 37004303 PMCID: PMC10192022 DOI: 10.1016/j.ygyno.2023.03.016] [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: 02/10/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE A quality improvement initiative (QII) was conducted with five community-based health systems' oncology care centers (sites A-E). The QII aimed to increase referrals, genetic counseling (GC), and germline genetic testing (GT) for patients with ovarian cancer (OC) and triple-negative breast cancer (TNBC). METHODS QII activities occurred at sites over several years, all concluding by December 2020. Medical records of patients with OC and TNBC were reviewed, and rates of referral, GC, and GT of patients diagnosed during the 2 years before the QII were compared to those diagnosed during the QII. Outcomes were analyzed using descriptive statistics, two-sample t-test, chi-squared/Fisher's exact test, and logistic regression. RESULTS For patients with OC, improvement was observed in the rate of referral (from 70% to 79%), GC (from 44% to 61%), GT (from 54% to 62%) and decreased time from diagnosis to GC and GT. For patients with TNBC, increased rates of referral (from 90% to 92%), GC (from 68% to 72%) and GT (81% to 86%) were observed. Effective interventions streamlined GC scheduling and standardized referral processes. CONCLUSION A multi-year QII increased patient referral and uptake of recommended genetics services across five unique community-based oncology care settings.
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Affiliation(s)
- Erica M Bednar
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Minxing Chen
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Michael T Walsh
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Amanda L Eppolito
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Molly H Klein
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Kelly Teed
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Brittany Hodge
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Jordan Hunter
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Han Gill Chao
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Dillon Davis
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Wilshauna Serchion
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Cara Yobbi
- Community Health Network, Indianapolis, IN, United States of America
| | | | | | - Jennifer J Moore
- Community Health Network, Indianapolis, IN, United States of America
| | - Cassandra Garcia
- Community Health Network, Indianapolis, IN, United States of America
| | | | - Towanna Murray
- Community Health Network, Indianapolis, IN, United States of America
| | - Linda D Nielsen
- Community Health Network, Indianapolis, IN, United States of America
| | - Brenda Ho
- Community Health Network, Indianapolis, IN, United States of America
| | - Megan Haas
- Community Health Network, Indianapolis, IN, United States of America
| | | | - Abby Anderson
- Community Health Network, Indianapolis, IN, United States of America
| | - Christina Johnson
- Community Health Network, Indianapolis, IN, United States of America
| | | | | | - Emaline Wise
- OhioHealth, Columbus, OH, United States of America
| | | | | | | | | | - Brooke Levin
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Kristin Mattie
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Kathryn Zarnawski
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Molly Kalasinski
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Jennifer Stone
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Caitlin O'Brien
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Alexa Bream
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Aidan M Kennedy
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Rachel A Paul
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Michelle Bilbao
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Maureen Romero
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Rebecca L Carr
- Banner MD Anderson Cancer Center, Gilbert, AZ, United States of America
| | | | | | - Kaycee Leon
- Banner MD Anderson Cancer Center, Gilbert, AZ, United States of America
| | - Banu K Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | | | - David P Warshal
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Erin Bowman
- Piedmont Oncology at Piedmont Healthcare, Atlanta, GA, United States of America
| | - Timothy A Goedde
- Community Health Network, Indianapolis, IN, United States of America
| | | | - Kellie Rath
- OhioHealth, Columbus, OH, United States of America
| | - Generosa Grana
- MD Anderson Cancer Center at Cooper University Health Care, Camden, NJ, United States of America
| | - Lida Mina
- Banner MD Anderson Cancer Center, Gilbert, AZ, United States of America
| | - Karen H Lu
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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10
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Lee JE, Goh ML, Yeo SF. Mental health awareness of secondary schools students: Mediating roles of knowledge on mental health, knowledge on professional help, and attitude towards mental health. Heliyon 2023; 9:e14512. [PMID: 36950622 PMCID: PMC10025912 DOI: 10.1016/j.heliyon.2023.e14512] [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: 08/26/2022] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Purpose The mental health situation among adolescents in Malaysia has reached a worrying state with the rising number of cases. Despite a significant increase in the literature on mental health, there is a lack of studies that focused on mental health awareness. Therefore, this study aimed to investigate the factors affecting Malaysian youth's mental health awareness as well as the mediating roles of knowledge on mental health, knowledge on professional help, and attitude towards mental health. Methods Self-administered questionnaires were distributed to 450 secondary school students aged 15-19 years old in Kuala Lumpur and Melaka who were recruited via purposive sampling. Data analysis was performed using SPSS and SmartPLS to obtain the descriptive analysis, measurement model, and structural model. Results The results indicated that mental health awareness was influenced by knowledge on mental health and attitude towards mental health. The findings also revealed that familiarity and media exposure were important determinants of knowledge on mental health, knowledge on professional help, and attitude towards mental health. Moreover, the results indicated that knowledge on mental health positively mediated the relationship between media exposure and mental health awareness. Besides, attitude towards mental health also found to play mediating roles between familiarity and mental health awareness, as well as between media exposure and mental health awareness. Conclusion This study contributed important knowledge to the limited literature in this contemporary domain. An effective public mental health campaign is needed to reduce the burden of disease and the cost of mental illness.
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Affiliation(s)
- Jia En Lee
- Faculty of Business, Multimedia University, Melaka, Malaysiax
| | - Mei Ling Goh
- Faculty of Business, Multimedia University, Melaka, Malaysiax
- Corresponding author.
| | - Sook Fern Yeo
- Faculty of Business, Multimedia University, Melaka, Malaysiax
- Department of Business Administration, Daffodil International University,Dhaka, Bangladesh
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11
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Schmidt MK, Kelly JE, Brédart A, Cameron DA, de Boniface J, Easton DF, Offersen BV, Poulakaki F, Rubio IT, Sardanelli F, Schmutzler R, Spanic T, Weigelt B, Rutgers EJT. EBCC-13 manifesto: Balancing pros and cons for contralateral prophylactic mastectomy. Eur J Cancer 2023; 181:79-91. [PMID: 36641897 PMCID: PMC10326619 DOI: 10.1016/j.ejca.2022.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/17/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Abstract
After a diagnosis of unilateral breast cancer, increasing numbers of patients are requesting contralateral prophylactic mastectomy (CPM), the surgical removal of the healthy breast after diagnosis of unilateral breast cancer. It is important for the community of breast cancer specialists to provide meaningful guidance to women considering CPM. This manifesto discusses the issues and challenges of CPM and provides recommendations to improve oncological, surgical, physical and psychological outcomes for women presenting with unilateral breast cancer: (1) Communicate best available risks in manageable timeframes to prioritise actions; better risk stratification and implementation of risk-assessment tools combining family history, genetic and genomic information, and treatment and prognosis of the first breast cancer are required; (2) Reserve CPM for specific situations; in women not at high risk of contralateral breast cancer (CBC), ipsilateral breast-conserving surgery is the recommended option; (3) Encourage patients at low or intermediate risk of CBC to delay decisions on CPM until treatment for the primary cancer is complete, to focus on treating the existing disease first; (4) Provide patients with personalised information about the risk:benefit balance of CPM in manageable timeframes; (5) Ensure patients have an informed understanding of the competing risks for CBC and that there is a realistic plan for the patient; (6) Ensure patients understand the short- and long-term physical effects of CPM; (7) In patients considering CPM, offer psychological and surgical counselling before surgery; anxiety alone is not an indication for CPM; (8) Eliminate inequality between countries in reimbursement strategies; CPM should be reimbursed if it is considered a reasonable option resulting from multidisciplinary tumour board assessment; (9) Treat breast cancer patients at specialist breast units providing the entire patient-centred pathway.
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Affiliation(s)
- Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Anne Brédart
- Institut Curie, Paris, France; Psychology Institute, Psychopathology and Health Process Laboratory UR4057, Paris City University, Paris, France
| | - David A Cameron
- Edinburgh University Cancer Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Breast Unit, Capio St. Göran's Hospital, Stockholm, Sweden
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital - Aarhus University, Aarhus N, Denmark
| | - Fiorita Poulakaki
- Breast Surgery Department, Athens Medical Center, Athens, Greece; Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
| | - Tanja Spanic
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy; Europa Donna Slovenia, Ljubljana, Slovenia
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emiel J T Rutgers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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12
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Toyokuni S, Kong Y, Motooka Y, Akatsuka S. Environmental impact on carcinogenesis under BRCA1 haploinsufficiency. Genes Environ 2023; 45:2. [PMID: 36639692 PMCID: PMC9837898 DOI: 10.1186/s41021-023-00258-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Cancer is the primary cause of human mortality in Japan since 1981. Although numerous novel therapies have been developed and applied in clinics, the number of deaths from cancer is still increasing worldwide. It is time to consider the strategy of cancer prevention more seriously. Here we propose a hypothesis that cancer can be side effects of long time-use of iron and oxygen and that carcinogenesis is an evolution-like cellular events to obtain "iron addiction with ferroptosis-resistance" where genes and environment interact each other. Among the recognized genetic risk factors for carcinogenesis, we here focus on BRCA1 tumor suppressor gene and how environmental factors, including daily life exposure and diets, may impact toward carcinogenesis under BRCA1 haploinsufficiency. Although mice models of BRCA1 mutants have not been successful for decades in generating phenotype mimicking the human counterparts, a rat model of BRCA1 mutant was recently established that reasonably mimics the human phenotype. Two distinct categories of oxidative stress, one by radiation and one by iron-catalyzed Fenton reaction, promoted carcinogenesis in Brca1 rat mutants. Furthermore, mitochondrial damage followed by alteration of iron metabolism finally resulted in ferroptosis-resistance of target cells in carcinogenesis. These suggest a possibility that cancer prevention by active pharmacological intervention may be possible for BRCA1 mutants to increase the quality of their life rather than preventive mastectomy and/or oophorectomy.
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Affiliation(s)
- Shinya Toyokuni
- grid.27476.300000 0001 0943 978XDepartment of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan ,grid.27476.300000 0001 0943 978XCenter for Low-Temperature Plasma Sciences, Nagoya University, Furo-Cho, Chikusa-Ku, Nagoya, 464-8603 Japan
| | - Yingyi Kong
- grid.27476.300000 0001 0943 978XDepartment of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Yashiro Motooka
- grid.27476.300000 0001 0943 978XDepartment of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Shinya Akatsuka
- grid.27476.300000 0001 0943 978XDepartment of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
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13
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Ibnat N, Chowdhury EH. Retarding breast tumor growth with nanoparticle-facilitated intravenous delivery of BRCA1 and BRCA2 tumor suppressor genes. Sci Rep 2023; 13:536. [PMID: 36631481 PMCID: PMC9834397 DOI: 10.1038/s41598-022-25511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
Gene augmentation therapy entails replacement of the abnormal tumor suppressor genes in cancer cells. In this study, we performed gene augmentation for BRCA1/2 tumor suppressors in order to retard tumor development in breast cancer mouse model. We formulated inorganic carbonate apatite (CA) nanoparticles (NPs) to carry and deliver the purified BRCA1/2 gene- bearing plasmid DNA both in vitro and in vivo. The outcome of BRCA1/2 plasmid-loaded NPs delivery on cellular viability of three breast cancer cell lines such as MCF-7, MDA-MB-231 and 4T1 were evaluated by MTT assay. The result in MCF-7 cell line exhibited that transfection of BRCA 1/2 plasmids with CA NPs significantly reduced cancer cell growth in comparison to control group. Moreover, we noticed a likely pattern of cellular cytotoxicity in 4T1 murine cancer cell line. Following transfection with BRCA1 plasmid-loaded NPs, and Western blot analysis, a notable reduction in the phospho-MAPK protein of MAPK signaling pathway was detected, revealing reduced growth signal. Furthermore, in vivo study in 4T1 induced breast cancer mouse model showed that the tumor growth rate and final volume were decreased significantly in the mouse group treated intravenously with BRCA1 + NPs and BRCA2 + NPs formulations. Our results established that BRCA1/2 plasmids incorporated into CA NPs mitigated breast tumor growth, signifying their application in the therapy for breast cancer.
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Affiliation(s)
- Nabilah Ibnat
- grid.440425.30000 0004 1798 0746Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia ,grid.22448.380000 0004 1936 8032Department of Bioengineering, George Mason University, Fairfax, VA 20110 USA
| | - Ezharul Hoque Chowdhury
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia.
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14
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Mazza M, Piperis M, Aasaithambi S, Chauhan J, Sagkriotis A, Vieira C. Social Media Listening to Understand the Lived Experience of Individuals in Europe With Metastatic Breast Cancer: A Systematic Search and Content Analysis Study. Front Oncol 2022; 12:863641. [PMID: 35719996 PMCID: PMC9205394 DOI: 10.3389/fonc.2022.863641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/06/2022] [Indexed: 02/05/2023] Open
Abstract
Background Despite a wealth of real-world data on metastatic breast cancer (mBC), insights into the lived experience are lacking. This study aimed to explore how the lived experience of mBC is described on social media. Methods A predefined search string identified posts relevant to the lived experience of mBC from Twitter, patient forums, and blogs across 14 European countries. The final data set was analyzed using content analysis. Results A total of 76,456 conversations were identified between November 1, 2018, and November 30, 2020. Twitter was the most commonly used social media platform across all 76,456 conversations from the raw data set (n = 61,165; 80%). Automated and manual relevancy checks followed by a final random sampling filter identified 820 conversations for content analysis. The majority of data from the raw data set was generated from the United Kingdom (n = 31,346; 41%). From this final data set, 61% of posts were authored by patients, 15% by friends and/or family members of patients, and 14% by caregivers. A total of 686 conversations described the patient journey (n = 686/820; 84%); 64% of these (n = 439) concerned breast cancer treatment, with approximately 40% of discussions regarding diagnosis and tests (n = 274/686) and less than 20% of discussions surrounding disease management (n = 123/686; 18%). Key themes relating to a lack of effective treatment, prolonged survival and associated quality of life, debilitating consequences of side effects, and the social impacts of living with mBC were identified. Conclusions The findings from this study provided an insight into the lived experience of mBC. While retrospective data collection inherently limits the amount of demographic or clinical information that can be obtained from the population sample, social media listening studies offer training to healthcare professionals in communication, the importance of quality of life, organization of healthcare, and even the design of clinical trials. As new targeted therapies are gradually incorporated into clinical practice, innovative technologies, such as social media listening, have the potential to support regulatory procedures and drug toxicity monitoring, as well as provide the patient voice in the regulation of new and existing medicines.
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Affiliation(s)
- Manuelita Mazza
- Divison of Medical Senology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Maria Piperis
- CyberKnife and TomoTherapy Department, Iatropolis Medical Group of Companies, Athens, Greece
| | | | - Jyoti Chauhan
- Insights and Analytics, Novartis Pharma AG, Basel, Switzerland
| | | | - Claudia Vieira
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal
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15
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Wang K, Lewis G. Insights and Strategies to Revive Brachytherapy Using Social Media: A Google Trends Analysis. Cureus 2022; 14:e25664. [PMID: 35812542 PMCID: PMC9256004 DOI: 10.7759/cureus.25664] [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] [Accepted: 06/02/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: The utilization and public awareness of brachytherapy are both declining. Social media has an increasing presence in health promotions. As regards cancer care, social media has been successfully used as a platform for information dissemination, psychosocial support, and patient engagement and empowerment. Methods and materials: Using Google Trends (Google LLC, Mountain View, CA, USA), we analyzed the impacts on the public interest of three brachytherapy-related social media campaigns/publicity events and compared and contrasted them with three other campaigns/publicity events. We used descriptive statistics (mean ± standard deviation (SD)) to describe the search results, independent t-tests to compare means before and after campaigns/announcements for short-term effects, and one-way ANOVA (or Kruskal-Wallis test when appropriate) to compare mean values across distinct time periods for long-term effects. Results: We identified three major types of social media campaigns/events: those that have a short-term impact but little long-term impact, those that have both short-term and long-term impacts, and those with little short-term or long-term impact. We examined campaigns with significant and lasting impacts and noticed that they tend to be celebrity-related/celebrity-endorsed, focused on sharing personal experiences, and occur with regular frequency. Conclusions: To increase public awareness of brachytherapy, the American Brachytherapy Society (ABS) can consider tie-ins with events and people with high search traffic (such as Breast Cancer Awareness Month), having celebrities/influencers who were treated with brachytherapy to provide testimonials, encouraging patient engagement and sharing of their experiences with brachytherapy on social media, and setting up recurring brachytherapy publicity events.
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16
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Henn D, Barrera JA, Sivaraj D, Lin JQ, Rizk NM, Ma I, Gurtner GC, Lee GK, Nazerali RS. Combining Breast and Ovarian Operations Increases Complications. Plast Reconstr Surg 2022; 149:1050-1059. [PMID: 35245249 DOI: 10.1097/prs.0000000000008984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast cancer resulting from a genetic mutations, such as BRCA1 or BRCA2, is seen in 5 to 10 percent of patients. More widespread genetic testing has increased the number of affected women undergoing prophylactic mastectomy and oophorectomy. Recent studies have yielded mixed results regarding complication rates after combined breast and ovarian operations. The authors compared surgical outcomes of breast operations performed in combination with salpingo-oophorectomies or as separate procedures. METHODS The authors retrospectively analyzed surgical complications and length of hospital stay in 145 female patients, from which 87 had undergone combined breast surgery and salpingo-oophorectomy, and 58 had undergone these procedures separately. Multivariate logistic regression models were used to calculate odds ratios and 95 percent confidence intervals. RESULTS Patients undergoing combined breast and ovarian operations experienced higher rates of overall complications (46.5 percent versus 19 percent; p < 0.001), infections (22.2 percent versus 8.6 percent; p < 0.05), and delayed wound healing (13.2 percent versus 0 percent; p < 0.05) related to the breast surgery, when compared with patients undergoing separate procedures. Multivariate logistic regression analysis confirmed a significant association between combined surgery and overall postoperative complications (OR, 5.87; 95 percent CI, 2.03 to 16.91; p = 0.02). Patients undergoing tissue expander-based breast reconstruction combined with ovarian surgery had significantly longer hospital stays compared to patients undergoing separate procedures (3.5 days versus 1.8 days; p < 0.001). CONCLUSIONS The authors' data indicate that combining breast and ovarian operations is associated with a higher risk of postoperative complications related to the breast procedure and increases the duration of hospital stay in patients with tissue expander-based reconstructions. The authors' study provides valuable information for preoperative counseling of patients considering both breast and ovarian surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Dominic Henn
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Janos A Barrera
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Dharshan Sivaraj
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - John Q Lin
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Nada M Rizk
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Irene Ma
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Geoffrey C Gurtner
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Gordon K Lee
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Rahim S Nazerali
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
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17
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Development and evaluation of a website with patients experiences of multiple sclerosis: a mixed methods study. BMC Neurol 2022; 22:146. [PMID: 35443631 PMCID: PMC9019288 DOI: 10.1186/s12883-022-02663-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A variety of management options (e.g., disease-modifying therapy, lifestyle interventions, rehabilitation) are available for persons with relapsing-remitting multiple sclerosis (MS). Besides coping with the diagnosis, persons with MS have to make complex decisions, e.g., regarding disease-modifying therapies. In addition to factual information, reports of patient experiences may support other patients in their decision-making. Therefore, we developed a website presenting patient experiences illustrated by video, audio and text files. This study aimed to test the acceptability and usability of a website with patient experiences with MS. METHODS A mixed-methods approach was applied. A total of 69 participants visited the German "Patient Experiences with MS (PExMS)" website and among them, 50 persons with MS and 6 experts completed an online survey. In total, 18 participants took part in telephone interviews or focus groups. Data from the survey were analysed using descriptive statistics. Qualitative data were analysed using thematic analysis. RESULTS Both quantitative and qualitative responses suggest that the PExMS website was viewed positively by patients and experts. 94% of persons with MS agreed that the information was comprehensible and reliable. 54% felt encouraged to share their health problems with others after having studied the website. 74% claimed to use the website if they had to make a decision regarding their health. Qualitative responses deduced from the website fell into 5 key themes: (1) web design, appearance, and functionality, (2) content, (3) usability, (4) satisfaction, and (5) loyalty. The search for persons of similar age and with comparable experiences was a major driving force to navigate the website. The material on the website was perceived as diverse, covering both positive and negative experiences in daily living with MS. All participants greatly appreciated having access to other people's experiences online and judged the material on the website as particularly helpful in decision-making for disease-modifying therapies. CONCLUSIONS The findings suggest that the PExMS website might have the potential to be a useful source of audio-visual information for persons with MS. Given the lack of websites available to patients with experiential information, health care professionals may be encouraged to routinely inform patients about this website at regular appointments.
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18
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Abdel-Razeq H, Tamimi F, Abujamous L, Abdel-Razeq R, Abunasser M, Edaily S, Abdulelah H, Khashabeh RA, Bater R. Rates of Variants of Uncertain Significance Among Patients With Breast Cancer Undergoing Genetic Testing: Regional Perspectives. Front Oncol 2022; 12:673094. [PMID: 35402282 PMCID: PMC8989924 DOI: 10.3389/fonc.2022.673094] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 02/25/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose Contrary to BRCA pathogenic variants, recommendations for management of variants of uncertain significance (VUS) are not clear and focus more on the patient’s family and personal history of cancer. Local and regional data on VUS are scarce. In this paper, we study patterns and frequency of VUS among breast cancer patients undergoing genetic testing. Patients and Methods Patients with breast cancer at high risk for pathogenic variants, as per the National Comprehensive Cancer Network (NCCN) guidelines, were tested at reference laboratories. Related surgical interventions were reviewed. Results Among a group of 1,197 patients with breast cancer who underwent genetic testing and counseling, 110 (9.2%) had VUS; most (n = 79, 71.8%) were in BRCA2. Median age (range) was 39 (25–66) years with 65 (59.1%) patients who were 40 years or younger at diagnosis. Among 103 patients with non-metastatic disease, 48 (46.6%) had breast-conserving surgery (BCS) while only 5 (4.9%) had bilateral mastectomies; all were due to bilateral disease and not prophylactic. VUS diagnosis was known prior to initial surgery in 34 (33.0%) patients; 11 (32.4%) of them had BCS only. Over the study period, only one VUS variant was upgraded to “likely positive.” The recent introduction of multiple-gene panel testing had resulted in a surge in VUS rate (22.2%) in genes other than BRCA1 or BRCA2, like PALB2, CHEK2, and ATM. Conclusions Rates of VUS are relatively high and increasing, mostly in non-BRCA1 or BRCA2, and this had no impact on the therapeutic or prophylactic surgical decisions. Adherence to guidelines is extremely important to avoid unnecessary procedures.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan.,School of Medicine, University of Jordan, Amman, Jordan
| | - Faris Tamimi
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Lama Abujamous
- Department of Cell Therapy & Applied Genomic, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Sara Edaily
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Hazem Abdulelah
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Razan Abu Khashabeh
- Department of Cell Therapy & Applied Genomic, King Hussein Cancer Center, Amman, Jordan
| | - Rayan Bater
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
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19
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Indremo M, Jodensvi AC, Arinell H, Isaksson J, Papadopoulos FC. Association of Media Coverage on Transgender Health With Referrals to Child and Adolescent Gender Identity Clinics in Sweden. JAMA Netw Open 2022; 5:e2146531. [PMID: 35107572 PMCID: PMC8811638 DOI: 10.1001/jamanetworkopen.2021.46531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Increasing numbers of transgender and gender diverse children and adolescents have been referred to gender identity clinics in Sweden in the past decade, and previous studies have found an association between media attention and referral counts. Whether the tone of media stories is associated with referrals is not yet known. OBJECTIVE To investigate whether positive or negative media coverage on transgender and gender diverse issues is associated with referral counts to child and adolescent gender identity clinics. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, referrals counts were collected from all 6 specialized gender identity clinics in Sweden, along with information on referral date, sex assigned at birth, and birth year. Participants were all individuals younger than 19 years, referred to a gender identity clinic between January 1, 2017, and December 31, 2019. Data were analyzed from May 2020 to September 2021. EXPOSURES Exposures included 3 major media events related to transgender health care in 2019; 1 event was categorized as positive and 2 events were categorized as negative press coverage. MAIN OUTCOMES AND MEASURES Referral counts before and after each of the 3 major media events were assessed, and the moderating association of sex assigned at birth and age was examined with stratified analyses. Weekly referral counts and trends were assessed with interrupted time series analysis. RESULTS Among 1784 referrals (359 referrals [21.4%] among individuals aged <13 years; 1034 referrals [72.1%] among individuals assigned female at birth and 401 referrals [27.9%] among individuals assigned male at birth), a negative association between media coverage and referral counts was found for the first of the negative media events. In the 3 months following the event, referrals decreased by 25.4% (95% CI, -31.9% to -18.9%) overall, by 32.2% (95 CI, -41.8% to -22.8%) for individuals assigned female at birth, and by 25.3% (95 CI, -32.4% to -18.3%) for individuals aged 13 to 18 years. In the interrupted time series analysis, a mean weekly decrease of 3% in the referrals was observed in the extended time interval of 39 weeks (incidence rate ratio, 0.97; 95 CI, 0.95 to 0.99). For the other 2 media events, no changes in referral counts or time trends were observed. CONCLUSIONS AND RELEVANCE These findings suggest that an event of negative media coverage on transgender-specific health care was negatively associated with access to health care for transgender children and adolescents; therefore, nuanced and accurate media coverage, as well as increased awareness of these mechanisms among key stakeholders, is essential.
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Affiliation(s)
- Malin Indremo
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | | | - Hans Arinell
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Johan Isaksson
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
- Center of Neurodevelopmental Disorders, Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
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20
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Petrova D, Cruz M, Sánchez MJ. BRCA1/2 testing for genetic susceptibility to cancer after 25 years: A scoping review and a primer on ethical implications. Breast 2022; 61:66-76. [PMID: 34920368 PMCID: PMC8686063 DOI: 10.1016/j.breast.2021.12.005] [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: 10/20/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mutations in the genes called BRCA1 and BRCA2 are associated with significantly elevated lifetime risk of developing breast and ovarian cancer. This year marks 25 years since genetic tests for BRCA1/2 mutations became available to the public. Currently, comprehensive guidelines exist regarding BRCA1/2 testing and preventive measures in mutation carriers. As such, BRCA1/2 testing represents a precedent not only in genetic testing and management of genetic cancer risk, but also in bioethics. The goal of the current research was to offer a review and an ethical primer of the main ethical challenges related to BRCA testing. METHOD A systematic scoping review was undertaken following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Four databases were searched and 18 articles that met the inclusion criteria were synthetized narratively into a conceptual map. RESULTS Ethical discussions revolved around the BRCA1/2 gene discovery, how tests are distributed for clinical use, the choice to undergo testing, unresolved issues in receiving and disclosing test results, reproductive decision-making, and culture-specific ethics. Several unique properties of the latest developments in testing circumstances (e.g., incorporation of BRCA1/2 testing in multi-gene or whole genome sequence panels and tests sold directly to consumers) significantly raised the complexity of ethical debates. CONCLUSIONS Multidisciplinary ethical discussion is necessary to guide not only individual decision making but also societal practices and medical guidelines in light of the new technologies available and the latest results regarding psychological, social, and health outcomes in cancer previvors and survivors affected by BRCA mutations.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Maite Cruz
- Escuela Andaluza de Salud Pública, Granada, Spain
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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21
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Lee YH, Yuan CW, Wohn DY. How Video Streamers' Mental Health Disclosures Affect Viewers' Risk Perceptions. HEALTH COMMUNICATION 2021; 36:1931-1941. [PMID: 32842773 DOI: 10.1080/10410236.2020.1808405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Celebrities' self-disclosures about their mental health issues can enhance public awareness of mental illness such as depression. As online live streaming becomes a popular choice for media entertainment, microcelebrities such as video streamers may have similar influence over their audience. Using an online survey (N = 474), this study examined how exposure to streamers' depression disclosures affected the viewer's perceptions toward the streamers and depression. We also examined how parasocial relationships, parasocial interactions, and identification with streamers were associated with 1) the viewers' perceived authenticity and credibility toward the streamers, 2) as well as increases in the viewers' perceived prevalence, risk susceptibility, and risk severity about mental health. The study demonstrates a strong association between streamers' health disclosures and public awareness regarding depression. The study extends previous studies around celebrity influencers as a promising opportunity for reducing social stigma around mental health discussions. The study also advances our theoretical understanding of microcelebrities' social influence in a new media context.
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Affiliation(s)
- Yu-Hao Lee
- Department of Telecommunication, University of Florida
| | - Chien Wen Yuan
- Graduate Institute of Library and Information Studies, National Taiwan Normal University
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22
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Lohn Z, Fok A, Richardson M, Derocher H, Mung SW, Nuk J, Yuson J, Jevon M, A Schrader K, Sun S. Large-scale group genetic counseling: Evaluation of a novel service delivery model in a Canadian hereditary cancer clinic. J Genet Couns 2021; 31:459-469. [PMID: 34596310 DOI: 10.1002/jgc4.1512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 11/12/2022]
Abstract
Increasing demand for genetic services has led to the development of streamlined genetic counseling (GC) models. We piloted large-scale group pre-test GC with up to 50 patients per group and compared this to a traditional one-on-one approach. Patients referred to the British Columbia (BC) Cancer Hereditary Cancer Program were eligible if they had: (a) family history meeting our program's referral criteria; (b) no relevant personal history of cancer; (c) no prior genetic testing in the family; and (d) no living testable relative in BC. Patient-reported outcome measures included: (a) Genetic Counselling Outcome Scale (GCOS) prior to pre-test GC (T1) and at 4 weeks post-test GC (T2); (b) Satisfaction Survey after pre-test GC; and (c) the Multidimensional Impact of Cancer Risk Assessment (MICRA) for patients undergoing testing (4 weeks after post-test GC). In total, 391 patients underwent GC, 184 by group and 207 by one-on-one appointments. Between May 2018 and May 2019, 6 pre-test group sessions were conducted (median number of patients per group = 28; range 15-48). 8% of patients (n = 32) declined large group GC due to personal preference for one-on-one GC. There were no statistically significant differences in MICRA and GCOS survey results when comparing the pre-test large group versus traditional pre-test one-on-one models (based on 3 MICRA subscales: p = 0.063, p = 0.612, p = 0.842; and GCOS p = 0.169). Overall, the large group pre-test counseling approach was more time-efficient with 15-48 patient group sessions conducted over a mean duration of 80 min as compared to 42 min per patient with the traditional one-on-one GC model. Large-scale group GC was feasible and acceptable to patients and represents a novel streamlined model for GC to enable timely access to cancer genetic services.
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Affiliation(s)
- Zoe Lohn
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Alexandra Fok
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Matthew Richardson
- Department of Interdisciplinary Oncology, The University of British Columbia, Vancouver, BC, Canada
| | | | - Sze Wing Mung
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Jennifer Nuk
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Jamie Yuson
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Mandy Jevon
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Kasmintan A Schrader
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada.,Department of Molecular Oncology, BC Cancer, Vancouver, BC, Canada.,Department of Medical Genetics, The University of British Columbia, Vancouver, BC, Canada
| | - Sophie Sun
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada.,Division of Medical Oncology, The University of British Columbia, Vancouver, BC, Canada
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Vasconcellos-Silva PR, Araújo-Jorge TCD. [Collective interest cycles and trends in Google searches related to institutional campaigns on prostate cancer: promoting health or illness?]. CIENCIA & SAUDE COLETIVA 2021; 26:3517-3525. [PMID: 34468647 DOI: 10.1590/1413-81232021269.2.26282019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/28/2019] [Indexed: 11/22/2022] Open
Abstract
Google algorithms record trends in interest on topics relevant to public health. WEB searches were analyzed (2014-2019) to identify patterns linked to prostate cancer. Relative Search Volumes (RSV) were analyzed by Google Trends on "prostate cancer" (PC), "prostate examination" (PE) and "PSA"; 260-week time series; Brazil region; Health category; Trend lines (degree 2 polynomials) to identify patterns; Averages compared by ANOVA; Sudden increase in November searches; Searches on PC greatly surpass PE and PSA; Stable annual PC averages; Discreet reduction in PE; Marked increase in PSA. In campaign months: Discreet increase in PC; stability in PE; Marked increase in PSA. "Blue November" campaigns encourage early identification of prostate cancer, although interest is seen to be focused on the disease per se with a lack of interest in diagnosis throughout the year. Differences in relation to "Pink October" are discussed - tenuous relation to educational level on prevention habits and the influence of celebrities. The conclusion drawn is that RSV analysis might be useful in tracking trends in prostate cancer screening to provide input for campaign developers.
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24
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Greener JR, Bass SB, Alhajji M, Gordon TF. Prospective assessment of contralateral prophylactic mastectomy decision-making in women with average risk: an application of perceptual mapping. Transl Behav Med 2021; 11:143-152. [PMID: 31760428 DOI: 10.1093/tbm/ibz159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Women with early-stage unilateral breast cancer and no familial or genetic risk factors are increasingly electing contralateral prophylactic mastectomy (CPM), despite the lack of evidence demonstrating improved outcomes. To better understand and extend the literature focused on treatment decision-making, a survey was conducted among women with early-stage breast cancer and no associated risk factors, who were in the process of making a surgical decision. This prospective study sought to expand our understanding of the factors that influence patients' decision to have CPM, with the goal of providing healthcare providers with useful guidance in supporting breast cancer patients who are making treatment decisions. Data were collected for this prospective study through an internet survey. Results were analyzed using perceptual mapping, a technique that provides visual insight into the importance of specific variables to groups of women making different surgical decisions, not available through conventional analyses. Results suggest that women more likely to elect CPM demonstrate greater worry about breast cancer through experiences with others and feel the need to take control of their health through selection of the most aggressive treatment option. The information obtained offers guidance for the development of targeted intervention and counsel that will support patients' ability to make high quality, informed decisions.
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Affiliation(s)
- Judith R Greener
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Sarah B Bass
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Mohammad Alhajji
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Thomas F Gordon
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
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Preoperative diagnosis of BRCA1/2 mutation impacts decision-making for risk-reducing mastectomy in breast cancer patients. Sci Rep 2021; 11:14747. [PMID: 34285295 PMCID: PMC8292311 DOI: 10.1038/s41598-021-94195-4] [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: 03/21/2021] [Accepted: 07/05/2021] [Indexed: 11/08/2022] Open
Abstract
Decision to undergo risk-reducing mastectomy (RRM) needs to consider several factors, including patient's preference, surgeon's preference, family history, and genetic predisposition. The aim of this study was to examine whether preoperative diagnosis of BRCA1/2 mutation status could influence surgical decision-making in newly diagnosed breast cancer patients. We retrospectively reviewed ipsilateral breast cancer patients with BRCA1/2 mutation who underwent primary surgery between January 2008 and November 2019 at a single institution in Korea. Of 344 eligible patients, 140 (40.7%) patients were aware of their mutation status 'prior to surgery', while 204 (59.3%) did not. Contralateral RRM rate was significantly higher in the group with BRCA1/2 mutation status identified 'prior to surgery' compared to the group with mutation status identified 'after surgery' [45.0% (63/140) vs. 2.0% (4/204)] (p < 0.001). Reduced turnaround time of BRCA1/2 testing (p < 0.001) and the use of neoadjuvant chemotherapy (p < 0.001) were associated with BRCA1/2 mutation status identified prior to surgery. Although not statistically significant, higher incidence of developing contralateral breast cancer for BRCA1/2 mutation carriers who underwent ipsilateral surgery-only compared to those who underwent contralateral RRM was observed [12.1% (95% CI: 7.7-17.7%)] (p = 0.1618). Preoperative diagnosis of BRCA1/2 mutation could impact surgical decision-making for breast cancer patients to undergo risk-reducing surgery at the time of initial surgery.
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Naik H, Johnson MDD, Johnson MR. Internet Interest in Colon Cancer Following the Death of Chadwick Boseman: Infoveillance Study. J Med Internet Res 2021; 23:e27052. [PMID: 34128824 PMCID: PMC8277405 DOI: 10.2196/27052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
Background Compared with White Americans, Black Americans have higher colon cancer mortality rates but lower up-to-date screening rates. Chadwick Boseman was a prominent Black American actor who died of colon cancer on August 28, 2020. As announcements of celebrity diagnoses often result in increased awareness, Boseman’s death may have resulted in greater interest in colon cancer on the internet, particularly among Black Americans. Objective This study aims to quantify the impact of Chadwick Boseman’s death on web-based search interest in colon cancer and determine whether there was an increase in interest in regions of the United States with a greater proportion of Black Americans. Methods We conducted an infoveillance study using Google Trends (GT) and Wikipedia pageview analysis. Using an autoregressive integrated moving average algorithm, we forecasted the weekly relative search volume (RSV) for GT search topics and terms related to colon cancer that would have been expected had his death not occurred and compared it with observed RSV data. This analysis was also conducted for the number of page views on the Wikipedia page for colorectal cancer. We then delineated GT RSV data for the term colon cancer for states and metropolitan areas in the United States and determined how the RSV values for these regions correlated with the percentage of Black Americans in that region. Differences in these correlations before and after Boseman’s death were compared to determine whether there was a shift in the racial demographics of the individuals conducting the searches. Results The observed RSVs for the topics colorectal cancer and colon cancer screening increased by 598% and 707%, respectively, and were on average 121% (95% CI 72%-193%) and 256% (95% CI 35%-814%) greater than expected during the first 3 months following Boseman’s death. Daily Wikipedia page view volume during the 2 months following Boseman’s death was on average 1979% (95% CI 1375%-2894%) greater than expected, and it was estimated that this represented 547,354 (95% CI 497,708-585,167) excess Wikipedia page views. Before Boseman’s death, there were negative correlations between the percentage of Black Americans living in a state or metropolitan area and the RSV for colon cancer in that area (r=−0.18 and r=−0.05, respectively). However, in the 2 weeks following his death, there were positive correlations between the RSV for colon cancer and the percentage of Black Americans per state and per metropolitan area (r=0.73 and r=0.33, respectively). These changes persisted for 4 months and were all statistically significant (P<.001). Conclusions There was a significant increase in web-based activity related to colon cancer following Chadwick Boseman’s death, particularly in areas with a higher proportion of Black Americans. This reflects a heightened public awareness that can be leveraged to further educate the public.
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Affiliation(s)
- Hiten Naik
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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27
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Genetic Predisposition to Breast Cancer and Its Management. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Jimenez-Sainz J, Jensen RB. Imprecise Medicine: BRCA2 Variants of Uncertain Significance (VUS), the Challenges and Benefits to Integrate a Functional Assay Workflow with Clinical Decision Rules. Genes (Basel) 2021; 12:genes12050780. [PMID: 34065235 PMCID: PMC8161351 DOI: 10.3390/genes12050780] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022] Open
Abstract
Pathological mutations in homology-directed repair (HDR) genes impact both future cancer risk and therapeutic options for patients. HDR is a high-fidelity DNA repair pathway for resolving DNA double-strand breaks throughout the genome. BRCA2 is an essential protein that mediates the loading of RAD51 onto resected DNA breaks, a key step in HDR. Germline mutations in BRCA2 are associated with an increased risk for breast, ovarian, prostate, and pancreatic cancer. Clinical findings of germline or somatic BRCA2 mutations in tumors suggest treatment with platinum agents or PARP inhibitors. However, when genetic analysis reveals a variant of uncertain significance (VUS) in the BRCA2 gene, precision medicine-based decisions become complex. VUS are genetic changes with unknown pathological impact. Current statistics indicate that between 10–20% of BRCA sequencing results are VUS, and of these, more than 50% are missense mutations. Functional assays to determine the pathological outcome of VUS are urgently needed to provide clinical guidance regarding cancer risk and treatment options. In this review, we provide a brief overview of BRCA2 functions in HDR, describe how BRCA2 VUS are currently assessed in the clinic, and how genetic and biochemical functional assays could be integrated into the clinical decision process. We suggest a multi-step workflow composed of robust and accurate functional assays to correctly evaluate the potential pathogenic or benign nature of BRCA2 VUS. Success in this precision medicine endeavor will offer actionable information to patients and their physicians.
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Affiliation(s)
- Judit Jimenez-Sainz
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA
- Correspondence: (J.J.-S.); (R.B.J.); Tel.:+1-203-737-6456 (R.B.J.)
| | - Ryan B. Jensen
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, USA
- Correspondence: (J.J.-S.); (R.B.J.); Tel.:+1-203-737-6456 (R.B.J.)
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Making Sense of a Health Threat: Illness Representations, Coping, and Psychological Distress among BRCA1/2 Mutation Carriers. Genes (Basel) 2021; 12:genes12050741. [PMID: 34069035 PMCID: PMC8156260 DOI: 10.3390/genes12050741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Little is known about how women with a BRCA1/2 mutation develop an individual understanding of their breast and ovarian cancer risk and how this affects their psychological distress. In this study, we investigated associations between illness representations, coping strategies and psychological distress. N = 101 BRCA1/2 mutation carriers answered self-report questionnaires on illness representations, coping strategies, cancer worry and depressive symptoms. Women without cancer were compared to women with a previous cancer diagnosis. Illness representations explained 50% and 45% of the variability in cancer worry and depressive symptoms, respectively. Woman perceiving severe consequences (β = 0.29, p < 0.01) and having more concerns (β = 0.37, p < 0.01) were found to report more cancer worry. Perceiving information about the mutation as less coherent (β = −0.17, p < 0.05) and experiencing negative emotional responses (β = 0.60, p < 0.01) were both associated with more depressive symptoms. Women with a previous cancer diagnosis show patterns of illness representations that are potentially more distressing than women without a cancer diagnosis. Findings suggest that physicians involved in counseling should pay attention to illness representations of distressed women. Thereby, it would be possible to detect maladaptive thoughts associated with the mutation, address negative emotions and encourage adaptive coping strategies.
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30
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Morgan JC, Silver N, Cappella JN. How did beliefs and perceptions about e-cigarettes change after national news coverage of the EVALI outbreak? PLoS One 2021; 16:e0250908. [PMID: 33930093 PMCID: PMC8087005 DOI: 10.1371/journal.pone.0250908] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Exposure to media content can shape public opinions about tobacco. In early September 2019, the outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) became headline news in the United States. METHODS In August and September 2019, we conducted two cross-sectional online surveys with current and former smokers assessing attitudes and beliefs about e-cigarettes. Study one (n = 865) was collected before the EVALI outbreak was widely covered and study two (n = 344) was collected after the outbreak had become nation-wide news. We examined differences in perceptions and beliefs between time points. RESULTS E-cigarette harm perceptions increased between study one (mean = 2.67) and study two (mean = 2.90, p < .05). Ever-users of e-cigarettes largely account for this change. Endorsement of the belief that e-cigarettes were risky and more likely to cause lung damage compared to cigarettes increased between studies (p < .05). Seventy eight percent of participants at study two were aware of the vaping illness story. Being aware of the story was associated with more endorsement of the belief that e-cigarettes were risky to use, but not that using e-cigarettes would make the participant more likely to get damaged lungs. DISCUSSION When the stories about the health and safety of tobacco products dominate the public information environment, it presents an opportunity to change beliefs that are frequently targeted by paid health campaigns. Changes in participant's perceptions of e-cigarettes were associated with coverage of this large news story, underscoring the importance of working to ensure that coverage is a scientifically accurate as possible.
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Affiliation(s)
- Jennifer C. Morgan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Nathan Silver
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Joseph N. Cappella
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, United States of America
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31
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Byun DJ, Wu SP, Nagar H, Gerber NK. Ductal Carcinoma in Situ in Young Women: Increasing Rates of Mastectomy and Variability in Endocrine Therapy Use. Ann Surg Oncol 2021; 28:6083-6096. [PMID: 33914220 DOI: 10.1245/s10434-021-09972-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 03/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Young women with ductal carcinoma in situ (DCIS) represent a unique cohort given considerations for future risk reduction and treatment effects on fertility and quality of life. We evaluated national patterns of care in the treatment of young women and the impact of those treatments on overall survival (OS). METHODS Women younger than 50 years of age diagnosed with pure DCIS from 2004 to 2016 in the National Cancer Database (NCDB) were identified. Clinical, demographic, and choice of local therapy are summarized and trended over time. OS was analyzed using Cox proportional hazard models. RESULTS A total of 52,150 women were identified, and the most common surgical treatment was breast-conservation surgery (BCS; 59%). Bilateral mastectomy (BM) increased in frequency from 2004 to 2016 (11-27%; p < 0.001). In women < 40 years of age, BM (39%) surpassed BCS (35%) in 2010 with a continued upward trend. On multivariable analysis, no OS benefit of BM (hazard ratio [HR] 0.99, p = 0.90) or unilateral mastectomy (UM; HR 0.98, p = 0.80) was observed when compared with BCS + radiation therapy (RT). Inferior OS was seen with BCS, Black race, estrogen receptor (ER)-negative, and tumor ≥ 2.5 cm (p ≤ 0.006). In ER+ patients, there was a significant difference in endocrine therapy (ET) use between BM (11%), UM (33%), and BCS (28%) compared with BCS + RT (64%, p < 0.001). CONCLUSION The use of BM for DCIS is increasing in younger patients and now exceeds breast-conservation approaches in women < 40 years of age with no evidence of improved OS. Among ER+ patients, the rates of ET are lower in the BM, UM, and BCS-alone groups compared with BCS + RT.
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Affiliation(s)
- David J Byun
- Department of Radiation Oncology, NYU Langone Health, Perlmutter Cancer Center, New York, NY, USA
| | - S Peter Wu
- Department of Radiation Oncology, Holy Name Medical Center, Teaneck, NJ, USA
| | - Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Naamit K Gerber
- Department of Radiation Oncology, NYU Langone Health, Perlmutter Cancer Center, New York, NY, USA.
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Trends and timing of risk-reducing mastectomy uptake in unaffected BRCA1 and BRCA2 carriers in Slovenia. Eur J Surg Oncol 2021; 47:1900-1906. [PMID: 33812767 DOI: 10.1016/j.ejso.2021.03.248] [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: 12/17/2020] [Revised: 02/22/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Risk-reducing mastectomy (RRM) is one of key prevention strategies in female carriers of germline BRCA pathogenic/likely pathogenic variants (PV/LPV). We retrospectively investigated the rate, timing and longitudinal trends of bilateral RRM uptake and the incidence and types of cancers among unaffected BRCA carriers who underwent genetic counseling at the Institute of Oncology Ljubljana in Slovenia. MATERIALS AND METHODS Female BRCA carriers without personal history of cancer were included in the study. Clinical data on PV/LPV type, date of RRM, type of reconstructive procedure, occult carcinoma and histopathology results was collected and analyzed. RESULTS Of the 346 unaffected BRCA carriers (median age 43 years, 70% BRCA1, 30% BRCA2, median follow-up 46 months) who underwent genetic testing between October 1999 and December 2019, 25.1% had a RRM (range 35-50 years, median age at surgery 38 years). A significant difference in time to prophylactic surgery between women undergoing RRM only vs. women undergoing RRM combined with risk-reducing salpingo-oophorectomy was observed (22.6 vs 8.7 months, p = 0.0009). We observed an upward trend in the annual uptake in line with the previously observed Angelina Jolie effect. In 5.7% of cases, occult breast cancer was detected. No women developed breast cancer after RRM. Women who did not opt for surgical prevention developed BRCA1/2-related cancers (9.3%). CONCLUSION The uptake of RRM among unaffected BRCA carriers is 25.1% and is similar to our neighboring countries. No women developed breast cancer after RRM while women who did not opt for surgical prevention developed BRCA1/2 related cancers in 9.3% of cases. The reported data may provide meaningful aid for carriers when deciding on an optimal prevention strategy.
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Basu NN, Hodson J, Chatterjee S, Gandhi A, Wisely J, Harvey J, Highton L, Murphy J, Barnes N, Johnson R, Barr L, Kirwan CC, Howell S, Baildam AD, Howell A, Evans DG. The Angelina Jolie effect: Contralateral risk-reducing mastectomy trends in patients at increased risk of breast cancer. Sci Rep 2021; 11:2847. [PMID: 33531640 PMCID: PMC7854742 DOI: 10.1038/s41598-021-82654-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
Contralateral risk-reducing mastectomy (CRRM) rates have tripled over the last 2 decades. Reasons for this are multi-factorial, with those harbouring a pathogenic variant in the BRCA1/2 gene having the greatest survival benefit. On May 14th, 2013, Angelina Jolie shared the news of her bilateral risk-reducing mastectomy (BRRM), on the basis of her BRCA1 pathogenic variant status. We evaluated the impact of this news on rates of CRRM in women with increased risk for developing breast cancer after being diagnosed with unilateral breast cancer. The prospective cohort study included all women with at least a moderate lifetime risk of developing breast cancer who attended our family history clinic (1987–2019) and were subsequently diagnosed with unilateral breast cancer. Rates of CRRM were then compared between patients diagnosed with breast cancer before and after Angelina Jolie’s announcement (pre- vs. post-AJ). Of 386 breast cancer patients, with a mean age at diagnosis of 48 ± 8 years, 268 (69.4%) were diagnosed in the pre-AJ period, and 118 (30.6%) in the post-AJ period. Of these, 123 (31.9%) underwent CRRM, a median 42 (interquartile range: 11–54) days after the index cancer surgery. Rates of CRRM doubled following AJ’s news, from 23.9% pre-AJ to 50.0% post AJ (p < 0.001). Rates of CRRM were found to decrease with increasing age at breast cancer (p < 0.001) and tumour TNM stage (p = 0.040), and to increase with the estimated lifetime risk of breast cancer (p < 0.001) and tumour grade (p = 0.015) on univariable analysis. After adjusting for these factors, the step-change increase in CRRM rates post-AJ remained significant (odds ratio: 9.61, p < 0.001). The AJ effect appears to have been associated with higher rates of CRRM amongst breast cancer patients with increased cancer risk. CRRM rates were highest amongst younger women and those with the highest lifetime risk profile. Clinicians need to be aware of how media news can impact on the delivery of cancer related services. Communicating objective assessment of risk is important when counselling women on the merits of risk-reducing surgery.
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Affiliation(s)
- Narendra Nath Basu
- University of Birmingham, Birmingham, B15 2TT, UK. .,University Hospital Birmingham NHS Trust, Mindelsohn Way, Birmingham, B15 2TH, UK.
| | - James Hodson
- University Hospital Birmingham NHS Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Shaunak Chatterjee
- University Hospital Birmingham NHS Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Ashu Gandhi
- Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - Julie Wisely
- Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - James Harvey
- Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - Lyndsey Highton
- Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - John Murphy
- Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - Nicola Barnes
- Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - Richard Johnson
- Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - Lester Barr
- Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - Cliona C Kirwan
- Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - Sacha Howell
- Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK.,Manchester Breast Centre, The Christie Hospital, Manchester, M20, UK
| | - Andrew D Baildam
- Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - Anthony Howell
- Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK.,Manchester Breast Centre, The Christie Hospital, Manchester, M20, UK
| | - D Gareth Evans
- Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK.,Manchester Breast Centre, The Christie Hospital, Manchester, M20, UK.,NW Genomic Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK.,Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Clinical Genetics Service, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
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Meier F, Harney A, Rhiem K, Neusser S, Neumann A, Braun M, Wasem J, Huster S, Dabrock P, Schmutzler RK. Risk-Adjusted Prevention. Perspectives on the Governance of Entitlements to Benefits in the Case of Genetic (Breast Cancer) Risks. Recent Results Cancer Res 2021; 218:47-66. [PMID: 34019162 DOI: 10.1007/978-3-030-63749-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article is a revised version of our proposal for the establishment of the legal concept of risk-adjusted prevention in the German healthcare system to regulate access to risk-reduction measures for persons at high and moderate genetic cancer risk (Meier et al. Risikoadaptierte Prävention'. Governance Perspective für Leistungsansprüche bei genetischen (Brustkrebs-)Risiken, Springer, Wiesbaden, 2018). The German context specifics are summarized to enable the source text to be used for other country-specific healthcare systems. Establishing such a legal concept is relevant to all universal and free healthcare systems similar to Germany's. Disease risks can be determined with increasing precision using bioinformatics and biostatistical innovations ('big data'), due to the identification of pathogenic germ line mutations in cancer risk genes as well as non-genetic factors and their interactions. These new technologies open up opportunities to adapt therapeutic and preventive measures to the individual risk profile of complex diseases in a way that was previously unknown, enabling not only adequate treatment but in the best case, prevention. Access to risk-reduction measures for carriers of genetic risks is generally not regulated in healthcare systems that guarantee universal and equal access to healthcare benefits. In many countries, including Austria, Denmark, the UK and the US, entitlement to benefits is essentially linked to the treatment of already manifest disease. Issues around claiming benefits for prophylactic measures involve not only evaluation of clinical options (genetic diagnostics, chemoprevention, risk-reduction surgery), but the financial cost and-from a social ethics perspective-the relationship between them. Section 1 of this chapter uses the specific example of hereditary breast cancer to show why from a medical, social-legal, health-economic and socio-ethical perspective, regulated entitlement to benefits is necessary for persons at high and moderate risk of cancer. Section 2 discusses the medical needs of persons with genetic cancer risks and goes on to develop the healthy sick model which is able to integrate the problems of the different disciplines into one scheme and to establish criteria for the legal acknowledgement of persons at high and moderate (breast cancer) risks. In the German context, the social-legal categories of classical therapeutic medicine do not adequately represent preventive measures as a regular service within the healthcare system. We propose risk-adjusted prevention as a new legal concept based on the heuristic healthy sick model. This category can serve as a legal framework for social law regulation in the case of persons with genetic cancer risks. Risk-adjusted prevention can be established in principle in any healthcare system. Criteria are also developed in relation to risk collectives and allocation (Sects. 3, 4, 5).
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Affiliation(s)
- Friedhelm Meier
- Systematic Theology II (Ethics), University of Tübingen, Liebermeisterstraße 12, 72076, Tübingen, Germany.
| | - Anke Harney
- Medical Faculty, Institute for Social and Health Law, University of Bochum, Bochum, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
| | - Silke Neusser
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Anja Neumann
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Matthias Braun
- Systematic Theology II (Ethics), University of Erlangen-Nuremberg, Erlangen-Nuremberg, Germany
| | - Jürgen Wasem
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Stefan Huster
- Medical Faculty, Institute for Social and Health Law, University of Bochum, Bochum, Germany
| | - Peter Dabrock
- Systematic Theology II (Ethics), University of Erlangen-Nuremberg, Erlangen-Nuremberg, Germany
| | - Rita Katharina Schmutzler
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), University Hospital Cologne, Cologne, Germany
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Long-Term Evaluation of Women Referred to a Breast Cancer Family History Clinic (Manchester UK 1987-2020). Cancers (Basel) 2020; 12:cancers12123697. [PMID: 33317064 PMCID: PMC7763143 DOI: 10.3390/cancers12123697] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary This study reports the management of women at high risk for breast cancer over a 33 years period. The aim was to summarize the numbers seen and to report the results of our studies on gene testing, the outcomes of screening and the success of preventive methods including lifestyle change, chemoprevention and risk-reducing mastectomy. We also discuss how the clinical Family History Service may be improved in the future. Abstract Clinics for women concerned about their family history of breast cancer are widely established. A Family History Clinic was set-up in Manchester, UK, in 1987 in a Breast Unit serving a population of 1.8 million. In this review, we report the outcome of risk assessment, screening and prevention strategies in the clinic and propose future approaches. Between 1987–2020, 14,311 women were referred, of whom 6.4% were from known gene families, 38.2% were at high risk (≥30% lifetime risk), 37.7% at moderate risk (17–29%), and 17.7% at an average/population risk who were discharged. A total of 4168 (29.1%) women were eligible for genetic testing and 736 carried pathogenic variants, predominantly in BRCA1 and BRCA2 but also other genes (5.1% of direct referrals). All women at high or moderate risk were offered annual mammographic screening between ages 30 and 40 years old: 646 cancers were detected in women at high and moderate risk (5.5%) with a detection rate of 5 per 1000 screens. Incident breast cancers were largely of good prognosis and resulted in a predicted survival advantage. All high/moderate-risk women were offered lifestyle prevention advice and 14–27% entered various lifestyle studies. From 1992–2003, women were offered entry into IBIS-I (tamoxifen) and IBIS-II (anastrozole) trials (12.5% of invitees joined). The NICE guidelines ratified the use of tamoxifen and raloxifene (2013) and subsequently anastrozole (2017) for prevention; 10.8% women took up the offer of such treatment between 2013–2020. Since 1994, 7164 eligible women at ≥25% lifetime risk of breast cancer were offered a discussion of risk-reducing breast surgery and 451 (6.2%) had surgery. New approaches in all aspects of the service are needed to build on these results.
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Jung SM, Ryu JM, Park HS, Park JS, Kang E, Lee S, Lee HB, Youn HJ, Yoo TK, Kim J, Lee JE, Han SA, Kim D, Kim SW. Trends in Risk-Reducing Mastectomy and Risk-Reducing Salpingo-Oophorectomy in Korean Carriers of the BRCA1/2 Mutation. J Breast Cancer 2020; 23:647-655. [PMID: 33408890 PMCID: PMC7779723 DOI: 10.4048/jbc.2020.23.e61] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose BRCA1/2 mutations are associated with risks of breast and ovarian cancer. In Korea, incidences of BRCA1/2 genetic testing and risk-reducing surgery (RRS) have increased with insurance coverage and the Angelina Jolie effect. The aim of this study was to identify trends in RRS performed in Korean women with the BRCA1/2 mutation. Methods We retrospectively reviewed the medical records of BRCA1/2 mutation carriers with (affected carriers) and without (unaffected carriers) breast cancer until August 2018 from 25 Korean Hereditary Breast Cancer (KOHBRA)-affiliated hospitals. Results The numbers of contralateral risk-reducing mastectomy (RRM) and risk-reducing bilateral salpingo-oophorectomy (RRBSO) in affected carriers have increased 5.8- and 3.6-fold, respectively, since 2013. The numbers of RRBSO in unaffected carriers has increased 8-fold since 2013. The number of institutions that perform RRS has increased gradually. The number of hospitals that perform contralateral RRM on affected carriers increased from 3 in 2012 to 11 in 2018, and that of those that perform RRBSO increased from 7 to 17. The number of hospitals that perform bilateral RRM on unaffected carriers increased from 1 in 2012 to 2 in 2018, and that of those that perform RRBSO increased from 1 to 8. However, the hospitals showed differences in the rates of RRM or RRBSO performed. Conclusion The incidence of RRS increased each year throughout the study period. However, in Korea, the rate of RRS procedures depended on the hospital.
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Affiliation(s)
- Sung Mi Jung
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Soo Park
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seeyoun Lee
- Department of Surgery, National Cancer Center, Goyang, Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jo Youn
- Division of Breast Thyroid Surgery, Department of Surgery, Jeonbuk National University Medical School, Jeonju, Korea
| | - Tae-Kyung Yoo
- Division of Breast Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Eon Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Ah Han
- Department of Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Dongwon Kim
- Department of Surgery, Daerim St. Mary's Hospital, Seoul, Korea
| | - Sung-Won Kim
- Department of Surgery, Daerim St. Mary's Hospital, Seoul, Korea
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Dayani F, Tijerina JD, Morrison SD, Nazerali RS. Public Interest in Textured Breast Implants Recall: A Google Trends Analysis. Aesthetic Plast Surg 2020; 44:1489-1497. [PMID: 32356152 DOI: 10.1007/s00266-020-01724-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Large-scale media coverage of health care outcomes can have a profound influence on health care utilization by the general population. Google trends (GT), an online resource, allows for tracking of global search volumes as a proxy for determining public interest. OBJECTIVE To utilize GT to characterize measurable effects on public interest in breast implant removal procedures and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) following March 2019 FDA Advisory Committee Meeting and July 2019 public statements by the FDA and Allergan announcing the voluntary recall of BIOCELL® textured breast implants. METHODS GT databases of search volumes were collected for terms related to 3 categories including Allergan BIOCELL® textured breast implants, BIA-ALCL, and breast implant removal from January 2004 to October 2019. The short-term and long-term interests were determined by the percent change in monthly search volumes with respect to the announcements from Allergan and FDA Advisory Committee Meeting. RESULTS Following Allergan's recall announcement, public interest in "textured breast implants" and "allergan breast implant" peaked in July 2019 and rose 456% and 669%, respectively. Public interest in "anaplastic large cell lymphoma breast implant" and "ALCL cancer" rose 200 and 175%, respectively. Long-term interest in all implant removal terms was found to be higher after March 2019 FDA Advisory Committee Meeting than beforehand (p < 0.05). CONCLUSIONS GT data correlate with shifts in real-world health care utilization and public interest caused by high-profile media coverage, making it a useful tool for providers for real-time prediction of trends in public health in response to observable influences. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Fara Dayani
- UCSF School of Medicine, 533 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Jonathan D Tijerina
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Rahim S Nazerali
- Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
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Hummel P, Braun M. Just data? Solidarity and justice in data-driven medicine. LIFE SCIENCES, SOCIETY AND POLICY 2020; 16:8. [PMID: 32839878 PMCID: PMC7445015 DOI: 10.1186/s40504-020-00101-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/23/2020] [Indexed: 05/26/2023]
Abstract
This paper argues that data-driven medicine gives rise to a particular normative challenge. Against the backdrop of a distinction between the good and the right, harnessing personal health data towards the development and refinement of data-driven medicine is to be welcomed from the perspective of the good. Enacting solidarity drives progress in research and clinical practice. At the same time, such acts of sharing could-especially considering current developments in big data and artificial intelligence-compromise the right by leading to injustices and affecting concrete modes of individual self-determination. In order to address this potential tension, two key elements for ethical reflection on data-driven medicine are proposed: the controllability of information flows, including technical infrastructures that are conducive towards controllability, and a paradigm shift towards output-orientation in governance and policy.
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Affiliation(s)
- Patrik Hummel
- Department of Theology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Kochstraße 6, 91054 Erlangen, Germany
| | - Matthias Braun
- Department of Theology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Kochstraße 6, 91054 Erlangen, Germany
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Mullally WJ, Keane F, Nolan A, Grogan L, Breathnach OS, Hennessy BT, Collins DC, Morris PG. Lack of familiarity with genetic testing among patients in Ireland with Cancer. Ir J Med Sci 2020; 190:547-553. [PMID: 32813148 DOI: 10.1007/s11845-020-02333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cancer gene panel testing is available in Ireland. The need for a clear strategy to deal with patient information generated from tumour genomic testing is recognised as a challenge in the National Cancer Strategy. However, the public's attitude and opinions regarding these results is not known in Ireland. AIMS This prospective questionnaire study assessed the knowledge and opinions of patients in a national oncology centre, surrounding cancer gene panel testing. METHODS An anonymised modified validated questionnaire was completed by volunteering patients in the medical oncology department. It comprised 14 questions which assessed patient's familiarity, intention, benefits and concerns associated with tumour genetic testing using a four-point Likert scale. Patients recorded their primary cancer diagnosis and family cancer history. RESULTS Eighty-four patients completed the questionnaire with 77 (92%) patients declaring their primary cancer diagnosis. The median age was 56 (range 26 to 83) years. Overall, 42% (n = 35) of oncology patients were familiar/somewhat familiar with testing and 90% (n = 76) stated they would avail of genetic testing if available. Patients with breast cancer were no more likely to avail of genetic testing when compared with the non-breast cancer cohort (n = 21 vs. 56, p = 0.58) though they identified concerns with potential discrimination. CONCLUSION This is the first prospective Irish study to assess opinions surrounding cancer gene results. Addressing patient's lack of information as regards genetic testing is the first step in establishing a national cancer genetics testing programme in Ireland.
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Affiliation(s)
| | - Fergus Keane
- Beaumont Hospital, Beaumont Rd., Dublin 9, Ireland
| | - Amy Nolan
- Beaumont Hospital, Beaumont Rd., Dublin 9, Ireland
| | - Liam Grogan
- Beaumont Hospital, Beaumont Rd., Dublin 9, Ireland
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Kaliszewski K, Diakowska D, Wojtczak B, Rudnicki J. Cancer screening activity results in overdiagnosis and overtreatment of papillary thyroid cancer: A 10-year experience at a single institution. PLoS One 2020; 15:e0236257. [PMID: 32692768 PMCID: PMC7373277 DOI: 10.1371/journal.pone.0236257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/29/2020] [Indexed: 01/02/2023] Open
Abstract
Background It is estimated that one of the potential cause of the increasing prevalence of thyroid cancer (TC) is the easier and widespread access to diagnostic tools. If an individual evaluates the thyroid gland due to a mentioned mechanism without considering TC risk factors or symptoms, we can describe this phenomenon as cancer screening activity (CSA). Aim of the study We 1) estimated what types of TC were diagnosed due to CSA, 2) analyzed what clinicopathological features were characteristic of TCs diagnosed by CSA, 3) determined if these features were characteristic of indolent cases, and finally we 4) assessed whether CSA could have resulted in the increasing incidence of potentially indolent papillary thyroid cancer (PTC). Materials and methods A retrospective review of 4,701 medical records of patients admitted and surgically treated at one surgical center between 2008 and 2017 was performed. Among the enrolled patients, 569 (12.1%) had thyroid malignancy, and 514 (10.9%) were diagnosed with PTC. We divided these patients into two groups: 1) patients in whom TC diagnostics were performed without considering any TC risk factors or symptoms (CSA-yes) and 2) those in whom TC was diagnosed due to TC risk factors or symptoms (CSA-no). We then compared the clinicopathological features of these two groups. Results The most common type of TC diagnosed in the CSA-group was PTC (p = 0.024). CSA-yes patients showed a significantly lower degree of Tumor-Node-Metastasis (TNM) staging and demonstrated a significantly lower rate of multifocality, but not of bilaterality (p<0.0001 and p = 0.198, respectively). In the CSA-yes group, the number of TC foci was significantly lower than that in the CSA-no group (p<0.0001). All clinicopathological features characteristic of aggressive cases of TC were absent in CSA-yes patients (p<0.0001), while all features observed in CSA-yes patients were characteristic of indolent cases (p<0.0001). Conclusions The use of CSA results in the diagnosis of indolent cases of PTC and may be one of the potential causes of overdiagnosis and overtreatment of this malignancy.
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Affiliation(s)
- Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
- * E-mail:
| | - Dorota Diakowska
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Beata Wojtczak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Rudnicki
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
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Hallquist MLG, Tricou EP, Hallquist MN, Savatt JM, Rocha H, Evans AE, Deckard N, Hu Y, Kirchner HL, Pervola J, Rahm AK, Rashkin M, Schmidlen TJ, Schwartz MLB, Williams JL, Williams MS, Buchanan AH. Positive impact of genetic counseling assistants on genetic counseling efficiency, patient volume, and cost in a cancer genetics clinic. Genet Med 2020; 22:1348-1354. [DOI: 10.1038/s41436-020-0797-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 12/29/2022] Open
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Forde C, Brunstrom K, Woodward E, Bowers N, Pereira M, Wallace AJ, Lalloo F, Harkness EF, Evans DG. Uptake of pre-symptomatic testing for BRCA1 and BRCA2 is age, gender, offspring and time-dependent. J Med Genet 2020; 58:jmedgenet-2019-106544. [PMID: 32354797 DOI: 10.1136/jmedgenet-2019-106544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 02/07/2020] [Accepted: 03/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Genetic testing for BRCA1 and BRCA2 pathogenic variants (PVs) has been available in North West England since 1995. We assessed uptake of pre-symptomatic testing in 1564 families with PVs over a 24.5year follow-up (FU) period. METHODS First-degree relatives (FDRs) in families with BRCA1 or BRCA2 PVs were eligible from date of index family report if unaffected by a relevant cancer and alive at report date. FDRs were censored as not having undergone a pre-symptomatic test at diagnosis of a relevant cancer, date of death, age 93 or 30/03/2019. Time to uptake of pre-symptomatic testing was assessed by Kaplan-Meier curves, by gender and children. RESULTS 2554 male and 3115 female FDRs were eligible. Overall uptake was 775 (30.3%) in men and 1935 (62.1%) in women. This increased at 15 years to 33.6% and 67.9%, and continued to rise until 24 years (p<0.001). For women, the 29-year to 39-year age group had the highest uptake at 10 years FU (72.5%; p<0.01), whereas the 50-year to 59-year age group was highest in men (37.2%; p<0.01). Women <18 years at the time of familial variant identification had lower initial uptake, but this rose to >80% by 15 years. Uptake was higher in parous women (p<0.001) and in men with daughters (p<0.0001). CONCLUSION Uptake of BRCA1/2 pre-symptomatic testing is age, gender and time-dependent, and higher in women with children and men with daughters.
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Affiliation(s)
- Claire Forde
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Kate Brunstrom
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Emma Woodward
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Naomi Bowers
- North West Genomic Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Marta Pereira
- North West Genomic Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Andrew J Wallace
- North West Genomic Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Fiona Lalloo
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Elaine F Harkness
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - D Gareth Evans
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, Greater Manchester, UK
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Döbrössy B, Girasek E, Susánszky A, Koncz Z, Győrffy Z, Bognár VK. "Clicks, likes, shares and comments" a systematic review of breast cancer screening discourse in social media. PLoS One 2020; 15:e0231422. [PMID: 32294139 PMCID: PMC7159232 DOI: 10.1371/journal.pone.0231422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/23/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Unsatisfactory participation rate at population based organised breast cancer screening is a long standing problem. Social media, with 3.2 billion users in 2019, is potentially an important site of breast cancer related discourse. Determining whether these platforms might be used as channels by screening providers to reach under-screened women may have considerable public health significance. OBJECTIVES By systematically reviewing original research studies on breast cancer related social media discourse, we had two aims: first, to assess the volume, participants and content of breast screening social media communication and second, to find out whether social media can be used by screening organisers as a channel of patient education. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). After searching PubMed, ScienceDirect, Web of Science, Springer and Ebsco, 17 studies were found that met our criteria. A systematic narrative framework was used for data synthesis. Owing to the high degree of heterogeneity in social media channels, outcomes and measurement included in this study, a meta-analytic approach was not appropriate. RESULTS The volume of breast cancer related social media discourse is considerable. The majority of participants are lay individuals as opposed to healthcare professionals or advocacy groups. The lay misunderstandings surrounding the harms and benefits of mammography is well mirrored in the content of social media discourse. Although there is criticism, breast cancer screening sentiment on the social media ranges from the neutral to the positive. Social media is suitable for offering peer emotional support for potential participants. CONCLUSION Dedicated breast screening websites operated by screening organisers would ensure much needed quality controlled information and also provide space for reliable question and answer forums, the sharing of personal experience and the provision of peer and professional support.
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Affiliation(s)
- Bence Döbrössy
- Institute of Behavioural Sciences, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Edmond Girasek
- Institute of Behavioural Sciences, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Anna Susánszky
- Institute of Behavioural Sciences, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Zsuzsa Koncz
- Institute of Behavioural Sciences, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Zsuzsa Győrffy
- Institute of Behavioural Sciences, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Virág Katalin Bognár
- Institute of Behavioural Sciences, Semmelweis University, Faculty of Medicine, Budapest, Hungary
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Drewniak D, Glässel A, Hodel M, Biller-Andorno N. Risks and Benefits of Web-Based Patient Narratives: Systematic Review. J Med Internet Res 2020; 22:e15772. [PMID: 32213468 PMCID: PMC7146251 DOI: 10.2196/15772] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/01/2019] [Accepted: 12/16/2019] [Indexed: 01/20/2023] Open
Abstract
Background Patient narratives are illustrative, individual accounts of patients’ experiences with certain health conditions. Web-based patient narratives have become widely available on the internet and in social media, as part of electronically available patient decision aids or Web-based databases. In recent years, the role of patient narratives as a source of information, insight, and support for both health care users and providers has increasingly been emphasized. Although the potential impact of patient stories has high immediate plausibility, it is of interest to know if this impact can be captured in quantitative studies. Objective This review aimed to evaluate whether research-generated Web-based patient narratives have quantifiable risks or benefits for (potential) patients, relatives, or health care professionals. Methods We searched the following databases from August 2017 to March 2019: Medical Literature Analysis and Retrieval System Online, PsycInfo, Sociological Abstracts, Web of Science, and EMBASE. Titles and abstracts of the retrieved studies were reviewed and assessed for the inclusion and exclusion criteria. Papers were included if they studied the following: (1) (potential) patients, relatives, or health care professionals; (2) the effects of Web-based patient narratives that were generated scientifically (eg, through qualitative research methods); and (3) were quantitative studies. Furthermore, 2 authors independently performed an assessment of the quality of the included studies using a validated checklist. Results Of 4226 documents, 17 studies met the inclusion criteria. The studies investigated 10 different sources of Web-based patient narratives. Sample sizes ranged from 23 to 2458. The mean score of the quality assessment was 82.6 (range 61-100). Effects regarding five different purposes were identified as follows: provide information, engage, model behavior, persuade, and comfort. We found positive effects in every category and negative effects in one category (persuade). Several of the reported effects are rather small or were identified under specific experimental conditions. Conclusions Patient narratives seem to be a promising means to support users in improving their understanding of certain health conditions and possibly to provide emotional support and have an impact on behavioral changes. There is limited evidence for beneficial effects on some outcomes. However, narratives are characterized by considerable heterogeneity and the investigated outcomes are hardly comparable with each other, which makes the overall judgment difficult. As there are numerous possible measures and purposes of narratives, quantifying the impact of Web-based patient narratives remains a challenge. Future research is needed to define the optimal standards for quantitative approaches to narrative-based interventions.
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Affiliation(s)
- Daniel Drewniak
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Andrea Glässel
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.,Institute of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Martina Hodel
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
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Trinh QD, Hong F, Halpenny B, Epstein M, Berry DL. Racial/ethnicity differences in endorsing influential factors for prostate cancer treatment choice: An analysis of data from the personal patient profile-prostate (P3P) I and II trials. Urol Oncol 2020; 38:78.e7-78.e13. [DOI: 10.1016/j.urolonc.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/12/2019] [Accepted: 10/29/2019] [Indexed: 11/25/2022]
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Richardson M, Min HJ, Hong Q, Compton K, Mung SW, Lohn Z, Nuk J, McCullum M, Portigal-Todd C, Karsan A, Regier D, Brotto LA, Sun S, Schrader KA. Oncology Clinic-Based Hereditary Cancer Genetic Testing in a Population-Based Health Care System. Cancers (Basel) 2020; 12:cancers12020338. [PMID: 32028617 PMCID: PMC7072228 DOI: 10.3390/cancers12020338] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 11/22/2022] Open
Abstract
New streamlined models for genetic counseling and genetic testing have recently been developed in response to increasing demand for cancer genetic services. To improve access and decrease wait times, we implemented an oncology clinic-based genetic testing model for breast and ovarian cancer patients in a publicly funded population-based health care setting in British Columbia, Canada. This observational study evaluated the oncology clinic-based model as compared to a traditional one-on-one approach with a genetic counsellor using a multi-gene panel testing approach. The primary objectives were to evaluate wait times and patient reported outcome measures between the oncology clinic-based and traditional genetic counselling models. Secondary objectives were to describe oncologist and genetic counsellor acceptability and experience. Wait times from referral to return of genetic testing results were assessed for 400 patients with breast and/or ovarian cancer undergoing genetic testing for hereditary breast and ovarian cancer from June 2015 to August 2017. Patient wait times from referral to return of results were significantly shorter with the oncology clinic-based model as compared to the traditional model (403 vs. 191 days; p < 0.001). A subset of 148 patients (traditional n = 99; oncology clinic-based n = 49) completed study surveys to assess uncertainty, distress, and patient experience. Responses were similar between both models. Healthcare providers survey responses indicated they believed the oncology clinic-based model was acceptable and a positive experience. Oncology clinic-based genetic testing using a multi-gene panel approach and post-test counselling with a genetic counsellor significantly reduced wait times and is acceptable for patients and health care providers.
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Affiliation(s)
- Matthew Richardson
- Interdisciplinary Oncology Program, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Hae Jung Min
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Quan Hong
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Katie Compton
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Sze Wing Mung
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Zoe Lohn
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Jennifer Nuk
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Mary McCullum
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Cheryl Portigal-Todd
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Aly Karsan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Dean Regier
- Department of School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Lori A. Brotto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC V6Z 2K8, Canada;
| | - Sophie Sun
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
- Division of Medical Oncology, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Correspondence: (S.S.); (K.A.S.); Tel.: +604-877-6000 (ext. 2752) (S.S.); +604-877-6000 (ext. 672324) (K.A.S.)
| | - Kasmintan A. Schrader
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1G1, Canada
- Correspondence: (S.S.); (K.A.S.); Tel.: +604-877-6000 (ext. 2752) (S.S.); +604-877-6000 (ext. 672324) (K.A.S.)
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Mallen AR, Conley CC, Townsend MK, Wells A, Boac BM, Todd S, Gandhi A, Kuznicki M, Augusto BM, McIntyre M, Fridley BL, Tworoger SS, Wenham RM, Vadaparampil ST. Patterns and predictors of genetic referral among ovarian cancer patients at a National Cancer Institute-Comprehensive Cancer Center. Clin Genet 2020; 97:370-375. [PMID: 31600840 PMCID: PMC7322721 DOI: 10.1111/cge.13654] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/26/2019] [Accepted: 09/18/2019] [Indexed: 12/23/2022]
Abstract
Germline mutations (eg, BRCA1/2) have prognostic and treatment implications for ovarian cancer (OVCA) patients. Thus, national guidelines recommend genetic testing for OVCA patients. The present study examines patterns and predictors of genetics referral in OVCA patients. Electronic medical record data were abstracted retrospectively from 557 OVCA patients treated from 1 January 2001 to 31 December 2015. Logistic regression models identified sociodemographic characteristics, disease/treatment characteristics, family history data, provider characteristics, and survival data that predicted genetics referral. Overall, 27.5% of patients received referral. Eleven variables predicting referral were selected during stepwise regression: younger age, White race, not having private insurance, professional school education, year of OVCA diagnosis, platinum sensitivity, female gynecologic oncologist, chemotherapy administered by a gynecologic oncologist, clinical trial enrollment, longer overall survival, and family history of OVCA. Genetics referral among OVCA patients was similar to rates reported nationwide. Unique predictive factors will contribute to quality improvement and should be validated at a multi-institutional level to ensure guideline concordant care is provided to all OVCA patients. Future research should identify both patient-level and provider-level factors associated with genetics referral.
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Affiliation(s)
- Adrianne R Mallen
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Claire C Conley
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Mary K Townsend
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Ali Wells
- University of South Florida, Morsani School of Medicine, Tampa, Florida
| | - Bernadette M Boac
- Department of Pathology, University of South Florida & Moffitt Cancer Center, Tampa, Florida
| | - Sarah Todd
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Anjalika Gandhi
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Michelle Kuznicki
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Bianca M Augusto
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - McKenzie McIntyre
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Brooke L Fridley
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
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Tijerina JD, Morrison SD, Nolan IT, Parham MJ, Richardson MT, Nazerali R. Celebrity Influence Affecting Public Interest in Plastic Surgery Procedures: Google Trends Analysis. Aesthetic Plast Surg 2019; 43:1669-1680. [PMID: 31392394 DOI: 10.1007/s00266-019-01466-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/17/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Medical decisions made by celebrities have a profound influence on medical decisions made by the general population. Google Trends (GT) is a free, online resource with virtually no barriers to use that allows for tracking of global search volumes as a proxy for determining public interest. In this study, we utilize GT to characterize the significant and measurable effects that the May 2013 announcement of Angelina Jolie's BRCA-influenced prophylactic mastectomy, May 2015 announcement of Kylie Jenner's lip augmentation, April 2017 announcement of Caitlyn Jenner's gender affirming surgery and February 2014 media attention given to Kim Kardashian's rumored buttock augmentation had on corresponding surgical procedure volumes. METHODS GT databases of search volumes were collected for terms related to prophylactic mastectomy, lip augmentation, gender affirming surgery and buttock augmentation categories from January 2004 to March 2019 using the "related queries" feature. Mean search volumes prior to respective announcements were compared to that of the period starting 6 months after. Additionally, the percent change from the month preceding respective celebrity announcements was compared to the month of the announcement for each search term. RESULTS For mastectomy, all terms demonstrated peak interest during May 2013. Following Jolie's announcement, interest in "mastectomy" rose 1328%, "prophylactic mastectomy" rose 324%, "BRCA1" rose 316%, "BRCA2" rose 138% and "BRCA gene" rose 354%. Long-term interest was higher after May 2013 than beforehand for all terms except "prophylactic mastectomy" (each, p < 0.001). Following Kylie Jenner's announcement, interest in "lip augmentation" rose 43%, "lip enhancement" rose 37%, "lip fillers" rose 3233%, "lip implants" rose 8% and "lip injections" rose 13%. Long-term interest was higher after May 2015 than beforehand for all terms except "lip augmentation" and "lip enhancement" (each, p < 0.001). Following Caitlyn Jenner's announcement, "gender affirming surgery" rose 119%, "gender reassignment" rose 186%, "gender reassignment surgery" rose 203% and "transgender surgery" rose 35%. Long-term interest was higher after April 2017 than beforehand for all terms except "sex change" (each, p < 0.001). Following Kardashian's rumored injections, interest in "butt enhancement" rose 34% and "butt implants" rose 100%. Long-term interest was higher after February 2014 than beforehand for all terms (each, p < 0.001). CONCLUSIONS GT data trends correlate with shifts in real-world healthcare utilization and healthcare-related public interest caused by high-profile public events, making it a useful tool for real-time prediction of trends in public health in response to a variety of observable influences. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Armstrong KA. Maximizing the Outcomes of Breast Cancer Prevention. JAMA Intern Med 2019; 179:1621-1623. [PMID: 31633744 DOI: 10.1001/jamainternmed.2019.4666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Katrina A Armstrong
- Department of Medicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
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