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Wu HC, Lai Y, Liao Y, Deyssenroth M, Miller GW, Santella RM, Terry MB. Plasma metabolomics profiles and breast cancer risk. Breast Cancer Res 2024; 26:141. [PMID: 39385226 PMCID: PMC11463119 DOI: 10.1186/s13058-024-01896-5] [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: 03/08/2024] [Accepted: 09/18/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Breast cancer (BC) is the most common cancer in women and incidence rates are increasing; metabolomics may be a promising approach for identifying the drivers of the increasing trends that cannot be explained by changes in known BC risk factors. METHODS We conducted a nested case-control study (median followup 6.3 years) within the New York site of the Breast Cancer Family Registry (BCFR) (n = 40 cases and 70 age-matched controls). We conducted a metabolome-wide association study using untargeted metabolomics coupling hydrophilic interaction liquid chromatography (HILIC) and C18 chromatography with high-resolution mass spectrometry (LC-HRMS) to identify BC-related metabolic features. RESULTS We found eight metabolic features associated with BC risk. For the four metabolites negatively associated with risk, the adjusted odds ratios (ORs) ranged from 0.31 (95% confidence interval (CI): 0.14, 0.66) (L-Histidine) to 0.65 (95% CI: 0.43, 0.98) (N-Acetylgalactosamine), and for the four metabolites positively associated with risk, ORs ranged from 1.61 (95% CI: 1.04, 2.51, (m/z: 101.5813, RT: 90.4, 1,3-dibutyl-1-nitrosourea, a potential carcinogen)) to 2.20 (95% CI: 1.15, 4.23) (11-cis-Eicosenic acid). These results were no longer statistically significant after adjusting for multiple comparisons. Adding the BC-related metabolic features to a model, including age, the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) risk score improved the accuracy of BC prediction from an area under the curve (AUC) of 66% to 83%. CONCLUSIONS If replicated in larger prospective cohorts, these findings offer promising new ways to identify exposures related to BC and improve BC risk prediction.
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Affiliation(s)
- Hui-Chen Wu
- Department of Environmental Health Sciences, Mailman School of Public Health of Columbia University, New York, NY, 10032, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
| | - Yunjia Lai
- Department of Environmental Health Sciences, Mailman School of Public Health of Columbia University, New York, NY, 10032, USA
| | - Yuyan Liao
- Department of Epidemiology, Mailman School of Public Health of Columbia University, New York, NY, USA
| | - Maya Deyssenroth
- Department of Environmental Health Sciences, Mailman School of Public Health of Columbia University, New York, NY, 10032, USA
| | - Gary W Miller
- Department of Environmental Health Sciences, Mailman School of Public Health of Columbia University, New York, NY, 10032, USA
| | - Regina M Santella
- Department of Environmental Health Sciences, Mailman School of Public Health of Columbia University, New York, NY, 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Mary Beth Terry
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health of Columbia University, New York, NY, USA
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Conley CC, Rodriguez JD, McIntyre M, Niell BL, O'Neill SC, Vadaparampil ST. Strategies for Identifying and Recruiting Women at High Risk for Breast Cancer for Research Outside of Clinical Settings: Observational Study. J Med Internet Res 2024; 26:e54450. [PMID: 39222344 PMCID: PMC11406107 DOI: 10.2196/54450] [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: 11/09/2023] [Revised: 04/22/2024] [Accepted: 07/17/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Research is needed to understand and address barriers to risk management for women at high (≥20% lifetime) risk for breast cancer, but recruiting this population for research studies is challenging. OBJECTIVE This paper compares a variety of recruitment strategies used for a cross-sectional, observational study of high-risk women. METHODS Eligible participants were assigned female at birth, aged 25-85 years, English-speaking, living in the United States, and at high risk for breast cancer as defined by the American College of Radiology. Individuals were excluded if they had a personal history of breast cancer, prior bilateral mastectomy, medical contraindications for magnetic resonance imaging, or were not up-to-date on screening mammography per American College of Radiology guidelines. Participants were recruited from August 2020 to January 2021 using the following mechanisms: targeted Facebook advertisements, Twitter posts, ResearchMatch (a web-based research recruitment database), community partner promotions, paper flyers, and community outreach events. Interested individuals were directed to a secure website with eligibility screening questions. Participants self-reported method of recruitment during the eligibility screening. For each recruitment strategy, we calculated the rate of eligible respondents and completed surveys, costs per eligible participant, and participant demographics. RESULTS We received 1566 unique responses to the eligibility screener. Participants most often reported recruitment via Facebook advertisements (724/1566, 46%) and ResearchMatch (646/1566, 41%). Community partner promotions resulted in the highest proportion of eligible respondents (24/46, 52%), while ResearchMatch had the lowest proportion of eligible respondents (73/646, 11%). Word of mouth was the most cost-effective recruitment strategy (US $4.66 per completed survey response) and paper flyers were the least cost-effective (US $1448.13 per completed survey response). The demographic characteristics of eligible respondents varied by recruitment strategy: Twitter posts and community outreach events resulted in the highest proportion of Hispanic or Latina women (1/4, 25% and 2/6, 33%, respectively), and community partner promotions resulted in the highest proportion of non-Hispanic Black women (4/24, 17%). CONCLUSIONS Although recruitment strategies varied in their yield of study participants, results overall support the feasibility of identifying and recruiting women at high risk for breast cancer outside of clinical settings. Researchers must balance the associated costs and participant yield of various recruitment strategies in planning future studies focused on high-risk women.
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Affiliation(s)
- Claire C Conley
- Department of Oncology, Georgetown University, Washington, DC, United States
| | | | - McKenzie McIntyre
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, United States
| | - Bethany L Niell
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, United States
| | - Suzanne C O'Neill
- Department of Oncology, Georgetown University, Washington, DC, United States
| | - Susan T Vadaparampil
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, United States
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Conley CC, Anderson A, Rodriguez JD, Kang H, Taylor EP, Luck C, Rosas Torres J, Cheraghi N, Newton N, Niell BL, O'Neill SC, Vadaparampil ST. Barriers and facilitators to breast cancer screening among high-risk women: a qualitative study. Breast Cancer Res Treat 2024:10.1007/s10549-024-07471-y. [PMID: 39190231 DOI: 10.1007/s10549-024-07471-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE Women with greater than 20-25% lifetime breast cancer risk are recommended to have breast cancer screening with annual mammogram and supplemental breast MRI. However, few women follow these screening recommendations. The objective of this study was to identify barriers and facilitators of screening among women at high risk for breast cancer, guided by the Health Services Utilization Model (HSUM). METHODS Unaffected high-risk women (N=63) completed semi-structured qualitative interviews exploring their experiences with breast cancer screening. Interviews were audio recorded, transcribed verbatim, and analyzed using a combined deductive and inductive approach. RESULTS Most participants (84%) had received a screening mammogram; fewer (33%) had received a screening breast MRI. Only 14% had received neither screening. In line with the HSUM, qualitative analysis identified predisposing factors, enabling factors, and need factors associated with receipt of breast cancer screening. Enabling factors - including financial burden, logistic barriers, social support, and care coordination - were most frequently discussed. Predisposing factors included knowledge, health beliefs, and self-advocacy. Need factors included healthcare provider recommendation, family history of breast cancer, and personal medical history. Although HSUM themes were consistent for both mammography and breast MRI, participants did highlight several important differences in barriers and facilitators between the two screening modalities. CONCLUSION Barriers and enabling factors associated with supplemental screening for high-risk women represent possible intervention targets. Future research is needed to develop and test multilevel interventions targeting these factors, with the ultimate goal of increasing access to supplemental screening for high-risk women.
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Affiliation(s)
- Claire C Conley
- Department of Oncology, Georgetown University, Washington, DC, USA.
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, 2115 Wisconsin Ave NW, Suite 300, Washington, DC, 20007, USA.
| | - Alaina Anderson
- Department of Oncology, Georgetown University, Washington, DC, USA
| | | | - Hannah Kang
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - Emily P Taylor
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - Conor Luck
- Department of Oncology, Georgetown University, Washington, DC, USA
| | | | - Nora Cheraghi
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - Noelle Newton
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - Bethany L Niell
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
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Gootzen TA, Steenbeek MP, van Bommel M, IntHout J, Kets CM, Hermens R, de Hullu JA. Risk-reducing salpingectomy with delayed oophorectomy to prevent ovarian cancer in women with an increased inherited risk: insights into an alternative strategy. Fam Cancer 2024:10.1007/s10689-024-00412-0. [PMID: 38907139 DOI: 10.1007/s10689-024-00412-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024]
Abstract
Epithelial ovarian cancer (EOC) is the most lethal type of gynaecological cancer, due to lack of effective screening possibilities and because the disease tends to metastasize before onset of symptoms. Women with an increased inherited risk for EOC are advised to undergo a risk-reducing salpingo-oophorectomy (RRSO), which decreases their EOC risk by 96% when performed within guideline ages. However, it also induces premature menopause, which has harmful consequences. There is compelling evidence that the majority of EOCs originate in the fallopian tube. Therefore, a risk-reducing salpingectomy with delayed oophorectomy (RRS with DO) has gained interest as an alternative strategy. Previous studies have shown that this alternative strategy has a positive effect on menopause-related quality of life and sexual health when compared to the standard RRSO. It is hypothesized that the alternative strategy is non-inferior to the standard RRSO with respect to oncological safety (EOC incidence). Three prospective studies are currently including patients to compare the safety and/or quality of life of the two distinct strategies. In this article we discuss the background, opportunities, and challenges of the current and alternative strategy.
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Affiliation(s)
- T A Gootzen
- Department of Gynaecology and Obstetrics, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, GA, 6525, The Netherlands.
| | - M P Steenbeek
- Department of Gynaecology and Obstetrics, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, GA, 6525, The Netherlands
| | - Mhd van Bommel
- Department of Gynaecology and Obstetrics, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, GA, 6525, The Netherlands
| | - J IntHout
- Department of IQ Health, Radboudumc, Kapittelweg 54, Nijmegen, EP, 6525, The Netherlands
| | - C M Kets
- Department of Genetics, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, GA, 6525, The Netherlands
| | - Rpmg Hermens
- Department of IQ Health, Radboudumc, Kapittelweg 54, Nijmegen, EP, 6525, The Netherlands
| | - J A de Hullu
- Department of Gynaecology and Obstetrics, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, GA, 6525, The Netherlands
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Mesa-Chavez F, Chavarri-Guerra Y, Aguilar-y-Mendez D, Becerril-Gaitan A, Vaca-Cartagena BF, Carrillo-Bedoya A, Santiesteban-González S, Aranda-Gutierrez A, Rodríguez-Faure A, Obregon-Leal D, Quintero-Beuló G, Rodriguez-Olivares JL, Miaja M, Weitzel JN, Villarreal-Garza C. Uptake of Risk-Reducing Measures, Cascade Testing, and Related Challenges Among Carriers of Breast Cancer-Associated Germline Pathogenic Variants in Mexico. JCO Glob Oncol 2024; 10:e2300417. [PMID: 38635940 PMCID: PMC11191870 DOI: 10.1200/go.23.00417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/22/2023] [Accepted: 02/20/2024] [Indexed: 04/20/2024] Open
Abstract
PURPOSE Genetic cancer risk assessment (GCRA) provides pathogenic variant (PV) carriers with the invaluable opportunity to undertake timely cancer risk-reducing (RR) measures and initiate cascade testing (CT). This study describes the uptake of these strategies and the related barriers among breast cancer-associated germline PV carriers in Mexico. METHODS Carriers who were at least 6 months after disclosure of genetic test results at two GCRA referral centers were invited to answer a survey assessing sociodemographic characteristics, awareness of their carrier status and its implications, uptake of RR measures according to international guidelines by PV, CT initiation, and associated challenges. RESULTS Of the eligible carriers, 246/384 (64%) answered the survey (median age: 44 years). Most were female (88%), married/in domestic partnership (66%), and had personal breast/ovarian cancer history (61%). PVs included BRCA1/2 (75%), CHEK2 (10%), PALB2 (5%), ATM (5%), NF1 (2%), RAD51C (2%), PTEN (1%), and TP53 (1%). Most (87%) participants were aware of their carrier status. When recommended, 37% underwent RR bilateral mastectomy, 48% RR oophorectomy, 70% annual mammogram, and 20% breast magnetic resonance imaging. Challenges hindering the uptake of RR measures included financial limitations (67%), lack of recommendation by their physician (35%), and fear (24%). Nearly all (98%) claimed sharing their results with their relatives. CT was initiated in 63% of families and was associated with carriers being married/in domestic partnership (P = .04) and believing GCRA was useful (P < .001). CONCLUSION Despite the resource-constrained setting, relevant rates of RR measures and CT were observed. Targeted interventions to reduce out-of-pocket expenses and improve patient-physician communication and patients' understanding on carrier status are warranted to enhance the overall benefit of GCRA and ultimately improve the provision of patient-centered care to both carriers and their at-risk relatives.
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Affiliation(s)
- Fernanda Mesa-Chavez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
| | - Yanin Chavarri-Guerra
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Dione Aguilar-y-Mendez
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Andrea Becerril-Gaitan
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Bryan F. Vaca-Cartagena
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
| | | | | | | | - Andrés Rodríguez-Faure
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Daniela Obregon-Leal
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
| | | | | | - Melina Miaja
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Jeffrey N. Weitzel
- The University of Kansas Cancer Center, Kansas City, MO
- Latin American School of Oncology, Sierra Madre, CA
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
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Oxley SG, Wei X, Sideris M, Blyuss O, Kalra A, Sia JJY, Ganesan S, Fierheller CT, Sun L, Sadique Z, Jin H, Manchanda R, Legood R. Utility Scores for Risk-Reducing Mastectomy and Risk-Reducing Salpingo-Oophorectomy: Mapping to EQ-5D. Cancers (Basel) 2024; 16:1358. [PMID: 38611036 PMCID: PMC11010846 DOI: 10.3390/cancers16071358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO) are the most effective breast and ovarian cancer preventive interventions. EQ-5D is the recommended tool to assess the quality of life and determine health-related utility scores (HRUSs), yet there are no published EQ-5D HRUSs after these procedures. These are essential for clinicians counselling patients and for health-economic evaluations. METHODS We used aggregate data from our published systematic review and converted SF-36/SF-12 summary scores to EQ-5D HRUSs using a published mapping algorithm. Study control arm or age-matched country-specific reference values provided comparison. Random-effects meta-analysis provided adjusted disutilities and utility scores. Subgroup analyses included long-term vs. short-term follow-up. RESULTS Four studies (209 patients) reported RRM outcomes using SF-36, and five studies (742 patients) reported RRSO outcomes using SF-12/SF-36. RRM is associated with a long-term (>2 years) disutility of -0.08 (95% CI -0.11, -0.04) (I2 31.4%) and a utility of 0.92 (95% CI 0.88, 0.95) (I2 31.4%). RRSO is associated with a long-term (>1 year) disutility of -0.03 (95% CI -0.05, 0.00) (I2 17.2%) and a utility of 0.97 (95% CI 0.94, 0.99) (I2 34.0%). CONCLUSIONS We present the first HRUSs sourced from patients following RRM and RRSO. There is a need for high-quality prospective studies to characterise quality of life at different timepoints.
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Affiliation(s)
- Samuel G. Oxley
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Xia Wei
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
| | - Michail Sideris
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Oleg Blyuss
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child´s Health, Sechenov First Moscow State Medical University, Sechenov University, Moscow 119991, Russia
| | - Ashwin Kalra
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Jacqueline J. Y. Sia
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Subhasheenee Ganesan
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Caitlin T. Fierheller
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
| | - Li Sun
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
| | - Haomiao Jin
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7YH, UK;
| | - Ranjit Manchanda
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, Faculty of Population Health Sciences, University College London, London WC1V 6LJ, UK
| | - Rosa Legood
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
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Zaluzec EK, Kenyon E, Volk M, Hayat H, Powell K, Loomis A, Chakravarty S, Hix JML, Schipper J, Chang C, Kiupel M, Wang P, Shapiro EM, Sempere LF. Tantalum oxide nanoparticles as versatile and high-resolution X-ray contrast agent for intraductal image-guided ablative procedure in rodent models of breast cancer. NPJ IMAGING 2024; 2:3. [PMID: 39301013 PMCID: PMC11412094 DOI: 10.1038/s44303-024-00007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/17/2024] [Indexed: 09/22/2024]
Abstract
There are limited options for primary prevention of breast cancer (BC). Experimental procedures to locally prevent BC have shown therapeutic efficacy in animal models. To determine the suitability of FDA-approved iodine-containing and various metal-containing (bismuth, gold, iodine, or tantalum) preclinical nanoparticle-based contrast agents for image-guided intraductal (ID) ablative treatment of BC in rodent models, we performed a prospective longitudinal study to determine the imaging performance, local retention and systemic clearance, safety profile, and compatibility with ablative solution of each contrast agent. At least six abdominal mammary glands (>3 female FVB/JN mice and/or Sprague-Dawley rats, 10-11 weeks of age) were intraductally injected with commercially available contrast agents (Omnipaque® 300, Fenestra® VC, MVivoTM Au, MVivoTM BIS) or in-house synthesized tantalum oxide (TaOx) nanoparticles. Contrast agents were administered at stock concentration or diluted in 70% ethanol (EtOH) and up to 1% ethyl cellulose (EC) as gelling agent to assess their compatibility with our image-guided ablative procedure. Mammary glands were serially imaged by microCT for up to 60 days after ID delivery. Imaging data were analyzed by radiologists and deep learning to measure in vivo signal disappearance of contrast agents. Mammary glands and major organs were ultimately collected for histopathological examination. TaOx-containing solutions provided best imaging performance for nitid visualization of ductal tree immediately after infusion, low outward diffusion (<1 day) and high homogeneity. Of all nanoparticles, TaOx had the highest local clearance rate (46% signal decay as stock and 36% as ablative solution 3 days after ID injection) and exhibited low toxicity. TaOx-containing ablative solution with 1% EC caused same percentage of epithelial cell death (88.62% ± 7.70% vs. 76.38% ± 9.99%, p value = 0.089) with similar minimal collateral damage (21.56 ± 5.28% vs. 21.50% ± 7.14%, p value = 0.98) in mouse and rat mammary glands, respectively. In conclusion, TaOx-nanoparticles are a suitable and versatile contrast agent for intraductal imaging and image-guided ablative procedures in rodent models of BC with translational potential to humans.
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Affiliation(s)
- Erin K Zaluzec
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA
- Department of Pharmacology & Toxicology, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
- These authors contributed equally: Erin K. Zaluzec, Elizabeth Kenyon
| | - Elizabeth Kenyon
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA
- These authors contributed equally: Erin K. Zaluzec, Elizabeth Kenyon
| | - Maximilian Volk
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA
| | - Hasaan Hayat
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Katherine Powell
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA
| | - Alexander Loomis
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA
| | - Shatadru Chakravarty
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Jeremy M L Hix
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Josh Schipper
- Van Andel Research Institute, Grand Rapids, MI 49503, USA
| | - Chi Chang
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Matti Kiupel
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Lansing, MI 48910, USA
| | - Ping Wang
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Erik M Shapiro
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
- Departments of Biomedical Engineering, Physiology, and Chemical Engineering and Materials Science, Michigan State University, East Lansing, MI 48824, USA
| | - Lorenzo F Sempere
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
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Padamsee TJ, Bijou C, Swinehart-Hord P, Hils M, Muraveva A, Meadows RJ, Shane-Carson K, Yee LD, Wills CE, Paskett ED. Risk-management decision-making data from a community-based sample of racially diverse women at high risk of breast cancer: rationale, methods, and sample characteristics of the Daughter Sister Mother Project survey. Breast Cancer Res 2024; 26:8. [PMID: 38212792 PMCID: PMC10785448 DOI: 10.1186/s13058-023-01753-x] [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: 09/08/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND To understand the dynamics that limit use of risk-management options by women at high risk of breast cancer, there is a critical need for research that focuses on patient perspectives. Prior research has left important gaps: exclusion of high-risk women not in risk-related clinical care, exclusion of non-white populations, and lack of attention to the decision-making processes that underlie risk-management choices. Our objective was to create a more inclusive dataset to facilitate research to address disparities related to decision making for breast cancer risk management. METHODS The Daughter Sister Mother Project survey collects comprehensive information about the experiences of women at high risk of breast cancer. We collected novel measures of feelings about and reactions to cancer screenings; knowledge, barriers, and facilitators of risk-management options; beliefs related to cancer risk and risk management; and involvement with loved ones who had cancer. Eligible individuals were non-Hispanic white and non-Hispanic Black adult women who self-identified as having high risk of breast cancer and had no personal history of cancer. Between October 2018 and August 2019, 1053 respondents completed the online survey. Of these, 717 were confirmed through risk prediction modeling to have a lifetime breast cancer risk of ≥ 20%. Sociodemographic characteristics of this sample were compared to those of nationally representative samples of the US population: the 2019 Health Information National Trends Survey and the Pew Research Center report: Jewish Americans in 2020. RESULTS The sample of 717 women at objectively high risk of breast cancer was largely (95%) recruited from non-clinical sources. Of these respondents, only 31% had seen a genetic counselor, 34% had had genetic testing specific to breast cancer risk, and 35% had seen at least one breast or cancer care specialist. The sample includes 35% Black respondents and 8% with Ashkenazi Jewish ancestry. Although encompassing a substantial range of ages, incomes, and education levels, respondents are overall somewhat younger, higher-income, and more educated than the US population as a whole. CONCLUSIONS The DSM dataset offers comprehensive data from a community-based, diverse sample of women at high risk of breast cancer. The dataset includes substantial proportions of Black and Ashkenazi Jewish women and women who are not already in clinical care related to their breast cancer risk. This sample will facilitate future studies of risk-management behaviors among women who are and are not receiving high-risk care, and of variations in risk-management experiences across race and ethnicity.
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Affiliation(s)
- Tasleem J Padamsee
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA.
| | - Christina Bijou
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Paige Swinehart-Hord
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA
| | - Megan Hils
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA
| | - Anna Muraveva
- Government Resources Center, The Ohio State University, Columbus, OH, USA
| | - Rachel J Meadows
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | | | - Lisa D Yee
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Celia E Wills
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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Zaluzec EK, Sempere LF. Systemic and Local Strategies for Primary Prevention of Breast Cancer. Cancers (Basel) 2024; 16:248. [PMID: 38254741 PMCID: PMC10814018 DOI: 10.3390/cancers16020248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 01/24/2024] Open
Abstract
One in eight women will develop breast cancer in the US. For women with moderate (15-20%) to average (12.5%) risk of breast cancer, there are few options available for risk reduction. For high-risk (>20%) women, such as BRCA mutation carriers, primary prevention strategies are limited to evidence-based surgical removal of breasts and/or ovaries and anti-estrogen treatment. Despite their effectiveness in risk reduction, not many high-risk individuals opt for surgical or hormonal interventions due to severe side effects and potentially life-changing outcomes as key deterrents. Thus, better communication about the benefits of existing strategies and the development of new strategies with minimal side effects are needed to offer women adequate risk-reducing interventions. We extensively review and discuss innovative investigational strategies for primary prevention. Most of these investigational strategies are at the pre-clinical stage, but some are already being evaluated in clinical trials and others are expected to lead to first-in-human clinical trials within 5 years. Likely, these strategies would be initially tested in high-risk individuals but may be applicable to lower-risk women, if shown to decrease risk at a similar rate to existing strategies, but with minimal side effects.
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Affiliation(s)
- Erin K. Zaluzec
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA;
- Department of Pharmacology & Toxicology, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Lorenzo F. Sempere
- Precision Health Program, Michigan State University, East Lansing, MI 48824, USA;
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
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10
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Dean M, Tezak AL, Johnson S, Weidner A, Almanza D, Pal T, Cragun DL. Factors that differentiate cancer risk management decisions among females with pathogenic/likely pathogenic variants in PALB2, CHEK2, and ATM. Genet Med 2023; 25:100945. [PMID: 37515473 DOI: 10.1016/j.gim.2023.100945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE Following disclosure of pathogenic or likely pathogenic variants in hereditary cancer genes, patients face cancer risk management decisions. Through this mixed-methods study, we investigated cancer risk management decisions among females with pathogenic or likely pathogenic variants in PALB2, CHEK2, and ATM to understand why some patients follow National Comprehensive Cancer Network guidelines, whereas others do not. METHODS Survey and interview data were cross-analyzed using a 3-stage approach. Identified factors were used to conduct coincidence analysis and differentiate between combinations of factors that result in following or not following guidelines. RESULTS Of the 13 participants who underwent guideline inconsistent prophylactic surgery, 12 fit 1 of 3 unique patterns: (1) cancer-related anxiety in the absence of trust in care, (2) provider recommending surgery inconsistent with National Comprehensive Cancer Network guidelines, or (3) surgery occurring before genetic testing. Two unique patterns were found among 18 of 20 participants who followed guidelines: (1) anxiety along with trust in care or (2) lack of anxiety and no prophylactic surgery before testing. CONCLUSION Health care provider recommendations and trust in care may influence whether individuals receive care that is congruent with risk levels conferred by specific genes. Interventions are needed to improve provider knowledge, patient trust in non-surgical care, and patient anxiety.
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Affiliation(s)
- Marleah Dean
- Department of Communication, University of South Florida, Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL
| | - Ann L Tezak
- Vanderbilt-Ingram Cancer Center in the Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Anne Weidner
- Vanderbilt-Ingram Cancer Center in the Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Deanna Almanza
- Division of Genetics and Metabolism, Department of Pediatrics, University of South Florida, Tampa, FL
| | - Tuya Pal
- Vanderbilt-Ingram Cancer Center in the Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Deborah L Cragun
- College of Public Health, University of South Florida, Tampa, FL.
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11
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Brincat MR, Mira AR, Lawrence A. Current and Emerging Strategies for Tubo-Ovarian Cancer Diagnostics. Diagnostics (Basel) 2023; 13:3331. [PMID: 37958227 PMCID: PMC10647517 DOI: 10.3390/diagnostics13213331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/22/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Tubo-ovarian cancer is the most lethal gynaecological cancer. More than 75% of patients are diagnosed at an advanced stage, which is associated with poorer overall survival. Symptoms at presentation are vague and non-specific, contributing to late diagnosis. Multimodal risk models have improved the diagnostic accuracy of adnexal mass assessment based on patient risk factors, coupled with findings on imaging and serum-based biomarker tests. Newly developed ultrasonographic assessment algorithms have standardised documentation and enable stratification of care between local hospitals and cancer centres. So far, no screening test has proven to reduce ovarian cancer mortality in the general population. This review is an update on the evidence behind ovarian cancer diagnostic strategies.
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Affiliation(s)
- Mark R. Brincat
- Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
| | - Ana Rita Mira
- Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
- Hospital Garcia de Orta, 2805-267 Almada, Portugal
| | - Alexandra Lawrence
- Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
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12
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Bigatti SM, Lydon-Lam J, Storniolo AM. Breast Cancer Worry in U.S. Female First-degree Relatives: Moderating Role of Daily Spiritual Experiences. JOURNAL OF RELIGION AND HEALTH 2023; 62:3466-3479. [PMID: 37014487 DOI: 10.1007/s10943-023-01807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
Female first degree relatives of breast cancer patients experience worry because of their own increased breast cancer risk. The aim in the present study was to examine the role of daily spiritual experiences as a potential protective factor against breast cancer worry. We hypothesized that daily spiritual experiences would moderate the relationship between relatives' stage of disease and breast cancer worry. Sixty-three mothers, daughters or sisters of breast cancer survivors completed surveys assessing relative's disease characteristics and their own demographics, fear of breast cancer, and daily spiritual experiences. All participants were living in the midwestern United States. Results showed that daily spiritual experiences moderated the relationship between stage of disease and breast cancer worry. Low scores on daily spiritual experiences were associated with more worry when relatives had advanced disease, and high scores on daily spiritual experiences was associated with less worry when relatives had advanced disease. Findings suggest the need to focus on this population when providing support services to families of patients.
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Affiliation(s)
- Silvia M Bigatti
- Department of Social and Behavioral Sciences, IU Fairbanks School of Public Health at IUPUI, 1050 Wishard Blvd., RG6044, Indianapolis, IN, 46202, USA.
| | - Jennifer Lydon-Lam
- Department of Social and Behavioral Sciences, IU Fairbanks School of Public Health at IUPUI, 1050 Wishard Blvd., RG6044, Indianapolis, IN, 46202, USA
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13
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Andreis TF, de Souza KIW, Vieira IA, Alemar B, Sinigaglia M, de Araújo Rocha YM, Artigalás O, Bittar C, Oliveira Netto CB, Ashton-Prolla P, Rosset C. Challenges in periodic revision of genetic testing results: Comparison of the main classification guidelines and report of a retrospective analysis involving BRCA1/BRCA2 variants of uncertain significance. Gene 2023; 862:147281. [PMID: 36775216 DOI: 10.1016/j.gene.2023.147281] [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: 11/16/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
In the context of cancer predisposition syndromes, it is widely known that the correct interpretation of germline variants identified in multigene panel testing is essential for adequate genetic counseling and clinical decision making, in which variants of uncertain significance (VUS) are not considered actionable findings. Thus, their periodic re-evaluation using appropriate guidelines is notably important. In the present study, we compared the performance of the main variant classification guidelines (ACMG, Sherloc and ENIGMA) in variant reassessment, using as input a BRCA1/2 VUS case series (retrospective analysis) from Brazil, an ethnically diverse and admixed country with substantial challenges in VUS reclassification. As main findings, two of the 15 VUS analyzed were reclassified as likely pathogenic by the 3 guidelines, BRCA1 c.4987-3C > G (rs397509213) and BRCA2 c.7868A > G (rs80359012). Moreover, challenges in variant classification and reassessment are described and additional in silico data about structural impact of the variant BRCA2 c.7868A > G are provided. We hypothesize that the establishment of a framework to reassess VUS could improve this process in health centers that have not yet implemented this practice. Results of this study underscore that periodic monitoring of the functional, clinical, and bioinformatics data of a VUS by a multidisciplinary team are of utmost importance in clinical practice. When there is a specific guideline for a given gene, such as ENIGMA for BRCA1/2, it should be considered the first option for variant assessment. Finally, recruitment of VUS carriers and their relatives to participate in variant segregation studies and publication of VUS reclassification results in the international scientific literature should be encouraged.
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Affiliation(s)
- Tiago Finger Andreis
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Kayana Isabel Weber de Souza
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Médicas: Medicina (PPGCM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Igor Araujo Vieira
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Escola de Saúde, Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, Rio Grande do Sul, Brazil
| | - Bárbara Alemar
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Yasminne Marinho de Araújo Rocha
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Osvaldo Artigalás
- Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil
| | - Camila Bittar
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Patricia Ashton-Prolla
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Médicas: Medicina (PPGCM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Clévia Rosset
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências Médicas: Medicina (PPGCM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Unidade de Pesquisa Laboratorial (UPL) - Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.
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14
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Hayes AE, Wardell DW, Engebretson J, LoBiondo-Wood G, Allicock M. Psychosexual responses to BRCA gene mutations in women of childbearing age. J Am Assoc Nurse Pract 2023; 35:242-251. [PMID: 36947688 DOI: 10.1097/jxx.0000000000000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Diagnosis of a BRCA gene mutation presents a dilemma because life-changing medical decisions must be made to prevent breast and ovarian cancer. There is minimal evidence regarding how psychosexual functioning, psychological well-being with regard to body image and sexuality, affects the decision to have prophylactic treatment in women of childbearing age (WCBA; 18-49 years) with a BRCA gene mutation. PURPOSE To explore, describe, and interpret the experience of women with a BRCA mutation during the treatment and decision-making process. METHODOLOGY A qualitative descriptive design was used to recruit participants online through social media postings and from national and local BRCA support groups. Participants participated in semistructured interviews exploring their experience after BRCA diagnosis. Interpretive descriptive analysis was used to identify themes. RESULTS The purposive sample comprised 18 women aged 21-49 years. Four major themes, such as body image, sexuality, femininity, and childbearing/childrearing, were identified that influenced decisions related to the diagnosis and management of a BRCA mutation. All participants voiced that concerns regarding body image and sexuality caused hesitancy in their decision to have prophylactic surgery. Women who had undergone bilateral prophylactic mastectomy were concerned about the impact of the surgery, scarring, breast disfigurement, and the lack of sensation resulting from surgical intervention. CONCLUSIONS Psychosexual concerns arise from internal and external influences that significantly affect the decision to undergo prophylactic measures. Therefore, body image, sexuality, and sexual orientation should all be addressed during the decision-making process. IMPLICATIONS Provider communication and preparation for realistic surgical outcomes can be improved to assist WCBA throughout the decision-making process and enhance psychosexual functioning.
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Affiliation(s)
- Alexis Elizabeth Hayes
- Department of Nursing, Center for Nursing Research, Education and Practice, Houston, Methodist Academic Institute, Houston, Texas
| | - Diane Wind Wardell
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Texas
| | - Joan Engebretson
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Texas
| | - Geri LoBiondo-Wood
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Texas
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, School of Public Health, Dallas Campus the University of Texas Health Science Center at Houston, Texas
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15
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Padamsee TJ, Muraveva A, Meadows RJ, Hils M, Yee LD, Wills CE, Paskett ED. Racial differences in prevention decision making among U.S. women at high risk of breast cancer: A qualitative study. PLoS One 2023; 18:e0278742. [PMID: 36857397 PMCID: PMC9977014 DOI: 10.1371/journal.pone.0278742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/19/2022] [Indexed: 03/02/2023] Open
Abstract
PURPOSE Women at high risk of breast cancer face complex decisions about how to manage those risks. Substantial gaps in current knowledge include how women make these decisions and how decision making may differ across sub-populations. Among these critical gaps are the questions of (a) whether racial differences exist between the experiences of high-risk women navigating breast cancer risk, and (b) what consequences those racial differences might have on women's ability to manage their cancer risks. The present study is designed to address these questions directly. METHODS Fifty semi-structured interviews were conducted with high-risk Black (n = 20) and white women (n = 30) between May 2015 and March 2016 in person in Ohio and by phone. Transcribed data were analyzed using grounded theory methods. MAIN FINDINGS Our analyses suggest that many of the core decision-making dynamics high-risk women navigate differ by race. The experiences of white and Black women in our study differ in terms of (a) contextualizing risk-how women make sense of their own breast cancer risk, the degree to which they worry about risk, and how they prioritize risk within the contexts of their broader lives; (b) conceptualizing risk management-how, how much, and from whom women learn about and conceptualize their options for preventing cancer and/or ensuring that cancer gets diagnosed early; and (c) constraints-the external barriers women face throughout their decision-making and risk-management processes. In sum, the Black women we interviewed reported feeling less well-situated to consider and cope actively with breast cancer risk, less well-informed about risk-management options, and more constrained in their use of these options. CONCLUSIONS High-risk women's accounts of the complex dynamics that shape breast cancer prevention decisions suggest that these dynamics vary substantially by race, such that Black women may experience disadvantages relative to whites.
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Affiliation(s)
- Tasleem J. Padamsee
- Division of Health Services Management and Policy at the Ohio State University College of Public Health, and Faculty Affiliate of the James Comprehensive Cancer Center, Columbus, OH, United States of America
- * E-mail:
| | - Anna Muraveva
- Division of Health Services Management and Policy at the Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Rachel J. Meadows
- Center for Epidemiology & Healthcare Delivery Research JPS Health Network, Ft. Worth, TX, United States of America
| | - Megan Hils
- Division of Health Services Management and Policy at the Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Lisa D. Yee
- City of Hope National Medical Center, Duarte, CA, United States of America
| | - Celia E. Wills
- The Ohio State University College of Nursing, Columbus, OH, United States of America
| | - Electra D. Paskett
- The Ohio State University College of Medicine and James Comprehensive Cancer Center, Columbus, OH, United States of America
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16
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Alves-Nogueira AC, Melo D, Carona C, Figueiredo-Dias M. The Psychosocial Impact of the Decision to Undergo Risk-Reducing Salpingo-Oophorectomy Surgery in BRCA Mutation Carriers and the Role of Physician-Patient Communication. Curr Oncol 2023; 30:2429-2440. [PMID: 36826146 PMCID: PMC9955232 DOI: 10.3390/curroncol30020185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Risk-reducing bilateral salpingo-oophorectomy (RRSO) is an effective prophylactic surgery provided to premenopausal women carrying BRCA1 or BRCA2 mutations and presenting an increased risk of developing breast or ovarian cancer. This procedure is related to physiological, sexual, and psychosocial distress, which altogether increase uncertainty and complexity in the clinical decision-making process and post-surgery adaptation. Physician-patient communication (PPC) has been pointed out as a determinant factor in the decision-making to undergo RRSO, and the subsequent adjustment of women. However, studies examining the psychosocial impact of the decision-making process have been scarce and often lack clear theoretical frameworks. While the role of PPC in such processes has been highlighted in a few qualitative studies, there is a paucity of quantitative research addressing this question. Therefore, this narrative review, conducted using a multidisciplinary approach, was planned to: (1) present an updated medical background for RRSO; (2) analyze the psychosocial impact of the decision-making process within a theoretical framework of the Health Belief Model; and (3) discuss the role of PPC in such a decision-making process and in post-surgery. The collected research also enabled the recommendation of some additions to the existing clinical guidelines and the outlining of future research directions.
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Affiliation(s)
- Ana C. Alves-Nogueira
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal
- Correspondence:
| | - Daniela Melo
- Gynecology Clinic, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Gynecology Department, Coimbra University Hospital Centre, 3004-561 Coimbra, Portugal
| | - Carlos Carona
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal
| | - Margarida Figueiredo-Dias
- Gynecology Clinic, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Gynecology Department, Coimbra University Hospital Centre, 3004-561 Coimbra, Portugal
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Usher-Smith JA, Hindmarch S, French DP, Tischkowitz M, Moorthie S, Walter FM, Dennison RA, Stutzin Donoso F, Archer S, Taylor L, Emery J, Morris S, Easton DF, Antoniou AC. Proactive breast cancer risk assessment in primary care: a review based on the principles of screening. Br J Cancer 2023; 128:1636-1646. [PMID: 36737659 PMCID: PMC9897164 DOI: 10.1038/s41416-023-02145-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
In the UK, the National Institute for Health and Care Excellence (NICE) recommends that women at moderate or high risk of breast cancer be offered risk-reducing medication and enhanced breast screening/surveillance. In June 2022, NICE withdrew a statement recommending assessment of risk in primary care only when women present with concerns. This shift to the proactive assessment of risk substantially changes the role of primary care, in effect paving the way for a primary care-based screening programme to identify those at moderate or high risk of breast cancer. In this article, we review the literature surrounding proactive breast cancer risk assessment within primary care against the consolidated framework for screening. We find that risk assessment for women under 50 years currently satisfies many of the standard principles for screening. Most notably, there are large numbers of women at moderate or high risk currently unidentified, risk models exist that can identify those women with reasonable accuracy, and management options offer the opportunity to reduce breast cancer incidence and mortality in that group. However, there remain a number of uncertainties and research gaps, particularly around the programme/system requirements, that need to be addressed before these benefits can be realised.
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Affiliation(s)
- Juliet A. Usher-Smith
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah Hindmarch
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David P. French
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Marc Tischkowitz
- grid.5335.00000000121885934Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Sowmiya Moorthie
- grid.5335.00000000121885934PHG Foundation, University of Cambridge, Cambridge, UK
| | - Fiona M. Walter
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK ,grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Rebecca A. Dennison
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Francisca Stutzin Donoso
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephanie Archer
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK ,grid.5335.00000000121885934Department of Psychology, University of Cambridge, Cambridge, UK
| | - Lily Taylor
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jon Emery
- grid.1008.90000 0001 2179 088XCentre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC Australia
| | - Stephen Morris
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Douglas F. Easton
- grid.5335.00000000121885934Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Antonis C. Antoniou
- grid.5335.00000000121885934Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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18
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Kotaniemi‐Talonen L, Pukkala E, Aittomäki K, Auranen A. Long-term risk of cancer among the first-degree relatives of epithelial ovarian cancer patients: A cohort study with 48 years of follow up. Acta Obstet Gynecol Scand 2023; 102:240-245. [PMID: 36645194 PMCID: PMC9951276 DOI: 10.1111/aogs.14504] [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: 08/22/2022] [Revised: 12/11/2022] [Accepted: 12/16/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The long-term risk of cancer among first-degree relatives of ovarian cancer patients, especially their offspring, is of apparent clinical importance. Risks caused by known inherited factors such as BRCA1 or BRCA2 pathogenic variants are well established, but these account for only about 15% of ovarian cancer cases. Less is known about the possible familial risks of sporadic ovarian cancers. MATERIAL AND METHODS Using registry data, we conducted a retrospective cohort study with a total of 6501 first-degree relatives of 559 epithelial ovarian cancer patients. We studied the occurrence of overall cancer and cancer in specific sites known or suspected to be associated with ovarian cancer (breast, cervix, colon, endometrium, lung and trachea, skin melanoma, ovary, pancreas, prostate, rectum, and stomach). RESULTS The overall number of cancers was not increased among the first-degree relatives of epithelial ovarian cancer patients during the up to 48 years of follow up. Among female relatives, the standardized incidence ratio for ovarian cancer was 1.92 (95% CI 1.27-2.79), mostly explained by a 2.30-fold (95% CI 1.46-3.45) risk among the patients' sisters. There was a decreasing trend in the standardized incidence ratio for ovarian cancer among patients' sisters by increasing age of the index patient. CONCLUSIONS In our study cohort, we did not observe an increase in the overall cancer risk among the first-degree relatives of epithelial ovarian cancer patients in comparison with the general population. The risk for ovarian cancer, however, was increased. Current recommendations suggest prophylactic removal of the fallopian tubes and ovaries only with identified inherited risk factors. Our results emphasize the role of genetic counseling and testing, particularly in young ovarian cancer patients and their close female relatives.
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Affiliation(s)
- Laura Kotaniemi‐Talonen
- Department of Obstetrics and GynecologyTampere University HospitalTampereFinland,Tays Cancer CentreTampere University HospitalTampereFinland,Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Eero Pukkala
- Finnish Cancer Registry—Institute for Statistical and Epidemiological Cancer ResearchHelsinkiFinland,Health Sciences Unit, Faculty of Social SciencesTampere UniversityTampereFinland
| | - Kristiina Aittomäki
- Department of Medical and Clinical GeneticsUniversity of HelsinkiHelsinkiFinland
| | - Annika Auranen
- Department of Obstetrics and GynecologyTampere University HospitalTampereFinland,Tays Cancer CentreTampere University HospitalTampereFinland,Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
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19
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Kenyon E, Zaluzec E, Powell K, Volk M, Chakravarty S, Hix J, Kiupel M, Shapiro EM, Sempere LF. X-Ray Visualization of Intraductal Ethanol-Based Ablative Treatment for Prevention of Breast Cancer in Rat Models. JOURNAL OF VISUALIZED EXPERIMENTS : JOVE 2022:10.3791/64042. [PMID: 36571406 PMCID: PMC9876732 DOI: 10.3791/64042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There are still a limited number of primary interventions for prevention of breast cancer. For women at a high risk of developing breast cancer, the most effective intervention is prophylactic mastectomy. This is a drastic surgical procedure in which the mammary epithelial cells that can give rise to breast cancer are completely removed along with the surrounding tissue. The goal of this protocol is to demonstrate the feasibility of a minimally invasive intraductal procedure that could become a new primary intervention for breast cancer prevention. This local procedure would preferentially ablate mammary epithelial cells before they can become malignant. Intraductal methods to deliver solutions directly to these epithelial cells in rodent models of breast cancer have been developed at Michigan State University and elsewhere. The rat mammary gland consists of a single ductal tree that has a simpler and more linear architecture compared to the human breast. However, chemically induced rat models of breast cancer offer valuable tools for proof-of-concept studies of new preventive interventions and scalability from mouse models to humans. Here, a procedure for intraductal delivery of an ethanol-based ablative solution containing tantalum oxide nanoparticles as X-ray contrast agent and ethyl cellulose as gelling agent into the rat mammary ductal tree is described. Delivery of aqueous reagents (e.g., cytotoxic compounds, siRNAs, AdCre) by intraductal injection has been described previously in mouse and rat models. This protocol description emphasizes methodological changes and steps that pertain uniquely to delivering an ablative solution, formulation consideration to minimize local and systemic side effects of the ablative solution, and X-ray imaging for in vivo assessment of ductal tree filling. Fluoroscopy and micro-CT techniques enable to determine the success of ablative solution delivery and the extent of ductal tree filling thanks to compatibility with the tantalum-containing contrast agent.
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Affiliation(s)
- Elizabeth Kenyon
- Precision Health Program, Michigan State University, East Lansing, MI, USA,Department of Radiology, Michigan State University, East Lansing, MI, USA
| | - Erin Zaluzec
- Precision Health Program, Michigan State University, East Lansing, MI, USA,Department of Pharmacology & Toxicology, Michigan State University, East Lansing, MI, USA
| | - Katherine Powell
- Precision Health Program, Michigan State University, East Lansing, MI, USA,Department of Radiology, Michigan State University, East Lansing, MI, USA
| | - Maximilian Volk
- Precision Health Program, Michigan State University, East Lansing, MI, USA,College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Shatadru Chakravarty
- Department of Radiology, Michigan State University, East Lansing, MI, USA,TechInsights Inc., Suite 500, 1891 Robertson Road, Nepean, Ontario, Canada K2H 5B7
| | - Jeremy Hix
- Department of Radiology, Michigan State University, East Lansing, MI, USA,IQ Advanced Molecular Imaging Facility, Michigan State University, East Lansing, MI, USA
| | - Matti Kiupel
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, Lansing, MI, USA
| | - Erik M. Shapiro
- Department of Radiology, Michigan State University, East Lansing, MI, USA
| | - Lorenzo F. Sempere
- Precision Health Program, Michigan State University, East Lansing, MI, USA,Department of Radiology, Michigan State University, East Lansing, MI, USA
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20
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Meadows RJ, Figueroa W, Shane‐Carson KP, Padamsee TJ. Predicting breast cancer risk in a racially diverse, community-based sample of potentially high-risk women. Cancer Med 2022; 11:4043-4052. [PMID: 35388639 PMCID: PMC9636513 DOI: 10.1002/cam4.4721] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Identifying women with high risk of breast cancer is necessary to study high-risk experiences and deliver risk-management care. Risk prediction models estimate individuals' lifetime risk but have rarely been applied in community-based settings among women not yet receiving specialized care. Therefore, we aimed: (1) to apply three breast cancer risk prediction models (i.e., Gail, Claus, and IBIS) to a racially diverse, community-based sample of women, and (2) to assess risk prediction estimates using survey data. METHODS An online survey was administered to women who were determined by a screening instrument to have potentially high risk for breast cancer. Risk prediction models were applied using their self-reported family and medical history information. Inclusion in the high-risk subsample required ≥20% lifetime risk per ≥1 model. Descriptive statistics were used to compare the proportions of women identified as high risk by each model. RESULTS N = 1053 women were initially eligible and completed the survey. All women, except one, self-reported the information necessary to run at least one model; 90% had sufficient information for >1 model. The high-risk subsample included 717 women, of which 75% were identified by one model only; 96% were identified by IBIS, 3% by Claus, <1% by Gail. In the high-risk subsample, 20% were identified by two models and 3% by all three models. CONCLUSIONS Assessing breast cancer risk using self-reported data in a community-based sample was feasible. Different models identify substantially different groups of women who may be at high risk for breast cancer; use of multiple models may be beneficial for research and clinical care.
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Affiliation(s)
- Rachel J. Meadows
- Center for Epidemiology & Healthcare Delivery ResearchJPS Health NetworkFort WorthTexasUSA
| | - Wilson Figueroa
- The Ohio State UniversityCenter for Health Outcomes and Policy Evaluation Studies, College of Public HealthColumbusOhioUSA
- Division of Health Services Management & PolicyCollege of Public Health, The Ohio State UniversityColumbusOhioUSA
| | - Kate P. Shane‐Carson
- Division of Human Genetics, Department of Internal MedicineOhio State University Comprehensive Cancer CenterColumbusOhioUSA
| | - Tasleem J. Padamsee
- Division of Health Services Management & PolicyCollege of Public Health, The Ohio State UniversityColumbusOhioUSA
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21
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Comeaux JG, Culver JO, Lee JE, Dondanville D, McArthur HL, Quinn E, Gorman N, Ricker C, Li M, Lerman C. Risk‐reducing mastectomy decisions among women with mutations in high‐ and moderate‐ penetrance breast cancer susceptibility genes. Mol Genet Genomic Med 2022; 10:e2031. [PMID: 36054727 PMCID: PMC9544212 DOI: 10.1002/mgg3.2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/08/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Women harboring mutations in breast cancer susceptibility genes are at increased lifetime risk of developing breast cancer and are faced with decisions about risk management, including whether to undergo high‐risk screening or risk‐reducing mastectomy (RRM). National guidelines recommend BRCA1 or BRCA2 mutation carriers consider RRM, but that carriers of moderate penetrance mutations (e.g., ATM or CHEK2) should be managed based on family history. We aimed to investigate determinants of decision for RRM, and hypothesized that mutation status, age, family history, partner status, and breast cancer would impact RRM decision making. Methods We performed a retrospective study assessing RRM decisions for 279 women. Results Women with BRCA and moderate penetrance gene mutations, a personal history of breast cancer, or a first degree relative with a history of breast cancer were more likely to undergo RRM. Breast cancer status and age showed an interaction effect such that women with breast cancer were less likely to undergo RRM with increasing age. Conclusion Although national guidelines do not recommend RRM for moderate penetrance carriers, the rates of RRM for this population approached those for BRCA mutation carriers. Further insights are needed to better support RRM decision‐making in this population.
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Affiliation(s)
- Jacob G. Comeaux
- Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Julie O. Culver
- Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - John E. Lee
- Samuel Oschin Cancer CenterCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | | | - Heather L. McArthur
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Emily Quinn
- Human Genetics and GenomicsKeck Graduate InstituteClaremontCaliforniaUSA
| | - Nicholas Gorman
- Human Genetics and GenomicsKeck Graduate InstituteClaremontCaliforniaUSA
| | - Charité Ricker
- Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Ming Li
- Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Caryn Lerman
- Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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22
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Søby AKH, Andersen CM, Bille C, Larsen BF, Heidemann LN, Johansen RA, Timm H, Roessler KK. What do women at high risk of breast cancer request of a patient education day? Focus interviews with women before and after deciding about prophylactic interventions. Eur J Cancer Care (Engl) 2022; 31:e13588. [PMID: 35396775 PMCID: PMC9539475 DOI: 10.1111/ecc.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/12/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE At a Danish Hospital, we wished to establish a co-designed patient education day about prophylactic interventions for women at high risk of developing breast cancer. However, knowledge is lacking on the women's acceptability and requests for content. The objective of this study is to gain knowledge about the acceptability and requests of the content of a patient education day among women at high risk of breast cancer considering prophylactic mastectomy. METHODS A user panel consisting of patients and health care professionals developed an interview guide for two focus interviews with two groups of women at high risk of breast cancer; one group had received a prophylactic mastectomy and one group considered it. Thematic analysis was used to explore the participants' acceptability and requests for content. RESULTS Meaningful content was knowledge about prophylactic interventions, how to share knowledge with partners and children, and talking to equals in a safe forum. Not all participants wished to discuss own surgery in a group setting. CONCLUSION An education day is an acceptable and supportive format for gaining knowledge about surgery, but since some topics may be vulnerable to discuss in a group setting to some women, we suggest the education day as a valuable supplement to the individual consultations.
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Affiliation(s)
| | | | - Camilla Bille
- Department of Plastic SurgeryOdense University HospitalOdenseDenmark
| | | | | | | | - Helle Timm
- National Institute of Public HealthUniversity of Southern DenmarkOdenseDenmark
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23
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Archer S, Fennell N, Colvin E, Laquindanum R, Mills M, Dennis R, Stutzin Donoso F, Gold R, Fan A, Downes K, Ford J, Antoniou AC, Kurian AW, Evans DG, Tischkowitz M. Personalised Risk Prediction in Hereditary Breast and Ovarian Cancer: A Protocol for a Multi-Centre Randomised Controlled Trial. Cancers (Basel) 2022; 14:2716. [PMID: 35681696 PMCID: PMC9179465 DOI: 10.3390/cancers14112716] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 12/16/2022] Open
Abstract
Women who test positive for an inherited pathogenic/likely pathogenic gene variant in BRCA1, BRCA2, PALB2, CHEK2 and ATM are at an increased risk of developing certain types of cancer-specifically breast (all) and epithelial ovarian cancer (only BRCA1, BRCA2, PALB2). Women receive broad cancer risk figures that are not personalised (e.g., 44-63% lifetime risk of breast cancer for those with PALB2). Broad, non-personalised risk estimates may be problematic for women when they are considering how to manage their risk. Multifactorial-risk-prediction tools have the potential to deliver personalised risk estimates. These may be useful in the patient's decision-making process and impact uptake of risk-management options. This randomised control trial (registration number to follow), based in genetic centres in the UK and US, will randomise participants on a 1:1 basis to either receive conventional cancer risk estimates, as per routine clinical practice, or to receive a personalised risk estimate. This personalised risk estimate will be calculated using the CanRisk risk prediction tool, which combines the patient's genetic result, family history and polygenic risk score (PRS), along with hormonal and lifestyle factors. Women's decision-making around risk management will be monitored using questionnaires, completed at baseline (pre-appointment) and follow-up (one, three and twelve months after receiving their risk assessment). The primary outcome for this study is the type and timing of risk management options (surveillance, chemoprevention, surgery) taken up over the course of the study (i.e., 12 months). The type of risk-management options planned to be taken up in the future (i.e., beyond the end of the study) and the potential impact of personalised risk estimates on women's psychosocial health will be collected as secondary-outcome measures. This study will also assess the acceptability, feasibility and cost-effectiveness of using personalised risk estimates in clinical care.
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Affiliation(s)
- Stephanie Archer
- Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK;
- Department of Psychology, University of Cambridge, Downing Street, Cambridge CB2 3EB, UK
| | - Nichola Fennell
- Academic Department of Medical Genetics, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK; (N.F.); (R.D.); (R.G.); (M.T.)
| | - Ellen Colvin
- Manchester Centre for Genomic Medicine, St. Marys Hospital, Oxford Road, Manchester M13 9WL, UK; (E.C.); (D.G.E.)
| | - Rozelle Laquindanum
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (R.L.); (M.M.); (A.F.); (J.F.); (A.W.K.)
| | - Meredith Mills
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (R.L.); (M.M.); (A.F.); (J.F.); (A.W.K.)
| | - Romy Dennis
- Academic Department of Medical Genetics, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK; (N.F.); (R.D.); (R.G.); (M.T.)
| | - Francisca Stutzin Donoso
- Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK;
| | - Rochelle Gold
- Academic Department of Medical Genetics, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK; (N.F.); (R.D.); (R.G.); (M.T.)
| | - Alice Fan
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (R.L.); (M.M.); (A.F.); (J.F.); (A.W.K.)
| | - Kate Downes
- Cambridge Genomics Laboratory, Cambridge University Hospitals Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK;
| | - James Ford
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (R.L.); (M.M.); (A.F.); (J.F.); (A.W.K.)
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Antonis C. Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge CB1 8RN, UK;
| | - Allison W. Kurian
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (R.L.); (M.M.); (A.F.); (J.F.); (A.W.K.)
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - D. Gareth Evans
- Manchester Centre for Genomic Medicine, St. Marys Hospital, Oxford Road, Manchester M13 9WL, UK; (E.C.); (D.G.E.)
- 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 M13 9PL, UK
| | - Marc Tischkowitz
- Academic Department of Medical Genetics, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK; (N.F.); (R.D.); (R.G.); (M.T.)
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24
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Espinel W, Champine M, Hampel H, Jeter J, Sweet K, Pilarski R, Pearlman R, Shane K, Brock P, Westman JA, Kipnis L, Sotelo J, Chittenden A, Culver S, Stopfer JE, Schneider KA, Sacca R, Koeller DR, Gaonkar S, Vaccari E, Kane S, Michalski ST, Yang S, Nielsen SM, Bristow SL, Lincoln SE, Nussbaum RL, Esplin ED. Clinical Impact of Pathogenic Variants in DNA Damage Repair Genes beyond BRCA1 and BRCA2 in Breast and Ovarian Cancer Patients. Cancers (Basel) 2022; 14:2426. [PMID: 35626031 PMCID: PMC9139211 DOI: 10.3390/cancers14102426] [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: 04/11/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022] Open
Abstract
Consensus guidelines for hereditary breast and ovarian cancer include management recommendations for pathogenic/likely pathogenic (P/LP) variants in ATM, CHEK2, PALB2, and other DNA damage repair (DDR) genes beyond BRCA1 or BRCA2. We report on clinical management decisions across three academic medical centers resulting from P/LP findings in DDR genes in breast/ovarian cancer patients. Among 2184 patients, 156 (7.1%) carried a P/LP variant in a DDR gene. Clinical follow-up information was available for 101/156 (64.7%) patients. Genetic test result-based management recommendations were made for 57.8% (n = 59) of patients and for 64.7% (n = 66) of patients' family members. Most recommendations were made for moderate-to-high risk genes and were consistent with guidelines. Sixty-six percent of patients (n = 39/59) implemented recommendations. This study suggests that P/LP variants in DDR genes beyond BRCA1 and BRCA2 can change clinical management recommendations for patients and their family members, facilitate identification of new at-risk carriers, and impact treatment decisions. Additional efforts are needed to improve the implementation rates of genetic-testing-based management recommendations for patients and their family members.
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Affiliation(s)
- Whitney Espinel
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (W.E.); (M.C.)
| | - Marjan Champine
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (W.E.); (M.C.)
| | - Heather Hampel
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Joanne Jeter
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Kevin Sweet
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Robert Pilarski
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Rachel Pearlman
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Kate Shane
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Pamela Brock
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Judith A. Westman
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Lindsay Kipnis
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Jilliane Sotelo
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Anu Chittenden
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Samantha Culver
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Jill E. Stopfer
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Katherine A. Schneider
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Rosalba Sacca
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Diane R. Koeller
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Shraddha Gaonkar
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Erica Vaccari
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Sarah Kane
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Scott T. Michalski
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
| | - Shan Yang
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
| | - Sarah M. Nielsen
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
| | - Sara L. Bristow
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
| | - Stephen E. Lincoln
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
| | - Robert L. Nussbaum
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
| | - Edward D. Esplin
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
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Park B, Kim D, Kim J, Lee BY, Yoon J, Kim SW. Attitudes toward Risk-Reducing Mastectomy and Risk-Reducing Salpingo-oophorectomy among Young, Unmarried, Healthy Women in Korea. Cancer Res Treat 2022; 54:375-382. [PMID: 34384016 PMCID: PMC9016293 DOI: 10.4143/crt.2021.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study investigated the attitudes toward risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO) as cancer prevention options for BRCA1/2 carriers in healthy, young, unmarried Korean women. MATERIALS AND METHODS A nationally representative sample of 600 women, aged 20-39 years, completed a questionnaire on sociodemographic variables, preference for genetic testing, and intention to undergo risk-reducing surgeries after receiving information on the cancer risk of BRCA1/2 mutations and benefits of risk-reducing surgeries. RESULTS A total of 54.7% and 57.7% had the intention to undergo RRM and RRSO, respectively, on the assumption that they were BRCA1/2 carriers. Older age and no intention to undergo genetic testing were associated with a reduced likelihood of undergoing RRM (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.14 to 0.61 for age 35-39 years and OR, 0.35; 95% CI, 0.20 to 0.62 for no intention for genetic testing) and RRSO (OR, 0.39; 95% CI, 0.19 to 0.79 for age 35-39 years and OR, 0.30; 95% CI, 0.17 to 0.53 for no intention for genetic testing). Women who chose to be single were likely to undergo risk-reducing surgeries (OR, 1.67; 95% CI, 1.07 to 2.60 for RRM and OR, 1.56; 95% CI, 1.00 to 2.44 for RRSO). CONCLUSION More than 50% of healthy, unmarried, young Korean women were inclined to undergo prophylactic surgeries if they were BRCA1/2 mutation carriers. Further studies on decision-making process for cancer prevention in individuals at high risk for cancer need to be conducted.
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Affiliation(s)
- Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dongwon Kim
- Department of Surgery, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jiyoung Kim
- Department of Surgery, Daerim St. Mary's Hospital, Seoul, Korea
| | - Bom Yi Lee
- Department of Surgery, Daerim St. Mary's Hospital, Seoul, Korea
| | - Junghyun Yoon
- Department of Health Sciences, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Won Kim
- Department of Surgery, Daerim St. Mary's Hospital, Seoul, Korea
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Kenyon E, Zaluzec EK, Powell K, Volk M, Chakravarty S, Hix J, Arora R, Westerhuis JJ, Kiupel M, Shapiro EM, Sempere LF. Intraductal Delivery and X-ray Visualization of Ethanol-Based Ablative Solution for Prevention and Local Treatment of Breast Cancer in Mouse Models. J Vis Exp 2022:10.3791/63457. [PMID: 35435915 PMCID: PMC9613378 DOI: 10.3791/63457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Breast cancer is the most prevalent cancer and the second-leading cause of cancer-related death for women in the USA. For high-risk women, prophylactic mastectomy is the most effective primary prevention strategy. Prophylactic mastectomy is an aggressive surgical procedure that completely removes the mammary epithelial cells from which breast cancer arises along with the surrounding tissue. We seek to develop a minimally invasive intraductal procedure as an alternative to prophylactic mastectomy to locally ablate the mammary epithelial cells before they can become malignant. We and others have developed an intraductal delivery procedure to reach and treat these epithelial cells in rodent models of breast cancer. While the mouse mammary gland with a single non-anastomosed ductal tree opening at the nipple has a much less complex and tortuous architecture than the human breast, chemically induced and genetically engineered mouse models of breast cancer are valuable to produce proof-of-concept studies of new preventative strategies. Here, we describe a procedure for intraductal delivery of an ethanol-based ablative solution containing micro-CT/X-ray tantalum-based contrast agent within the mouse mammary ductal tree for the therapeutic purpose of primary prevention of breast cancer. Intraductal delivery of aqueous reagents (e.g., cytotoxic compounds, siRNAs, AdCre) has been previously described in mouse models. Thus, we focus our protocol description on methodological modifications and unique experimental considerations for optimizing delivery of ethanol, for minimizing local and systemic side effects of ethanol administration, and for in vivo visualization of ductal tree filling via micro-CT/fluoroscopy imaging. Visualization of the ductal tree immediately after injection of a contrast-containing solution allows for confirmation of complete filling or unsuccessful outcomes such as underfilling or overfilling. This procedure can be applied for delivery and imaging of other ablative compounds aimed at either preventing tumor formation or locally treating early-stage tumors accessible via the ductal tree.
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Affiliation(s)
- Elizabeth Kenyon
- Precision Health Program, Michigan State University; Department of Radiology, College of Human Medicine, Michigan State University
| | - Erin K Zaluzec
- Precision Health Program, Michigan State University; Department of Pharmacology & Toxicology, College of Veterinary Medicine, Michigan State University
| | - Katherine Powell
- Precision Health Program, Michigan State University; Department of Radiology, College of Human Medicine, Michigan State University
| | - Maximilian Volk
- Precision Health Program, Michigan State University; College of Osteopathic Medicine, Michigan State University
| | - Shatadru Chakravarty
- Department of Radiology, College of Human Medicine, Michigan State University; Advanced Materials Characterization Laboratory/Materials Research Center, Missouri University of Science and Technology
| | - Jeremy Hix
- Department of Radiology, College of Human Medicine, Michigan State University; Institute for Quantitative (IQ) Health Science and Engineering Advanced Molecular Imaging Facility, Michigan State University
| | - Ripla Arora
- Department of Obstetrics Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University; Institute for Quantitative (IQ) Health Science and Engineering, Michigan State University
| | | | - Matti Kiupel
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University
| | - Erik M Shapiro
- Department of Radiology, College of Human Medicine, Michigan State University; Institute for Quantitative (IQ) Health Science and Engineering Advanced Molecular Imaging Facility, Michigan State University
| | - Lorenzo F Sempere
- Precision Health Program, Michigan State University; Department of Radiology, College of Human Medicine, Michigan State University;
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Wu HC, Kehm R, Santella RM, Brenner DJ, Terry MB. DNA repair phenotype and cancer risk: a systematic review and meta-analysis of 55 case-control studies. Sci Rep 2022; 12:3405. [PMID: 35233009 PMCID: PMC8888613 DOI: 10.1038/s41598-022-07256-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 02/15/2022] [Indexed: 01/01/2023] Open
Abstract
DNA repair phenotype can be measured in blood and may be a potential biomarker of cancer risk. We conducted a systematic review and meta-analysis of epidemiological studies of DNA repair phenotype and cancer through March 2021. We used random-effects models to calculate pooled odds ratios (ORs) of cancer risk for those with the lowest DNA repair capacity compared with those with the highest capacity. We included 55 case–control studies that evaluated 12 different cancers using 10 different DNA repair assays. The pooled OR of cancer risk (all cancer types combined) was 2.92 (95% Confidence Interval (CI) 2.49, 3.43) for the lowest DNA repair. Lower DNA repair was associated with all studied cancer types, and pooled ORs (95% CI) ranged from 2.02 (1.43, 2.85) for skin cancer to 7.60 (3.26, 17.72) for liver cancer. All assays, except the homologous recombination repair assay, showed statistically significant associations with cancer. The effect size ranged from 1.90 (1.00, 3.60) for the etoposide-induced double-strand break assay to 5.06 (3.67, 6.99) for the γ-H2AX assay. The consistency and strength of the associations support the use of these phenotypic biomarkers; however large-scale prospective studies will be important for understanding their use related to age and screening initiation.
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Affiliation(s)
- Hui-Chen Wu
- Department of Environmental Health Sciences, Mailman School of Public Health of Columbia University, 630 West 168th St., Room P&S 16-421E, New York, NY, 10032, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
| | - Rebecca Kehm
- Department of Epidemiology, Mailman School of Public Health of Columbia University, New York, NY, USA
| | - Regina M Santella
- Department of Environmental Health Sciences, Mailman School of Public Health of Columbia University, 630 West 168th St., Room P&S 16-421E, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - David J Brenner
- Center for Radiological Research, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
| | - Mary Beth Terry
- Department of Environmental Health Sciences, Mailman School of Public Health of Columbia University, 630 West 168th St., Room P&S 16-421E, New York, NY, 10032, USA.,Department of Epidemiology, Mailman School of Public Health of Columbia University, New York, NY, USA
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Lamb LR, Baird GL, Roy IT, Choi PHS, Lehman CD, Miles RC. Are English-language online patient education materials related to breast cancer risk assessment understandable, readable, and actionable? Breast 2022; 61:29-34. [PMID: 34894464 PMCID: PMC8665407 DOI: 10.1016/j.breast.2021.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the readability, understandability, and actionability of online patient education materials (OPEM) related to breast cancer risk assessment. MATERIAL AND METHODS We queried seven English-language search terms related to breast cancer risk assessment: breast cancer high-risk, breast cancer risk factors, breast cancer family history, BRCA, breast cancer risk assessment, Tyrer-Cuzick, and Gail model. Websites were categorized as: academic/hospital-based, commercial, government, non-profit or academic based on the organization hosting the site. Grade-level readability of qualifying websites and categories was determined using readability metrics and generalized estimating equations based on written content only. Readability scores were compared to the recommended parameters set by the American Medical Association (AMA). Understandability and actionability of OPEM related to breast cancer high-risk were evaluated using the Patient Education Materials Assessment Tool (PEMAT) and compared to criteria set at ≥70%. Descriptive statistics and inter-rater reliability analysis were utilized. RESULTS 343 websites were identified, of which 162 met study inclusion criteria. The average grade readability score was 12.1 across all websites (range 10.8-13.4). No website met the AMA recommendation. Commercial websites demonstrated the highest overall average readability of 13.1. Of the 26 websites related to the search term breast cancer high-risk, the average understandability and actionability scores were 62% and 34% respectively, both below criteria. CONCLUSIONS OPEM on breast cancer risk assessment available to the general public do not meet criteria for readability, understandability, or actionability. To ensure patient comprehension of medical information online, future information should be published in simpler, more appropriate terms.
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Affiliation(s)
- Leslie R Lamb
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street Boston, MA, 02114-2696, USA.
| | - Grayson L Baird
- Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Ishita T Roy
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street Boston, MA, 02114-2696, USA.
| | - Paul H S Choi
- Tufts Medical Center, 800 Washington St Boston, MA, 02111, USA.
| | - Constance D Lehman
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street Boston, MA, 02114-2696, USA.
| | - Randy C Miles
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street Boston, MA, 02114-2696, USA.
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Shamsunder MG, Polanco TO, McCarthy CM, Allen RJ, Matros E, Coriddi M, Mehrara BJ, Pusic A, Nelson JA. Understanding Preoperative Breast Satisfaction among Patients Undergoing Mastectomy and Immediate Reconstruction: BREAST-Q Insights. Plast Reconstr Surg 2021; 148:891e-902e. [PMID: 34847108 PMCID: PMC8638966 DOI: 10.1097/prs.0000000000008521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aims to present normative values for satisfaction with breasts among preoperative breast reconstruction patients as assessed using the BREAST-Q instrument and to delineate factors associated with preoperative breast satisfaction. METHODS A retrospective analysis of prospectively collected data was performed examining women undergoing postmastectomy breast reconstruction at a tertiary care center who preoperatively completed the BREAST-Q from 2010 to 2017. Because breast satisfaction scores were nonnormally distributed, scores were categorized into quartiles for analysis. Patient- and treatment-level variables were tested in a multivariable ordinal logistic regression model as predictors of breast satisfaction. Preoperative satisfaction was also tested for association with choice of reconstructive modality. RESULTS Among 1306 postmastectomy reconstruction patients included in the study, mean preoperative Satisfaction with Breasts score was 61.8 ± 21.5 and the median score was 58.0 (interquartile range, 48 to 70). Factors associated with significantly lower preoperative satisfaction included history of psychiatric diagnosis, preoperative radiotherapy, marital status (married), and higher body mass index. Factors associated with significantly higher scores were malignancy (localized tumor), medium bra size (B to C cup), and self-identification as black. Preoperative breast satisfaction was lower among patients who elected autologous reconstruction than among those with implant reconstruction (p < 0.001). CONCLUSIONS Preoperative breast satisfaction is influenced by multiple factors. Understanding these factors may improve preoperative counseling and expectation management for patients who undergo postmastectomy breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Meghana G Shamsunder
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Thais O Polanco
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Colleen M McCarthy
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Robert J Allen
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Evan Matros
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Michelle Coriddi
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Babak J Mehrara
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Andrea Pusic
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
| | - Jonas A Nelson
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital
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Mittendorf KF, Knerr S, Kauffman TL, Lindberg NM, Anderson KP, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Zepp JM, Syngal S, Wilfond BS, Goddard KAB. Systemic Barriers to Risk-Reducing Interventions for Hereditary Cancer Syndromes: Implications for Health Care Inequities. JCO Precis Oncol 2021; 5:PO.21.00233. [PMID: 34778694 PMCID: PMC8585306 DOI: 10.1200/po.21.00233] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kathleen F. Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sarah Knerr
- School of Public Health, University of Washington, Seattle, WA
| | - Tia L. Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Nangel M. Lindberg
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | | | - Marian J. Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Jamilyn M. Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sapna Syngal
- Dana Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Katrina A. B. Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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Padamsee TJ, Meadows R, Hils M. Layers of information: interacting constraints on breast cancer risk-management by high-risk African American women. ETHNICITY & HEALTH 2021; 26:787-810. [PMID: 30589360 PMCID: PMC9529154 DOI: 10.1080/13557858.2018.1562053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/20/2018] [Indexed: 06/09/2023]
Abstract
Objectives: To understand how various decision-making dynamics interact to shape the risk-management choices of African American women at high-risk of breast cancer, and to explore whether African American and White women have differential access to the information and interactions that promote proactive, confident risk-management behavior.Design: This paper draws on 50 original in-depth, semi-structured interviews with African American and White women at elevated risk of breast cancer. We used inductive grounded-theory methodology to explore the processes by which women make risk-management decisions and to compare those processes between racial groups. Moving backward from women's decisions about whether or not to engage in specific risk-management behaviors, we explored the patterns that underlie behavioral decisions.Results: We find that decisions to engage in risk-management behavior rest on three accumulated layers of information. The layer most proximal to making risk-management decisions involves specific information about risk-management options; the middle layer involves general information about managing breast cancer risk; and the foundational layer involves personal perceptions of breast cancer risk and prevention. African American and White women experience distinct dynamics at each of these levels, and these differences may help explain racial differences in risk-management behavior. Compared to their White counterparts, African American women faced additional burdens at every step along the risk-management journey.Conclusion: These findings suggest that information gathering is more complex than has previously been addressed, that information access and provider access are closely related, and that African American women may be systematically disadvantaged with respect to information-generating experiences. Preventing cancer morbidity and mortality requires that all high-risk women have access to the layers of information necessary to engage in cancer screenings and preventive interventions. These results exemplify the ways that structural, social, and interpersonal inequalities combine to influence risk-management choices.
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Affiliation(s)
- Tasleem J. Padamsee
- Corresponding Author. 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210, United States; ; Phone: 1-614-688-0986; Fax: 1-614-247-1846
| | - Rachel Meadows
- Suite 525 Gateway Building C, 1590 N High Street, Columbus, OH 43201, United States
| | - Megan Hils
- 282-2 Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210, United States
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Weltz C, Port E. Surgical Risk Reduction, Breast Cancer and Childbearing. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00424-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose of Review
Young women who carry a genetic predisposition to breast cancer need to balance surgical and nonsurgical risk reducing options with childbearing. In this review, we explore how women make decisions without the benefit of official guidelines and in the context of frequently contradictory strategies.
Recent Findings
Women of reproductive age with known BRCA mutations receive incomplete and conflicting advice regarding the urgency and timing of risk reducing mastectomy (RRM). Those who prioritize RRM achieve highly effective prevention and thereby avoid not only a diagnosis of breast cancer but also adjuvant therapies which limit future childbearing. All reconstructive options are available and high levels of satisfaction are reported. Those who delay prophylactic mastectomy can pursue nonsurgical breast and ovarian risk reduction strategies such as tamoxifen and oral contraception, yet these delay child bearing. Women who prioritize child bearing maintain the ability to breast feed but have limited screening options during pregnancy and lactation.
Summary
Prioritization and timing of risk reduction and childbearing in young BRCA positive women is challenging. Elucidating these challenges enables clinicians to better counsel these women.
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Safra T, Waissengrin B, Gerber D, Bernstein-Molho R, Klorin G, Salman L, Josephy D, Chen-Shtoyerman R, Bruchim I, Frey MK, Pothuri B, Muggia F. Breast cancer incidence in BRCA mutation carriers with ovarian cancer: A longitudal observational study. Gynecol Oncol 2021; 162:715-719. [PMID: 34172288 DOI: 10.1016/j.ygyno.2021.06.009] [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: 03/22/2021] [Accepted: 06/10/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We evaluated the incidence of breast cancer and overall survival in a multi-center cohort of ovarian cancer patients carrying BRCA1/2 mutations in order to assess risks and formulate optimal preventive interventions and/or surveillance. METHODS Medical records of 502 BRCA1/2 mutation carriers diagnosed with ovarian cancer between 2000 and 2018 at 7 medical centers in Israel and one in New York were retrospectively analyzed for breast cancer diagnosis. Data included demographics, type of BRCA mutations, surveillance methods, timing of breast cancer diagnosis, and family history of cancer. RESULTS The median age at diagnosis of ovarian cancer was 55.8 years (range, 23.9-90.1). A third (31.5%) had a family history of breast cancer and 17.1% of ovarian cancer. Most patients (67.3%) were Ashkenazi Jews, 72.9% were BRCA1 carriers. Breast cancer preceded ovarian cancer in 17.5% and was diagnosed after ovarian cancer in 6.2%; an additional 2.2% had a synchronous presentation. Median time to breast cancer diagnosis after ovarian cancer was 46.0 months (range, 11-168). Of those diagnosed with both breast cancer and ovarian cancer (n = 31), 83.9% and 16.1% harbored BRCA1 and BRCA2 mutations, respectively. No deaths from breast cancer were recorded. Overall survival did not differ statistically between patients with an ovarian cancer diagnosis only and those diagnosed with breast cancer after ovarian cancer. CONCLUSION The low incidence of breast cancer after ovarian cancer in women carrying BRCA1/2 mutations suggests that routine breast surveillance, rather than risk-reducing surgical interventions, may be sufficient in ovarian cancer survivors.
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Affiliation(s)
- Tamar Safra
- New York University Cancer Institute, New York, ,NY, United States of America; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.
| | | | - Deanna Gerber
- New York University Cancer Institute, New York, ,NY, United States of America
| | - Rinat Bernstein-Molho
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel; Chaim Sheba Medical Center, Breast Cancer Center, Oncology Institute, Ramat Gan, Israel
| | - Geula Klorin
- Rambam Health Care Campus, Haifa, Israel; Technion Institute of Technology, Rappaport School of Medicine, Haifa, Israel
| | | | - Dana Josephy
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel; Meir Medical Center, Kfar Saba, Israel
| | - Rakefet Chen-Shtoyerman
- The Oncogenetic Clinic, The Clinical Genetics Institute, Kaplan Medical Center, Rehovot, Israel; Ariel University, Ariel, Israel
| | - Ilan Bruchim
- Technion Institute of Technology, Rappaport School of Medicine, Haifa, Israel; Hillel Yaffe Medical Center, Hadera, Israel
| | - Melissa K Frey
- New York University Cancer Institute, New York, ,NY, United States of America
| | - Bhavana Pothuri
- New York University Cancer Institute, New York, ,NY, United States of America
| | - Franco Muggia
- New York University Cancer Institute, New York, ,NY, United States of America
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Cortesi L, Rugo HS, Jackisch C. An Overview of PARP Inhibitors for the Treatment of Breast Cancer. Target Oncol 2021; 16:255-282. [PMID: 33710534 PMCID: PMC8105250 DOI: 10.1007/s11523-021-00796-4] [Citation(s) in RCA: 179] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 12/13/2022]
Abstract
Loss-of-function mutations in BRCA1 and BRCA2 are detected in at least 5% of unselected patients with breast cancer (BC). These BC susceptibility genes encode proteins critical for DNA homologous recombination repair (HRR). This review provides an update on oral poly(ADP-ribose) polymerase (PARP) inhibitors for the treatment of BC. Olaparib and talazoparib are PARP inhibitors approved as monotherapies for deleterious/suspected deleterious germline BRCA-mutated, HER2-negative BC. Olaparib is approved in the USA for metastatic BC and in Europe for locally advanced/metastatic BC. Talazoparib is approved for locally advanced/metastatic BC in the USA and Europe. In phase 3 trials, olaparib and talazoparib monotherapies demonstrated significant progression-free survival benefits compared with chemotherapy. Common toxicities were effectively managed by supportive treatment and dose interruptions/reductions. Veliparib combined with platinum-based chemotherapy has also shown promise for locally advanced/metastatic BC in a phase 3 trial. Differences in efficacy and safety across PARP inhibitors (olaparib, talazoparib, veliparib, niraparib, rucaparib) may relate to differences in potency of PARP trapping on DNA and cytotoxic specificity. PARP inhibitors are being investigated in early BC, in novel combinations, and in patients without germline BRCA mutations, including those with somatic BRCA mutations and other HRR gene mutations. Ongoing phase 2/3 studies include PARP inhibitors combined with immune checkpoint inhibitors for the treatment of triple-negative BC. Wider access to testing for BRCA and other mutations, and to genetic counseling, are required to identify patients who could benefit from PARP inhibitor therapy. The advent of PARP inhibitors has potential benefits for BC treatment beyond the locally advanced/metastatic setting.
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Affiliation(s)
- Laura Cortesi
- Department of Oncology and Hematology, Azienda Ospedaliero, Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - Hope S Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Christian Jackisch
- Sana Klinikum Offenbach, Department of Obstetrics and Gynecology and Breast Cancer Center, Starkenburgring 66, 63069, Offenbach, Germany.
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Meiser B, Kaur R, Morrow A, Peate M, Wong WKT, McPike E, Cops E, Nichols C, Austin R, Fine M, Thrupp L, Ward R, Macrae F, Hiller JE, Trainer AH, Mitchell G. Impact of national guidelines on use of BRCA1/2 germline testing, risk management advice given to women with pathogenic BRCA1/2 variants and uptake of advice. Hered Cancer Clin Pract 2021; 19:24. [PMID: 33836815 PMCID: PMC8035714 DOI: 10.1186/s13053-021-00180-3] [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: 01/17/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background This nationwide study assessed the impact of nationally agreed cancer genetics guidelines on use of BRCA1/2 germline testing, risk management advice given by health professionals to women with pathogenic BRCA1/2 variants and uptake of such advice by patients. Methods Clinic files of 883 women who had initial proband screens for BRCA1/2 pathogenic variants at 12 familial cancer clinics between July 2008–July 2009 (i.e. before guideline release), July 2010–July 2011 and July 2012–July 2013 (both after guideline release) were audited to determine reason given for genetic testing. Separately, the clinic files of 599 female carriers without a personal history of breast/ovarian cancer who underwent BRCA1/2 predictive genetic testing and received their results pre- and post-guideline were audited to ascertain the risk management advice given by health professionals. Carriers included in this audit were invited to participate in a telephone interview to assess uptake of advice, and 329 agreed to participate. Results There were no significant changes in the percentages of tested patients meeting at least one published indication for genetic testing - 79, 77 and 78% of files met criteria before guideline, and two-, and four-years post-guideline, respectively (χ = 0.25, p = 0.88). Rates of documentation of post-test risk management advice as per guidelines increased significantly from pre- to post-guideline for 6/9 risk management strategies. The strategies with the highest compliance amongst carriers or awareness post-release of guidelines were annual magnetic resonance imaging plus mammography in women 30–50 years (97%) and annual mammography in women > 50 years (92%). Of women aged over 40 years, 41% had a risk-reducing bilateral mastectomy. Amongst women aged > 40 years, 75% had a risk-reducing salpingo-oophorectomy. Amongst women who had not had a risk-reducing bilateral mastectomy, only 6% took risk-reducing medication. Fear of side-effects was cited as the main reasons for not taking these medicines by 73% of women. Conclusions Guidelines did not change the percentages of tested patients meeting genetic testing criteria but improved documentation of risk management advice by health professionals. Effective approaches to enhance compliance with guidelines are needed to improve risk management and quality of care. Supplementary Information The online version contains supplementary material available at 10.1186/s13053-021-00180-3.
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Affiliation(s)
- Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Rajneesh Kaur
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - April Morrow
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Michelle Peate
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia.,Department of Obstetrics and Oncology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - W K Tim Wong
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia.,School of Social Sciences, UNSW Sydney, Sydney, Australia
| | - Emily McPike
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Elisa Cops
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Cassandra Nichols
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia
| | - Rachel Austin
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Miriam Fine
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide and School of Medicine, University of Adelaide, Adelaide, Australia
| | - Letitia Thrupp
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Robyn Ward
- University of Queensland, Brisbane, Australia.,University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Finlay Macrae
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia.,Department of Colorectal Medicine and Genetics, University of Melbourne, Melbourne, Australia
| | - Janet E Hiller
- Swinburne University of Technology, Hawthorn, Australia.,School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Alison H Trainer
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Gillian Mitchell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Meadows RJ, Padamsee TJ. Financial constraints on genetic counseling and further risk-management decisions among U.S. women at elevated breast cancer risk. J Genet Couns 2021; 30:1452-1467. [PMID: 33749063 DOI: 10.1002/jgc4.1413] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 12/30/2022]
Abstract
Clinical guidelines recommend that women at high risk of breast cancer should consider various risk-management options, which remain widely underutilized. We conducted semi-structured, qualitative interviews with 50 high-risk women to understand how financial constraints affect use of genetic counseling, genetic testing, and further risk-management decisions. Inductive analyses revealed three categories of health-related financial constraint: (a) lack of insurance, (b) underinsurance, and (c) other financial constraints (e.g., medical debt, raising children, managing comorbidities). Various breast cancer risk-management actions were limited by these financial constraints, including genetic counseling, genetic testing, enhanced screening, and prophylactic surgeries. Women's narratives also identified complex relationships between financial constraint and perceptions of healthcare providers and insurance companies, particularly as related to bias, price transparency, and potential genetic discrimination. Results from this study have implications for further research and expansion of genetic counseling services delivery to more economically and racially diverse women.
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Affiliation(s)
- Rachel J Meadows
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.,Center for Outcomes Research, JPS Health Network, Fort Worth, TX, USA
| | - Tasleem J Padamsee
- Division of Health Services Management and Policy, College of Public Health and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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Park SY, Kim Y, Kim S. Factors associated with the decision to undergo risk-reducing salpingo-oophorectomy among women at high risk for hereditary breast and ovarian cancer: a systematic review. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2020; 26:285-299. [PMID: 36312308 PMCID: PMC9328615 DOI: 10.4069/kjwhn.2020.11.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose This systematic review aims to identify factors associated with risk-reducing salpingo-oophorectomy (RRSO), including the uptake rate and decision timing, among women at high risk for hereditary breast and ovarian cancer (HBOC). Methods We found 4,935 relevant studies using MEDLINE, Embase, CINAHL, and PsycINFO on July 6, 2020. Two authors screened the articles and extracted data. Twenty-four studies met the inclusion criteria. Quality assessment of articles was conducted using the Risk of Bias for Nonrandomized Studies tool. Results Five types of factors were identified (demographic factors, clinical factors, family history of cancer, psychological factors, and objective cancer risk). The specific significant factors were older age, having child(ren), being a BRCA1/2 carrier, mastectomy history, perceived risk for ovarian cancer, and perceived advantages of RRSO, whereas objective cancer risk was not significant. The uptake rate of RRSO was 23.4% to 87.2% (mean, 45.2%) among high-risk women for HBOC. The mean time to decide whether to undergo RRSO after BRCA testing was 4 to 34 months. Conclusion RRSO decisions are affected by demographic, clinical, and psychological factors, rather than objective cancer risk. Nonetheless, women seeking RRSO should be offered information about objective cancer risk. Even though decision-making for RRSO is a complex and multifaceted process, the psychosocial factors that may influence decisions have not been comprehensively examined, including family attitudes toward RRSO, cultural norms, social values, and health care providers’ attitudes.
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Affiliation(s)
- Sun-young Park
- Graduate School, Yonsei University, Seoul, Korea
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Youlim Kim
- Graduate School, Yonsei University, Seoul, Korea
- Mo-Im Kim Nursing Research Institute and College of Nursing, Yonsei University, Seoul, Korea
| | - Sue Kim
- Mo-Im Kim Nursing Research Institute and College of Nursing, Yonsei University, Seoul, Korea
- Corresponding author: Sue Kim College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2228-3276 E-mail:
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Gustavsson E, Galvis G, Juth N. Genetic testing for breast cancer risk, from BRCA1/2 to a seven gene panel: an ethical analysis. BMC Med Ethics 2020; 21:102. [PMID: 33087101 PMCID: PMC7579789 DOI: 10.1186/s12910-020-00545-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background Genetic testing is moving from targeted investigations of monogenetic diseases to broader testing that may provide more information. For example, recent health economic studies of genetic testing for an increased risk of breast cancer suggest that it is associated with higher cost-effectiveness to screen for pathogenic variants in a seven gene panel rather than the usual two gene test for variants in BRCA1 and BRCA2. However, irrespective of the extent to which the screening of the panel is cost-effective, there may be ethical reasons to not screen for pathogenic variants in a panel, or to revise the way in which testing and disclosing of results are carried out.
Main text In this paper we discuss the ethical aspects of genetic testing for an increased risk of breast cancer with a special focus on the ethical differences between screening for pathogenic variants in BRCA1/2 and a seven gene panel. The paper identifies that the panel increases the number of secondary findings as well as the number of variants of uncertain significance as two specific issues that call for ethical reflection. Conclusions We conclude that while the problem of handling secondary findings should not be overstated with regard to the panel, the fact that the panel also generate more variants of uncertain significance, give rise to a more complex set of problems that relate to the value of health as well as the value of autonomy. Therefore, it is insufficient to claim that the seven gene panel is preferable by only referring to the higher cost effectiveness of the panel.
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Affiliation(s)
- Erik Gustavsson
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden. .,Centre for Applied Ethics, Department of Culture and Society, Linköping University, Linköping, Sweden.
| | - Giovanni Galvis
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Niklas Juth
- LIME, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Stockholm, Sweden
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Skrovanek E, Dunbar-Jacob J, Dunwoody C, Wesmiller S. Integrative Review of Reproductive Decision Making of Women Who Are BRCA Positive. J Obstet Gynecol Neonatal Nurs 2020; 49:525-536. [PMID: 32926832 DOI: 10.1016/j.jogn.2020.07.006] [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] [Accepted: 07/01/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To synthesize research findings about reproductive decision making among women who are BRCA positive. DATA SOURCES PubMed and CINAHL. STUDY SELECTION Articles published in English between 2000 and June 28, 2020, about the reproductive decision making of women with a confirmed BRCA1 or BRCA2 mutation. DATA EXTRACTION We extracted data about participants, study design, analysis, follow-up, and results. We used the modified Downs and Black checklist and Kennelly's qualitative data analysis to rate studies for quality and applicability by using. DATA SYNTHESIS We included five of 257 screened articles in our synthesis. The total sample size of the five studies was 1,468 women. The most prevalent factors related to reproductive decision making were the impending decisions regarding childbearing and family choices, including decisions about biological children, preventive surgery, preimplantation genetic diagnosis, and prenatal diagnosis to prevent further transmission of a BRCA mutation, and family planning. CONCLUSION A lack of knowledge exists about the reproductive decision-making processes of women who are BRCA positive. A better understanding of this process would provide nurses and other clinicians with the knowledge needed to support these women through their reproductive life choices.
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Using patient perspectives to inform communication training materials for health care professionals discussing BRCA mutation testing. Breast Cancer Res Treat 2020; 184:491-498. [PMID: 32812179 PMCID: PMC7599138 DOI: 10.1007/s10549-020-05871-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/08/2020] [Indexed: 12/16/2022]
Abstract
Purpose As demand for genetic testing grows and a wide range of health care professionals (HCPs) are potentially involved in discussions about testing and delivering results, we developed an educational package to help HCPs with these conversations. Methods To inform the content of training materials, we conducted interviews with 11 women four of whom had BRCA1 and seven with BRCA2 mutations. Five women had or were currently receiving breast cancer treatment. Ages ranged from 38 to 77 years. Interviews were audio-recorded, transcribed verbatim and analysed using the Framework approach to thematic analysis. Results We identified 18 themes and 12 subthemes across the interviews, encompassed by six overarching themes: risk, decision-making, information and understanding, communication and improvement, accessing the system: process and frustration, emotional and social drivers. Conclusions The findings informed the didactic components of an educational communication workshop and a summary document for attendees. Qualitative interviews provide an important way of incorporating the patient perspective into communication training materials for HCPs by highlighting key issues that matter most to the patient.
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El Ansari FZ, Jouali F, Marchoudi N, Bennani MM, Ghailani NN, Barakat A, Fekkak J. Screening of BRCA1/2 genes mutations and copy number variations in patients with high risk for hereditary breast and ovarian cancer syndrome (HBOC). BMC Cancer 2020; 20:747. [PMID: 32778078 PMCID: PMC7418307 DOI: 10.1186/s12885-020-07250-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background Hereditary breast and ovarian cancer (HBOC) is an autosomal dominant inherited cancer susceptibility disorder. Both BRCA1 and BRCA2 genes are considered as high penetrance genes of this syndrome. The identification of BRCA1/2 genetic alterations before cancer development, grant patients the chance to benefit from various medical cancer prevention approaches. Therefore, the appearance of recent advanced technologies in molecular analysis such as next generation sequencing has simplified full BRCA1/2 analysis. Many attempts took place in hope of understanding the molecular germline spectrum of these two genes in Moroccan HBOC patients. However, most of the past projects focused only on young breast cancer cases, lacked ovarian cancer cases in their cohort and only a limited number of these studies were able to analyze the entire exons or copy number variations for both genes. In attempt of gaining more information regarding the molecular profile of BRCA1/2 in HBOC, we conducted a study in which we analyze their molecular profile on selected Moroccan patients suspected of having HBOC syndrome. Methods In this study we obtained blood samples from 64 selected Moroccan patients, who suffered from Breast and/or ovarian cancer and had a strong family history for cancer. To analyze BRCA1/2 punctual variants and copy number variations, we used the Ion Personal Genome Machine (PGM) and Oncomine BRCA1/2 research assay panel. Afterward, we correlated the molecular results with the clinic-pathologic data using IBM SPSS Statistics ver 2. Results From the 64 selected cases, Forty-six had breast cancer, fifteen had ovarian cancer and three had both breast and ovarian cancer. The molecular analysis revealed that 18 patients from the 64 harbored a pathogenic variant (28%). Twelve had six different BRCA1 pathogenic variants and six had six different BRCA2 pathogenic variants. In this study, we report four pathogenic variants that to the best of our knowledge has never been reported in the Moroccan population before. Regarding copy number variation analysis, No CNV was detected in both genes for all the 64 successfully sequenced and analyzed patients in our cohort. Conclusion Work like the present has an important implication on public health and science. It is critical that molecular profiling studies are performed on underserved and understudied population like Morocco.
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Affiliation(s)
- Fatima Zahra El Ansari
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, 90000, Tangier, Morocco. .,Molecular Biology Department, ANOUAL Laboratory, Casablanca, Morocco.
| | - Farah Jouali
- Molecular Biology Department, ANOUAL Laboratory, Casablanca, Morocco
| | - Nabila Marchoudi
- Molecular Biology Department, ANOUAL Laboratory, Casablanca, Morocco
| | - Mohcine Mechita Bennani
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, 90000, Tangier, Morocco
| | - Naima Nourouti Ghailani
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, 90000, Tangier, Morocco
| | - Amina Barakat
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, University Abdelmalek Essaâdi, 90000, Tangier, Morocco
| | - Jamal Fekkak
- Molecular Biology Department, ANOUAL Laboratory, Casablanca, Morocco
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Oceguera-Basurto P, Topete A, Oceguera-Villanueva A, Rivas-Carrillo J, Paz-Davalos M, Quintero-Ramos A, Del Toro-Arreola A, Daneri-Navarro A. Selective estrogen receptor modulators in the prevention of breast cancer in premenopausal women: a review. Transl Cancer Res 2020; 9:4444-4456. [PMID: 35117809 PMCID: PMC8797886 DOI: 10.21037/tcr-19-1956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 06/15/2020] [Indexed: 12/28/2022]
Abstract
The detection of premenopausal women at high risk of breast cancer is key to chemoprevention. Therapy with selective estrogen receptor modulators (SERMs) induces a significant antiproliferative effect in estrogen receptor (ER) positive breast cancer. This review was designed according the guidelines of the 2009 PRISMA statement. Searching different databases, including PubMed, MedlinePlus, PLoS One, Cochrane Breast Cancer Specialized Register, Clinical Trials.gov and American Society of Clinical Oncology. From 168 records screened, 15 full text articles were assessed for eligibility and only 7 studies met the inclusion criteria. Three of the studies included analyzed changes in Ki-67 expression, revealing weaker expression after treatment with acolbifene and raloxifene (P<0.001). Three studies also analyzed the breast volume by magnetic resonance imagining (MRI) and demonstrate a significant difference after 1 year with raloxifene treatment (P=0.0017). Moreover, a 20% reduction in breast density was observed after a 2-year treatment with tamoxifen in premenopausal women. SERMs reduce the risk of developing breast cancer. The studies reviewed here demonstrate the modulation of Ki-67 expression and changes in breast density, suggesting an important preventive role for this group of drugs in prevention for premenopausal women at high risk of developing breast cancer.
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Affiliation(s)
- Paola Oceguera-Basurto
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | - Antonio Topete
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | | | - Jorge Rivas-Carrillo
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | | | - Antonio Quintero-Ramos
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | - Alicia Del Toro-Arreola
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | - Adrián Daneri-Navarro
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
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A systematic review of communication interventions to help healthcare professionals discuss genetic testing for breast cancer. Breast Cancer Res Treat 2020; 183:9-21. [PMID: 32577939 PMCID: PMC7376076 DOI: 10.1007/s10549-020-05741-z] [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: 05/15/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
Purpose This systematic review examined educational training interventions for healthcare professionals (HCPs) discussing genetic testing and risk for hereditary breast cancer. There was a particular focus on the presence, and content, of communication elements within these packages. Methods Searches were run via CINAHL, EMBASE, PUBMED, and PsychInfo in February 2019 to identify training interventions available to HCPs with reference to communication skills. Studies were assessed for quality, with relevant intervention and outcome data extracted and synthesized. This review followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement and was registered on the PROSPERO database (CRD42019124010). Results Of 3,988 items, seven papers, two of which were linked, were eligible for inclusion. There was a mix of randomized and single arm studies with web-based and face-to-face interventions. Content included an overview of genetics, hereditary and familial background, and recommended practice techniques. Outcomes focused on communication, self-efficacy, knowledge, and satisfaction. Interventions were designed for genetic counselors, physicians, primary care physicians (PCPs), medical students, and nurses. None of the papers featured oncologists or surgeons. Conclusions This review revealed an overall lack of publications which evaluated interventions to assist HCPs discussing hereditary breast cancer risk and testing. Studies failed to operationalize which ‘communication skills’ they included, nor did they consistently report randomization, outcome measures, or analysis. Discussing the need for, and management of, genetic testing for inherited cancer risk with individuals and their families can be challenging. As genetic testing in breast cancer becomes more common, the provision of specific communication-based training programs, with reference to genetic testing, risk assessments, and counseling skills is warranted. Electronic supplementary material The online version of this article (10.1007/s10549-020-05741-z) contains supplementary material, which is available to authorized users.
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Landry KK, Wood ME. Panel Testing for Hereditary Breast Cancer: More or Less? CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00361-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kenyon E, Westerhuis JJ, Volk M, Hix J, Chakravarty S, Claucherty E, Zaluzec E, Ramsey L, Madaj Z, Hostetter G, Eagleson B, Shapiro E, Moore A, Sempere LF. Ductal tree ablation by local delivery of ethanol prevents tumor formation in an aggressive mouse model of breast cancer. Breast Cancer Res 2019; 21:129. [PMID: 31779648 PMCID: PMC6883550 DOI: 10.1186/s13058-019-1217-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/16/2019] [Indexed: 12/15/2022] Open
Abstract
Background Prophylactic mastectomy is the most effective intervention to prevent breast cancer. However, this major surgery has life-changing consequences at the physical, emotional, psychological, and social levels. Therefore, only high-risk individuals consider this aggressive procedure, which completely removes the mammary epithelial cells from which breast cancer arises along with surrounding tissue. Here, we seek to develop a minimally invasive procedure as an alternative to prophylactic mastectomy by intraductal (ID) delivery of a cell-killing solution that locally ablates the mammary epithelial cells before they become malignant. Methods After ID injection of a 70% ethanol-containing solution in FVB/NJ female animals, ex vivo dual stained whole-mount tissue analysis and in vivo X-ray microcomputed tomography imaging were used to visualize ductal tree filling, and histological and multiplex immunohistochemical assays were used to characterize ablative effects and quantitate the number of intact epithelial cells and stroma. After ID injection of 70% ethanol or other solutions in cancer-prone FVB-Tg-C3(1)-TAg female animals, mammary glands were palpated weekly to establish tumor latency and examined after necropsy to record tumor incidence. Statistical difference in median tumor latency and tumor incidence between experimental groups was analyzed by log-rank test and logistic mixed-effects model, respectively. Results We report that ID injection of 70% ethanol effectively ablates the mammary epithelia with limited collateral damage to surrounding stroma and vasculature in the murine ductal tree. ID injection of 70% ethanol into the mammary glands of the C3(1)-TAg multifocal breast cancer model significantly delayed tumor formation (median latency of 150 days in the untreated control group [n = 25] vs. 217 days in the ethanol-treated group [n = 13], p value < 0.0001) and reduced tumor incidence (34% of glands with tumors [85 of 250] in the untreated control group vs. 7.3% of glands with tumor [7 of 95] in the ethanol-treated group, risk ratio = 4.76 [95% CI 1.89 to 11.97, p value < 0.0001]). Conclusions This preclinical study demonstrates the feasibility of local ductal tree ablation as a novel strategy for primary prevention of breast cancer. Given the existing clinical uses of ethanol, ethanol-based ablation protocols could be readily implemented in first-in-human clinical trials for high-risk individuals.
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Affiliation(s)
- Elizabeth Kenyon
- Precision Health Program, Michigan State University, East Lansing, MI, 48824, USA
| | | | - Maximilian Volk
- Precision Health Program, Michigan State University, East Lansing, MI, 48824, USA
| | - Jeremy Hix
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - Shatadru Chakravarty
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - Ethan Claucherty
- Precision Health Program, Michigan State University, East Lansing, MI, 48824, USA
| | - Erin Zaluzec
- Precision Health Program, Michigan State University, East Lansing, MI, 48824, USA
| | - Lisa Ramsey
- Van Andel Research Institute, Grand Rapids, MI, 49503, USA
| | - Zach Madaj
- Van Andel Research Institute, Grand Rapids, MI, 49503, USA
| | | | - Bryn Eagleson
- Van Andel Research Institute, Grand Rapids, MI, 49503, USA
| | - Erik Shapiro
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - Anna Moore
- Precision Health Program, Michigan State University, East Lansing, MI, 48824, USA
| | - Lorenzo F Sempere
- Precision Health Program, Michigan State University, East Lansing, MI, 48824, USA.
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Tharmapalan P, Mahendralingam M, Berman HK, Khokha R. Mammary stem cells and progenitors: targeting the roots of breast cancer for prevention. EMBO J 2019; 38:e100852. [PMID: 31267556 PMCID: PMC6627238 DOI: 10.15252/embj.2018100852] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/11/2019] [Accepted: 04/11/2019] [Indexed: 12/24/2022] Open
Abstract
Breast cancer prevention is daunting, yet not an unsurmountable goal. Mammary stem and progenitors have been proposed as the cells-of-origin in breast cancer. Here, we present the concept of limiting these breast cancer precursors as a risk reduction approach in high-risk women. A wealth of information now exists for phenotypic and functional characterization of mammary stem and progenitor cells in mouse and human. Recent work has also revealed the hormonal regulation of stem/progenitor dynamics as well as intrinsic lineage distinctions between mammary epithelial populations. Leveraging these insights, molecular marker-guided chemoprevention is an achievable reality.
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Affiliation(s)
| | - Mathepan Mahendralingam
- Princess Margaret Cancer CentreUniversity Health NetworkUniversity of TorontoTorontoONCanada
| | - Hal K Berman
- Princess Margaret Cancer CentreUniversity Health NetworkUniversity of TorontoTorontoONCanada
| | - Rama Khokha
- Princess Margaret Cancer CentreUniversity Health NetworkUniversity of TorontoTorontoONCanada
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Rebitschek FG, Pashayan N, Widschwendter M, Wegwarth O. Do cancer risk and benefit-harm ratios influence women's consideration of risk-reducing mastectomy? A scenario-based experiment in five European countries. PLoS One 2019; 14:e0218188. [PMID: 31188874 PMCID: PMC6561593 DOI: 10.1371/journal.pone.0218188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Personal cancer risk assessments enable stratified care, for example, offering preventive surgical measures such as risk-reducing mastectomy (RRM) to women at high risk for breast cancer. In scenario-based experiments, we investigated whether different benefit-harm ratios of RRM influence women's consideration of this, whether this consideration is influenced by women's perception of and desire to know their personal cancer risk, or by their intention to take a novel cancer risk-predictive test, and whether consideration varies across different countries. METHOD In January 2017, 1,675 women 40 to 75 years of age from five European countries-Czech Republic, Germany, UK, Italy, and Sweden-took part in an online scenario-based experiment. Six different scenarios of hypothetical benefit-harm ratios of RRM were presented in accessible fact box formats: Baseline risk/risk reduction pairings were 20/16, 20/4, 10/8, 10/2, 5/4, and 5/1 out of 1,000 women dying from breast cancer. RESULTS Varying the baseline risk of dying from breast cancer and the extent of risk reduction influenced the decision to consider RRM for 23% of women. Decisions varied by country, risk perception, and the intention to take a cancer risk-predictive test. Women who expressed a stronger intention to take such a test were more likely to consider having RRM. The desire to know one's risk of developing any female cancer in general moderated women's decisions, whereas the specific desire to know the risk of breast cancer did not. CONCLUSIONS In this hypothetical scenario-based study, only for a minority of women did the change in benefit-harm ratio inform their consideration of RRM. Because this consideration is influenced by risk perception and the intention to learn one's cancer risks via a cancer risk-predictive test, careful disclosure of different potential preventive measures and their benefit-harm ratios is necessary before testing for individual risk. Furthermore, information on risk testing should acknowledge country-specific sensitivities for benefit-harm ratios.
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Affiliation(s)
- Felix G. Rebitschek
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
- * E-mail:
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, United Kingdom
| | | | - Odette Wegwarth
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
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Fraile-Bethencourt E, Valenzuela-Palomo A, Díez-Gómez B, Goina E, Acedo A, Buratti E, Velasco EA. Mis-splicing in breast cancer: identification of pathogenic BRCA2 variants by systematic minigene assays. J Pathol 2019; 248:409-420. [PMID: 30883759 DOI: 10.1002/path.5268] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/21/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022]
Abstract
Splicing disruption is a common mechanism of gene inactivation associated with germline variants of susceptibility genes. To study the role of BRCA2 mis-splicing in hereditary breast/ovarian cancer (HBOC), we performed a comprehensive analysis of variants from BRCA2 exons 2-9, as well as the initial characterization of the regulatory mechanisms of such exons. A pSAD-based minigene with exons 2-9 was constructed and validated in MCF-7 cells, producing the expected transcript (1016-nt/V1-BRCA2_exons_2-9-V2). DNA variants from mutational databases were analyzed by NNSplice and Human Splicing Finder softwares. To refine ESE-variant prediction, we mapped the regulatory regions through a functional strategy whereby 26 exonic microdeletions were introduced into the minigene and tested in MCF-7 cells. Thus, we identified nine spliceogenic ESE-rich intervals where ESE-variants may be located. Combining bioinformatics and microdeletion assays, 83 variants were selected and genetically engineered in the minigene. Fifty-three changes impaired splicing: 28 variants disrupted the canonical sites, four created new ones, 10 abrogated enhancers, eight created silencers and three caused a double-effect. Notably, nine spliceogenic-ESE variants were located within ESE-containing intervals. Capillary electrophoresis and sequencing revealed more than 23 aberrant transcripts, where exon skipping was the most common event. Interestingly, variant c.67G>A triggered the usage of a noncanonical GC-donor 4-nt upstream. Thirty-six variants that induced severe anomalies (>60% aberrant transcripts) were analyzed according to the ACMG guidelines. Thus, 28 variants were classified as pathogenic, five as likely pathogenic and three as variants of uncertain significance. Interestingly, 13 VUS were reclassified as pathogenic or likely pathogenic variants. In conclusion, a large fraction of BRCA2 variants (∼64%) provoked splicing anomalies lending further support to the high prevalence of this disease-mechanism. The low accuracy of ESE-prediction algorithms may be circumvented by functional ESE-mapping that represents an optimal strategy to identify spliceogenic ESE-variants. Finally, systematic functional assays by minigenes depict a valuable tool for the initial characterization of splicing anomalies and the clinical interpretation of variants. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Eugenia Fraile-Bethencourt
- Splicing and Genetic Susceptibility to Cancer, Instituto de Biología y Genética Molecular (CSIC-UVa), Valladolid, Spain
| | - Alberto Valenzuela-Palomo
- Splicing and Genetic Susceptibility to Cancer, Instituto de Biología y Genética Molecular (CSIC-UVa), Valladolid, Spain
| | - Beatriz Díez-Gómez
- Splicing and Genetic Susceptibility to Cancer, Instituto de Biología y Genética Molecular (CSIC-UVa), Valladolid, Spain
| | - Elisa Goina
- Molecular Pathology Group, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Alberto Acedo
- Splicing and Genetic Susceptibility to Cancer, Instituto de Biología y Genética Molecular (CSIC-UVa), Valladolid, Spain
| | - Emanuele Buratti
- Molecular Pathology Group, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Eladio A Velasco
- Splicing and Genetic Susceptibility to Cancer, Instituto de Biología y Genética Molecular (CSIC-UVa), Valladolid, Spain
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Trends in lobular carcinoma in situ management: endocrine therapy use in California and New Jersey. Cancer Causes Control 2019; 30:129-136. [DOI: 10.1007/s10552-019-1126-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 01/03/2019] [Indexed: 12/15/2022]
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Brédart A, Kop JL, Antoniou AC, Cunningham AP, De Pauw A, Tischkowitz M, Ehrencrona H, Schmidt MK, Dolbeault S, Rhiem K, Easton DF, Devilee P, Stoppa-Lyonnet D, Schmutlzer R. Clinicians' use of breast cancer risk assessment tools according to their perceived importance of breast cancer risk factors: an international survey. J Community Genet 2019; 10:61-71. [PMID: 29508368 PMCID: PMC6325038 DOI: 10.1007/s12687-018-0362-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/20/2018] [Indexed: 01/31/2023] Open
Abstract
The BOADICEA breast cancer (BC) risk assessment model and its associated Web Application v3 (BWA) tool are being extended to incorporate additional genetic and non-genetic BC risk factors. From an online survey through the BOADICEA website and UK, Dutch, French and Swedish national genetic societies, we explored the relationships between the usage frequencies of the BWA and six other common BC risk assessment tools and respondents' perceived importance of BC risk factors. Respondents (N = 443) varied in age, country and clinical seniority but comprised mainly genetics health professionals (82%) and BWA users (93%). Oncology professionals perceived reproductive, hormonal (exogenous) and lifestyle BC risk factors as more important in BC risk assessment compared to genetics professionals (p values < 0.05 to 0.0001). BWA was used more frequently by respondents who gave high weight to breast tumour pathology and low weight to personal BC history as BC risk factors. BWA use was positively related to the weight given to hormonal BC risk factors. The importance attributed to lifestyle and BMI BC risk factors was not associated with the use of BWA or any of the other tools. Next version of the BWA encompassing additional BC risk factors will facilitate more comprehensive BC risk assessment in genetics and oncology practice.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-Oncology Unit, 26 rue d'Ulm, 75005 Cedex 05, Paris, France.
- University Paris Descartes, 71 avenue Edouard Vaillant, 92774, Boulogne-Billancourt, France.
| | - Jean-Luc Kop
- Université de Lorraine, 2LPN-CEMA, 23 boulevard Albert 1er-BP, 60446-54001 Cedex, Nancy, France
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Worts Causeway, CB1 8RN, University of Cambridge, Cambridge, UK
| | - Alex P Cunningham
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Worts Causeway, CB1 8RN, University of Cambridge, Cambridge, UK
| | - Antoine De Pauw
- Institut Curie, Cancer genetic clinic, 26 rue d'Ulm, 75005, Paris Cedex 05, France
| | - Marc Tischkowitz
- Department of Medical Genetics, University of Cambridge, Box 238, Level 6 Addenbrooke's Treatment Centre Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Hans Ehrencrona
- Department of Clinical Genetics, Laboratory Medicine, Office for Medical Services and Department of Clinical Genetics, Lund University, 221 85, Lund, Sweden
| | - Marjanka K Schmidt
- Netherlands Cancer Institute, Division of Molecular Pathology, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-Oncology Unit, 26 rue d'Ulm, 75005 Cedex 05, Paris, France
- CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 avenue Paul Vaillant-Couturier, 94807, Villejuif, France
| | - Kerstin Rhiem
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital and Faculty of Medicine, Kerpener Str. 34, I 50931, Cologne, Germany
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Worts Causeway, CB1 8RN, University of Cambridge, Cambridge, UK
| | - Peter Devilee
- Department of Human Genetics, Department of Pathology, Leiden University Medical Centre, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Rita Schmutlzer
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital and Faculty of Medicine, Kerpener Str. 34, I 50931, Cologne, Germany
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