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Nabioglu M, Kus T, Aktas G, Ahmet K, Arak H. The effect of knowledge and person-related factors on breast cancer susceptibility genes (BRCA1/2) testing perception in Turkish women. J Genet Couns 2024. [PMID: 39373305 DOI: 10.1002/jgc4.1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/09/2024] [Accepted: 09/12/2024] [Indexed: 10/08/2024]
Abstract
Genetic testing for breast cancer susceptibility genes (BRCA1/2) plays a pivotal role in risk assessment and preventive interventions. However, individuals' awareness, knowledge, and attitudes toward genetic testing can vary across different societies. This study focuses on understanding Turkish women's knowledge, perceptions, and attitudes toward BRCA1/2 testing, considering demographic factors and awareness. In this cross-sectional study, 301 Turkish participants, including breast/ovarian cancer patients and their first-degree relatives, were surveyed. Information on sociodemographics, cancer history, awareness, knowledge, and perceptions was collected. The study aimed to assess knowledge levels about breast cancer inheritance and BRCA1/2 testing, describe perspectives about testing in women with a family history of breast or ovarian cancer, and determine associations between knowledge, personal factors, anxiety, and genetic testing perspectives. Results showed a wide range in correct responses (31.6%-96.7%) for knowledge items. No significant relationship between knowledge levels and positive perception was observed. However, participants answering a specific question incorrectly showed higher negative perceptions. While most participants recognized the benefits of genetic testing, concerns centered around passing the genes to future generations. Participants who were younger, more educated, had higher income, were employed, at an earlier disease stage, and were social media users demonstrated more positive attitudes. Negative perceptions were higher among younger patients, physicians, and healthcare professionals. Interestingly, anxiety in cancer patients did not correlate with either positive or negative perceptions. In conclusion, this study identifies participant-related factors influencing perceptions of hereditary genetic tests. Understanding these factors and addressing associated issues can enhance the utilization of genetic testing and promote preventive oncology applications.
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Affiliation(s)
- Mertcan Nabioglu
- Department of Medical Internal Medicine, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Tulay Kus
- Department of Medical Oncology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Gokmen Aktas
- Gaziantep Medical Point Private Hospital, Gaziantep, Turkey
| | - Konca Ahmet
- Department of Medical Oncology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Hacı Arak
- Department of Medical Oncology, School of Medicine, Gaziantep University, Gaziantep, Turkey
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2
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Ricker C, Arun B, Pirzadeh-Miller S, Stoffel EM, Messersmith H, Tung N. Selection of Germline Genetic Testing Panels in Patients With Cancer: ASCO Guideline Clinical Insights. JCO Oncol Pract 2024; 20:1308-1313. [PMID: 38759126 DOI: 10.1200/op.24.00278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Affiliation(s)
| | - Banu Arun
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sara Pirzadeh-Miller
- Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Nadine Tung
- Beth Israel Deaconess Medical Center, Sharon, MA
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3
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Ntowe KW, Thomas SM, Dalton JC, Olunuga E, Wang T, Chiba A, Plichta JK. Demographics and Clinical Decision Making in Patients with Germline Moderate Penetrance Non-BRCA Mutations in Breast Cancer Related Genes. Ann Surg Oncol 2024; 31:7290-7300. [PMID: 38976158 PMCID: PMC11452274 DOI: 10.1245/s10434-024-15793-w] [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: 04/09/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Management of pathogenic variants in high penetrance genes related to breast cancer (BC), such as BRCA1 and BRCA2, are well established. However, moderate penetrance mutations are understudied. We aim to compare risk reduction decision-making patterns in patients with a moderate penetrance BC-related genetic mutations, without a prior BC diagnosis. PATIENTS AND METHODS Female patients aged ≥ 18 years who tested positive for a BRCA1/2, high penetrance, or moderate penetrance mutation related to BC between 1996 and 2023 without a concurrent or prior BC diagnosis were retrospectively identified from a single academic center's database. Groups were stratified by mutation type: BRCA1/2 mutations (BRCA1, BRCA2), high penetrance mutations (HPM; CDH1, PALB2, PTEN, STK11, TP53), or moderate penetrance mutations (MPM; ATM, BARD1, CHEK2, NF1, RAD51C, RAD51D). Demographics and clinical outcomes were compared. RESULTS A total of 528 patients met the inclusion criteria, with 66% (n = 350) having a BRCA1/2 mutation, 8% (n = 44) having HPM, and 25% (n = 134) having MPM; the median follow-up was 56.0 months. In our cohort, 20.9% of patients with BRCA mutations, 9.1% with HPM, and 7.5% with MPM chose to undergo risk-reducing mastectomies (RRM). Within the moderate penetrance cohort, patients who chose to undergo RRM were younger at the time of genetic testing (39.4 vs. 47.5 years, p = 0.03) and had a higher number of family members with BC (2 vs. 1, p = 0.05). CONCLUSIONS Our findings provide insights into the demographic characteristics and family history of patients with moderate penetrance mutations and those who pursue risk-reducing surgery.
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Affiliation(s)
- Koumani W Ntowe
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Juliet C Dalton
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Ebunoluwa Olunuga
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Ton Wang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Akiko Chiba
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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4
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Katz SJ, Abrahamse P, Furgal A, Hodan R, Tocco RS, Ward KC, Hamilton AS, Wallner LP, Kurian AW. Genetic Counseling, Testing, and Family Communication Into Survivorship After Diagnosis of Breast Cancer. J Clin Oncol 2024; 42:3123-3129. [PMID: 39008790 PMCID: PMC11377164 DOI: 10.1200/jco.24.00122] [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: 01/18/2024] [Revised: 05/01/2024] [Accepted: 05/14/2024] [Indexed: 07/17/2024] Open
Abstract
PURPOSE To examine receipt of genetic testing and communication with relatives about results into survivorship after diagnosis of breast cancer. METHODS Women age 20-79 years diagnosed with early-stage breast cancer in 2014-2015 and reported to the Georgia and Los Angeles County SEER registries were surveyed approximately 7 months and 6 years after diagnosis (n = 1,412). We asked about genetic counseling, testing, and communication with relatives about results. We categorized women into indications for testing on the basis of clinical guidelines at the time of diagnosis and at the time of the follow-up survey (FUPs). RESULTS A total of 47.4% had indications for genetic testing at any time: 28.0% at baseline and an additional 19.4% at the time of the FUPs (only); 71.9% (95% CI, 67.4 to 76.4) of those with a baseline indication reported genetic testing versus 53.3% (95% CI, 47.3 to 59.2) with an indication at FUPs only and 35.0% (95% CI, 31.6 to 38.4) with no indication (P < .001). There were no significant racial or ethnic differences in receipt of testing, controlling for age and clinical indications (P = .239); results for genetic counseling were similar. Only 3.4% of survivors had direct-to-consumer genetic testing (DTCt) for cancer. Testers who reported a pathogenic variant (n = 62) were much more likely to have talked to most or all their first-degree adult relatives about genetic testing than those with a variant of unknown significance (n = 49) or a negative finding (n = 419): 62.7% versus 38.8% and 38.0%, respectively (P < .001). CONCLUSION Many women with indications for genetic counseling and testing into survivorship do not receive it. But those tested reach out to family members on the basis of the clinical relevance of their results. Very few patients obtained DTCt, which suggests that these tests do not substitute for clinical testing in breast cancer survivors.
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Affiliation(s)
- Steven J Katz
- Department of Medicine, University of Michigan, Ann Arbor, MI
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Paul Abrahamse
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Allison Furgal
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Rachel Hodan
- Cancer Genetics, Stanford Health Care, Stanford, CA
| | - Rachel S Tocco
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GE
| | - Ann S Hamilton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lauren P Wallner
- Department of Medicine, University of Michigan, Ann Arbor, MI
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Allison W Kurian
- Department of Medicine, Stanford University, Stanford, CA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA
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5
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Nakahara M, Ushiama M, Tanabe N, Gotoh M, Sakamoto H, Yoshida T, Hirata M. Multi-gene panel analysis in BRCA1/2-negative patients suspected of hereditary breast and ovarian cancer syndrome: Real-world data from a single institution. J Obstet Gynaecol Res 2024; 50:1591-1597. [PMID: 39077936 DOI: 10.1111/jog.16026] [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: 03/16/2024] [Accepted: 07/08/2024] [Indexed: 07/31/2024]
Abstract
AIM Although BRCA1/2 is most frequently associated with hereditary breast and ovarian cancer (HBOC), many other related genes have been implicated. Therefore, we investigated the prevalence of non-BRCA1/2 genes associated with hereditary cancer predisposition in BRCA1/2-negative patients from the Department of Genetic Medicine and Services with breast and ovarian cancer using a multi-gene panel (MGP) analysis. METHODS We conducted a retrospective MGP analysis (National Cancer Center Onco-Panel for Familial Cancer; NOP_FC) in BRCA1/2-negative patients with breast, ovarian, and overlapping breast/ovarian cancers who visited our genetic counseling between April 2004 and October 2022. RESULTS NOP_FC was performed in 128 of the 390 BRCA test-negative cases (117 breast cancer, 9 ovarian cancer, and 2 overlapping breast/ovarian cancer cases). Among the BRCA1/2-negative patients, nine (7.7%) with breast cancer and one (11%) with ovarian cancer had pathogenic variants (PVs) in non-BRCA1/2 genes associated with breast and ovarian cancers, respectively. Five patients had PVs in RAD51D, two in PALB2, one in BARD1, one in ATM, and one in RAD51C. CONCLUSIONS Additional MGP testing of germline genes associated with hereditary cancer predisposition syndrome in BRCA1/2-negative breast and ovarian cancer patients revealed PVs in non-BRCA1/2 breast cancer- and ovarian cancer-related genes in 7.7% of breast cancer and 11% of ovarian cancer. Therefore, additional testing may provide useful information for subsequent risk-reducing surgery and surveillance in BRCA1/2-negative patients.
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Affiliation(s)
- Mariko Nakahara
- Department of Gynecology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Mineko Ushiama
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
- Department of Clinical Genomics, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
| | - Noriko Tanabe
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Masahiro Gotoh
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
- Department of Clinical Genomics, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
| | - Hiromi Sakamoto
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
- Department of Clinical Genomics, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
| | - Teruhiko Yoshida
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Makoto Hirata
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
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6
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Lin L, Lu E, Yurasits J, Mercado J, Myers M, Holden S, Shuch B. Utilization of a Third-party Partnership in Tele-genetic Risk Assessment Program in Genitourinary Oncology. Urology 2024; 191:95-100. [PMID: 38795832 DOI: 10.1016/j.urology.2024.05.011] [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: 01/04/2024] [Revised: 04/29/2024] [Accepted: 05/15/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE To meet the increasing demands of genetic risk assessment for genitourinary cancers due to expanded clinical guidelines, we established an academic/industry partnership to create a streamlined workflow to overcome the barriers to access to care. MATERIALS AND METHODS Genome Medical offers multilingual genetic counseling. A pilot program evaluated patients at risk for hereditary genitourinary syndromes. Between January 1, 2020 and January 07, 2022, all patients in need of germline testing were offered hybrid in-clinic telehealth pre-test counseling and when indicated, genetic testing. Post-test counseling was offered based on results and encouraged if positive. Testing results, patient satisfaction, and costs were evaluated. RESULTS A total of 146 of 182 (80.0%) patients agreed to participate, with 130 (89.0%) completing pre-test counseling. Median age was 65 (range 22-95), with 91% being male and approximately 60% having prostate cancer. The median time from referral to pre-test counseling was 11 days (IQR 7-20). After assessment, testing was recommended for 127 (97.7%) of which 123 (96.8%) completed testing. The median time from testing to result release was 15 days (IQR 10-20.8). Forty (32.5%) had post-test counseling. Reimbursement by private insurers increased annually from $17.2 to $52.4. Patient satisfaction was high with a mean Genetic Counselor Satisfaction Scale of 27.9 out of 30. CONCLUSION Our program provided high patient satisfaction, rapid access to genetic counseling, prompt genetic testing, timely release of results, and was cost-effective compared to traditional models. This approach is scalable across community and academic settings and across cancer types.
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Affiliation(s)
- Lin Lin
- Department of Urology, UCLA, Los Angeles, CA
| | - Eric Lu
- Division of Hematology/Oncology, UCLA, Los Angeles, CA
| | | | | | | | | | - Brian Shuch
- Department of Urology, UCLA, Los Angeles, CA.
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7
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Kumar P, Benjamin DJ, Darabi S, Kloecker G, Rezazadeh Kalebasty A. Implications of genetic testing and informed consent before and after genetic testing in individuals with cancer. World J Clin Oncol 2024; 15:975-981. [PMID: 39193166 PMCID: PMC11346064 DOI: 10.5306/wjco.v15.i8.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/15/2024] [Accepted: 07/23/2024] [Indexed: 08/16/2024] Open
Abstract
Recent advancements in next generation sequencing have allowed for genetic information become more readily available in the clinical setting for those affected by cancer and by treating clinicians. Given the lack of access to geneticists, medical oncologists and other treating physicians have begun ordering and interpreting genetic tests for individuals with cancer through the process of "mainstreaming". While this process has allowed for quicker access to genetic tests, the process of "mainstreaming" has also brought several challenges including the dissemination of variants of unknown significance results, ordering of appropriate tests, and accurate interpretation of genetic results with appropriate follow-up testing and interventions. In this editorial, we seek to explore the process of informed consent of individuals before obtaining genetic testing and offer potential solutions to optimize the informed consent process including categorization of results as well as a layered consent model.
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Affiliation(s)
- Priyanka Kumar
- Department of Hematology and Medical Oncology, Harbor-UCLA Medical Center, Torrance, CA 90502, United States
| | - David J Benjamin
- Department of Medical Oncology, Hoag Family Cancer Institute, Newport Beach, CA 92663, United States
| | - Sourat Darabi
- Department of Precision Medicine, Hoag Family Cancer Institute, Newport Beach, CA 92663, United States
| | - Goetz Kloecker
- Department of Hematology and Medical Oncology, University of Louisville, Louisville, KY 40202, United States
| | - Arash Rezazadeh Kalebasty
- Department of Hematology and Medical Oncology, University of California-Irvine, Orange, CA 92868, United States
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8
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Mellgard GS, Atabek Z, LaRose M, Kastrinos F, Bates SE. Variants of uncertain significance in precision oncology: nuance or nuisance? Oncologist 2024; 29:641-644. [PMID: 38847368 PMCID: PMC11299927 DOI: 10.1093/oncolo/oyae135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/21/2024] [Indexed: 08/07/2024] Open
Abstract
Variants of unknown significance cause uncertainty for patients and are a challenge for oncologists. This commentary describes 4 clinical examples illustrating these challenges.
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Affiliation(s)
| | - Zoey Atabek
- Columbia University Irving Medical Center, New York, NY, USA
| | - Meredith LaRose
- Columbia University Irving Medical Center, New York, NY, USA
| | - Fay Kastrinos
- Columbia University Irving Medical Center, New York, NY, USA
| | - Susan E Bates
- Columbia University Irving Medical Center, New York, NY, USA
- James J. Peters VA Medical Center, Bronx, NY, USA
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9
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Tung N, Ricker C, Messersmith H, Balmaña J, Domchek S, Stoffel EM, Almhanna K, Arun B, Chavarri-Guerra Y, Cohen SA, Cragun D, Crew KD, Hall MJ, Idos G, Lopez G, Pal T, Pirzadeh-Miller S, Pritchard C, Rana HQ, Swami U, Vidal GA. Selection of Germline Genetic Testing Panels in Patients With Cancer: ASCO Guideline. J Clin Oncol 2024; 42:2599-2615. [PMID: 38759122 DOI: 10.1200/jco.24.00662] [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: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE To guide use of multigene panels for germline genetic testing for patients with cancer. METHODS An ASCO Expert Panel convened to develop recommendations on the basis of a systematic review of guidelines, consensus statements, and studies of germline and somatic genetic testing. RESULTS Fifty-two guidelines and consensus statements met eligibility criteria for the primary search; 14 studies were identified for Clinical Question 4. RECOMMENDATIONS Patients should have a family history taken and recorded that includes details of cancers in first- and second-degree relatives and the patient's ethnicity. When more than one gene is relevant based on personal and/or family history, multigene panel testing should be offered. When considering what genes to include in the panel, the minimal panel should include the more strongly recommended genes from Table 1 and may include those less strongly recommended. A broader panel may be ordered when the potential benefits are clearly identified, and the potential harms from uncertain results should be mitigated. Patients who meet criteria for germline genetic testing should be offered germline testing regardless of results from tumor testing. Patients who would not normally be offered germline genetic testing based on personal and/or family history criteria but who have a pathogenic or likely pathogenic variant identified by tumor testing in a gene listed in Table 2 under the outlined circumstances should be offered germline testing.Additional information is available at www.asco.org/molecular-testing-and-biomarkers-guidelines.
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Affiliation(s)
- Nadine Tung
- Beth Israel Deaconess Medical Center, Sharon, MA
| | | | | | | | | | | | | | - Banu Arun
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yanin Chavarri-Guerra
- Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | - Gregory Idos
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ghecemy Lopez
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Tuya Pal
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Sara Pirzadeh-Miller
- Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Umang Swami
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Gregory A Vidal
- The West Cancer Center and Research Institute and The University of Tennessee Health Sciences Center, Germantown, TN
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10
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Cragun D, Dean M, Baker D, Kelley M, Hooker G, Weidner A, Hunt P, Pal T. The Development and Evaluation of Novel Patient Educational Material for a Variant of Uncertain Significance (VUS) Result in Hereditary Cancer Genes. Curr Oncol 2024; 31:3361-3378. [PMID: 38920739 PMCID: PMC11202617 DOI: 10.3390/curroncol31060256] [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: 04/25/2024] [Revised: 05/30/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
A Variant of Uncertain Significance (VUS) is a difference in the DNA sequence with uncertain consequences for gene function. A VUS in a hereditary cancer gene should not change medical care, yet some patients undergo medical procedures based on their VUS result, highlighting the unmet educational needs among patients and healthcare providers. To address this need, we developed, evaluated, and refined novel educational materials to explain that while VUS results do not change medical care, it remains important to share any personal or family history of cancer with family members given that their personal and family medical history can guide their cancer risk management. We began by reviewing the prior literature and transcripts from interviews with six individuals with a VUS result to identify content and design considerations to incorporate into educational materials. We then gathered feedback to improve materials via a focus group of multidisciplinary experts and multiple rounds of semi-structured interviews with individuals with a VUS result. Themes for how to improve content, visuals, and usefulness were used to refine the materials. In the final round of interviews with an additional 10 individuals with a VUS result, materials were described as relatable, useful, factual, and easy to navigate, and also increased their understanding of cancer gene VUS results.
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Affiliation(s)
- Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL 33620, USA
| | - Marleah Dean
- Department of Communication, University of South Florida, Tampa, FL 33620, USA
- Outcomes & Behavior Program, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - David Baker
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Meghan Kelley
- Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA
| | - Gillian Hooker
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Anne Weidner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Paige Hunt
- College of Public Health, University of South Florida, Tampa, FL 33620, USA
| | - Tuya Pal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212, USA
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11
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Pederson HJ, Al-Hilli Z, Kurian AW. Racial disparities in breast cancer risk factors and risk management. Maturitas 2024; 184:107949. [PMID: 38652937 DOI: 10.1016/j.maturitas.2024.107949] [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: 12/12/2023] [Revised: 02/03/2024] [Accepted: 02/19/2024] [Indexed: 04/25/2024]
Abstract
Racial disparities in breast cancer outcomes are well described across the spectrum of screening, diagnosis, treatment, and survivorship. Breast cancer mortality is markedly elevated for Non-Hispanic Black women compared with other racial and ethnic groups, with multifactorial causes. Here, we aim to reduce this burden by identifying disparities in breast cancer risk factors, risk assessment, and risk management before breast cancer is diagnosed. We describe a reproductive profile and modifiable risk factors specific to the development of triple-negative breast cancer. We also propose that screening strategies should be both risk- and race-based, given the prevalence of early-onset triple-negative breast cancer in young Black women. We emphasize the importance of early risk assessment and identification of patients at hereditary and familial risk and discuss indications for a high-risk referral. We discuss the subtleties following genetic testing and highlight "uncertain" genetic testing results and risk estimation challenges in women who test negative. We trace aspects of the obesity epidemic in the Black community to infant feeding patterns and emphasize healthy eating and activity. Finally, we discuss building an environment of trust to foster adherence to recommendations, follow-up care, and participation in clinical trials. Addressing relevant social determinants of health; educating patients and clinicians on factors impacting disparities in outcomes; and encouraging participation in targeted, culturally sensitive research are essential to best serve all communities.
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Affiliation(s)
- Holly J Pederson
- Breast Center, Integrated Surgical Institute, Cleveland Clinic, 9500 Euclid Avenue, A80, OH 44195, United States of America.
| | - Zahraa Al-Hilli
- Breast Center, Integrated Surgical Institute, Cleveland Clinic, 9500 Euclid Avenue, A80, OH 44195, United States of America.
| | - Allison W Kurian
- Department of Medicine and Epidemiology and Population Health, Stanford University, 900 Blake Wilbur Drive, 1st Floor, Palo Alto, CA 94304, United States of America.
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12
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Rimini M, Presi S, Pipitone GB, Russo Raucci A, Ratti F, Della Corte A, Pedica F, Vanella G, Tonon G, Burgio V, Vitiello F, Rossari F, Amadeo E, Maria Giulia C, Pecciarini L, Arcidiacono PG, Falcinelli F, Cascinu S, De Cobelli F, Aldrighetti L, Patricelli MG, Carrera P, Casadei-Gardini A. Germline testing and genetic counseling in biliary tract cancer: an operative proposal to improve the state of art. Expert Rev Gastroenterol Hepatol 2024; 18:141-146. [PMID: 38584510 DOI: 10.1080/17474124.2024.2337000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION A genetic predisposition seems to be involved in biliary tract cancer, but the prevalence of germline mutations in BTC remains unclear, and the therapeutic role of the germline pathologic variants is still unknown. AREA COVERED The aim of the present work is to systematically review the data available on the hereditary predisposition of biliary tract cancer by a specific research on PubMed, in order to highlight the most important critical points and to define the current possible role of germinal testing and genetic counseling in this setting of patients. EXPERT OPINION Basing on data already available, we decided to start in our institution a specific genetic protocol focused on biliary tract cancer patients, which includes genetic counseling and, if indicated, germline test. The inclusion criteria are: 1) Patient with personal history of oncologic disease other than BTC, 2) Patient with familiar history of oncologic disease (considering relatives of first and second grade), 3) Patient with ≤ 50 years old, 4) Patient presenting a somatic mutation in genes involved in DNA damage repair pathways and mismatch repair. The aim of the presented protocol is to identify germline pathogenic variants with prophylactic and therapeutic impact, and to collect and integrate a significant amount of clinical, familial, somatic, and genetic data.
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Affiliation(s)
- Margherita Rimini
- Vita-Salute San Raffaele
- IRCCS San Raffaele Hospital, Oncology Department, Milan, Italy
| | - Silvia Presi
- Laboratory of Clinical Genomics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Annalisa Russo Raucci
- Laboratory of Clinical Genomics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy
| | - Angelo Della Corte
- Vita-Salute San Raffaele
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Federica Pedica
- Vita-Salute San Raffaele
- Unit of Pathology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giuseppe Vanella
- Pancreatic Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Tonon
- Center of Omics Sciences, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | | | | | - Cangi Maria Giulia
- Pathology Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lorenza Pecciarini
- Pathology Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatic Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Stefano Cascinu
- Vita-Salute San Raffaele
- IRCCS San Raffaele Hospital, Oncology Department, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Luca Aldrighetti
- Vita-Salute San Raffaele
- Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy
| | | | - Paola Carrera
- Laboratory of Clinical Genomics, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Genomics for Human Disease Diagnosis, IRCCS San Raffaele Scientific Institute, Milan, Italy
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13
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Kamaraju S, Conroy M, Harris A, Georgen M, Min H, Powell M, Kurzrock R. Challenges to genetic testing for germline mutations associated with breast cancer among African Americans. Cancer Treat Rev 2024; 124:102695. [PMID: 38325071 DOI: 10.1016/j.ctrv.2024.102695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
Inequities in preventive cancer screening, diagnosis, treatment, and inferior cancer outcomes continue to pose challenges across the cancer continuum. While the exact reasons for these inferior outcomes are unknown, multiple barriers to various domains of social determinants of health (SDOH) play a vital role, leading to inequities in cancer care. These include barriers to transportation, housing, and food insecurities, contributing to delays in preventive screening and treatment. Furthermore, aggressive biologies also exist across various racial profiles with accompanying germline mutations. For example, African Americans (AAs) have a higher incidence of triple-negative breast cancer subtype and a high prevalence of BRCA1/2 gene mutations, increasing the risk of multiple cancers, warranting high-risk screening for these populations. Unfortunately, other barriers, such as financial insecurities, low health literacy rates, and lack of awareness, lead to delays in cancer screening and genetic testing, even with available high-risk screening and risk reduction procedures. In addition, physicians receive minimal interdisciplinary training to address genetic assessment, interpretation of the results, and almost no additional training in addressing the unique needs of racial minorities, leading to suboptimal delivery of genetic assessment provision resources among AAs. In this review, we discuss the confluence of factors and barriers limiting genetic testing among AAs and highlight the prevalence of germline mutations associated with increased risk of breast cancer among AAs, reflecting the need for multi-panel germline testing as well as education regarding hereditary cancer risks in underserved minorities.
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Affiliation(s)
- S Kamaraju
- Medical College of Wisconsin, Milwaukee, WI, USA; Department of Medicine, Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI, USA; Froedtert Hospital, Milwaukee, WI, USA.
| | - M Conroy
- Medical College of Wisconsin, Milwaukee, WI, USA; Froedtert Hospital, Milwaukee, WI, USA
| | - A Harris
- Medical College of Wisconsin, Milwaukee, WI, USA; Froedtert Hospital, Milwaukee, WI, USA
| | - M Georgen
- Medical College of Wisconsin, Milwaukee, WI, USA; Department of Medicine, Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI, USA; Froedtert Hospital, Milwaukee, WI, USA
| | - H Min
- Medical College of Wisconsin, Milwaukee, WI, USA; Froedtert Hospital, Milwaukee, WI, USA
| | - M Powell
- Medical College of Wisconsin, Milwaukee, WI, USA; Froedtert Hospital, Milwaukee, WI, USA
| | - R Kurzrock
- Medical College of Wisconsin, Milwaukee, WI, USA; Department of Medicine, Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI, USA; Froedtert Hospital, Milwaukee, WI, USA
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14
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Yi H, Trivedi MS, Crew KD, Schechter I, Appelbaum P, Chung WK, Allegrante JP, Kukafka R. Understanding Social, Cultural, and Religious Factors Influencing Medical Decision-Making on BRCA1/2 Genetic Testing in the Orthodox Jewish Community. Public Health Genomics 2024; 27:57-67. [PMID: 38402864 DOI: 10.1159/000536391] [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: 07/19/2023] [Accepted: 01/10/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Although the prevalence of a pathogenic variant in the BRCA1 and BRCA2 genes is about 1:400 (0.25%) in the general population, the prevalence is as high as 1:40 (2.5%) among the Ashkenazi Jewish population. Despite cost-effective preventive measures for mutation carriers, Orthodox Jews constitute a cultural and religious group that requires different approaches to BRCA1 and BRCA2 genetic testing relative to other groups. This study analyzed a dialog of key stakeholders and community members to explore factors that influence decision-making about BRCA1 and BRCA2 genetic testing in the New York Orthodox Jewish community. METHODS Qualitative research methods, based on Grounded Theory and Narrative Research, were utilized to analyze the narrative data collected from 49 key stakeholders and community members. A content analysis was conducted to identify themes; inter-rater reliability was 71%. RESULTS Facilitators of genetic testing were a desire for preventive interventions and education, while barriers to genetic testing included negative emotions, feared impact on family/romantic relationships, cost, and stigma. Views differed on the role of religious leaders and healthcare professionals in medical decision-making. Education, health, and community were discussed as influential factors, and concerns were expressed about disclosure, implementation, and information needs. CONCLUSION This study elicited the opinions of Orthodox Jewish women (decision-makers) and key stakeholders (influencers) who play critical roles in the medical decision-making process. The findings have broad implications for engaging community stakeholders within faith-based or culturally distinct groups to ensure better utilization of healthcare services for cancer screening and prevention designed to improve population health.
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Affiliation(s)
- Haeseung Yi
- Department of Health Studies and Applied Educational Psychology, Teachers College, Columbia University, New York, New York, USA,
| | - Meghna S Trivedi
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Katherine D Crew
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Isaac Schechter
- Achieve Behavioral Health, Monsey, New York, USA
- Institute for Applied Research and Community Collaboration (ARCC), Spring Valley, New York, USA
| | - Paul Appelbaum
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Center for Law, Ethics and Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Wendy K Chung
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - John P Allegrante
- Department of Health Studies and Applied Educational Psychology, Teachers College, Columbia University, New York, New York, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Rita Kukafka
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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15
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Shastry M, Hammer ME, McKenzie AJ, Hamilton EP. Breaking Barriers: Integrating Germline Testing With Oncology Care. JCO Oncol Pract 2024; 20:157-159. [PMID: 38096468 DOI: 10.1200/op.23.00627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 02/15/2024] Open
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16
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Culver JO, Bertsch NL, Kurz RN, Cheng LL, Pritzlaff M, Rao SK, Stasi SM, Stave CD, Sharaf RN. Systematic evidence review and meta-analysis of outcomes associated with cancer genetic counseling. Genet Med 2024; 26:100980. [PMID: 37688462 DOI: 10.1016/j.gim.2023.100980] [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: 01/27/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE Genetic counseling (GC) is standard of care in genetic cancer risk assessment (GCRA). A rigorous assessment of the data reported from published studies is crucial to ensure the evidence-based implementation of GC. METHODS We conducted a systematic review and meta-analysis of 17 patient-reported and health-services-related outcomes associated with pre- and post-test GC in GCRA in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS Twenty-five of 5393 screened articles met inclusion criteria. No articles reporting post-test GC outcomes met inclusion criteria. For patient-reported outcomes, pre-test GC significantly decreased worry, increased knowledge, and decreased perceived risk but did not significantly affect patient anxiety, depression, decisional conflict, satisfaction, or intent to pursue genetic testing. For health-services outcomes, pre-test GC increased correct genetic test ordering, reduced inappropriate services, increased spousal support for genetic testing, and expedited care delivery but did not consistently improve cancer prevention behaviors nor lead to accurate risk assessment. The GRADE certainty in the evidence was very low or low. No included studies elucidated GC effect on mortality, cascade testing, cost-effectiveness, care coordination, shared decision making, or patient time burden. CONCLUSION The true impact of GC on relevant outcomes is not known low quality or absent evidence. Although a meta-analysis found that pre-test GC had beneficial effects on knowledge, worry, and risk perception, the certainty of this evidence was low according to GRADE methodology. Further studies are needed to support the evidence-based application of GC in GCRA.
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Affiliation(s)
- Julie O Culver
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
| | | | - Raluca N Kurz
- Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Linda L Cheng
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA
| | | | | | | | | | - Ravi N Sharaf
- Division of Gastroenterology, Department of Medicine and Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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17
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Mir ZM, Fei LYN, McKeown S, Dinchong R, Cofie N, Dalgarno N, Rusnak A, Cheifetz RE, Merchant SJ. Knowledge, perceptions, attitudes, and barriers pertaining to genetic literacy among surgeons: a scoping review. Can J Surg 2024; 67:E118-E127. [PMID: 38503461 PMCID: PMC10959449 DOI: 10.1503/cjs.001523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The rapid evolution of genetic technologies and utilization of genetic information for clinical decision-making has necessitated increased surgeon participation in genetic counselling, testing, and appropriate referral of patients for genetic services, without formal training in genetics. We performed a scoping review to describe surgeons' knowledge, perceptions, attitudes, and barriers pertaining to genetic literacy in the management of patients who had confirmed cancer or who were potentially genetically at risk. METHODS We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews checklist. We performed a comprehensive literature search, and 2 reviewers independently screened studies for inclusion. These studies included surgeons involved in the care of patients with confirmed gastrointestinal, breast, and endocrine and neuroendocrine cancers, or patients who were potentially genetically at risk for these cancers. RESULTS We analyzed 17 studies, all of which used survey or interview-based formats. Many surgeons engaged in genetic counselling, testing, and referral, but reported low confidence and comfort in doing so. Knowledge assessments showed lower confidence in identifying genetic inheritance patterns and hereditary cancer syndromes, but awareness was higher among surgeons with greater clinical volume or subspecialty training in oncology. Surgeons felt responsible for facilitating these services and explicitly requested educational support in genetics. Barriers to genetic literacy were identified and catalogued at patient, surgeon, and system levels. CONCLUSION Surgeons frequently engage in genetics-related tasks despite a lack of formal genetics training, and often report low knowledge, comfort, and confidence in providing such services. We have identified several barriers to genetic literacy that can be used to develop interventions to enhance genetic literacy among surgeons.
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Affiliation(s)
- Zuhaib M Mir
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Linda Y N Fei
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Sandra McKeown
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Rachelle Dinchong
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Nicholas Cofie
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Nancy Dalgarno
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Alison Rusnak
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Rona E Cheifetz
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
| | - Shaila J Merchant
- From the Divisions of General Surgery and Surgical Oncology, Department of Surgery, Queen's University, Kingston, Ont. (Mir, Fei, Merchant); the Bracken Health Sciences Library, Queen's University, Kingston, Ont. (McKeown); the Division of Medical Genetics, Kingston Health Sciences Centre, Kingston, Ont. (Dinchong); the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ont. (Cofie, Dalgarno); the Inherited Cancer Program, Children's Hospital of Eastern Ontario, Ottawa, Ont. (Rusnak); the Department of Surgery, University of British Columbia, Vancouver, B.C. (Cheifetz)
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18
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Bilyalov A, Danishevich A, Nikolaev S, Vorobyov N, Abramov I, Pismennaya E, Terehova S, Kosilova Y, Primak A, Stanoevich U, Lisica T, Shipulin G, Gamayunov S, Kolesnikova E, Khatkov I, Gusev O, Bodunova N. Novel Pathogenic Variants in Hereditary Cancer Syndromes in a Highly Heterogeneous Cohort of Patients: Insights from Multigene Analysis. Cancers (Basel) 2023; 16:85. [PMID: 38201513 PMCID: PMC10778304 DOI: 10.3390/cancers16010085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Cancer is a major global public health challenge, affecting both quality of life and mortality. Recent advances in genetic research have uncovered hereditary cancer syndromes (HCS) that predispose individuals to malignant neoplasms. While traditional single-gene testing has focused on high-penetrance genes, the past decade has seen a shift toward multigene panels, which facilitate the analysis of multiple genes associated with specific HCS. This approach reveals variants in less-studied gene regions and improves our understanding of cancer predisposition. In a study composed of Russian patients with clinical signs of HCS, we used a multigene hereditary cancer panel and revealed 21.6% individuals with pathogenic or likely pathogenic genetic variants. BRCA1/BRCA2 mutations predominated, followed by the CHEK2 and ATM variants. Of note, 16 previously undescribed variants were identified in the MUTYH, GALNT12, MSH2, MLH1, MLH3, EPCAM, and POLE genes. The implications of the study extend to personalized cancer prevention and treatment strategies, especially in populations lacking extensive epidemiological data, such as Russia. Overall, our research provides valuable genetic insights that give the way for further investigation and advances in the understanding and management of hereditary cancer syndromes.
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Affiliation(s)
- Airat Bilyalov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
- SBHI Moscow Clinical Scientific Center Named after Loginov MHD, 111123 Moscow, Russia (I.K.)
| | - Anastasiia Danishevich
- SBHI Moscow Clinical Scientific Center Named after Loginov MHD, 111123 Moscow, Russia (I.K.)
| | - Sergey Nikolaev
- SBHI Moscow Clinical Scientific Center Named after Loginov MHD, 111123 Moscow, Russia (I.K.)
| | - Nikita Vorobyov
- SBHI Moscow Clinical Scientific Center Named after Loginov MHD, 111123 Moscow, Russia (I.K.)
| | - Ivan Abramov
- SBHI Moscow Clinical Scientific Center Named after Loginov MHD, 111123 Moscow, Russia (I.K.)
- The Federal State Budgetary Scientific Institution “Izmerov Research Institute of Occupational Health”, 105275 Moscow, Russia
| | | | - Svetlana Terehova
- Kursk Regional Scientific and Clinical Center Named after G. Y. Ostroverkhov, 305524 Kursk, Russia; (S.T.); (Y.K.); (A.P.)
| | - Yuliya Kosilova
- Kursk Regional Scientific and Clinical Center Named after G. Y. Ostroverkhov, 305524 Kursk, Russia; (S.T.); (Y.K.); (A.P.)
| | - Anastasiia Primak
- Kursk Regional Scientific and Clinical Center Named after G. Y. Ostroverkhov, 305524 Kursk, Russia; (S.T.); (Y.K.); (A.P.)
| | - Uglesha Stanoevich
- Kursk Regional Scientific and Clinical Center Named after G. Y. Ostroverkhov, 305524 Kursk, Russia; (S.T.); (Y.K.); (A.P.)
| | - Tatyana Lisica
- Centre for Strategic Planning and Management of Biomedical Health Risks, Federal Medical and Biological Agency, 119435 Moscow, Russia
| | - German Shipulin
- Centre for Strategic Planning and Management of Biomedical Health Risks, Federal Medical and Biological Agency, 119435 Moscow, Russia
| | - Sergey Gamayunov
- Nizhny Novgorod Regional Oncologic Hospital, 603163 Nizhny Novgorod, Russia
| | - Elena Kolesnikova
- Nizhny Novgorod Regional Oncologic Hospital, 603163 Nizhny Novgorod, Russia
| | - Igor Khatkov
- SBHI Moscow Clinical Scientific Center Named after Loginov MHD, 111123 Moscow, Russia (I.K.)
| | - Oleg Gusev
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
- Life Improvement by Future Technologies (LIFT) Center, 121205 Moscow, Russia
| | - Natalia Bodunova
- SBHI Moscow Clinical Scientific Center Named after Loginov MHD, 111123 Moscow, Russia (I.K.)
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19
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Kameyama H, Dondapati P, Simmons R, Leslie M, Langenheim JF, Sun Y, Yi M, Rottschaefer A, Pathak R, Nuguri S, Fung KM, Tsaih SW, Chervoneva I, Rui H, Tanaka T. Needle biopsy accelerates pro-metastatic changes and systemic dissemination in breast cancer: Implications for mortality by surgery delay. Cell Rep Med 2023; 4:101330. [PMID: 38118415 PMCID: PMC10772461 DOI: 10.1016/j.xcrm.2023.101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/14/2022] [Accepted: 11/17/2023] [Indexed: 12/22/2023]
Abstract
Increased breast cancer (BC) mortality risk posed by delayed surgical resection of tumor after diagnosis is a growing concern, yet the underlying mechanisms remain unknown. Our cohort analyses of early-stage BC patients reveal the emergence of a significantly rising mortality risk when the biopsy-to-surgery interval was extended beyond 53 days. Additionally, histology of post-biopsy tumors shows prolonged retention of a metastasis-permissive wound stroma dominated by M2-like macrophages capable of promoting cancer cell epithelial-to-mesenchymal transition and angiogenesis. We show that needle biopsy promotes systemic dissemination of cancer cells through a mechanism of sustained activation of the COX-2/PGE2/EP2 feedforward loop, which favors M2 polarization and its associated pro-metastatic changes but are abrogated by oral treatment with COX-2 or EP2 inhibitors in estrogen-receptor-positive (ER+) syngeneic mouse tumor models. Therefore, we conclude that needle biopsy of ER+ BC provokes progressive pro-metastatic changes, which may explain the mortality risk posed by surgery delay after diagnosis.
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Affiliation(s)
- Hiroyasu Kameyama
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - Priya Dondapati
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - Reese Simmons
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - Macall Leslie
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - John F Langenheim
- Department of Pharmacology, Physiology & Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 233 S 10th St., BLSB 1008, Philadelphia, PA 19107, USA
| | - Yunguang Sun
- Department of Pathology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Misung Yi
- Division of Biostatistics, Department of Pharmacology, Physiology & Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 233 S 10th St., BLSB 1008, Philadelphia, PA 19107, USA
| | - Aubrey Rottschaefer
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - Rashmi Pathak
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - Shreya Nuguri
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA
| | - Kar-Ming Fung
- Department of Pathology, School of Medicine, University of Oklahoma Health Sciences Center, 940 Stanton L Young Boulevard, Oklahoma City, OK 73104, USA
| | - Shirng-Wern Tsaih
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Inna Chervoneva
- Division of Biostatistics, Department of Pharmacology, Physiology & Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 233 S 10th St., BLSB 1008, Philadelphia, PA 19107, USA
| | - Hallgeir Rui
- Department of Pharmacology, Physiology & Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 233 S 10th St., BLSB 1008, Philadelphia, PA 19107, USA
| | - Takemi Tanaka
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 975 NE 10th St., Oklahoma City, OK 73104, USA; Department of Pathology, School of Medicine, University of Oklahoma Health Sciences Center, 940 Stanton L Young Boulevard, Oklahoma City, OK 73104, USA.
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20
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Kelly P, Mahon S, Friend P. When Germline Genetic Testing Results Are Unclear: Highlighting Variants of Uncertain Significance. J Adv Pract Oncol 2023; 14:631-638. [PMID: 38196669 PMCID: PMC10715289 DOI: 10.6004/jadpro.2023.14.7.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
With the advent of high-throughput next-generation sequencing (NGS) and multigene panel testing, genetic testing and interpretations have become increasingly complex. Specifically, reports demonstrating "variant of uncertain significance" (VUS) present interpretative challenges. Misinterpretation of a VUS may result in clinical harm, emotional distress for patients and family members, and potential health-care provider liability. The following article and deidentified case study illustrate how a lack of health-care provider and patient understanding of a germline VUS resulted in a negative patient outcome and unnecessary surgery.
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Affiliation(s)
| | | | - Patricia Friend
- Marcella Niehoff School of Nursing, Loyola University Chicago, Illinois
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21
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Al Eissa MM, Alotibi RS, Alhaddad B, Aloraini T, Samman MS, AlAsiri A, Abouelhoda M, AlQahtani AS. Reclassifying variations of unknown significance in diseases affecting Saudi Arabia's population reveal new associations. Front Genet 2023; 14:1250317. [PMID: 38028588 PMCID: PMC10646566 DOI: 10.3389/fgene.2023.1250317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction: Physicians face diagnostic dilemmas upon reports indicating disease variants of unknown significance (VUS). The most puzzling cases are patients with rare diseases, where finding another matched genotype and phenotype to associate their results is challenging. This study aims to prove the value of updating patient files with new classifications, potentially leading to better assessment and prevention. Methodology: We recruited retrospective phenotypic and genotypic data from King Saud Medical City, Riyadh, Kingdom of Saudi Arabia. Between September 2020 and December 2021, 1,080 patients' genetic profiles were tested in a College of American Pathologists accredited laboratory. We excluded all confirmed pathogenic variants, likely pathogenic variants and copy number variations. Finally, we further reclassified 194 VUS using different local and global databases, employing in silico prediction to justify the phenotype-genotype association. Results: Of the 194 VUS, 90 remained VUS, and the other 104 were reclassified as follows: 16 pathogenic, 49 likely pathogenic, nine benign, and 30 likely benign. Moreover, most of these variants had never been observed in other local or international databases. Conclusion: Reclassifying the VUS adds value to understanding the causality of the phenotype if it has been reported in another family or population. The healthcare system should establish guidelines for re-evaluating VUS, and upgrading VUS should reflect on individual/family risks and management strategies.
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Affiliation(s)
- Mariam M. Al Eissa
- Public Health Authority, Public Health Lab, Molecular Genetics Laboratory, Riyadh, Saudi Arabia
- Medical School, AlFaisal University, Riyadh, Saudi Arabia
| | - Raniah S. Alotibi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Bader Alhaddad
- Laboratory Medicine Department, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Molecular Genetics Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Taghrid Aloraini
- Division of Translational Pathology, Department of Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Department of Genetics, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, MNGHA, Riyadh, Saudi Arabia
| | - Manar S. Samman
- Department of Pathology and Clinical Laboratory Medicine Administration, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia
| | - Abdulrahman AlAsiri
- Medical Genomics Research Department, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Mohamed Abouelhoda
- Chairman Computational Science Department at King Faisal Specialised Hospital and Research Center, KFSHRC, Riyadh, Saudi Arabia
| | - Amerh S. AlQahtani
- Medical Genetics Department, King Saud Medical City, Riyadh, Saudi Arabia
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22
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Rodgers-Fouche L, Arora S, Ricker C, Li D, Farooqi M, Balaguer F, Dominguez-Valentin M, Guillem JG, Kanth P, Liska D, Melson J, Mraz KA, Shirts BH, Vilar E, Katona BW, Hodan R. Exploring Stakeholders' Perspectives on Implementing Universal Germline Testing for Colorectal Cancer: Findings From a Clinical Practice Survey. JCO Precis Oncol 2023; 7:e2300440. [PMID: 37897815 PMCID: PMC10860957 DOI: 10.1200/po.23.00440] [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: 08/13/2023] [Revised: 08/24/2023] [Accepted: 09/13/2023] [Indexed: 10/30/2023] Open
Abstract
PURPOSE New guidelines recommend considering germline genetic testing for all patients with colorectal cancer (CRC). However, there is a lack of data on stakeholders' perspectives on the advantages and barriers of implementing universal germline testing (UGT). This study assessed the perspectives of members of the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer (CGA-IGC) regarding the implementation of UGT for patients with CRC, including readiness, logistics, and barriers. METHODS A cross-sectional survey was sent to 317 active members of CGA-IGC. The survey included sections on demographics, clinical practice specialty, established institutional practices for testing, and questions pertaining to support of and barriers to implementing UGT for patients with CRC. RESULTS Eighty CGA-IGC members (25%) participated, including 42 genetic counselors (53%) and 14 gastroenterologists (18%). Forty-seven (59%) reported an academic medical center as their primary work setting, and most participants (56%) had more than 10 years of clinical practice. Although most participants (73%) supported UGT, 54% indicated that changes in practice would be required before adopting UGT, and 39% indicated that these changes would be challenging to implement. There was support for both genetics and nongenetics providers to order genetic testing, and a majority (57%) supported a standardized multigene panel rather than a customized gene panel. Key barriers to UGT implementation included limited genetics knowledge among nongenetics providers, time-consuming processes for obtaining consent, ordering tests, disclosing results, and lack of insurance coverage. CONCLUSION This study demonstrates wide support among hereditary GI cancer experts for implementation of UGT for patients with CRC. However, alternative service delivery models using nongenetics providers should be considered to address the logistical barriers to UGT implementation, particularly the growing demand for genetic testing.
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Affiliation(s)
| | - Sanjeevani Arora
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA
| | - Charité Ricker
- Division of Medical Oncology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Dan Li
- Department of Gastroenterology, Kaiser Permanente Medical Center, Santa Clara, CA
| | - Maheen Farooqi
- Division of Medical Oncology, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Mev Dominguez-Valentin
- Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, Oslo, Norway
| | - Jose G. Guillem
- Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Priyanka Kanth
- Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC
| | - David Liska
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Joshua Melson
- Division of Gastroenterology, University of Arizona Cancer Center, Tucson, AZ
| | | | - Brian H. Shirts
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Eduardo Vilar
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bryson W. Katona
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Rachel Hodan
- Cancer Genetics, Stanford Health Care, Palo Alto, CA
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23
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Clayton EW, Tritell AM, Thorogood AM. Avoiding Liability and Other Legal Land Mines in the Evolving Genomics Landscape. Annu Rev Genomics Hum Genet 2023; 24:333-346. [PMID: 36630592 DOI: 10.1146/annurev-genom-100722-021725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This article reviews evolving legal implications for clinicians and researchers as genomics is used more widely in both the clinic and in translational research, reflecting rapid changes in scientific knowledge as well as the surrounding cultural and political environment. Professionals will face new and changing duties to make or act upon a genetic diagnosis, address direct-to-consumer genetic testing in patient care, consider the health implications of results for patients' family members, and recontact patients when test results change over time. Professional duties in reproductive genetic testing will need to be recalibrated in response to disruptive changes to reproductive rights in the United States. We also review the debate over who controls the flow of genetic information and who is responsible for its protection, considering the globally influential European Union General Data Protection Regulation and the rapidly evolving data privacy law landscape of the United States.
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Affiliation(s)
- Ellen Wright Clayton
- Department of Pediatrics and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
- School of Law, Vanderbilt University, Nashville, Tennessee, USA;
| | - Alex M Tritell
- School of Law, Vanderbilt University, Nashville, Tennessee, USA;
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24
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West HJ, Lovly CM. Ferrying Oncologists Across the Chasm of Interpreting Biomarker Testing Reports: Systematic Support Needed to Improve Care and Decrease Disparities. JCO Oncol Pract 2023; 19:530-532. [PMID: 36977283 DOI: 10.1200/op.23.00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Affiliation(s)
| | - Christine M Lovly
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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25
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Bilyalov A, Nikolaev S, Danishevich A, Khatkov I, Makhmudov K, Isakova Z, Bakirov N, Omurbaev E, Osipova A, Ramaldanov R, Shagimardanova E, Kiyasov A, Gusev O, Bodunova N. The Spectrum of Germline Nucleotide Variants in Gastric Cancer Patients in the Kyrgyz Republic. Curr Issues Mol Biol 2023; 45:6383-6394. [PMID: 37623222 PMCID: PMC10453583 DOI: 10.3390/cimb45080403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/11/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023] Open
Abstract
Gastric cancer is a major challenge in modern oncology due to its high detection rate and prevalence. While sporadic cases make up the majority of gastric cancer, hereditary gastric cancer is caused by germline mutations in several genes linked to different syndromes. Thus, identifying hereditary forms of gastric cancer is considered crucial globally. A survey study using NGS-based analysis was conducted to determine the frequency of different types of hereditary gastric cancer in the yet-unstudied Kyrgyz population. The study cohort included 113 patients with diagnosed gastric cancer from Kyrgyzstan. The age of patients was 57.6 ± 8.9. Next-generation sequencing analysis of genomic DNA was performed using a custom Roche NimbleGen enrichment panel. The results showed that 6.2% (7/113) of the patients had pathogenic or likely pathogenic genetic variants. Additionally, 3.5% (4/113) of the patients carried heterozygous pathogenic/likely pathogenic variants in high penetrance genes, such as TP53, POLD1, RET, and BRCA2. Moreover, 2.7% (3/113) of the patients carried heterozygous mutations in genes linked to autosomal recessive conditions, specifically PALB2, FANCA, and FANCD2. We have not identified any genetic variants in hereditary GC-associated genes: CDH1, STK11, SMAD4, BMPRIA, APC, MLH1, and others. Our study included patients with sporadic features of GC. The use of recognized criteria (NCCN, Gastric Cancer, Version 2.2022) would increase the number of identified genetic variants in hereditary GC-associated genes. Further research is required to determine the clinical relevance of the genetic variants identified in the current study.
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Affiliation(s)
- Airat Bilyalov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (K.M.); (E.S.); (A.K.); (O.G.)
- SBHI Moscow Clinical Scientific Center Named after Loginov MHD, 111123 Moscow, Russia; (S.N.); (A.D.); (I.K.); (A.O.); (N.B.)
| | - Sergey Nikolaev
- SBHI Moscow Clinical Scientific Center Named after Loginov MHD, 111123 Moscow, Russia; (S.N.); (A.D.); (I.K.); (A.O.); (N.B.)
| | - Anastasiia Danishevich
- SBHI Moscow Clinical Scientific Center Named after Loginov MHD, 111123 Moscow, Russia; (S.N.); (A.D.); (I.K.); (A.O.); (N.B.)
| | - Igor Khatkov
- SBHI Moscow Clinical Scientific Center Named after Loginov MHD, 111123 Moscow, Russia; (S.N.); (A.D.); (I.K.); (A.O.); (N.B.)
| | - Komron Makhmudov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (K.M.); (E.S.); (A.K.); (O.G.)
| | - Zhainagul Isakova
- Research Institute of Molecular Biology and Medicine, Bishkek 720005, Kyrgyzstan;
| | - Nurbek Bakirov
- National Center of Oncology and Hematology of the Ministry of Health of the Kyrgyz Republic, Bishkek 720055, Kyrgyzstan; (N.B.); (E.O.); (R.R.)
| | - Ernis Omurbaev
- National Center of Oncology and Hematology of the Ministry of Health of the Kyrgyz Republic, Bishkek 720055, Kyrgyzstan; (N.B.); (E.O.); (R.R.)
| | - Alena Osipova
- SBHI Moscow Clinical Scientific Center Named after Loginov MHD, 111123 Moscow, Russia; (S.N.); (A.D.); (I.K.); (A.O.); (N.B.)
- Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Ramaldan Ramaldanov
- National Center of Oncology and Hematology of the Ministry of Health of the Kyrgyz Republic, Bishkek 720055, Kyrgyzstan; (N.B.); (E.O.); (R.R.)
| | - Elena Shagimardanova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (K.M.); (E.S.); (A.K.); (O.G.)
| | - Andrey Kiyasov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (K.M.); (E.S.); (A.K.); (O.G.)
| | - Oleg Gusev
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (K.M.); (E.S.); (A.K.); (O.G.)
- Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
- Endocrinology Research Centre, 117036 Moscow, Russia
| | - Natalia Bodunova
- SBHI Moscow Clinical Scientific Center Named after Loginov MHD, 111123 Moscow, Russia; (S.N.); (A.D.); (I.K.); (A.O.); (N.B.)
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26
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Kurian AW, Abrahamse P, Furgal A, Ward KC, Hamilton AS, Hodan R, Tocco R, Liu L, Berek JS, Hoang L, Yussuf A, Susswein L, Esplin ED, Slavin TP, Gomez SL, Hofer TP, Katz SJ. Germline Genetic Testing After Cancer Diagnosis. JAMA 2023; 330:43-51. [PMID: 37276540 PMCID: PMC10242510 DOI: 10.1001/jama.2023.9526] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023]
Abstract
Importance Germline genetic testing is recommended by practice guidelines for patients diagnosed with cancer to enable genetically targeted treatment and identify relatives who may benefit from personalized cancer screening and prevention. Objective To describe the prevalence of germline genetic testing among patients diagnosed with cancer in California and Georgia between 2013 and 2019. Design, Setting, and Participants Observational study including patients aged 20 years or older who had been diagnosed with any type of cancer between January 1, 2013, and March 31, 2019, that was reported to statewide Surveillance, Epidemiology, and End Results registries in California and Georgia. These patients were linked to genetic testing results from 4 laboratories that performed most germline testing for California and Georgia. Main Outcomes and Measures The primary outcome was germline genetic testing within 2 years of a cancer diagnosis. Testing trends were analyzed with logistic regression modeling. The results of sequencing each gene, including variants associated with increased cancer risk (pathogenic results) and variants whose cancer risk association was unknown (uncertain results), were evaluated. The genes were categorized according to their primary cancer association, including breast or ovarian, gastrointestinal, and other, and whether practice guidelines recommended germline testing. Results Among 1 369 602 patients diagnosed with cancer between 2013 and 2019 in California and Georgia, 93 052 (6.8%) underwent germline testing through March 31, 2021. The proportion of patients tested varied by cancer type: male breast (50%), ovarian (38.6%), female breast (26%), multiple (7.5%), endometrial (6.4%), pancreatic (5.6%), colorectal (5.6%), prostate (1.1%), and lung (0.3%). In a logistic regression model, compared with the 31% (95% CI, 30%-31%) of non-Hispanic White patients with male breast cancer, female breast cancer, or ovarian cancer who underwent testing, patients of other races and ethnicities underwent testing less often: 22% (95% CI, 21%-22%) of Asian patients, 25% (95% CI, 24%-25%) of Black patients, and 23% (95% CI, 23%-23%) of Hispanic patients (P < .001 using the χ2 test). Of all pathogenic results, 67.5% to 94.9% of variants were identified in genes for which practice guidelines recommend testing and 68.3% to 83.8% of variants were identified in genes associated with the diagnosed cancer type. Conclusions and Relevance Among patients diagnosed with cancer in California and Georgia between 2013 and 2019, only 6.8% underwent germline genetic testing. Compared with non-Hispanic White patients, rates of testing were lower among Asian, Black, and Hispanic patients.
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Affiliation(s)
- Allison W. Kurian
- Department of Medicine, School of Medicine, Stanford University, Stanford, California
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California
| | - Paul Abrahamse
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Allison Furgal
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Kevin C. Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ann S. Hamilton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Rachel Hodan
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Rachel Tocco
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Lihua Liu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Jonathan S. Berek
- Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, California
| | | | | | | | | | | | - Scarlett L. Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - Timothy P. Hofer
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Steven J. Katz
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
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27
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Zukin E, Culver JO, Liu Y, Yang Y, Ricker CN, Hodan R, Sturgeon D, Kingham K, Chun NM, Rowe-Teeter C, Singh K, Zell JA, Ladabaum U, McDonnell KJ, Ford JM, Parmigiani G, Braun D, Kurian AW, Gruber SB, Idos GE. Clinical implications of conflicting variant interpretations in the cancer genetics clinic. Genet Med 2023; 25:100837. [PMID: 37057674 PMCID: PMC10416421 DOI: 10.1016/j.gim.2023.100837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE The aim of this study was to describe the clinical impact of commercial laboratories issuing conflicting classifications of genetic variants. METHODS Results from 2000 patients undergoing a multigene hereditary cancer panel by a single laboratory were analyzed. Clinically significant discrepancies between the laboratory-provided test reports and other major commercial laboratories were identified, including differences between pathogenic/likely pathogenic and variant of uncertain significance (VUS) classifications, via review of ClinVar archives. For patients carrying a VUS, clinical documentation was assessed for evidence of provider awareness of the conflict. RESULTS Fifty of 975 (5.1%) patients with non-negative results carried a variant with a clinically significant conflict, 19 with a pathogenic/likely pathogenic variant reported in APC or MUTYH, and 31 with a VUS reported in CDKN2A, CHEK2, MLH1, MSH2, MUTYH, RAD51C, or TP53. Only 10 of 28 (36%) patients with a VUS with a clinically significant conflict had a documented discussion by a provider about the conflict. Discrepant counseling strategies were used for different patients with the same variant. Among patients with a CDKN2A variant or a monoallelic MUTYH variant, providers were significantly more likely to make recommendations based on the laboratory-reported classification. CONCLUSION Our findings highlight the frequency of variant interpretation discrepancies and importance of clinician awareness. Guidance is needed on managing patients with discrepant variants to support accurate risk assessment.
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Affiliation(s)
- Elyssa Zukin
- City of Hope National Medical Center, Center for Precision Medicine, Duarte, CA; University of California, Irvine, Irvine, CA
| | - Julie O Culver
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Yuxi Liu
- Dana-Farber Cancer Institute, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yunqi Yang
- Dana-Farber Cancer Institute, Boston, MA
| | - Charité N Ricker
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Rachel Hodan
- Stanford University School of Medicine, Stanford, CA
| | - Duveen Sturgeon
- City of Hope National Medical Center, Center for Precision Medicine, Duarte, CA
| | - Kerry Kingham
- Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | - Uri Ladabaum
- Stanford University School of Medicine, Stanford, CA
| | - Kevin J McDonnell
- City of Hope National Medical Center, Center for Precision Medicine, Duarte, CA
| | - James M Ford
- Stanford University School of Medicine, Stanford, CA
| | - Giovanni Parmigiani
- Dana-Farber Cancer Institute, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA
| | - Danielle Braun
- Dana-Farber Cancer Institute, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Stephen B Gruber
- City of Hope National Medical Center, Center for Precision Medicine, Duarte, CA
| | - Gregory E Idos
- City of Hope National Medical Center, Center for Precision Medicine, Duarte, CA.
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28
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Crown A, Fazeli S, Kurian AW, Ochoa DA, Joseph KA. Disparity in Breast Cancer Care: Current State of Access to Screening, Genetic Testing, Oncofertility, and Reconstruction. J Am Coll Surg 2023; 236:1233-1239. [PMID: 36971366 DOI: 10.1097/xcs.0000000000000647] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Breast cancer is the most common cancer diagnosed in women, accounting for an estimated 30% of all new cancer diagnoses in women in 2022. Advances in breast cancer treatment have reduced the mortality rate over the past 25 years by up to 34% but not all groups have benefitted equally from these improvements. These disparities span the continuum of care from screening to the receipt of guideline-concordant therapy and survivorship. At the 2022 American College of Surgeons Clinical Congress, a panel session was dedicated to educating and discussing methods of addressing these disparities in a coordinated manner. While there are multilevel solutions to address these disparities, this article focuses on screening, genetic testing, reconstruction, and oncofertility.
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Affiliation(s)
- Angelena Crown
- From the True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA (Crown)
| | | | - Allison W Kurian
- Division of Oncology, Population Sciences Program, Stanford Cancer Institute, Stanford, CA (Kurian)
- Women's Clinical Cancer Genetics Program, Stanford University School of Medicine, Stanford, CA (Kurian)
| | - Daniela A Ochoa
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Science, Little Rock, AR (Ochoa)
| | - Kathie-Ann Joseph
- Department of Surgery, NYU Grossman School of Medicine, New York, NY (Joseph)
- NYU Langone Health Institute for Excellence in Health Equity, New York, NY (Joseph)
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29
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Al-Sukhun S, Masannat Y, Wegman-Ostrosky T, Shrikhande SV, Manirakiza A, Fadelu T, Rebbeck TR. Germline Testing Around the Globe: Challenges in Different Practice Settings. Am Soc Clin Oncol Educ Book 2023; 43:e390522. [PMID: 37220318 DOI: 10.1200/edbk_390522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Cancer is an increasing global public health burden. Lately, more emphasis has emerged on the importance of heredity in cancer, mostly driven by the introduction of germline genetic variants-directed therapeutics. It is true that 40% of cancer risk is attributed to modifiable environmental and lifestyle factors; still, 16% of cancers could be heritable, accounting for 2.9 of the 18.1 million cases diagnosed worldwide. At least two third of those will be diagnosed in countries with limited resources-low- and middle-income countries, especially where high rates of consanguine marriage and early age at diagnosis are already prevalent. Both are hallmarks of hereditary cancer. This creates a new opportunity for prevention, early detection, and recently therapeutic intervention. However, this opportunity is challenged by many obstacles along the path to addressing germline testing in patients with cancer in the clinic worldwide. Global collaboration and expertise exchange are important to bridge the knowledge gap and facilitate practical implementation. Adapting existing guidelines and prioritization according to local resources are essential to address the unique needs and overcome the unique barriers of each society.
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Affiliation(s)
| | - Yazan Masannat
- Aberdeen Royal Infirmary, Scotland, United Kingdom
- The University of Aberdeen, Scotland, United Kingdom
| | | | | | | | - Temidayo Fadelu
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA
| | - Timothy R Rebbeck
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA
- Harvard TH Chan School of Public Health, Boston, MA
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30
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Wong SM, Foulkes WD. Moving breast cancer susceptibility gene testing into the mainstream. Med J Aust 2023; 218:359-360. [PMID: 37015678 DOI: 10.5694/mja2.51916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Stephanie M Wong
- McGill University, Montreal, QC, Canada
- Stroll Cancer Prevention Centre, Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - William D Foulkes
- McGill University, Montreal, QC, Canada
- Stroll Cancer Prevention Centre, Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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31
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Kuo WL, Lin PH, Peng MT, Chu CH, Cho CW. Patients' attitudes regarding genetic counseling before germline BRCA1/2 pathogenic variants testing in Taiwan: A single-country, multi-center, patient-reported outcome study. J Genet Couns 2023. [PMID: 36872635 DOI: 10.1002/jgc4.1688] [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: 10/26/2021] [Revised: 01/15/2023] [Accepted: 01/21/2023] [Indexed: 03/07/2023]
Abstract
Germline pathogenic variants of BRCA1 or BRCA2 cause hereditary breast and ovarian cancer syndromes. The present study investigated the participants' understanding and awareness of germline BRCA1/2 pathogenic variants before genetic counseling, the expectations and obstacles for genetic testing from the perspective of participants and their families, and their attitudes towards genetic testing after counseling. In this single-country, multicenter, non-interventional, patient-reported outcome study, untested cancer patients and their families who visited genetic counseling clinics or who wanted to receive pre-test genetic counseling were eligible to fill in the questionnaire after pre-test counseling for germline BRCA1/2 testing. Demographic information, clinical characteristics, and information collected from the questionnaires, including the understanding of BRCA1/2 pathogenic variants before genetic counseling, understanding of BRCA1/2 pathogenic variants and feelings after genetic counseling, willingness to share results of genetic testing with family, and willingness to receive genetic testing, were summarized using descriptive statistics. A total of 88 participants were enrolled. The proportion of slight understanding of BRCA1/2 pathogenic variants increased from 11.4% to 67.0%, and the proportion of full understanding increased from 0% to 8.0%. After genetic counseling, most participants were willing to undergo genetic testing (87.5%) and share the results with their families (96.6%). The main factors that may affect participants' willingness to undergo BRCA1/2 testing were management (61.2%) and testing costs (25.9%). After pre-test counseling, there was a high acceptance of BRCA1/2 testing and in-family information sharing in Taiwanese patients with cancer and their families, which may serve as a reference for implementing genetic counseling in Taiwan.
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Affiliation(s)
- Wen-Ling Kuo
- Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.,Chang Gung University, Taoyuan, Taiwan.,School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Po-Han Lin
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan.,Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meng-Ting Peng
- Chang Gung University, Taoyuan, Taiwan.,Division of Haematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chia-Hui Chu
- Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.,Chang Gung University, Taoyuan, Taiwan
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Bokkers K, Bleiker EMA, Aalfs CM, van Dalen T, Velthuizen ME, Duijveman P, Sijmons RH, Koole W, Schoenmaeckers EJP, Ausems MGEM. Surgical Oncologists and Nurses in Breast Cancer Care are Ready to Provide Pre-Test Genetic Counseling. Ann Surg Oncol 2023; 30:3248-3258. [PMID: 36853565 PMCID: PMC10175452 DOI: 10.1245/s10434-023-13229-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/24/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Pre-test genetic counseling for patients with breast cancer is increasingly being provided by nongenetic healthcare professionals. We evaluated the attitudes, knowledge, and self-efficacy of surgeons, oncologists, and nurses regarding mainstream genetic testing and the feasibility to incorporate pre-test genetic counseling into routine care. METHODS We offered an online training to healthcare professionals from 13 hospitals and implemented a mainstream genetic testing pathway in 11/13 (85%) hospitals. Questionnaires were sent before (T0) and 6 months after (T1) completing the training. Those who did not complete the training received a questionnaire to assess their motivations. RESULTS In 11 hospitals, 80 (65%) healthcare professionals completed the training, of whom 70 (88%) completed both questionnaires. The attitudes, (perceived) knowledge and self-efficacy of healthcare professionals were high both at baseline and 6 months after completing the training. After 6 months, their perceived knowledge about the advantages and disadvantages of a genetic test and implications for family members had significantly improved (p = 0.012 and p = 0.021, respectively). For the majority (89%), the time investment for pre-test genetic counseling was less than 15 min per patient and as expected or better. Healthcare professionals considered the total time investment feasible to incorporate mainstream genetic testing into their daily practice. The main barrier to complete the training was lack of time. The online training was considered useful, with a rating of 8/10. CONCLUSION Surgical oncologists and nurses in breast cancer care feel well-equipped and motivated to provide pre-test genetic counseling after completion of an online training module.
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Affiliation(s)
- K Bokkers
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E M A Bleiker
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - C M Aalfs
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T van Dalen
- Department of surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - M E Velthuizen
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Duijveman
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - R H Sijmons
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Koole
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - M G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.
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Chang EY, Solomon I, Culver JO, Gorman N, Comeaux JG, Lerman C, Quinn EA, Ekstein T. Clinical and laboratory genetic counselor attitudes on the reporting of variants of uncertain significance for multigene cancer panels. J Genet Couns 2023. [PMID: 36747331 DOI: 10.1002/jgc4.1680] [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: 01/26/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 02/08/2023]
Abstract
Research suggests variants of uncertain significance (VUSs) present a variety of challenges for genetic counselors (GCs), nongenetics clinicians, and patients. Multigene cancer panels reveal more VUSs than single gene testing as a result of the increase in the number of genes being tested. This study surveyed 87 clinical cancer GCs involved with direct patient care and 19 laboratory GCs who provide guidance to clinicians regarding genetic test results about their attitudes on various options for the reporting of VUSs by laboratories for broad multigene cancer panels. Independent samples t-tests were utilized to compare the two groups. Based on a six-point Likert-type scale (1 = Strongly Disagree to 6 = Strongly Agree), clinical cancer GCs (M = 5.4; SD = 0.8) and laboratory GCs (M = 5.2; SD = 0.9) agreed overall that VUSs should be reported (p = 0.44; Cohen's d = 0.21). When asked about specific reporting options, both clinical cancer GCs (M = 1.9; SD = 1.1) and laboratory GCs (M = 2.1; SD = 1.4) disagreed that VUSs should be reported only for genes related to the indication for testing (p = 0.50; Cohen's d = 0.17). Overall, most GCs felt clinicians should not choose whether VUSs should be reported on genetic test results, with clinical cancer GCs (M = 1.9; SD = 1.3) feeling more strongly against it than laboratory GCs (M = 3.1; SD = 1.4; p = 0.002; Cohen's d = 0.88). Generally, GCs were more in favor of VUSs not being reported for population-based screening, with laboratory GCs (M = 4.7; SD = 0.8) agreeing more with that practice than clinical cancer GCs (M = 3.7; SD = 1.4; p = 0.001; Cohen's d = 0.80). Both clinical cancer GCs (M = 4.1; SD = 1.2) and laboratory GCs (M = 3.9; SD = 1.2) agreed additional guidelines on how to approach VUSs in clinical practice should be developed (p = 0.54; Cohen's d = 0.17). While most GCs supported the reporting of VUSs overall, our analyses suggest clinical cancer and laboratory GCs may have different attitudes toward specific VUS-related reporting options. Further research is needed to elucidate GC preferences to help inform best practices for the reporting of VUSs. The development of additional standardized guidelines on how to approach VUSs would further support clinical practice.
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Affiliation(s)
- Emmeline Y Chang
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA.,Department of Human Genetics and Genetic Counseling, Keck Graduate Institute, Claremont, California, USA
| | - Ilana Solomon
- Center for Precision Medicine, City of Hope, Duarte, California, USA
| | - Julie O Culver
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Nicholas Gorman
- Department of Human Genetics and Genetic Counseling, Keck Graduate Institute, Claremont, California, USA
| | - Jacob G Comeaux
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Caryn Lerman
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Emily A Quinn
- Department of Human Genetics and Genetic Counseling, Keck Graduate Institute, Claremont, California, USA
| | - Tali Ekstein
- Clinical Consultation Services, Invitae, San Francisco, California, USA
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Makhnoon S, Levin B, Ensinger M, Mattie K, Volk RJ, Zhao Z, Mendoza T, Shete S, Samiian L, Grana G, Grainger A, Arun B, Shirts BH, Peterson SK. A multicenter study of clinical impact of variant of uncertain significance reclassification in breast, ovarian and colorectal cancer susceptibility genes. Cancer Med 2023; 12:2875-2884. [PMID: 36426404 PMCID: PMC9939195 DOI: 10.1002/cam4.5202] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/30/2022] [Accepted: 08/23/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Clinical interpretation of genetic test results is complicated by variants of uncertain significance (VUS) that have an unknown impact on health but can be clarified through reclassification. There is little empirical evidence regarding VUS reclassification in oncology care settings, including the prevalence and outcomes of reclassification, and racial/ethnic differences. METHODS This was a retrospective analysis of persons with and without a personal history of cancer carrying VUS (with or without an accompanying pathogenic or likely pathogenic [P/LP] variant) in breast, ovarian, and colorectal cancer predisposition genes seen at four cancer care settings (in Texas, Florida, Ohio, and New Jersey) between 2013 and 2019. RESULTS In 2715 individuals included in the study, 3261 VUS and 313 P/LP variants were reported; 8.1% of all individuals with VUS experienced reclassifications and rates varied significantly among cancer care settings from 4.81% to 20.19% (overall p < 0.001). Compared to their prevalence in the overall sample, reclassification rates for Black individuals were higher (13.6% vs. 19.0%), whereas the rates for Asian individuals were lower (6.3% vs. 3.5%) and rates for White and Hispanic individuals were proportional. Two-year prevalence of VUS reclassification remained steady between 2014 and 2019. Overall, 11.3% of all reclassified VUS resulted in clinically actionable findings and 4.6% subsequently changed individuals' clinical managements. CONCLUSIONS The findings from this large multisite study suggest that VUS reclassification alters clinical management, has implications for precision cancer prevention, and highlights the need for implementing practices and solutions for efficiently returning reinterpreted genetic test results.
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Affiliation(s)
- Sukh Makhnoon
- Department of Behavioral ScienceUT MD Anderson Cancer CenterHoustonTexasUSA
| | - Brooke Levin
- William G. Rohrer Cancer Genetics Program, Division of Hematology and Medical OncologyMD Anderson Cancer Center at Cooper University Health CareCamdenNew JerseyUSA
| | | | - Kristin Mattie
- William G. Rohrer Cancer Genetics Program, Division of Hematology and Medical OncologyMD Anderson Cancer Center at Cooper University Health CareCamdenNew JerseyUSA
| | - Robert J. Volk
- Department of Health Services ResearchUT MD Anderson Cancer CenterHoustonTexasUSA
| | - Zhongming Zhao
- Center for Precision Health, School of Biomedical InformaticsThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Tito Mendoza
- Department of Symptoms researchUT MD Anderson Cancer CenterHoustonTexasUSA
| | - Sanjay Shete
- Division of Cancer Prevention and Population SciencesUT MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Generosa Grana
- William G. Rohrer Cancer Genetics Program, Division of Hematology and Medical OncologyMD Anderson Cancer Center at Cooper University Health CareCamdenNew JerseyUSA
| | | | - Banu Arun
- Clinical Cancer GeneticsUT MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Susan K. Peterson
- Department of Behavioral ScienceUT MD Anderson Cancer CenterHoustonTexasUSA
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Culver JO, Freiberg Y, Ricker C, Comeaux JG, Chang EY, Banerjee V, Sturgeon D, Solomon I, Kagey J, Dobre MG, Carey J, Carr A, Cho S, Lu J, Kang IM, Patel K, Terando A, Ye JC, Li M, Lerman C, Spicer D, Nelson M. Integration of Universal Germline Genetic Testing for All New Breast Cancer Patients. Ann Surg Oncol 2023; 30:1017-1025. [PMID: 36161375 PMCID: PMC9512964 DOI: 10.1245/s10434-022-12595-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/09/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The American Society of Breast Surgeons recommends genetic testing (GT) for all women with breast cancer (BC), but implementation and uptake of GT has not been well-described. METHODS A retrospective chart review was performed for newly diagnosed BC patients or patients with a newly identified recurrence of BC seen in a multidisciplinary clinic (MDBC) who were offered genetic counseling (GC) and GT. RESULTS The 138 women attending the MDBC had a median age of 54 years and comprised non-Hispanic whites (46%), Asians (28%), Hispanics (17%), blacks (4%), and other (5%). Of the 105 (76%) patients without prior GT, 100 (95%) accepted GC, with 93 (93%) of these 100 patients undergoing GT. The patients meeting the National Comprehensive Cancer Network (NCCN) guidelines for GT were more likely to undergo GT. Testing was performed with a 67- to 84-gene panel, together with an 8- to 9-gene STAT panel if needed. Among 120 patients with reports available, including 33 patients previously tested, 15 (12%) were positive (1 BLM, 1 BRCA1, 3 BRCA2, 1 BRIP1, 1 CFTR, 1 CHEK2, 1 MUTYH, 1 PALB2, 1 PRSS1, 1 RAD50, 1 RET, and 2 TP53), 44 (37%) were negative, and 61 (51%) had an uncertain variant. The median time to STAT results (n = 50) was 8 days. The STAT results were available before surgery for 47 (98%) of the 48 STAT patients undergoing surgery. CONCLUSIONS New BC patients attending the MDBC demonstrated high rates of acceptance of GC and GT. The combination of GC and GT can offer timely information critical to patient risk assessment and treatment planning.
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Affiliation(s)
- Julie O Culver
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Yael Freiberg
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Charité Ricker
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jacob G Comeaux
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Emmeline Y Chang
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Victoria Banerjee
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Duveen Sturgeon
- Center for Precision Medicine, City of Hope, Duarte, CA, USA
| | - Ilana Solomon
- Center for Precision Medicine, City of Hope, Duarte, CA, USA
| | - Josie Kagey
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mariana G Dobre
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joseph Carey
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Azadeh Carr
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stephanie Cho
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Janice Lu
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Irene M Kang
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ketan Patel
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alicia Terando
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jason C Ye
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ming Li
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Caryn Lerman
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Darcy Spicer
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Maria Nelson
- USC Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Wilkerson AD, Obi M, Ortega C, Sebikali-Potts A, Wei W, Pederson HJ, Al-Hilli Z. Young Black Women May be More Likely to Have First Mammogram Cancers: A New Perspective in Breast Cancer Disparities. Ann Surg Oncol 2023; 30:2856-2869. [PMID: 36602665 DOI: 10.1245/s10434-022-12995-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/10/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Black women are diagnosed with breast cancer at earlier ages and are 42% more likely to die from the disease than White women. Recommendations for commencement of screening mammography remain discordant. This study sought to determine the frequency of first mammogram cancers among Black women versus other self-reported racial groups. METHODS In this retrospective cohort study, clinical and mammographic data were obtained from 738 women aged 40-45 years who underwent treatment for breast cancer between 2010 and 2019 within a single hospital system. First mammogram cancers were defined as those with tissue diagnoses within 3 months of baseline mammogram. Multivariate logistic regression was applied to assess variables associated with first mammogram cancer detection. RESULTS Black women were significantly more likely to have first mammogram cancer diagnoses (39/82, 47.6%) compared with White women (162/610, 26.6%) and other groups (16/46, 34.8%) [p < 0.001]. Black women were also more likely to have a body mass index > 30 (p < 0.001), higher clinical T categories (p = 0.02), and present with more advanced clinical stages (p = 0.03). Every month delay in mammographic screening beyond age 40 years (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.05-1.07; p < 0.0001), Black race (OR 2.24, 95% CI 1.10-4.53; p = 0.03), and lack of private insurance (OR 2.41, 95% CI 1.22-4.73; p = 0.01) were associated with an increased likelihood of cancer detection on first mammogram. CONCLUSION Our findings suggests that Black women aged 40-45 years may be more likely to have cancer detected on their first mammogram and would benefit from starting screening mammography no later than age 40 years, and for those with elevated lifetime risk, even sooner.
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Affiliation(s)
- Avia D Wilkerson
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Megan Obi
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Camila Ortega
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Wei Wei
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Holly J Pederson
- Department of Breast Services, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Zahraa Al-Hilli
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA. .,Department of Breast Services, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Villavicencio EA, Maldonado A, Crocker RM, Guan Y, Stallman C, Garcia DO. Communicating PNPLA3 genetic risk status for NAFLD among Mexican-origin men. Front Public Health 2023; 10:1090101. [PMID: 36684893 PMCID: PMC9846364 DOI: 10.3389/fpubh.2022.1090101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction The burden of non-alcoholic fatty liver disease (NAFLD) continues to disproportionately impact under-resourced communities in the U.S., particularly Mexican-origin populations. Genetic polymorphisms such as the rs738409 C/G variant in patatin-like phospholipase domain-containing 3 (PNPLA3) have been associated with higher prevalence of and progression along the NAFLD spectrum. This qualitative study conducted in the U.S. Southwest aimed to assess Mexican-origin men's experience receiving genetic testing for PNPLA3 risk carrier status. Methods Semi-structured interviews were conducted with 17 Mexican-origin men whose NAFLD status and genetic predisposition were determined as part of a previous cross-sectional study. The interview guide included questions exploring participants' insights on how genetic risk status was delivered, how the information influenced their motivation for lifestyle modification to reduce NAFLD risk, and any knowledge sharing that occurred with family members after learning of their PNPLA3 risk status. Interviews were conducted and audio recorded in English (n = 6) and Spanish (n = 11) and uploaded into NVivo software for data analysis and interpretation. Guided by the Health Belief Model, a thematic analysis approach was used to identify primary themes. Results Results highlighted men's preference for receiving this type of genetic risk information through a letter sent to their homes. General comprehension of PNPLA3 risk status was deemed high and most men stated sharing their genetic predisposition to NAFLD with their immediate family members. Participants also indicated that family and awareness of this genetic risk acted as primary motivators for implementing behavior changes (e.g., diet, physical activity) toward the prevention of more severe liver conditions. Discussion Findings from this qualitative study suggest the feasibility of communicating genetic risk for NAFLD among Mexican-origin men. Future strategies for the dissemination of genetic risk results among Mexican-origin individuals should consider familial and cultural appropriate strategies.
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Affiliation(s)
- Edgar A. Villavicencio
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Adriana Maldonado
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Rebecca M. Crocker
- Center for Border Health Disparities, Health Sciences, University of Arizona, Tucson, AZ, United States
| | - Yue Guan
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Chris Stallman
- Genetic Counseling Graduate Program, University of Arizona, Tucson, AZ, United States
| | - David O. Garcia
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Zhao Y, Brush M, Wang C, Wagner AH, Liu H, Freimuth RR. Leveraging a pharmacogenomics knowledgebase to formulate a drug response phenotype terminology for genomic medicine. Bioinformatics 2022; 38:5279-5287. [PMID: 36222570 PMCID: PMC9710557 DOI: 10.1093/bioinformatics/btac646] [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: 07/13/2021] [Revised: 05/31/2022] [Indexed: 12/24/2022] Open
Abstract
MOTIVATION Despite the increasing evidence of utility of genomic medicine in clinical practice, systematically integrating genomic medicine information and knowledge into clinical systems with a high-level of consistency, scalability and computability remains challenging. A comprehensive terminology is required for relevant concepts and the associated knowledge model for representing relationships. In this study, we leveraged PharmGKB, a comprehensive pharmacogenomics (PGx) knowledgebase, to formulate a terminology for drug response phenotypes that can represent relationships between genetic variants and treatments. We evaluated coverage of the terminology through manual review of a randomly selected subset of 200 sentences extracted from genetic reports that contained concepts for 'Genes and Gene Products' and 'Treatments'. RESULTS Results showed that our proposed drug response phenotype terminology could cover 96% of the drug response phenotypes in genetic reports. Among 18 653 sentences that contained both 'Genes and Gene Products' and 'Treatments', 3011 sentences were able to be mapped to a drug response phenotype in our proposed terminology, among which the most discussed drug response phenotypes were response (994), sensitivity (829) and survival (332). In addition, we were able to re-analyze genetic report context incorporating the proposed terminology and enrich our previously proposed PGx knowledge model to reveal relationships between genetic variants and treatments. In conclusion, we proposed a drug response phenotype terminology that enhanced structured knowledge representation of genomic medicine. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Yiqing Zhao
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew Brush
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Chen Wang
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Alex H Wagner
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Hongfang Liu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert R Freimuth
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN 55905, USA
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Bilyalov A, Nikolaev S, Shigapova L, Khatkov I, Danishevich A, Zhukova L, Smolin S, Titova M, Lisica T, Bodunova N, Shagimardanova E, Gusev O. Application of Multigene Panels Testing for Hereditary Cancer Syndromes. BIOLOGY 2022; 11:biology11101461. [PMID: 36290365 PMCID: PMC9598138 DOI: 10.3390/biology11101461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Approximately 5-10% of all cancers are associated with hereditary cancer predisposition syndromes (HCPS). Early identification of HCPS is facilitated by widespread use of next-generation sequencing (NGS) and brings significant benefits to both the patient and their relatives. This study aims to evaluate the landscape of genetic variants in patients with personal and/or family history of cancer using NGS-based multigene panel testing. MATERIALS AND METHODS The study cohort included 1117 probands from Russia: 1060 (94.9%) patients with clinical signs of HCPS and 57 (5.1%) healthy individuals with family history of cancer. NGS analysis of 76 HCPS genes was performed using a custom Roche NimbleGen enrichment panel. RESULTS Pathogenic/likely pathogenic variants were identified in 378 of 1117 individuals (33.8%). The predominant number (59.8%) of genetic variants was identified in BRCA1/BRCA2 genes. CHEK2 was the second most commonly altered gene with a total of 28 (7.4%) variants, and 124 (32.8%) genetic variants were found in other 35 cancer-associated genes with variable penetrance. CONCLUSIONS Multigene panel testing allows for a differential diagnosis and identification of high-risk group for oncological diseases. Our results demonstrate that inclusion of non-coding gene regions into HCPS gene panels is highly important for the identification of rare spliceogenic variants with high penetrance.
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Affiliation(s)
- Airat Bilyalov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia
- Correspondence: ; Tel.: +7-9625-6038-02
| | - Sergey Nikolaev
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia
| | - Leila Shigapova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Igor Khatkov
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia
| | | | - Ludmila Zhukova
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia
| | - Sergei Smolin
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia
| | - Marina Titova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Tatyana Lisica
- Centre for Strategic Planning of FMBA of Russia, 119121 Moscow, Russia
| | - Natalia Bodunova
- The Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia
| | - Elena Shagimardanova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Oleg Gusev
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
- Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
- Endocrinology Research Centre, 117036 Moscow, Russia
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40
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Physicians' experience, practice and education, on genetic testing and genetic counseling: a nationwide survey study in Greece. Fam Cancer 2022; 21:479-487. [PMID: 35067824 DOI: 10.1007/s10689-022-00290-4] [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: 05/29/2021] [Accepted: 01/19/2022] [Indexed: 01/07/2023]
Abstract
Genetic testing has been implemented in clinical practice. However, data on physician's practices and education related to cancer genetics, risk assessment and clinical management in Greece, is limited. In Greece, genetic counseling is performed by treating physicians in collaboration with clinical laboratory geneticists due to the absence of medical geneticists and genetic counsellors. We evaluated treating physicians' experience on genetic testing for hereditary cancer and counseling practices in Greece, thus providing critical areas for improvement of genetic counseling processes. A 28-question survey was used to assess physicians' experience with genetic testing practices, factors that affect their clinical management and decision making and limitations in their education. Of 250 physicians, 208 (83%) completed the survey; of whom 89 (42.8%) were medical oncologists, 88 general surgeons (42.3%), 26 gynecologists (12.5%) and 5 (2.4%) of other specialties. Overall, 91.8% of participants referred patients for genetic testing, with 51.8% recommending multigene panel testing. While most clinicians (84%) reported lack of a clinical genetics department at their institution, 75.7% referred patients for genetic counseling at available departments or healthcare professionals with expertise in genetic counseling. Overall, 68.8% of respondents reported no training or moderate training on cancer genetics. A higher proportion of medical oncologists reported sufficient/very satisfactory training (40.9%) compared to general surgeons (27.3%) or gynecologists (11.5%) (p = 0.012). Time spent on pre- and post-testing sessions varied significantly among respondents. Of 199 physicians, 70% would manage patients with BRCA1 VUS as patients with pathogenic variants, mainly surgeons (83.1%) and gynecologists (80%), compared to oncologists (52.3%) (p < 0.001). Additionally, 64% of physicians treating patients with breast and ovarian cancer would recommend an intervention based on the presence of a BRCA1 VUS. Most respondents (87%) were interested in receiving additional education on cancer risk assessment. Limited consensus was observed during physicians' genetic testing, counseling practices and clinical management of patients with increased predisposition to cancer. Our findings highlight the need for improvement in physician education on cancer risk assessment and increase of genetic counseling resources and services.
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Thompson JL, Sinco BR, McCaffrey RL, Chang AE, Sabel MS, Dossett LA, Hughes TM, Jeruss JS. Prophylactic mastectomy and occult malignancy: Surgical and imaging considerations. J Surg Oncol 2022; 127:18-27. [PMID: 36069388 PMCID: PMC10087968 DOI: 10.1002/jso.27088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sentinel node biopsy (SLNB) is not routinely recommended for patients undergoing prophylactic mastectomy (PM), yet omission remains a subject of debate among surgeons. A modern patient cohort was examined to determine occult malignancy (OM) incidence within PM specimens to reinforce current recommendations. METHODS All PM performed over a 5-year period were retrospectively identified, including women with unilateral breast cancer who underwent synchronous or delayed contralateral PM or women with elevated cancer risk who underwent bilateral PM. RESULTS The study population included 772 patients (598 CPM, 174 BPM) with a total of 39 OM identified: 17 invasive cancers (14 CPM, 3 BPM) and 22 DCIS (19 CPM, 3 BPM). Of the 86 patients for whom SLNB was selectively performed, 1 micrometastasis was identified. In the CPM cohort, risk of OM increased with age, presence of LCIS of either breast, or presence of a non-BRCA high-penetrance gene mutation, while preoperative magnetic resonance imaging was associated with lower likelihood of OM. CONCLUSIONS Given the low incidence of invasive OM in this updated series, routine SLNB is of low value for patients undergoing PM. For patients with indeterminate radiographic findings, discordant preoperative biopsies, LCIS, or non-BRCA high-penetrance gene mutations, selective SLNB implementation could be considered.
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Affiliation(s)
- Jessica L Thompson
- Department of Surgery, Division of Surgical Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Brandy R Sinco
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Alfred E Chang
- Department of Surgery, Division of Surgical Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael S Sabel
- Department of Surgery, Division of Surgical Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lesly A Dossett
- Department of Surgery, Division of Surgical Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Tasha M Hughes
- Department of Surgery, Division of Surgical Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jacqueline S Jeruss
- Department of Surgery, Division of Surgical Oncology, University of Michigan, Ann Arbor, Michigan, USA
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42
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Esplin ED, Nielsen SM, Bristow SL, Garber JE, Hampel H, Rana HQ, Samadder NJ, Shore ND, Nussbaum RL. Universal Germline Genetic Testing for Hereditary Cancer Syndromes in Patients With Solid Tumor Cancer. JCO Precis Oncol 2022; 6:e2100516. [PMID: 36108258 PMCID: PMC9489188 DOI: 10.1200/po.21.00516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | | | | | - Heather Hampel
- Division of Clinical Cancer Genomics, Department of Medical Oncology & Therapeutic Research, City of Hope National Cancer Center, Duarte, CA
| | | | - N Jewel Samadder
- Center for Individualized Medicine, Mayo Clinic, Phoenix, AZ.,Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Phoenix, AZ.,Department of Clinical Genomics, Mayo Clinic, Phoenix, AZ
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC
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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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Carlsson L, Thain E, Gillies B, Metcalfe K. Psychological and health behaviour outcomes following multi-gene panel testing for hereditary breast and ovarian cancer risk: a mini-review of the literature. Hered Cancer Clin Pract 2022; 20:25. [PMID: 35733200 PMCID: PMC9215075 DOI: 10.1186/s13053-022-00229-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Knowledge of the genetic mechanisms driving hereditary breast and ovarian cancer (HBOC) has recently expanded due to advances in gene sequencing technologies. Genetic testing for HBOC risk now involves multi-gene panel testing, which includes well characterized high-penetrance genes (e.g. BRCA1 and BRCA2), as well as moderate- and low-penetrance genes. Certain moderate and low penetrance genes are associated with limited data to inform cancer risk estimates and clinical management recommendations, which create new sources of genetic and clinical uncertainty for patients. PURPOSE The aim of this review is to evaluate the psychological and health behaviour outcomes associated with multi-gene panel testing for HBOC risk. The search was developed in collaboration with an Information Specialist (Princess Margaret Cancer Centre) and conducted in the following databases: MEDLINE, EMBASE, EMCare, PsycINFO, Epub Ahead of Publication. RESULTS Similar to the BRCA1/2 literature, individuals with a pathogenic variant (PV) reported higher levels of testing-related concerns and cancer-specific distress, as well as higher uptake of prophylactic surgery in both affected and unaffected individuals compared to those with variant of uncertain significance (VUS) or negative result. A single study demonstrated that individuals with a PV in a moderate penetrance gene reported higher rates of cancer worry, genetic testing concerns and cancer-related distress when compared to women with high penetrance PV. Analysis of cancer screening and prevention outcomes based upon gene penetrance were limited to two studies, with conflicting findings. CONCLUSION The findings in this review emphasize the need for studies examining psychological and health behavior outcomes associated with panel testing to include between group differences based upon both variant pathogenicity and gene penetrance. Future studies evaluating the impact of gene penetrance on patient-reported and clinical outcomes will require large samples to be powered for these analyses given that a limited number of tested individuals are found to have a PV.
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Affiliation(s)
- Lindsay Carlsson
- Drug Development Program, Princess Margaret Cancer Centre, 620 University Avenue, 8-132, Toronto, ON, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
| | - Emily Thain
- Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Brittany Gillies
- Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Canada
| | - Kelly Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute , Toronto, ON, Canada
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Murray MF, Khoury MJ, Abul-Husn NS. Addressing the routine failure to clinically identify monogenic cases of common disease. Genome Med 2022; 14:60. [PMID: 35672798 PMCID: PMC9175445 DOI: 10.1186/s13073-022-01062-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/16/2022] [Indexed: 12/14/2022] Open
Abstract
Changes in medical practice are needed to improve the diagnosis of monogenic forms of selected common diseases. This article seeks to focus attention on the need for universal genetic testing in common diseases for which the recommended clinical management of patients with specific monogenic forms of disease diverges from standard management and has evidence for improved outcomes.We review evidence from genomic screening of large patient cohorts, which has confirmed that important monogenic case identification failures are commonplace in routine clinical care. These case identification failures constitute diagnostic misattributions, where the care of individuals with monogenic disease defaults to the treatment plan offered to those with polygenic or non-genetic forms of the disease.The number of identifiable and actionable monogenic forms of common diseases is increasing with time. Here, we provide six examples of common diseases for which universal genetic test implementation would drive improved care. We examine the evidence to support genetic testing for common diseases, and discuss barriers to widespread implementation. Finally, we propose recommendations for changes to genetic testing and care delivery aimed at reducing diagnostic misattributions, to serve as a starting point for further evaluation and development of evidence-based guidelines for implementation.
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Affiliation(s)
- Michael F. Murray
- grid.47100.320000000419368710Yale Center for Genomic Health, Department of Genetics, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520 USA
| | - Muin J. Khoury
- grid.416738.f0000 0001 2163 0069Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329 USA
| | - Noura S. Abul-Husn
- grid.59734.3c0000 0001 0670 2351Institute for Genomic Health, Division of Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1041, New York, NY 10029 USA
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46
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Hampel H, Yurgelun MB. Point/Counterpoint: Is It Time for Universal Germline Genetic Testing for all GI Cancers? J Clin Oncol 2022; 40:2681-2692. [PMID: 35649230 DOI: 10.1200/jco.21.02764] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Use of germline genetic testing among patients with cancer is increasing because of (1) the availability of multigene panel tests that include multiple cancer susceptibility genes in a single test, (2) decreased costs of these tests and improvements in insurance coverage, and (3) US Food and Drug Administration-approval of genotype-directed therapies such as poly(ADP-ribose) polymerase inhibitors for individuals with certain cancers and pathogenic germline variants in BRCA1 and BRCA2 (with possible benefits with other genes in the homologous repair deficiency pathway). In addition, National Comprehensive Cancer Network guidelines have already endorsed germline genetic testing for all patients with certain cancer types (epithelial ovarian cancer, exocrine pancreatic cancer, and high-grade/metastatic prostate cancer), regardless of age or personal/family history of cancer. Herein, we debate the pros and cons of offering germline multigene panel testing to all patients diagnosed with any GI cancer. The authors agree that it may just be a matter of time before germline multigene panel testing is offered to all patients with cancer; however, this article will highlight some of the benefits, risks, and limitations of this approach so that research can help fill some of the gaps to ensure that genetic medicine continues to be implemented in ways that improve real-world patient care and outcomes.
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Affiliation(s)
- Heather Hampel
- Division of Clinical Cancer Genomics, City of Hope National Medical Center, Duarte, CA
| | - Matthew B Yurgelun
- Dana-Farber Cancer Institute, Brigham & Women's Hospital, and Harvard Medical School, Boston, MA
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47
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McHugh JK, Offiah G, Daly S, El Beltagi N, Barry MK, O'Reilly S, McVeigh TP. Postgraduate training in Cancer Genetics-a cross-specialty survey exploring experience of clinicians in Ireland. Ir J Med Sci 2022; 191:1427-1434. [PMID: 34195919 PMCID: PMC8244677 DOI: 10.1007/s11845-021-02637-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND As genomic profiling of constitutional and tumour-derived DNA becomes increasingly critical in cancer risk estimation, prognostication and treatment, there is a growing need for clinicians involved in cancer care to up-skill in Cancer Genetics. In the Republic of Ireland (ROI), this is particularly crucial, given a paucity of vocationally trained Clinical Geneticists per capita compared to other European countries. AIMS We aimed to assess the self-reported confidence of postgraduate medical/surgical trainees in ROI in requesting, interpreting, and managing genomic data in patients with cancer, and to assess their selfreported experience, and demand for future training in this area. METHODS A cross-sectional survey of postgraduate trainees in four specialties (Medical and Radiation Oncology, Surgery, and Obstetrics and Gynaecology (O&G)), training in ROI, was undertaken. A bespoke electronic questionnaire was designed to capture data regarding preceding experience, and confidence across several hypothetical clinical scenarios involving genomic testing. The survey was circulated to eligible participants by training programme administrators, after relevant institutional ethical approval. Data was collected anonymously. RESULTS The study cohort included 62 respondents. A paucity of cancer genetics training at every level was demonstrated, with "hardly any" or "none at all" reported by 47(76%), 62(100%), and 50(81%) during undergraduate, core specialty, and higher specialist training, respectively. A relative lack of confidence in all clinical scenarios was apparent, particularly among Surgery/O&G trainees. Most respondents would value more training in Cancer Genetics. CONCLUSIONS This study demonstrates an unmet need in dedicated Cancer Genetics training for postgraduate specialty trainees in ROI.
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Affiliation(s)
- Jana K McHugh
- Institute of Cancer Research, London, UK.
- Royal Marsden NHS Foundation Trust, London, UK.
| | - Gozie Offiah
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sean Daly
- Rotunda Hospital, Parnell Square E, Rotunda, Dublin 1, D01 P5W9, Dublin, Ireland
| | | | | | | | - Terri P McVeigh
- Institute of Cancer Research, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
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48
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Dettwyler SA, Thull DL, McAuliffe PF, Steiman JG, Johnson RR, Diego EJ, Mai PL. Timely cancer genetic counseling and testing for young women with breast cancer: impact on surgical decision-making for contralateral risk-reducing mastectomy. Breast Cancer Res Treat 2022; 194:393-401. [PMID: 35596825 DOI: 10.1007/s10549-022-06619-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/25/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE Genetic testing (GT) can identify individuals with pathogenic/likely pathogenic variants (PV/LPVs) in breast cancer (BC) predisposition genes, who may consider contralateral risk-reducing mastectomy (CRRM). We report on CRRM rates in young women newly diagnosed with BC who received GT through a multidisciplinary clinic. METHODS Clinical data were reviewed for patients seen between November 2014 and June 2019. Patients with non-metastatic, unilateral BC diagnosed at age ≤ 45 and completed GT prior to surgery were included. Associations between surgical intervention and age, BC stage, family history, and GT results were evaluated. RESULTS Of the 194 patients, 30 (15.5%) had a PV/LPV in a BC predisposition gene (ATM, BRCA1, BRCA2, CHEK2, NBN, NF1), with 66.7% in BRCA1 or BRCA2. Of 164 (84.5%) uninformative results, 132 (68%) were negative and 32 (16.5%) were variants of uncertain significance (VUS). Overall, 67 (34.5%) had CRRM, including 25/30 (83.3%) PV/LPV carriers and 42/164 (25.6%) non-carriers. A positive test result (p < 0.01) and significant family history were associated with CRRM (p = 0.02). For the 164 with uninformative results, multivariate analysis showed that CRRM was not associated with age (p = 0.23), a VUS, (p = 0.08), family history (p = 0.10), or BC stage (p = 0.11). CONCLUSION In this cohort of young women with BC, the identification of a PV/LPV in a BC predisposition gene and a significant family history were associated with the decision to pursue CRRM. Thus, incorporation of genetic services in the initial evaluation of young patients with a new BC could contribute to the surgical decision-making process.
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Affiliation(s)
- Shenin A Dettwyler
- UPMC Magee-Womens Hospital (Cancer Genetics Program), Pittsburgh, PA, USA. .,Currently at NYU Langone Health (The Pancreatic Cancer Center), New York, NY, USA.
| | - Darcy L Thull
- UPMC Magee-Womens Hospital (Cancer Genetics Program), Pittsburgh, PA, USA
| | | | - Jennifer G Steiman
- UPMC Magee-Womens Hospital (Magee-Womens Surgical Associates), Pittsburgh, PA, USA
| | - Ronald R Johnson
- UPMC Magee-Womens Hospital (Magee-Womens Surgical Associates), Pittsburgh, PA, USA
| | - Emilia J Diego
- UPMC Magee-Womens Hospital (Magee-Womens Surgical Associates), Pittsburgh, PA, USA
| | - Phuong L Mai
- University of Pittsburgh School of Medicine (Center for Clinical Genetics and Genomics), Pittsburgh, PA, USA
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Kritzik R, Usoro E, Peshkin BN, Isaacs C, Valdimarsdottir HB, Willey S, O’Neill S, DeMarco T, Nusbaum R, Jandorf L, Kelleher S, Schwartz MD. Psychosocial impact of proactive rapid genetic counseling following breast cancer diagnosis. Psychooncology 2022; 31:788-797. [PMID: 34921700 PMCID: PMC9920729 DOI: 10.1002/pon.5863] [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: 08/09/2021] [Revised: 11/22/2021] [Accepted: 12/06/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE As germline genetic referral becomes increasingly routine as part of the care of newly diagnosed breast cancer patients, it is important to understand the psychosocial impact of genetic counseling at the time of diagnosis. We examined the psychosocial and quality of life (QOL) impact of providing proactive rapid genetic counseling and testing (RGCT) in the immediate aftermath of a breast cancer diagnosis. METHODS We randomized 330 patients in a 2:1 ratio to proactive rapid genetic counseling (RGCT; N = 222) versus usual care (UC; N = 108). Participants completed a baseline telephone survey before randomization and definitive surgery and a follow-up survey at 1-month post-randomization. We evaluated the impact of RGCT versus UC on breast cancer genetic knowledge, distress, QOL, and decisional conflict. Given that 43% of UC participants and 86% of RGCT participants completed genetic counseling prior to the 1-month assessment, we also evaluated the impact of genetic counseling participation over and above group assignment. RESULTS The RGCT intervention led to increased breast cancer genetic knowledge relative to UC but did not differentially impact other study outcomes. Across groups patients who participated in genetic counseling had significantly increased knowledge and improved QOL compared to those who did not participate in genetic counseling. CONCLUSIONS While prior research has documented the impact of genetic counseling and testing on surgical decisions, these results confirm that participation in genetic counseling at the time of diagnosis can yield improvements in knowledge and QOL in the short-term.
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Affiliation(s)
- Rachel Kritzik
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, Washington, DC, USA
| | - Edidiong Usoro
- Department of Biology, University of the District of Columbia, Washington, DC, USA
| | - Beth N. Peshkin
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, Washington, DC, USA
| | - Claudine Isaacs
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, Washington, DC, USA
| | - Heiddis B. Valdimarsdottir
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shawna Willey
- Breast Cancer Program, Schar Cancer Institute, INOVA Health System, Fairfax, VA, USA
| | - Suzanne O’Neill
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, Washington, DC, USA
| | - Tiffani DeMarco
- Cancer Genetics Program, INOVA Health System, Fairfax, VA, USA
| | - Rachel Nusbaum
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lina Jandorf
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Marc D. Schwartz
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer, Georgetown University, Washington, DC, USA
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50
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Lee YQ, Yoon SY, Hassan T, Padmanabhan H, Yip CH, Keng WT, Thong MK, Ahmad Annuar MA, Mohd Taib NA, Teo SH. Attitudes and training needs of oncologists and surgeons in mainstreaming breast cancer genetic counseling in a low-to-middle income Asian country. J Genet Couns 2022; 31:1080-1089. [PMID: 35481858 DOI: 10.1002/jgc4.1579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 03/26/2022] [Accepted: 04/03/2022] [Indexed: 12/20/2022]
Abstract
With the advent of poly-ADP-ribose polymerase inhibitor (PARPi) therapies, the focus of genetic testing for breast, ovarian, and other cancers has shifted from risk management to treatment decision-making in high-resource settings. Due to the shortage of genetic counselors worldwide, alternative ways of delivering genetic counseling have been explored, including training nongenetics healthcare professionals (NGHPs) to provide genetic counseling. However, little is known about the feasibility of adopting such models in healthcare settings with insufficient specialists, where population health literacy is low and where access to new therapies may be limited. In this study, we evaluated the attitudes, considerations, and self-efficacy of oncologists, breast surgeons, and general surgeons in mainstreaming breast cancer genetic counseling in Malaysia, a middle-income Asian country with a universal healthcare system. We developed a 32-item survey via a modified Delphi method, which was then distributed via a purposive and network sampling approach. While 77% of respondents expressed interest in providing breast cancer genetic counseling, 85% preferred to refer patients directly to genetic services for genetic counseling and testing. The main considerations for mainstreaming were the cost of genetic testing and PARPi therapy, as well as the availability of support from genetics professionals. Respondents reported a lack of confidence in communicating genetic risk, particularly to patients with poor health literacy, and in the clinical management of patients with variants of uncertain significance. Our results highlight the urgent need to train more NGHPs in providing genetic counseling and testing in low-to-middle income countries, and suggest that the mainstay for genetic counseling in this setting may be for risk management rather than access to PARPi therapy.
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Affiliation(s)
| | | | | | | | | | - Wee-Teik Keng
- Genetics Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Meow-Keong Thong
- Department of Paediatrics, Genetic Medicine Unit, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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