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Greenberger C, Mor P. Underpinnings of the Halachic Approach to BRCA Screening and Intervention: Facilitating Provider Counseling for Observant Jewish Populations. Rambam Maimonides Med J 2024; 15:RMMJ.10522. [PMID: 38717180 PMCID: PMC11065093 DOI: 10.5041/rmmj.10522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Halacha is the corpus of Jewish law which serves as a life blueprint for observant Jewish individuals. Health professionals counseling halachically observant populations at risk for breast cancer gene (BRCA) mutations should be well informed of the halachic approach to screening for BRCA mutations and subsequent interventions. AIM To address the intersection of halacha with ethical norms and current medical evidence-based data as they relate to potential and identified BRCA mutation carriers at their various stages of decision-making. RESULTS Halacha, ethics, and medicine have much in common, but there are specific principles which guide halacha; decision-making in light of halacha is complex and varies with respect to the multi-faceted aspects of screening and intervention. Halacha encourages the exercise of autonomy regarding situations in which beneficence is not clear-cut and dependent on subjective perceptions. CONCLUSIONS Health professionals knowledgeable of halacha are better equipped to counsel the observant Jewish population at risk of BRCA mutations or identified as mutation carriers, enabling them to present targeted questions to halachic authorities and thus achieve optimal decision-making.
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Affiliation(s)
- Chaya Greenberger
- Adjunct Professor of Nursing, Lev Academic Center, Jerusalem, Israel
| | - Pnina Mor
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
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Kabeya V, Puthussery S, Furmanski A. Barriers and facilitators to genetic testing for breast and ovarian cancer amongst Black African women in Luton (UK). J Genet Couns 2024; 33:425-444. [PMID: 37403830 DOI: 10.1002/jgc4.1742] [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: 11/24/2021] [Revised: 04/22/2023] [Accepted: 05/28/2023] [Indexed: 07/06/2023]
Abstract
Evidence suggests that although Black African women have the lowest incidence of breast and ovarian cancer, they have the highest mortality rate and low rates of uptake for cancer screening services for these conditions in the United Kingdom (UK). This study aimed to explore the perceived barriers and facilitators to genetic testing for breast and ovarian cancer amongst Black African women in Luton (UK). We conducted a qualitative study that included one face-to-face and five telephone focus group discussions. Consistent with the health belief model, a focus group discussion guide was developed. A total of 24 participants, aged 23-57 who self-identified as Black African women and who were English speakers residing in Luton, took part in the focus group discussions. Purposive and snowballing sampling were used to recruit the participants for this study. The focus group discussions were recorded, transcribed per verbatim, coded and analyzed using an inductive thematic analysis approach, and the findings were classified. Nine themes emerged from the narratives obtained including six barriers and three facilitators. Barriers to genetic testing included (1) Cost and affordability, (2) Lack of knowledge, awareness, and family health history knowledge, (3) Language barrier, immigration, and distrust in western healthcare services, (4) Fear, (5) Cultural, religious, and intergenerational views and perceptions, and (6) Eligibility for genetic testing for the BRCA1/2 pathogenic variants and a lack of referral to specialist genetic clinics. Facilitators to genetic testing included (7) Availability of tests cost-free under the National Health Service (NHS) (8) Family members' health and (9) Awareness and education on genetic testing. The barriers and facilitators identified could enable policy makers and healthcare services alike to gain a better understanding of the factors influencing Black African women's decision-making process toward genetic testing. Ultimately, this work can inform interventions aiming to increase the uptake of genetic testing among this group.
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Affiliation(s)
- Valencia Kabeya
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Anna Furmanski
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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3
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Wildin RS. Cost Effectiveness of Genomic Population Health Screening in Adults: A Review of Modeling Studies and Future Directions. J Appl Lab Med 2024; 9:92-103. [PMID: 38167759 DOI: 10.1093/jalm/jfad093] [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: 07/18/2023] [Accepted: 10/09/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Detecting actionable health risks for genetic diseases prior to symptomatic presentation at population scale using genomic test technologies is a preventive health innovation being piloted in multiple locations. Standard practice is to screen for risks only in those with personal or family history of specific disease. Genomic population heath screening has proven feasible and potentially scalable. The value of this intervention in terms of economic benefit has been scientifically modeled by several groups. CONTENT Eight recent cost-effectiveness modeling studies for high penetrance monogenic dominant diseases that used input parameters from 3 different countries are reviewed. Results and their uses in refining implementations are analyzed and the roles for laboratory medicine in facilitating success are discussed. SUMMARY The reviewed studies generally found evidence for cost-effectiveness of genomic population health screening in at least a subset of their base case screening scenario. Sensitivity analyses identified opportunities for improving the likelihood of cost-effectiveness. On the whole, the modeling results suggest genomic population health screening is likely to be cost-effective for high penetrance disorders in younger adults, especially with achievable reductions in test cost effected partially through combining tests for individual disorders into one screening procedure. Policies founded on the models studied should consider limitations of the modeling methods and the potential for impacts on equity and access in the design and implementation of genomic screening programs.
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Affiliation(s)
- Robert S Wildin
- Departments of Pathology & Laboratory Medicine and Pediatrics, The Larner College of Medicine at the University of Vermont, Burlington, VT, United States
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4
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Genetic risk factors have a substantial impact on healthy life years. Nat Med 2022; 28:1893-1901. [PMID: 36097220 PMCID: PMC9499866 DOI: 10.1038/s41591-022-01957-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/19/2022] [Indexed: 12/15/2022]
Abstract
The impact of genetic variation on overall disease burden has not been comprehensively evaluated. We introduce an approach to estimate the effect of genetic risk factors on disability-adjusted life years (DALYs; 'lost healthy life years'). We use genetic information from 735,748 individuals and consider 80 diseases. Rare variants had the highest effect on DALYs at the individual level. Among common variants, rs3798220 (LPA) had the strongest individual-level effect, with 1.18 DALYs from carrying 1 versus 0 copies. Being in the top 10% versus the bottom 90% of a polygenic score for multisite chronic pain had an effect of 3.63 DALYs. Some common variants had a population-level effect comparable to modifiable risk factors such as high sodium intake and low physical activity. Attributable DALYs vary between males and females for some genetic exposures. Genetic risk factors can explain a sizable number of healthy life years lost both at the individual and population level.
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Manchanda R, Sideris M. Population based genetic testing for cancer susceptibility genes: quo vadis. BJOG 2022; 130:125-130. [PMID: 36017754 PMCID: PMC10087260 DOI: 10.1111/1471-0528.17283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/23/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ranjit Manchanda
- Wolfson Institute of Population Health, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Department of Gynaecological Oncology, Barts Health NH Trust, EC1A 7BE, London, UK.,Department of Health Services Research and Policy, School of Hygiene & Tropical Medicine, London WC1H 9SH, London, UK.,Department of Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Michail Sideris
- Wolfson Institute of Population Health, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Department of Gynaecological Oncology, Barts Health NH Trust, EC1A 7BE, London, UK
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Jürgens H, Roht L, Leitsalu L, Nõukas M, Palover M, Nikopensius T, Reigo A, Kals M, Kallak K, Kütner R, Budrikas K, Kuusk S, Valvere V, Laidre P, Toome K, Rekker K, Tooming M, Ülle Murumets, Kahre T, Kruuv-Käo K, Õunap K, Padrik P, Metspalu A, Esko T, Fischer K, Tõnisson N. Precise, Genotype-First Breast Cancer Prevention: Experience With Transferring Monogenic Findings From a Population Biobank to the Clinical Setting. Front Genet 2022; 13:881100. [PMID: 35938029 PMCID: PMC9355130 DOI: 10.3389/fgene.2022.881100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Although hereditary breast cancer screening and management are well accepted and established in clinical settings, these efforts result in the detection of only a fraction of genetic predisposition at the population level. Here, we describe our experience from a national pilot study (2018–2021) in which 180 female participants of Estonian biobank (of >150,000 participants in total) were re-contacted to discuss personalized clinical prevention measures based on their genetic predisposition defined by 11 breast cancer–related genes. Our results show that genetic risk variants are relatively common in the average-risk Estonian population. Seventy-five percent of breast cancer cases in at-risk subjects occurred before the age of 50 years. Only one-third of subjects would have been eligible for clinical screening according to the current criteria. The participants perceived the receipt of genetic risk information as valuable. Fluent cooperation of project teams supported by state-of-art data management, quality control, and secure transfer can enable the integration of research results to everyday medical practice in a highly efficient, timely, and well-accepted manner. The positive experience in this genotype-first breast cancer study confirms the value of using existing basic genomic data from population biobanks for precise prevention.
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Dibble KE, K. M. Donorfio L, Britner PA, Bellizzi KM. Perceptions and Care Recommendations from Previvors: Qualitative Analysis of Female BRCA1/2 Mutation Carriers’ Experience with Genetic Testing and Counseling. Gynecol Oncol Rep 2022; 41:100989. [PMID: 35540028 PMCID: PMC9079684 DOI: 10.1016/j.gore.2022.100989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022] Open
Abstract
BRCA1/2-positive women listed negative and positive aspects of testing/counseling. A wide range of emotions concerning healthcare experiences existed post-testing. Improved patient-oriented care and communication was recommended.
Introduction It is estimated that 12.5% of women will be diagnosed with breast cancer and 1.10% with ovarian cancer during their lifetime. Although less common, women with these mutations have a 11–72% increased risk of breast/ovarian cancers and are hereditary. Genetic testing/counseling presents the opportunity to identify carriers of BRCA1/2 genetic mutations before a cancer diagnosis. Methods Thirty-four BRCA1/2-positive women (with and without histories of breast/ovarian cancers) were recruited through online national support groups to gain a better understanding of their genetic testing/counseling perceptions and experiences. After confirming eligibility, they were invited to participate in either a telephone or webcam interview. Interview transcripts were analyzed using qualitative thematic text analysis and descriptive coding techniques. Results Six major themes emerged, capturing the perceptions and experiences of genetic testing/counseling for these women: 1) Emotional Reactions to Results and Genetic Counseling, 2) Future Recommendations, 3) Family Solidarity and Support, 4) Experiences with the Healthcare System, 5) Preventive Concerns and Decisions, and 6) Sources Affecting Perceived Risk. Two subthemes also emerged within the first theme, which are termed “Pre-vivor,” and “Testing Intuition.” Conclusions Participants indicated that genetic testing/counseling improvements would be helpful for women in this population surrounding quality care, including sensitivity training for healthcare professionals involved in testing/counseling, additional educational resources, and increased emotional and financial support. Although these recommendations may be beneficial, more widespread research with greater generalizability to disparate groups may be necessary prior to implementation.
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Gaba F, Oxley S, Liu X, Yang X, Chandrasekaran D, Kalsi J, Antoniou A, Side L, Sanderson S, Waller J, Ahmed M, Wallace A, Wallis Y, Menon U, Jacobs I, Legood R, Marks D, Manchanda R. Unselected Population Genetic Testing for Personalised Ovarian Cancer Risk Prediction: A Qualitative Study Using Semi-Structured Interviews. Diagnostics (Basel) 2022; 12:1028. [PMID: 35626184 PMCID: PMC9139231 DOI: 10.3390/diagnostics12051028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 12/24/2022] Open
Abstract
Unselected population-based personalised ovarian cancer (OC) risk assessments combining genetic, epidemiological and hormonal data have not previously been undertaken. We aimed to understand the attitudes, experiences and impact on the emotional well-being of women from the general population who underwent unselected population genetic testing (PGT) for personalised OC risk prediction and who received low-risk (<5% lifetime risk) results. This qualitative study was set within recruitment to a pilot PGT study using an OC risk tool and telephone helpline. OC-unaffected women ≥ 18 years and with no prior OC gene testing were ascertained through primary care in London. In-depth, semi-structured and 1:1 interviews were conducted until informational saturation was reached following nine interviews. Six interconnected themes emerged: health beliefs; decision making; factors influencing acceptability; effect on well-being; results communication; satisfaction. Satisfaction with testing was high and none expressed regret. All felt the telephone helpline was helpful and should remain optional. Delivery of low-risk results reduced anxiety. However, care must be taken to emphasise that low risk does not equal no risk. The main facilitators were ease of testing, learning about children’s risk and a desire to prevent disease. Barriers included change in family dynamics, insurance, stigmatisation and personality traits associated with stress/worry. PGT for personalised OC risk prediction in women in the general population had high acceptability/satisfaction and reduced anxiety in low-risk individuals. Facilitators/barriers observed were similar to those reported with genetic testing from high-risk cancer clinics and unselected PGT in the Jewish population.
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Affiliation(s)
- Faiza Gaba
- Wolfson Institute of Population Health, Barts CRUK Centre, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK; (F.G.); (S.O.); (X.L.); (D.C.)
- Department of Gynaecological Oncology, St Bartholomew’s Hospital, London EC1A 7BE, UK
| | - Samuel Oxley
- Wolfson Institute of Population Health, Barts CRUK Centre, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK; (F.G.); (S.O.); (X.L.); (D.C.)
- Department of Gynaecological Oncology, St Bartholomew’s Hospital, London EC1A 7BE, UK
| | - Xinting Liu
- Wolfson Institute of Population Health, Barts CRUK Centre, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK; (F.G.); (S.O.); (X.L.); (D.C.)
| | - Xin Yang
- Strangeways Research Laboratory, Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, The University of Cambridge, Cambridge CB1 8RN, UK; (X.Y.); (A.A.)
| | - Dhivya Chandrasekaran
- Wolfson Institute of Population Health, Barts CRUK Centre, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK; (F.G.); (S.O.); (X.L.); (D.C.)
- Department of Gynaecological Oncology, St Bartholomew’s Hospital, London EC1A 7BE, UK
| | - Jatinderpal Kalsi
- Department of Women’s Cancer, University College London, Gower St, Bloomsbury, London WC1E 6BT, UK;
| | - Antonis Antoniou
- Strangeways Research Laboratory, Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, The University of Cambridge, Cambridge CB1 8RN, UK; (X.Y.); (A.A.)
| | - Lucy Side
- Department of Clinical Genetics, University Hospital Southampton NHS Foundation Trust, Tremona Rd, Southampton SO16 6YD, UK;
| | - Saskia Sanderson
- Early Disease Detection Research Project UK (EDDRP UK), 2 Redman Place, London E20 1JQ, UK;
| | - Jo Waller
- Cancer Prevention Group, King’s College London, Great Maze Pond, London SE1 9RT, UK;
| | - Munaza Ahmed
- North East Thames Regional Genetics Unit, Department Clinical Genetics, Great Ormond Street Hospital, London WC1N 3JH, UK;
| | - Andrew Wallace
- Manchester Centre for Genomic Medicine, 6th Floor Saint Marys Hospital, Oxford Rd, Manchester M13 9WL, UK;
| | - Yvonne Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women’s NHS Foundation Trust, Birmingham B15 2TG, UK;
| | - Usha Menon
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London WC1V 6LJ, UK;
| | - Ian Jacobs
- Department of Women’s Health, University of New South Wales, Sydney 2052, Australia;
| | - Rosa Legood
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; (R.L.); (D.M.)
| | - Dalya Marks
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; (R.L.); (D.M.)
| | - Ranjit Manchanda
- Wolfson Institute of Population Health, Barts CRUK Centre, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK; (F.G.); (S.O.); (X.L.); (D.C.)
- Department of Gynaecological Oncology, St Bartholomew’s Hospital, London EC1A 7BE, UK
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London WC1V 6LJ, UK;
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; (R.L.); (D.M.)
- Department of Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
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Shah SM, Demidova EV, Lesh RW, Hall MJ, Daly MB, Meyer JE, Edelman MJ, Arora S. Therapeutic implications of germline vulnerabilities in DNA repair for precision oncology. Cancer Treat Rev 2022; 104:102337. [PMID: 35051883 PMCID: PMC9016579 DOI: 10.1016/j.ctrv.2021.102337] [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: 11/10/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 12/12/2022]
Abstract
DNA repair vulnerabilities are present in a significant proportion of cancers. Specifically, germline alterations in DNA repair not only increase cancer risk but are associated with treatment response and clinical outcomes. The therapeutic landscape of cancer has rapidly evolved with the FDA approval of therapies that specifically target DNA repair vulnerabilities. The clinical success of synthetic lethality between BRCA deficiency and poly(ADP-ribose) polymerase (PARP) inhibition has been truly revolutionary. Defective mismatch repair has been validated as a predictor of response to immune checkpoint blockade associated with durable responses and long-term benefit in many cancer patients. Advances in next generation sequencing technologies and their decreasing cost have supported increased genetic profiling of tumors coupled with germline testing of cancer risk genes in patients. The clinical adoption of panel testing for germline assessment in high-risk individuals has generated a plethora of genetic data, particularly on DNA repair genes. Here, we highlight the therapeutic relevance of germline aberrations in DNA repair to identify patients eligible for precision treatments such as PARP inhibitors (PARPis), immune checkpoint blockade, chemotherapy, radiation therapy and combined treatment. We also discuss emerging mechanisms that regulate DNA repair.
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Affiliation(s)
- Shreya M. Shah
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States,Science Scholars Program, Temple University, Philadelphia, PA, United States
| | - Elena V. Demidova
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States,Kazan Federal University, Kazan, Russian Federation
| | - Randy W. Lesh
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States,Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | - Michael J. Hall
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States,Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Mary B. Daly
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States,Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Joshua E. Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States,Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Martin J. Edelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States,Correspondence: Sanjeevani Arora, PhD, Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111-2497, OR Martin J Edelman, MD, Department of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111-2497,
| | - Sanjeevani Arora
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States; Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States.
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ElBiad O, Laraqui A, El Boukhrissi F, Mounjid C, Lamsisi M, Bajjou T, Elannaz H, Lahlou AI, Kouach J, Benchekroune K, Oukabli M, Chahdi H, Ennaji MM, Tanz R, Sbitti Y, Ichou M, Ennibi K, Badaoui B, Sekhsokh Y. Prevalence of specific and recurrent/founder pathogenic variants in BRCA genes in breast and ovarian cancer in North Africa. BMC Cancer 2022; 22:208. [PMID: 35216584 PMCID: PMC8876448 DOI: 10.1186/s12885-022-09181-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/24/2021] [Indexed: 12/11/2022] Open
Abstract
Background Elucidation of specific and recurrent/founder pathogenic variants (PVs) in BRCA (BRCA1 and BRCA2) genes can make the genetic testing, for breast cancer (BC) and/or ovarian cancer (OC), affordable for developing nations. Methods To establish the knowledge about BRCA PVs and to determine the prevalence of the specific and recurrent/founder variants in BRCA genes in BC and/or OC women in North Africa, a systematic review was conducted in Morocco, Algeria, and Tunisia. Results Search of the databases yielded 25 relevant references, including eleven studies in Morocco, five in Algeria, and nine in Tunisia. Overall, 15 studies investigated both BRCA1 and BRCA2 genes, four studies examined the entire coding region of the BRCA1 gene, and six studies in which the analysis was limited to a few BRCA1 and/or BRCA2 exons. Overall, 76 PVs (44 in BRCA1 and32 in BRCA2) were identified in 196 BC and/or OC patients (129 BRCA1 and 67 BRCA2 carriers). Eighteen of the 76 (23.7%) PVs [10/44 (22.7%) in BRCA1 and 8/32 (25%) in BRCA2] were reported for the first time and considered to be novel PVs. Among those identified as unlikely to be of North African origin, the BRCA1 c.68_69del and BRCA1 c.5266dupC Jewish founder alleles and PVs that have been reported as recurrent/founder variants in European populations (ex: BRCA1 c.181T>G, BRCA1 c1016dupA). The most well characterized PVs are four in BRCA1 gene [c.211dupA (14.7%), c.798_799detTT (14%), c.5266dup (8.5%), c.5309G>T (7.8%), c.3279delC (4.7%)] and one in BRCA2 [c.1310_1313detAAGA (38.9%)]. The c.211dupA and c.5309G>T PVs were identified as specific founder variants in Tunisia and Morocco, accounting for 35.2% (19/54) and 20.4% (10/49) of total established BRCA1 PVs, respectively. c.798_799delTT variant was identified in 14% (18/129) of all BRCA1 North African carriers, suggesting a founder allele. A broad spectrum of recurrent variants including BRCA1 3279delC, BRCA1 c.5266dup and BRCA2 c.1310_1313detAAGA was detected in 42 patients. BRCA1 founder variants explain around 36.4% (47/129) of BC and outnumber BRCA2 founder variants by a ratio of ≈3:1. Conclusions Testing BC and/or OC patients for the panel of specific and recurrent/founder PVs might be the most cost-effective molecular diagnosis strategy.
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Affiliation(s)
- Oubaida ElBiad
- Laboratoire de Recherche et de Biosécurité P3, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc. .,Unité de séquençage, Laboratoire de Virologie, Centre de Virologie, des Maladies Infectieuses et Tropicales, Hôpital Militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc. .,Laboratoire de Biodiversité, Ecologie et Génome, Faculté des Sciences, Université Mohammed V, Rabat, Maroc.
| | - Abdelilah Laraqui
- Laboratoire de Recherche et de Biosécurité P3, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc.,Unité de séquençage, Laboratoire de Virologie, Centre de Virologie, des Maladies Infectieuses et Tropicales, Hôpital Militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc.,Centre de virologie, des maladies infectieuses et tropicales, Hôpital militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Fatima El Boukhrissi
- Laboratoire de Biochimie-Toxicologie, Hôpital Militaire Moulay Ismail Meknès, Faculté de Médecine et de Pharmacie, Université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Chaimaa Mounjid
- Laboratoire de Recherche et de Biosécurité P3, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Maryame Lamsisi
- Laboratoire de Virologie, Microbiologie, Qualité, Biotechnologies/Ecotoxicologie et Biodiversité, Faculté des sciences et techniques, Mohammadia, Université Hassan II, Casa, Maroc
| | - Tahar Bajjou
- Laboratoire de Recherche et de Biosécurité P3, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Hicham Elannaz
- Unité de séquençage, Laboratoire de Virologie, Centre de Virologie, des Maladies Infectieuses et Tropicales, Hôpital Militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc.,Centre de virologie, des maladies infectieuses et tropicales, Hôpital militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Amine Idriss Lahlou
- Unité de séquençage, Laboratoire de Virologie, Centre de Virologie, des Maladies Infectieuses et Tropicales, Hôpital Militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc.,Centre de virologie, des maladies infectieuses et tropicales, Hôpital militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Jaouad Kouach
- Service de Gynécologie Obstétrique, Hôpital militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Khadija Benchekroune
- Service de Gynécologie Obstétrique, Hôpital militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Mohammed Oukabli
- Laboratoire d'Anatomopathologie, Hôpital militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Hafsa Chahdi
- Laboratoire d'Anatomopathologie, Hôpital militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Moulay Mustapha Ennaji
- Laboratoire de Virologie, Microbiologie, Qualité, Biotechnologies/Ecotoxicologie et Biodiversité, Faculté des sciences et techniques, Mohammadia, Université Hassan II, Casa, Maroc
| | - Rachid Tanz
- Service d'Oncologie Médicale, Hôpital militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Yassir Sbitti
- Service d'Oncologie Médicale, Hôpital militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Mohammed Ichou
- Service d'Oncologie Médicale, Hôpital militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Khalid Ennibi
- Unité de séquençage, Laboratoire de Virologie, Centre de Virologie, des Maladies Infectieuses et Tropicales, Hôpital Militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc.,Centre de virologie, des maladies infectieuses et tropicales, Hôpital militaire d'Instruction Mohammed V, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Bouabid Badaoui
- Laboratoire de Biodiversité, Ecologie et Génome, Faculté des Sciences, Université Mohammed V, Rabat, Maroc
| | - Yassine Sekhsokh
- Laboratoire de Recherche et de Biosécurité P3, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
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11
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Patruno M, De Summa S, Resta N, Caputo M, Costanzo S, Digennaro M, Pilato B, Bagnulo R, Pantaleo A, Simone C, Natalicchio MI, De Matteis E, Tarantino P, Tommasi S, Paradiso A. Spectrum of Germline Pathogenic Variants in BRCA1/2 Genes in the Apulian Southern Italy Population: Geographic Distribution and Evidence for Targeted Genetic Testing. Cancers (Basel) 2021; 13:cancers13184714. [PMID: 34572941 PMCID: PMC8467705 DOI: 10.3390/cancers13184714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary BRCA1 and BRCA2 are two major high-penetrance breast/ovarian cancer predisposition genes, whose mutations can lead to high risk and early onset of breast and ovarian cancer. Numerous studies are focused on spectrum and prevalence of BRCA1/2 mutations worldwide. This is the first study that exclusively focused on native Apulian probands. We found that ten recurrent BRCA1/2 pathogenic variants account for more than half of the patients with proven HBOC syndrome from Apulia. Besides BRCA1 c.5266dupC, which is present in significant numbers in every Apulian province, the other PVs occur at a high frequency in some areas and not others. In-depth knowledge of the mutation spectrum of the target population and of the relatively small number of recurrent mutations is crucial to develop a specific cost-effective strategy for mutation screening and a program for breast–ovarian cancer control and prevention through more liberal, yet rational, genetic testing and counseling. Abstract BRCA1/2-associated hereditary breast and ovarian cancer is the most common form of hereditary breast and ovarian cancer and occurs in all ethnicities and racial populations. Different BRCA1/BRCA2 pathogenic variants (PVs) have been reported with a wide variety among populations. In this study, we retrospectively analyzed prevalence and geographic distribution of pathogenic germline BRCA1/2 variants in families from Apulia in southern Italy and evaluated the genotype–phenotype correlations. Data were collected from Oncogenetic Services present in Apulian hospitals and a shared database was built containing Apulian native probands (n = 2026) that had undergone genetic testing from 2004 to 2019. PVs were detected in 499 of 2026 (24.6%) probands and 68.5% of them (342 of 499) were in the BRCA1 gene. We found 65 different PVs in BRCA1 and 46 in BRCA2. There were 10 most recurrent PVs and their geographical distribution appears to be significantly specific for each province. We have assumed that these PVs are related to the historical and geopolitical changes that occurred in Apulia over time and/or to a “founder effect”. Broader knowledge of BRCA1/2 prevalence and recurring PVs in specific geographic areas could help establish more flexible genetic testing strategies that may enhance our ability to detect high-risk subjects.
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Affiliation(s)
- Margherita Patruno
- Center for Hereditary Tumors Research, Istituto Tumori Bari, Giovani Paolo II, IRCCS, 70124 Bari, Italy; (S.C.); (M.D.); (A.P.)
- Correspondence: (M.P.); (S.D.S.)
| | - Simona De Summa
- Molecular and Pharmacogenetics Diagnostic Laboratory, IRCCS-IstitutoTumori “Giovanni Paolo II”, 70124 Bari, Italy; (M.C.); (B.P.); (S.T.)
- Correspondence: (M.P.); (S.D.S.)
| | - Nicoletta Resta
- Medical Genetics Unit, Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari, Policlinico Hospital Bari, 70124 Bari, Italy; (N.R.); (R.B.); (A.P.); (C.S.)
| | - Mariapia Caputo
- Molecular and Pharmacogenetics Diagnostic Laboratory, IRCCS-IstitutoTumori “Giovanni Paolo II”, 70124 Bari, Italy; (M.C.); (B.P.); (S.T.)
| | - Silvia Costanzo
- Center for Hereditary Tumors Research, Istituto Tumori Bari, Giovani Paolo II, IRCCS, 70124 Bari, Italy; (S.C.); (M.D.); (A.P.)
| | - Maria Digennaro
- Center for Hereditary Tumors Research, Istituto Tumori Bari, Giovani Paolo II, IRCCS, 70124 Bari, Italy; (S.C.); (M.D.); (A.P.)
| | - Brunella Pilato
- Molecular and Pharmacogenetics Diagnostic Laboratory, IRCCS-IstitutoTumori “Giovanni Paolo II”, 70124 Bari, Italy; (M.C.); (B.P.); (S.T.)
| | - Rosanna Bagnulo
- Medical Genetics Unit, Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari, Policlinico Hospital Bari, 70124 Bari, Italy; (N.R.); (R.B.); (A.P.); (C.S.)
| | - Antonino Pantaleo
- Medical Genetics Unit, Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari, Policlinico Hospital Bari, 70124 Bari, Italy; (N.R.); (R.B.); (A.P.); (C.S.)
| | - Cristiano Simone
- Medical Genetics Unit, Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari, Policlinico Hospital Bari, 70124 Bari, Italy; (N.R.); (R.B.); (A.P.); (C.S.)
- Medical Genetics, National Institute of Gastroenterology “S. de Bellis” Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | | | | | - Paolo Tarantino
- Medical Genetics Unit, “Vito Fazzi” Hospital, 73100 Lecce, Italy;
| | - Stefania Tommasi
- Molecular and Pharmacogenetics Diagnostic Laboratory, IRCCS-IstitutoTumori “Giovanni Paolo II”, 70124 Bari, Italy; (M.C.); (B.P.); (S.T.)
| | - Angelo Paradiso
- Center for Hereditary Tumors Research, Istituto Tumori Bari, Giovani Paolo II, IRCCS, 70124 Bari, Italy; (S.C.); (M.D.); (A.P.)
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12
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Meshkani Z, Aboutorabi A, Moradi N, Langarizadeh M, Motlagh AG. Population or family history based BRCA gene tests of breast cancer? A systematic review of economic evaluations. Hered Cancer Clin Pract 2021; 19:35. [PMID: 34454549 PMCID: PMC8399845 DOI: 10.1186/s13053-021-00191-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nearly 56% of at-risk carriers are not identified and missed as a result of the current family-history (FH) screening for genetic testing. The present study aims to review the economic evaluation studies on BRCA genetic testing strategies for screening and early detection of breast cancer. METHODS This systematic literature review is conducted within the Cochrane Library, PubMed, Scopus, Web of Science, ProQuest, and EMBASE databases. In this paper, the relevant published economic evaluation studies are identified by following the standard Cochrane Collaboration methods and adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement reporting some recommendations for articles up to March 2020. Thereafter, the inclusion and exclusion criteria are applied to screen the articles. Disagreements are resolved through a consensus meeting. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist is used in the evaluation of quality. Finally, a narrative synthesis is performed. To compare the different levels of incremental cost-effectiveness ratio (ICER), the net present value is calculated based on a discount rate of 3% in 2019. RESULTS Among 788 initially retrieved citations, 12 studies were included. More than 60% of the studies were originated from high-income countries and were published after 2016. It is noteworthy that most of the studies evaluated the payer perspective. Moreover, the robustness of the results were analyzed through one-way and probabilistic sensitivity analyses in nearly 66% of these studies. Nearly, 25% of the studies are focused and defined population-based and family history BRCA tests as comparators; afterwards, the cost-effectiveness of the former was confirmed. The highest and lowest absolute values for the ICERs were $65,661 and $9 per quality adjusted life years, respectively. All studies met over 70% of the CHEERs criteria checklist, which was considered as 93% of high quality on average as well. CONCLUSIONS The genetic BRCA tests for the general population as well as unselected breast cancer patients were cost-effective in high and upper-middle income countries and those with prevalence of gene mutation while population-based genetic tests for low-middle income countries are depended on the price of the tests.
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Affiliation(s)
- Zahra Meshkani
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Aboutorabi
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Najmeh Moradi
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Langarizadeh
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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13
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Cortesi L, Rugo HS, Jackisch C. An Overview of PARP Inhibitors for the Treatment of Breast Cancer. Target Oncol 2021; 16:255-282. [PMID: 33710534 PMCID: PMC8105250 DOI: 10.1007/s11523-021-00796-4] [Citation(s) in RCA: 162] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 12/13/2022]
Abstract
Loss-of-function mutations in BRCA1 and BRCA2 are detected in at least 5% of unselected patients with breast cancer (BC). These BC susceptibility genes encode proteins critical for DNA homologous recombination repair (HRR). This review provides an update on oral poly(ADP-ribose) polymerase (PARP) inhibitors for the treatment of BC. Olaparib and talazoparib are PARP inhibitors approved as monotherapies for deleterious/suspected deleterious germline BRCA-mutated, HER2-negative BC. Olaparib is approved in the USA for metastatic BC and in Europe for locally advanced/metastatic BC. Talazoparib is approved for locally advanced/metastatic BC in the USA and Europe. In phase 3 trials, olaparib and talazoparib monotherapies demonstrated significant progression-free survival benefits compared with chemotherapy. Common toxicities were effectively managed by supportive treatment and dose interruptions/reductions. Veliparib combined with platinum-based chemotherapy has also shown promise for locally advanced/metastatic BC in a phase 3 trial. Differences in efficacy and safety across PARP inhibitors (olaparib, talazoparib, veliparib, niraparib, rucaparib) may relate to differences in potency of PARP trapping on DNA and cytotoxic specificity. PARP inhibitors are being investigated in early BC, in novel combinations, and in patients without germline BRCA mutations, including those with somatic BRCA mutations and other HRR gene mutations. Ongoing phase 2/3 studies include PARP inhibitors combined with immune checkpoint inhibitors for the treatment of triple-negative BC. Wider access to testing for BRCA and other mutations, and to genetic counseling, are required to identify patients who could benefit from PARP inhibitor therapy. The advent of PARP inhibitors has potential benefits for BC treatment beyond the locally advanced/metastatic setting.
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Affiliation(s)
- Laura Cortesi
- Department of Oncology and Hematology, Azienda Ospedaliero, Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - Hope S Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Christian Jackisch
- Sana Klinikum Offenbach, Department of Obstetrics and Gynecology and Breast Cancer Center, Starkenburgring 66, 63069, Offenbach, Germany.
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14
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Gallagher A, Waller J, Manchanda R, Jacobs I, Sanderson S. Women's Intentions to Engage in Risk-Reducing Behaviours after Receiving Personal Ovarian Cancer Risk Information: An Experimental Survey Study. Cancers (Basel) 2020; 12:cancers12123543. [PMID: 33260928 PMCID: PMC7760356 DOI: 10.3390/cancers12123543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/11/2020] [Accepted: 11/24/2020] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Risk stratification using genetic testing to identify women at increased risk of ovarian cancer may increase the number of patients to whom risk-reducing surgery (e.g., salpingo-oophorectomy) may be offered. However, little is known about public acceptability of such approaches. Our online experimental survey aimed to explore whether women aged 45–75 in the general population are willing to undergo ovarian cancer risk assessment, including genetic testing, and whether women’s potential acceptance of risk-reducing surgery differs depending on their estimated risk. We looked at whether psychological and cognitive factors mediated women’s decision-making. The majority of participants would be interested in having genetic testing. In response to our hypothetical scenarios, a substantial proportion of participants were open to the idea of surgery to reduce risk of ovarian cancer, even if their absolute lifetime risk is only increased from 2% to 5 or 10%. Abstract Risk stratification using genetic and/or other types of information could identify women at increased ovarian cancer risk. The aim of this study was to examine women’s potential reactions to ovarian cancer risk stratification. A total of 1017 women aged 45–75 years took part in an online experimental survey. Women were randomly assigned to one of three experimental conditions describing hypothetical personal results from ovarian cancer risk stratification, and asked to imagine they had received one of three results: (a) 5% lifetime risk due to single nucleotide polymorphisms (SNPs) and lifestyle factors; (b) 10% lifetime risk due to SNPs and lifestyle factors; (c) 10% lifetime risk due to a single rare mutation in a gene. Results: 83% of women indicated interest in having ovarian cancer risk assessment. After receiving their hypothetical risk estimates, 29% of women stated they would have risk-reducing surgery. Choosing risk-reducing surgery over other behavioural responses was associated with having higher surgery self-efficacy and perceived response-efficacy, but not with perceptions of disease threat, i.e., perceived risk or severity, or with experimental condition. A substantial proportion of women age 45–75 years may be open to the idea of surgery to reduce risk of ovarian cancer, even if their absolute lifetime risk is only increased to as little as 5 or 10%.
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Affiliation(s)
- Ailish Gallagher
- Research Department of Behavioural Science and Health, University College London, Gower Street, London WC1E 6BT, UK;
| | - Jo Waller
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, King’s College London, Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK;
| | - Ranjit Manchanda
- Wolfson Institute of Preventive Medicine, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK;
- Department of Gynaecological Oncology, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Ian Jacobs
- Department of Women’s Health, University of New South Wales, Australia, Level 1, Chancellery Building, Sydney 2052, Australia;
| | - Saskia Sanderson
- Research Department of Behavioural Science and Health, University College London, Gower Street, London WC1E 6BT, UK;
- Early Disease Detection Research Project UK (EDDRP UK), 2 Redman Place, London E20 1JQ, UK
- Correspondence:
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15
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Jeong GW, Shin W, Lee DO, Seo SS, Kang S, Park SY, Lim MC. Uptake of Family-Specific Mutation Genetic Testing Among Relatives of Patients with Ovarian Cancer with BRCA1 or BRCA2 Mutation. Cancer Res Treat 2020; 53:207-211. [PMID: 32777875 PMCID: PMC7812001 DOI: 10.4143/crt.2020.364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/08/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose The BRCA1 or BRCA2 gene is transmitted in an autosomal dominant fashion, and genetic testing of first-degree relatives of patients with family-specific mutation (FSM) is recommended. This study examined factors affecting the uptake of FSM testing among relatives of patients with peritoneal, ovarian, or fallopian tube (POFT) cancer with confirmed BRCA1 or BRCA2 germline mutation. Materials and Methods Data from medical charts of 392 eligible patients and their relatives who had undergone outpatient genetic counseling/testing were retrospectively reviewed. Clinical factors were compared between family members who had and had not undergone genetic counseling/testing. Results The uptake of FSM testing was 30.5% (129/423) among first-degree living relatives and 53.5% (69/129) within the overall family unit. The average time from genetic testing of the proband to the first FSM test within a family was 168 days (range, 23 to 681 days). Having a living father (33.8% vs. 13.3%, p=0.007) and daughter (79.4% vs. 60.3%, p=0.019) increased the uptake of FSM testing. FSM testing was more likely among female than among male relatives of cancer patients (40.9% vs. 17.6%, p < 0.001). Conclusion Approximately one-third of first-degree relatives of patients with a POFT cancer with BRCA1 or BRCA2 mutation underwent FSM testing. Having a living father or daughter was a factor affecting the uptake of FSM testing, which was higher among female than among male relatives of the proband. This discrepancy might be due to a misconception that the BRCA gene is associated with women rather than with men.
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Affiliation(s)
- Go Woon Jeong
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea
| | - Wonkyo Shin
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea
| | - Dong Ock Lee
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea
| | - Sang-Soo Seo
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea
| | - Sokbom Kang
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea.,Divison of Precision Medicine, Research Institute, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, Research Institute, National Cancer Center, Goyang, Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, Research Institute, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, Research Institute, National Cancer Center, Goyang, Korea.,Center for Clinical Trials, Hospital, Research Institute, National Cancer Center, Goyang, Korea.,Division of Tumor Immunology, Research Institute, National Cancer Center, Goyang, Korea
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16
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Manchanda R, Sun L, Patel S, Evans O, Wilschut J, De Freitas Lopes AC, Gaba F, Brentnall A, Duffy S, Cui B, Coelho De Soarez P, Husain Z, Hopper J, Sadique Z, Mukhopadhyay A, Yang L, Berkhof J, Legood R. Economic Evaluation of Population-Based BRCA1/BRCA2 Mutation Testing across Multiple Countries and Health Systems. Cancers (Basel) 2020; 12:cancers12071929. [PMID: 32708835 PMCID: PMC7409094 DOI: 10.3390/cancers12071929] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022] Open
Abstract
Clinical criteria/Family history-based BRCA testing misses a large proportion of BRCA carriers who can benefit from screening/prevention. We estimate the cost-effectiveness of population-based BRCA testing in general population women across different countries/health systems. A Markov model comparing the lifetime costs and effects of BRCA1/BRCA2 testing all general population women ≥30 years compared with clinical criteria/FH-based testing. Separate analyses are undertaken for the UK/USA/Netherlands (high-income countries/HIC), China/Brazil (upper–middle income countries/UMIC) and India (low–middle income countries/LMIC) using both health system/payer and societal perspectives. BRCA carriers undergo appropriate screening/prevention interventions to reduce breast cancer (BC) and ovarian cancer (OC) risk. Outcomes include OC, BC, and additional heart disease deaths and incremental cost-effectiveness ratio (ICER)/quality-adjusted life year (QALY). Probabilistic/one-way sensitivity analyses evaluate model uncertainty. For the base case, from a societal perspective, we found that population-based BRCA testing is cost-saving in HIC (UK-ICER = $−5639/QALY; USA-ICER = $−4018/QALY; Netherlands-ICER = $−11,433/QALY), and it appears cost-effective in UMIC (China-ICER = $18,066/QALY; Brazil-ICER = $13,579/QALY), but it is not cost-effective in LMIC (India-ICER = $23,031/QALY). From a payer perspective, population-based BRCA testing is highly cost-effective in HIC (UK-ICER = $21,191/QALY, USA-ICER = $16,552/QALY, Netherlands-ICER = $25,215/QALY), and it is cost-effective in UMIC (China-ICER = $23,485/QALY, Brazil−ICER = $20,995/QALY), but it is not cost-effective in LMIC (India-ICER = $32,217/QALY). BRCA testing costs below $172/test (ICER = $19,685/QALY), which makes it cost-effective (from a societal perspective) for LMIC/India. Population-based BRCA testing can prevent an additional 2319 to 2666 BC and 327 to 449 OC cases per million women than the current clinical strategy. Findings suggest that population-based BRCA testing for countries evaluated is extremely cost-effective across HIC/UMIC health systems, is cost-saving for HIC health systems from a societal perspective, and can prevent tens of thousands more BC/OC cases.
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Affiliation(s)
- Ranjit Manchanda
- Wolfson Institute for Preventive Medicine, CRUK Barts Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UK; (L.S.); (S.P.); (O.E.); (F.G.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, Faculty of Population Health Sciences, University College London, London WC1V 6LJ, UK
- Correspondence:
| | - Li Sun
- Wolfson Institute for Preventive Medicine, CRUK Barts Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UK; (L.S.); (S.P.); (O.E.); (F.G.)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (Z.S.); (R.L.)
| | - Shreeya Patel
- Wolfson Institute for Preventive Medicine, CRUK Barts Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UK; (L.S.); (S.P.); (O.E.); (F.G.)
| | - Olivia Evans
- Wolfson Institute for Preventive Medicine, CRUK Barts Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UK; (L.S.); (S.P.); (O.E.); (F.G.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Janneke Wilschut
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, Netherlands; (J.W.); (J.B.)
| | - Ana Carolina De Freitas Lopes
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, 01246903 Sao Paulo, Brazil; (A.C.D.F.L.); (P.C.D.S.)
| | - Faiza Gaba
- Wolfson Institute for Preventive Medicine, CRUK Barts Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UK; (L.S.); (S.P.); (O.E.); (F.G.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Adam Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK; (A.B.); (S.D.)
| | - Stephen Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK; (A.B.); (S.D.)
| | - Bin Cui
- School of Public Health, Peking University, Beijing 100191, China; (B.C.); (L.Y.)
| | - Patricia Coelho De Soarez
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, 01246903 Sao Paulo, Brazil; (A.C.D.F.L.); (P.C.D.S.)
| | - Zakir Husain
- Department of Humanities & Social Sciences, Indian Institute of Technology, Kharagpur, West Bengal 721302, India;
- Department of Economics, Presidency University, Kolkata 700073, India
| | - John Hopper
- Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Victoria 3010, Australia;
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (Z.S.); (R.L.)
| | - Asima Mukhopadhyay
- Tata Medical Centre, Kolkata, West Bengal 700160, India;
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Li Yang
- School of Public Health, Peking University, Beijing 100191, China; (B.C.); (L.Y.)
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, Netherlands; (J.W.); (J.B.)
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (Z.S.); (R.L.)
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17
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Gaba F, Blyuss O, Liu X, Goyal S, Lahoti N, Chandrasekaran D, Kurzer M, Kalsi J, Sanderson S, Lanceley A, Ahmed M, Side L, Gentry-Maharaj A, Wallis Y, Wallace A, Waller J, Luccarini C, Yang X, Dennis J, Dunning A, Lee A, Antoniou AC, Legood R, Menon U, Jacobs I, Manchanda R. Population Study of Ovarian Cancer Risk Prediction for Targeted Screening and Prevention. Cancers (Basel) 2020; 12:E1241. [PMID: 32429029 PMCID: PMC7281662 DOI: 10.3390/cancers12051241] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 02/03/2023] Open
Abstract
Unselected population-based personalised ovarian cancer (OC) risk assessment combining genetic/epidemiology/hormonal data has not previously been undertaken. We aimed to perform a feasibility study of OC risk stratification of general population women using a personalised OC risk tool followed by risk management. Volunteers were recruited through London primary care networks. INCLUSION CRITERIA women ≥18 years. EXCLUSION CRITERIA prior ovarian/tubal/peritoneal cancer, previous genetic testing for OC genes. Participants accessed an online/web-based decision aid along with optional telephone helpline use. Consenting individuals completed risk assessment and underwent genetic testing (BRCA1/BRCA2/RAD51C/RAD51D/BRIP1, OC susceptibility single-nucleotide polymorphisms). A validated OC risk prediction algorithm provided a personalised OC risk estimate using genetic/lifestyle/hormonal OC risk factors. Population genetic testing (PGT)/OC risk stratification uptake/acceptability, satisfaction, decision aid/telephone helpline use, psychological health and quality of life were assessed using validated/customised questionnaires over six months. Linear-mixed models/contrast tests analysed impact on study outcomes. MAIN OUTCOMES feasibility/acceptability, uptake, decision aid/telephone helpline use, satisfaction/regret, and impact on psychological health/quality of life. In total, 123 volunteers (mean age = 48.5 (SD = 15.4) years) used the decision aid, 105 (85%) consented. None fulfilled NHS genetic testing clinical criteria. OC risk stratification revealed 1/103 at ≥10% (high), 0/103 at ≥5%-<10% (intermediate), and 100/103 at <5% (low) lifetime OC risk. Decision aid satisfaction was 92.2%. The telephone helpline use rate was 13% and the questionnaire response rate at six months was 75%. Contrast tests indicated that overall depression (p = 0.30), anxiety (p = 0.10), quality-of-life (p = 0.99), and distress (p = 0.25) levels did not jointly change, while OC worry (p = 0.021) and general cancer risk perception (p = 0.015) decreased over six months. In total, 85.5-98.7% were satisfied with their decision. Findings suggest population-based personalised OC risk stratification is feasible and acceptable, has high satisfaction, reduces cancer worry/risk perception, and does not negatively impact psychological health/quality of life.
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Affiliation(s)
- Faiza Gaba
- Wolfson Institute of Preventative Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; (F.G.); (X.L.); (S.G.); (N.L.); (D.C.)
- Department of Gynaecological Oncology, St Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK;
| | - Oleg Blyuss
- School of Physics, Astronomy and Mathematics, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK;
- Department of Paediatrics and Paediatric Infectious Diseases, Sechenov First Moscow State Medical University, Moscow 119146, Russia
- Department of Applied Mathematics, Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod 603098, Russia
| | - Xinting Liu
- Wolfson Institute of Preventative Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; (F.G.); (X.L.); (S.G.); (N.L.); (D.C.)
| | - Shivam Goyal
- Wolfson Institute of Preventative Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; (F.G.); (X.L.); (S.G.); (N.L.); (D.C.)
| | - Nishant Lahoti
- Wolfson Institute of Preventative Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; (F.G.); (X.L.); (S.G.); (N.L.); (D.C.)
| | - Dhivya Chandrasekaran
- Wolfson Institute of Preventative Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; (F.G.); (X.L.); (S.G.); (N.L.); (D.C.)
- Department of Gynaecological Oncology, St Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK;
| | - Margarida Kurzer
- Department of Gynaecological Oncology, St Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK;
| | - Jatinderpal Kalsi
- Department of Women’s Cancer, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6AU, UK; (J.K.); (A.L.)
| | - Saskia Sanderson
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK;
| | - Anne Lanceley
- Department of Women’s Cancer, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6AU, UK; (J.K.); (A.L.)
| | - Munaza Ahmed
- Department Clinical Genetics, North East Thames Regional Genetics Unit, Great Ormond Street Hospital, London WC1N 3JH, UK;
| | - Lucy Side
- Department of Clinical Genetics, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK;
| | - Aleksandra Gentry-Maharaj
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London WC1V 6LJ, UK; (A.G.-M.); (U.M.)
| | - Yvonne Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women’s NHS Foundation Trust, Birmingham B15 2TG, UK;
| | - Andrew Wallace
- Manchester Centre for Genomic Medicine, 6th Floor Saint Marys Hospital, Oxford Rd, Manchester M13 9WL, UK;
| | - Jo Waller
- Cancer Prevention Group, King’s College London, Great Maze Pond, London SE1 9RT, UK;
| | - Craig Luccarini
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, Worts Causeway, Cambridge CB1 8RN, UK; (C.L.); (X.Y.); (J.D.); (A.D.); (A.L.); (A.C.A.)
| | - Xin Yang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, Worts Causeway, Cambridge CB1 8RN, UK; (C.L.); (X.Y.); (J.D.); (A.D.); (A.L.); (A.C.A.)
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, Worts Causeway, Cambridge CB1 8RN, UK; (C.L.); (X.Y.); (J.D.); (A.D.); (A.L.); (A.C.A.)
| | - Alison Dunning
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, Worts Causeway, Cambridge CB1 8RN, UK; (C.L.); (X.Y.); (J.D.); (A.D.); (A.L.); (A.C.A.)
| | - Andrew Lee
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, Worts Causeway, Cambridge CB1 8RN, UK; (C.L.); (X.Y.); (J.D.); (A.D.); (A.L.); (A.C.A.)
| | - Antonis C. Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, Worts Causeway, Cambridge CB1 8RN, UK; (C.L.); (X.Y.); (J.D.); (A.D.); (A.L.); (A.C.A.)
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Usha Menon
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London WC1V 6LJ, UK; (A.G.-M.); (U.M.)
| | - Ian Jacobs
- Department of Women’s Health, University of New South Wales, Australia, Level 1, Chancellery Building, Sydney 2052, Australia;
| | - Ranjit Manchanda
- Wolfson Institute of Preventative Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; (F.G.); (X.L.); (S.G.); (N.L.); (D.C.)
- Department of Gynaecological Oncology, St Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK;
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London WC1V 6LJ, UK; (A.G.-M.); (U.M.)
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18
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Hereditary Breast and Ovarian Cancer in Families from Southern Italy (Sicily)-Prevalence and Geographic Distribution of Pathogenic Variants in BRCA1/2 Genes. Cancers (Basel) 2020; 12:cancers12051158. [PMID: 32380732 PMCID: PMC7280980 DOI: 10.3390/cancers12051158] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 12/20/2022] Open
Abstract
Recent advances in the detection of germline pathogenic variants (PVs) in BRCA1/2 genes have allowed a deeper understanding of the BRCA-related cancer risk. Several studies showed a significant heterogeneity in the prevalence of PVs across different populations. Because little is known about this in the Sicilian population, our study was aimed at investigating the prevalence and geographic distribution of inherited BRCA1/2 PVs in families from this specific geographical area of Southern Italy. We retrospectively collected and analyzed all clinical information of 1346 hereditary breast and/or ovarian cancer patients genetically tested for germline BRCA1/2 PVs at University Hospital Policlinico "P. Giaccone" of Palermo from January 1999 to October 2019. Thirty PVs were more frequently observed in the Sicilian population but only some of these showed a specific territorial prevalence, unlike other Italian and European regions. This difference could be attributed to the genetic heterogeneity of the Sicilian people and its historical background. Therefore hereditary breast and ovarian cancers could be predominantly due to BRCA1/2 PVs different from those usually detected in other geographical areas of Italy and Europe. Our investigation led us to hypothesize that a higher prevalence of some germline BRCA PVs in Sicily could be a population-specific genetic feature of BRCA-positive carriers.
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19
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Current and future approaches to screening for endometrial cancer. Best Pract Res Clin Obstet Gynaecol 2020; 65:79-97. [DOI: 10.1016/j.bpobgyn.2019.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023]
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20
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Yadav S, Hu C, Hart SN, Boddicker N, Polley EC, Na J, Gnanaolivu R, Lee KY, Lindstrom T, Armasu S, Fitz-Gibbon P, Ghosh K, Stan DL, Pruthi S, Neal L, Sandhu N, Rhodes DJ, Klassen C, Peethambaram PP, Haddad TC, Olson JE, Hoskin TL, Goetz MP, Domchek SM, Boughey JC, Ruddy KJ, Couch FJ. Evaluation of Germline Genetic Testing Criteria in a Hospital-Based Series of Women With Breast Cancer. J Clin Oncol 2020; 38:1409-1418. [PMID: 32125938 PMCID: PMC7193748 DOI: 10.1200/jco.19.02190] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To determine the sensitivity and specificity of genetic testing criteria for the detection of germline pathogenic variants in women with breast cancer. MATERIALS AND METHODS Women with breast cancer enrolled in a breast cancer registry at a tertiary cancer center between 2000 and 2016 were evaluated for germline pathogenic variants in 9 breast cancer predisposition genes (ATM, BRCA1, BRCA2, CDH1, CHEK2, NF1, PALB2, PTEN, and TP53). The performance of the National Comprehensive Cancer Network (NCCN) hereditary cancer testing criteria was evaluated relative to testing of all women as recommended by the American Society of Breast Surgeons. RESULTS Of 3,907 women, 1,872 (47.9%) meeting NCCN criteria were more likely to carry a pathogenic variant in 9 predisposition genes compared with women not meeting criteria (9.0% v 3.5%; P < .001). Of those not meeting criteria (n = 2,035), 14 (0.7%) had pathogenic variants in BRCA1 or BRCA2. The sensitivity of NCCN criteria was 70% for 9 predisposition genes and 87% for BRCA1 and BRCA2, with a specificity of 53%. Expansion of the NCCN criteria to include all women diagnosed with breast cancer at ≤ 65 years of age achieved > 90% sensitivity for the 9 predisposition genes and > 98% sensitivity for BRCA1 and BRCA2. CONCLUSION A substantial proportion of women with breast cancer carrying germline pathogenic variants in predisposition genes do not qualify for testing by NCCN criteria. Expansion of NCCN criteria to include all women diagnosed at ≤ 65 years of age improves the sensitivity of the selection criteria without requiring testing of all women with breast cancer.
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Affiliation(s)
| | - Chunling Hu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Steven N. Hart
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Eric C. Polley
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jie Na
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Rohan Gnanaolivu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Kun Y. Lee
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Tricia Lindstrom
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Sebastian Armasu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | | | | | | | - Janet E. Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Tanya L. Hoskin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Susan M. Domchek
- Perelman School of Medicine, University of Pennsylvania, and Basser Center for BRCA, Philadelphia, PA
| | | | | | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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21
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Patel AP, Wang M, Fahed AC, Mason-Suares H, Brockman D, Pelletier R, Amr S, Machini K, Hawley M, Witkowski L, Koch C, Philippakis A, Cassa CA, Ellinor PT, Kathiresan S, Ng K, Lebo M, Khera AV. Association of Rare Pathogenic DNA Variants for Familial Hypercholesterolemia, Hereditary Breast and Ovarian Cancer Syndrome, and Lynch Syndrome With Disease Risk in Adults According to Family History. JAMA Netw Open 2020; 3:e203959. [PMID: 32347951 PMCID: PMC7292735 DOI: 10.1001/jamanetworkopen.2020.3959] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Pathogenic DNA variants associated with familial hypercholesterolemia, hereditary breast and ovarian cancer syndrome, and Lynch syndrome are widely recognized as clinically important and actionable when identified, leading some clinicians to recommend population-wide genomic screening. OBJECTIVES To assess the prevalence and clinical importance of pathogenic or likely pathogenic variants associated with each of 3 genomic conditions (familial hypercholesterolemia, hereditary breast and ovarian cancer syndrome, and Lynch syndrome) within the context of contemporary clinical care. DESIGN, SETTING, AND PARTICIPANTS This cohort study used gene-sequencing data from 49 738 participants in the UK Biobank who were recruited from 22 sites across the UK between March 21, 2006, and October 1, 2010. Inpatient hospital data date back to 1977; cancer registry data, to 1957; and death registry data, to 2006. Statistical analysis was performed from July 22, 2019, to November 15, 2019. EXPOSURES Pathogenic or likely pathogenic DNA variants classified by a clinical laboratory geneticist. MAIN OUTCOMES AND MEASURES Composite end point specific to each genomic condition based on atherosclerotic cardiovascular disease events for familial hypercholesterolemia, breast or ovarian cancer for hereditary breast and ovarian cancer syndrome, and colorectal or uterine cancer for Lynch syndrome. RESULTS Among 49 738 participants (mean [SD] age, 57 [8] years; 27 144 female [55%]), 441 (0.9%) harbored a pathogenic or likely pathogenic variant associated with any of 3 genomic conditions, including 131 (0.3%) for familial hypercholesterolemia, 235 (0.5%) for hereditary breast and ovarian cancer syndrome, and 76 (0.2%) for Lynch syndrome. Presence of these variants was associated with increased risk of disease: for familial hypercholesterolemia, 28 of 131 carriers (21.4%) vs 4663 of 49 607 noncarriers (9.4%) developed atherosclerotic cardiovascular disease; for hereditary breast and ovarian cancer syndrome, 32 of 116 female carriers (27.6%) vs 2080 of 27 028 female noncarriers (7.7%) developed associated cancers; and for Lynch syndrome, 17 of 76 carriers (22.4%) vs 929 of 49 662 noncarriers (1.9%) developed colorectal or uterine cancer. The predicted probability of disease at age 75 years despite contemporary clinical care was 45.3% for carriers of familial hypercholesterolemia, 41.1% for hereditary breast and ovarian cancer syndrome, and 38.3% for Lynch syndrome. Across the 3 conditions, 39.7% (175 of 441) of the carriers reported a family history of disease vs 23.2% (34 517 of 148 772) of noncarriers. CONCLUSIONS AND RELEVANCE The findings suggest that approximately 1% of the middle-aged adult population in the UK Biobank harbored a pathogenic variant associated with any of 3 genomic conditions. These variants were associated with an increased risk of disease despite contemporary clinical care and were not reliably detected by family history.
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Affiliation(s)
- Aniruddh P Patel
- Division of Cardiology and Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Minxian Wang
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Akl C Fahed
- Division of Cardiology and Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Heather Mason-Suares
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Boston, Massachusetts
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Deanna Brockman
- Division of Cardiology and Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Renee Pelletier
- Division of Cardiology and Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Sami Amr
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Boston, Massachusetts
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kalotina Machini
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Boston, Massachusetts
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Megan Hawley
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Boston, Massachusetts
| | - Leora Witkowski
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Boston, Massachusetts
| | - Christopher Koch
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Boston, Massachusetts
| | - Anthony Philippakis
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Christopher A Cassa
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Patrick T Ellinor
- Division of Cardiology and Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Sekar Kathiresan
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Verve Therapeutics, Cambridge, Massachusetts
| | - Kenney Ng
- Center for Computational Health, IBM Research, Cambridge, Massachusetts
| | - Matthew Lebo
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Boston, Massachusetts
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amit V Khera
- Division of Cardiology and Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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22
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Hao J, Hassen D, Manickam K, Murray MF, Hartzel DN, Hu Y, Liu K, Rahm AK, Williams MS, Lazzeri A, Buchanan A, Sturm A, Snyder SR. Healthcare Utilization and Costs after Receiving a Positive BRCA1/2 Result from a Genomic Screening Program. J Pers Med 2020; 10:jpm10010007. [PMID: 32028596 PMCID: PMC7151600 DOI: 10.3390/jpm10010007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/21/2020] [Accepted: 01/28/2020] [Indexed: 01/08/2023] Open
Abstract
Population genomic screening has been demonstrated to detect at-risk individuals who would not be clinically identified otherwise. However, there are concerns about the increased utilization of unnecessary services and the associated increase in costs. The objectives of this study are twofold: (1) determine whether there is a difference in healthcare utilization and costs following disclosure of a pathogenic/likely pathogenic (P/LP) BRCA1/2 variant via a genomic screening program, and (2) measure the post-disclosure uptake of National Comprehensive Cancer Network (NCCN) guideline-recommended risk management. We retrospectively reviewed electronic health record (EHR) and billing data from a female population of BRCA1/2 P/LP variant carriers without a personal history of breast or ovarian cancer enrolled in Geisinger’s MyCode genomic screening program with at least a one-year post-disclosure observation period. We identified 59 women for the study cohort out of 50,726 MyCode participants. We found no statistically significant differences in inpatient and outpatient utilization and average total costs between one-year pre- and one-year post-disclosure periods ($18,821 vs. $19,359, p = 0.76). During the first year post-disclosure, 49.2% of women had a genetic counseling visit, 45.8% had a mammography and 32.2% had an MRI. The uptake of mastectomy and oophorectomy was 3.5% and 11.8%, respectively, and 5% of patients received chemoprevention.
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Affiliation(s)
- Jing Hao
- Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA
| | - Dina Hassen
- Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA
| | - Kandamurugu Manickam
- Division of Genetic and Genomic Medicine, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Michael F Murray
- Department of Genetics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Dustin N Hartzel
- Phenomic Analytics and Clinical Data Core, Geisinger, Danville, PA 17822, USA
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA
| | - Kunpeng Liu
- Department of Computer Science, University of Central Florida, Orlando, FL 32816, USA
| | | | - Marc S Williams
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA
| | - Amanda Lazzeri
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA
| | - Adam Buchanan
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA
| | - Amy Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA
| | - Susan R Snyder
- Department of Health Policy and Behavioral Science, School of Public Health, Georgia State University, Atlanta, GA 30302, USA
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23
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Sun L, Brentnall A, Patel S, Buist DSM, Bowles EJA, Evans DGR, Eccles D, Hopper J, Li S, Southey M, Duffy S, Cuzick J, dos Santos Silva I, Miners A, Sadique Z, Yang L, Legood R, Manchanda R. A Cost-effectiveness Analysis of Multigene Testing for All Patients With Breast Cancer. JAMA Oncol 2019; 5:1718-1730. [PMID: 31580391 PMCID: PMC6777250 DOI: 10.1001/jamaoncol.2019.3323] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/19/2019] [Indexed: 02/06/2023]
Abstract
Importance Moving to multigene testing for all women with breast cancer (BC) could identify many more mutation carriers who can benefit from precision prevention. However, the cost-effectiveness of this approach remains unaddressed. Objective To estimate incremental lifetime effects, costs, and cost-effectiveness of multigene testing of all patients with BC compared with the current practice of genetic testing (BRCA) based on family history (FH) or clinical criteria. Design, Setting, and Participants This cost-effectiveness microsimulation modeling study compared lifetime costs and effects of high-risk BRCA1/BRCA2/PALB2 (multigene) testing of all unselected patients with BC (strategy A) with BRCA1/BRCA2 testing based on FH or clinical criteria (strategy B) in United Kingdom (UK) and US populations. Data were obtained from 11 836 patients in population-based BC cohorts (regardless of FH) recruited to 4 large research studies. Data were collected and analyzed from January 1, 2018, through June 8, 2019. The time horizon is lifetime. Payer and societal perspectives are presented. Probabilistic and 1-way sensitivity analyses evaluate model uncertainty. Interventions In strategy A, all women with BC underwent BRCA1/BRCA2/PALB2 testing. In strategy B, only women with BC fulfilling FH or clinical criteria underwent BRCA testing. Affected BRCA/PALB2 carriers could undertake contralateral preventive mastectomy; BRCA carriers could choose risk-reducing salpingo-oophorectomy (RRSO). Relatives of mutation carriers underwent cascade testing. Unaffected relative carriers could undergo magnetic resonance imaging or mammography screening, chemoprevention, or risk-reducing mastectomy for BC risk and RRSO for ovarian cancer (OC) risk. Main Outcomes and Measures Incremental cost-effectiveness ratio (ICER) was calculated as incremental cost per quality-adjusted life-year (QALY) gained and compared with standard £30 000/QALY and $100 000/QALY UK and US thresholds, respectively. Incidence of OC, BC, excess deaths due to heart disease, and the overall population effects were estimated. Results BRCA1/BRCA2/PALB2 multigene testing for all patients detected with BC annually would cost £10 464/QALY (payer perspective) or £7216/QALY (societal perspective) in the United Kingdom or $65 661/QALY (payer perspective) or $61 618/QALY (societal perspective) in the United States compared with current BRCA testing based on clinical criteria or FH. This is well below UK and US cost-effectiveness thresholds. In probabilistic sensitivity analysis, unselected multigene testing remained cost-effective for 98% to 99% of UK and 64% to 68% of US health system simulations. One year's unselected multigene testing could prevent 2101 cases of BC and OC and 633 deaths in the United Kingdom and 9733 cases of BC and OC and 2406 deaths in the United States. Correspondingly, 8 excess deaths due to heart disease occurred in the United Kingdom and 35 in the United States annually. Conclusions and Relevance This study found unselected, high-risk multigene testing for all patients with BC to be extremely cost-effective compared with testing based on FH or clinical criteria for UK and US health systems. These findings support changing current policy to expand genetic testing to all women with BC.
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Affiliation(s)
- Li Sun
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Adam Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Shreeya Patel
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Erin J. A. Bowles
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - D. Gareth R. Evans
- Genomic Medicine, Manchester Academic Health Science Centre, Manchester Universities Foundation Trust, St Mary’s Hospital, The University of Manchester, Manchester, United Kingdom
| | - Diana Eccles
- Cancer Sciences Academic Unit, Faculty of Medicine and Cancer Sciences, University of Southampton, Southampton, United Kingdom
| | - John Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Shuai Li
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Melissa Southey
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Department of Clinical Pathology, Melbourne Medical School, Melbourne University, Melbourne, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia
| | - Stephen Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Isabel dos Santos Silva
- Department of Noncommunicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Li Yang
- School of Public Health, Peking University, Beijing, China
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ranjit Manchanda
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
- Department of Gynaecological Oncology, Barts Health National Health System Trust, Royal London Hospital, London, United Kingdom
- MRC (Medical Research Counsel) Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, Faculty of Population Health Sciences, University College London, London, United Kingdom
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Rubinsak LA, Kleinman A, Quillin J, Gordon SW, Sullivan SA, Sutton AL, Sheppard VB, Temkin SM. Awareness and acceptability of population-based screening for pathogenic BRCA variants: Do race and ethnicity matter? Gynecol Oncol 2019; 154:383-387. [DOI: 10.1016/j.ygyno.2019.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 02/07/2023]
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Chen J. A fully-automated event-based variant prioritizing solution to the CAGI5 intellectual disability gene panel challenge. Hum Mutat 2019; 40:1364-1372. [PMID: 31066479 DOI: 10.1002/humu.23781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/28/2019] [Accepted: 05/02/2019] [Indexed: 11/07/2022]
Abstract
Recent applications of gene panel sequencing analysis have significantly helped with identifying genetic causes for inherited diseases. However, large amounts of candidate variants remain a major challenge for prioritizing, often requiring arbitrary cutoffs in multiple steps. In addition, existing tools often prioritize a list of promising candidates that require much manual work to evaluate. To this end, we designed an automated, basically cutoff-free scoring scheme named Context and Hereditary Event based Scoring Scheme (CHESS), that scores all possible inheritance events in each gene, by taking into consideration phenotypes, genotypes, and how the manual prioritization works. We applied CHESS to the Critical Assessment of Genome Interpretation 5 intellectual disability panel challenge, to assign clinical phenotypes to patients based on gene panel sequencing data. Through this blind testing, CHESS proved to be a leading and useful tool for genetic diagnosis in a research setting. Further analyses showed that precise phenotype terms played an important role in variant prioritization and that multiple etiologies may exist for some patients. CHESS also successfully identified many of the causal, putative and contributing variants. In the postchallenge analysis, we showed that our best submission performed slightly better than the predictions made by a state-of-the-art tool. We believe that CHESS can provide aid to this and many other diagnostic scenarios.
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Affiliation(s)
- Jingqi Chen
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China.,Department of Plant & Microbial Biology, University of California, Berkeley, California, USA
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Genetic Testing to Guide Risk-Stratified Screens for Breast Cancer. J Pers Med 2019; 9:jpm9010015. [PMID: 30832243 PMCID: PMC6462925 DOI: 10.3390/jpm9010015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/18/2019] [Accepted: 02/22/2019] [Indexed: 12/14/2022] Open
Abstract
Breast cancer screening modalities and guidelines continue to evolve and are increasingly based on risk factors, including genetic risk and a personal or family history of cancer. Here, we review genetic testing of high-penetrance hereditary breast and ovarian cancer genes, including BRCA1 and BRCA2, for the purpose of identifying high-risk individuals who would benefit from earlier screening and more sensitive methods such as magnetic resonance imaging. We also consider risk-based screening in the general population, including whether every woman should be genetically tested for high-risk genes and the potential use of polygenic risk scores. In addition to enabling early detection, the results of genetic screens of breast cancer susceptibility genes can be utilized to guide decision-making about when to elect prophylactic surgeries that reduce cancer risk and the choice of therapeutic options. Variants of uncertain significance, especially missense variants, are being identified during panel testing for hereditary breast and ovarian cancer. A finding of a variant of uncertain significance does not provide a basis for increased cancer surveillance or prophylactic procedures. Given that variant classification is often challenging, we also consider the role of multifactorial statistical analyses by large consortia and functional tests for this purpose.
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