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Padmanabhan H, Mariapun S, Lee SY, Hassan NT, Lee DSC, Meiser B, Wong SW, Lee YQ, Yip CH, Teo SH, Thong MK, Taib NAM, Yoon SY. Impact of BRCA1/2 cascade testing on anxiety, depression, and cancer worry levels among unaffected relatives in a multiethnic Asian cohort. J Genet Couns 2023; 32:43-56. [PMID: 35913122 DOI: 10.1002/jgc4.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 06/10/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022]
Abstract
Cascade testing for families with BRCA pathogenic variants is important to identify relatives who are carriers. These relatives can benefit from appropriate risk management and preventative strategies arising from an inherited increased risk of breast, ovarian, prostate, melanoma, and pancreatic cancers. Cascade testing has the potential to enable cost-effective cancer control even in low- and middle-income settings, but few studies have hitherto evaluated the psychosocial impact of cascade testing in an Asian population, where the cultural and religious beliefs around inheritance and destiny have previously been shown to influence perception and attitudes toward screening. In this study, we evaluated the short- and long-term psychosocial impact of genetic testing among unaffected relatives of probands identified through the Malaysian Breast Cancer Genetics Study and the Malaysian Ovarian Cancer Study, using validated questionnaires (Hospital Anxiety and Depression Scale and Cancer Worry Scale) administered at baseline, and 1-month and 2-year post-disclosure of results. Of the 305 unaffected relatives from 98 independent families who were offered cascade testing, 256 (84%) completed predictive testing and family history of cancers was the only factor significantly associated with uptake of predictive testing. We found that the levels of anxiety, depression, and cancer worry among unaffected relatives decreased significantly after result disclosure and remained low 2-year post-result disclosure. Younger relatives and relatives of Malay descent had higher cancer worry at both baseline and after result disclosure compared to those of Chinese and Indian descent, whereas relatives of Indian descent and those with family history of cancers had higher anxiety and depression levels post-result disclosure. Taken together, the results from this Asian cohort highlight the differences in psychosocial needs in different communities and inform the development of culture-specific genetic counseling strategies.
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Affiliation(s)
| | | | | | | | | | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | | | | | | | | | - Meow-Keong Thong
- Department of Paediatrics, Genetic Medicine Unit, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Lourenção M, Simões Correa Galendi J, Galvão HDCR, Antoniazzi AP, Grasel RS, Carvalho AL, Mauad EC, de Oliveira JHC, Reis RM, Mandrik O, Palmero EI. Cost-Effectiveness of BRCA 1/2 Genetic Test and Preventive Strategies: Using Real-World Data From an Upper-Middle Income Country. Front Oncol 2022; 12:951310. [PMID: 35898894 PMCID: PMC9309566 DOI: 10.3389/fonc.2022.951310] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Although BRCA1/2 genetic testing in developed countries is part of the reality for high-risk patients for hereditary breast and ovarian cancer (HBOC), the same is not true for upper-middle-income countries. For that reason, this study aimed to evaluate whether the BRCA1/2 genetic test and preventive strategies for women at high risk for HBOC are cost-effective compared to not performing these strategies in an upper-middle-income country. Adopting a payer perspective, a Markov model with a time horizon of 70 years was built to delineate the health states for a cohort of healthy women aged 30 years that fulfilled the BRCA1/2 testing criteria according to the guidelines. Transition probabilities were calculated based on real-world data of women tested for BRCA1/2 germline mutations in a cancer reference hospital from 2011 to 2020. We analyzed 275 BRCA mutated index cases and 356 BRCA mutation carriers that were first- or second-degree relatives of the patients. Costs were based on the Brazilian public health system reimbursement values. Health state utilities were retrieved from literature. The BRCA1/2 genetic test and preventive strategies result in more quality-adjusted life years (QALYs) and costs with an incremental cost-effectiveness ratio of R$ 11,900.31 (U$ 5,504.31)/QALY. This result can represent a strong argument in favor of implementing genetic testing strategies for high-risk women even in countries with upper-middle income, considering not only the cancer prevention possibilities associated with the genetic testing but also its cost-effectiveness to the health system. These strategies are cost-effective, considering a willingness-to-pay threshold of R$ 25,000 (U$ 11,563.37)/QALY, indicating that the government should consider offering them for women at high risk for HBOC. The results were robust in deterministic and probabilistic sensitivity analyses.
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Affiliation(s)
- Marina Lourenção
- School of Economics, Business Administration and Accounting at Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | - Julia Simões Correa Galendi
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | | | | | - Rebeca Silveira Grasel
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Department of Genetics, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - André Lopes Carvalho
- Early Detection Prevention and Infections, International Agency for Research on Cancer, Lyon, France
| | | | | | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s – PT Government Associate Laboratory, Guimarães, Portugal
| | - Olena Mandrik
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - Edenir Inêz Palmero
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Department of Genetics, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
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Pelletier S, Larouche G, Chiquette J, El Haffaf Z, Foulkes WD, Hamet P, Simard J, Dorval M. Survey of primary care physicians' views about breast and ovarian cancer screening for true BRCA1/2 non-carriers. J Community Genet 2019; 11:205-213. [PMID: 31659621 DOI: 10.1007/s12687-019-00438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/04/2019] [Indexed: 10/25/2022] Open
Abstract
Despite some controversy, true BRCA1/2 non-carriers are generally considered to be at an average risk for breast and ovarian cancer. Primary care physicians are then expected to encourage their non-carrier patients to adopt cancer screening practices appropriate to women of the same age in the general population. This study aimed to describe breast and ovarian cancer screening recommendations that primary care physicians would consider advisable for young true BRCA1/2 non-carriers. One hundred thirty-four family physicians and 123 gynecologists (response rate 45%) completed a cross-sectional mailed survey administered in the Province of Quebec, Canada. The survey included questions about basic genetic knowledge and screening recommendations for two fictitious cases (< 40 years), one carrier and one non-carrier, from a BRCA1/2 mutation-positive family. Screening exams considered advisable did not differ significantly between family physicians and gynecologists. More than 75% of physicians considered the cancer risks of true non-carriers to be comparable with that of the general population and 14% to be a little higher. Still, 53% would prescribe a biennial and or even an annual (27%) mammography to a non-carrier woman before the recommended starting age. Physician considerations of non-carriers' expectations or requests for screening were associated with more screening prescriptions. More than half of primary care physicians would recommend more mammography screenings than expected for a young true BRCA1/2 non-carrier. Personalized cancer risk assessment may help primary care physicians tailor screening of women from BRCA1/2 mutation-positive families and allow these women to make more informed choices regarding cancer risk management options.
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Affiliation(s)
- S Pelletier
- Oncology Division, CHU de Québec - Université Laval Research Center, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada.,Université Laval Cancer Research Centre, Québec, QC, Canada
| | - G Larouche
- Oncology Division, CHU de Québec - Université Laval Research Center, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada.,Université Laval Cancer Research Centre, Québec, QC, Canada
| | - J Chiquette
- Oncology Division, CHU de Québec - Université Laval Research Center, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada.,Université Laval Cancer Research Centre, Québec, QC, Canada.,Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Z El Haffaf
- Genetic Medicine Service, Montreal University Hospital (CHUM), Montréal, QC, Canada
| | - W D Foulkes
- Department of Medical Genetics, Jewish General Hospital, Montréal, QC, Canada.,Lady Davis Institute of the Jewish General Hospital, Montréal, QC, Canada.,Departments of Oncology, Human Genetics and Medicine, McGill University, Montréal, QC, Canada
| | - P Hamet
- Research Centre, Montreal University Hospital (CHUM), Montréal, QC, Canada
| | - J Simard
- Oncology Division, CHU de Québec - Université Laval Research Center, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada.,Université Laval Cancer Research Centre, Québec, QC, Canada.,Faculty of Medicine, Université Laval, Québec, QC, Canada.,Canada Research Chair in Oncogenetics, Université Laval, Québec, QC, Canada
| | - M Dorval
- Oncology Division, CHU de Québec - Université Laval Research Center, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada. .,Université Laval Cancer Research Centre, Québec, QC, Canada. .,Faculty of Pharmacy, Université Laval, Québec, QC, Canada. .,Research Centre of the CISSS Chaudière-Appalaches, Lévis, QC, Canada.
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