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Hage AM, Gebert P, Blohmer JU, Hedayati E, Speiser D, Karsten MM. Subtype-Specific Survival of Young Women with Breast Cancer and Its Interaction with the Germline BRCA Status. Cancers (Basel) 2024; 16:738. [PMID: 38398129 PMCID: PMC10887122 DOI: 10.3390/cancers16040738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Data are scarce on the role of pathogenic germline variants in BRCA1 and BRCA2 (gBRCAm) in subtype-specific survival in young women who develop breast cancer under the age of 40. This retrospective, real-world cohort study assessed the distant disease-free survival (DDFS) and overall survival (OS) of young women diagnosed with breast cancer between 2008 and 2019 while taking into consideration the interaction of clinical subtypes and the gBRCA status. Among 473 women, HR+/Her2- was the most common subtype (49.0%), followed by TNBC (31.3%), HR+/Her2+ (13.7%), and Her2+/HR- (5.9%). The gBRCA status was known for 319 cases (gBRCAwt (wild-type - without pathogenic variants in BRCA1 or BRCA2): 204, gBRCA1m: 83, gBRCA2m: 31, 1 patient with both). The distribution of clinical subtypes varied depending on the gBRCA status (p < 0.001). In survival analysis with a median follow-up of 43 months, the unadjusted DDFS and OS were worse for gBRCAwt TNBC compared to both HR+ subtypes, but not for gBRCAm TNBC patients. T-stage, nodal involvement, and the gBRCA status were identified as significant for survival in TNBC. In TNBC, gBRCAm was associated with better DDFS and OS than gBRCAwt (5-year DDFS 81.4% vs. 54.3%, p = 0.012 and 5-year OS 96.7% vs. 62.7%, p < 0.001). In contrast, in HR+/Her2- patients, gBRCAm patients showed a tendency for worse survival, though not statistically significant. Subtype-specific survival in young women with breast cancer needs to be evaluated in interaction with the gBRCA status. For TNBC, gBRCAm is of favorable prognostic value for overall survival, while patients with gBRCAwt TNBC need to be considered to have the highest risk for adverse survival outcomes.
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Affiliation(s)
- Anna Maria Hage
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Comprehensive Cancer Centre, 17176 Stockholm, Sweden
| | - Dorothee Speiser
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Maria Margarete Karsten
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
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Speiser D, Kendel F, Fechner K, Olbrich C, Stegen S, Häring S, Rörig A, Feufel MA. iKNOWgynetics - A web-based learning concept to empower primary care gynecologists to participate in the care of patients with a family history of breast and ovarian cancer. J Genet Couns 2024; 33:189-196. [PMID: 37452466 DOI: 10.1002/jgc4.1750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
Familial cancer burden and genetics play an increasingly important role in the early detection and prevention of gynecological cancers. However, people with hereditary cancer risks are often identified late when they already have cancer. We aimed at developing and evaluating a training concept for primary care gynecologists-iKNOWgynetics-to improve their knowledge and awareness of genetic cancer syndromes and their ability to identify patients with increased familial cancer risks based on up-to-date evidence and current guidelines (in Germany, primary care includes all doctors treating patients on an outpatient basis without a clear separation of the expertise of the doctor or of their specialty). Starting off with a needs assessment among primary care gynecologists, we developed and evaluated an online training concept-using a web-based learning platform in combination with a live virtual seminar-to convey practice-relevant knowledge about familial cancer. After registration, participants get access to the web-based learning platform (www.iknowgynetics.de) to prepare for the virtual seminars and to use it as online reference to re-access the contents after the training. Evaluation included multiple-choice (MC) questions on knowledge and participants' self-efficacy to implement the acquired knowledge, which were administered in a pre-post design. Of 109 participants, 103 (94.5%) filled out pre- and post-questionnaires. Eighty-five participants were gynecologists in primary care from Berlin (81.2%) and Brandenburg (18.8%) and had an average of 24.1 years (SD = 8.5 years) of professional experience. After the training, participants answered significantly more knowledge questions correctly (M = 15.2 of 17, SD = 1.3) than before (M = 13.8 of 17, SD = 1.7) (p < 0.01) and felt more confident to be able to apply referral criteria for specialized counseling in practice (p < 0.001). The online-based training iKNOWgynetics considers the busy schedule of primary care gynecologists and supports them in acquiring practice-relevant information on familial cancer risks and on how to identify healthy persons at risk, which may ultimately help to improve the prevention of gynecological cancers. In future studies, the reported concept could be transferred to other entities.
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Affiliation(s)
- Dorothee Speiser
- Department of Gynecology, Center Hereditary Breast and Ovarian Cancer, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friederike Kendel
- Gender in Medicine, Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Karen Fechner
- Department of Gynecology, Center Hereditary Breast and Ovarian Cancer, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christine Olbrich
- Department of Gynecology, Center Hereditary Breast and Ovarian Cancer, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Stephanie Häring
- Gender in Medicine, Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Alina Rörig
- Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Markus A Feufel
- Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Technische Universität Berlin, Berlin, Germany
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Kendel F, Speiser D, Fechner K, Olbrich C, Stegen S, Rörig A, Feufel MA, Haering S. Talking about Familial Breast and Ovarian Cancer Risk-Evaluation of a Psychosocial Training Module for Gynecologists in Germany. Cancers (Basel) 2024; 16:310. [PMID: 38254800 PMCID: PMC10813984 DOI: 10.3390/cancers16020310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Primary care gynecologists are increasingly integrated into the care of patients with hereditary breast and ovarian cancer (HBOC) risks. These physicians should not only have basic genetic knowledge; they should also feel able to sensitively address an increased HBOC risk and deal with emotional, stressful situations in this context. Our project aimed at developing a training module, 'iKNOWgynetics', addressing psychosocial challenges in the context of HBOC care for primary care gynecologists. We developed the psychosocial training module in three phases: first, we conducted an online survey with n = 35 women with a family history of breast or ovarian cancer to assess patients' experiences and needs. Second, based on the results of the needs assessment, we developed the training module. Third, we evaluated the training by assessing physicians' (n = 109) self-efficacy with regard to communication skills in the context of HBOC before and after the training. In the needs assessment, seven psychosocial themes emerged. These themes, complementing a review of the literature, informed the training curriculum. The training was divided into two parts: (1) communicating with women before genetic testing and (2) care co-management for women with HBOC after genetic testing. After the training, participants reported a significant increase in self-efficacy in three domains: communicating empathetically, educating patients in a comprehensible way and dealing with emotionally challenging situations. Our results highlight the relevance of psychosocial issues for patients with HBOC. A genetic literacy training module that integrates aspects of psychosocial care increases physicians' confidence in dealing with emotionally challenging situations before and after their patients' genetic testing. Thus, such trainings may improve the care of women with hereditary cancer risks.
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Affiliation(s)
- Friederike Kendel
- Gender in Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany;
| | - Dorothee Speiser
- Hereditary Breast and Ovarian Cancer Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (D.S.); (K.F.); (C.O.); (S.S.)
| | - Karen Fechner
- Hereditary Breast and Ovarian Cancer Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (D.S.); (K.F.); (C.O.); (S.S.)
| | - Christine Olbrich
- Hereditary Breast and Ovarian Cancer Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (D.S.); (K.F.); (C.O.); (S.S.)
| | - Stephanie Stegen
- Hereditary Breast and Ovarian Cancer Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (D.S.); (K.F.); (C.O.); (S.S.)
- BRCA-Netzwerk e.V., Thomas-Mann-Str. 40, 53111 Bonn, Germany
| | - Alina Rörig
- Division of Ergonomics, Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Marchstr. 23, 10587 Berlin, Germany; (A.R.); (M.A.F.)
| | - Markus A. Feufel
- Division of Ergonomics, Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Marchstr. 23, 10587 Berlin, Germany; (A.R.); (M.A.F.)
| | - Stephanie Haering
- Gender in Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany;
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Zilski N, Speiser D, Bartley J, Roehle R, Blohmer JU, Keilholz U, Goerling U. Quality of life after risk-reducing salpingo-oophorectomy in women with a pathogenic BRCA variant. J Sex Med 2023; 21:33-39. [PMID: 37973412 DOI: 10.1093/jsxmed/qdad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/27/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Risk-reducing salpingo-oophorectomy (RRSO) is recommended to women with a pathogenic BRCA variant, but as a main side effect, RRSO could lead to an early onset of menopause. AIM To evaluate the impact of RRSO and preoperative menopausal status on menopausal symptoms, sexual functioning, and quality of life (QOL). METHODS The study was conducted between November 2019 and April 2020. Women were included who tested positive for a pathogenic BRCA1/2 variant between 2015 and 2018. Depression levels, QOL, and global health status were measured and compared with those of women who opted against RRSO. Furthermore, women who underwent RRSO treatment were asked to report menopausal complaints that they experienced at 1 month postsurgery and any current complaints. OUTCOMES RRSO had no significant impact on QOL, but women who were premenopausal at the time of surgery reported more sexual complaints than postmenopausal women. RESULTS In total, 134 carriers of a BRCA mutation were included: 90 (67%) underwent RRSO and 44 (33%) did not. At the time of the survey, neither the control nor experimental group experienced significant changes in QOL (b = -0.18, P = .59). Women who underwent RRSO reported a significantly lower global health status (b = -0.66, P = .05). Women who were premenopausal at the time of surgery were bothered more by sexual symptoms (b = 0.91, P = .19) but experienced fewer vasomotor complaints (b = -1.09, P = .13) than women who were postmenopausal at the time of RRSO. CLINICAL IMPLICATIONS The decrease of sexual functioning after RRSO should be an integral part of preoperative counseling because it is important for BRCA carriers, especially for premenopausal women. STRENGTHS AND LIMITATIONS Some strengths of the present study were the long follow-up, a high response rate, and the existence of a control group, whereas defining menopausal status by last menstrual bleeding and self-report of data (eg, breast cancer history) increased the risk of errors. CONCLUSION Our study indicated that women who underwent RRSO experienced no difference in QOL when compared with women without RRSO and that patients with premenopausal status seemed to be at higher risk to experience sexual complaints after surgery.
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Affiliation(s)
- Nicole Zilski
- Hereditary Breast and Ovarian Cancer Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Department of Gynecology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Dorothee Speiser
- Hereditary Breast and Ovarian Cancer Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Department of Gynecology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Julia Bartley
- Department of Gynecology, Universitätsklinikum Magdeburg, 39108 Magdeburg, Germany
- TFP Fertility Berlin, 10117 Berlin, Germany
| | - Robert Roehle
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Clinical Study Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, 10178, Berlin, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Ulrich Keilholz
- Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Ute Goerling
- Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
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Speiser D, Bick U. Primary Prevention and Early Detection of Hereditary Breast Cancer. Breast Care (Basel) 2023; 18:448-454. [PMID: 38125920 PMCID: PMC10730103 DOI: 10.1159/000533391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/01/2023] [Indexed: 12/23/2023] Open
Abstract
Background Primary prevention and early detection of hereditary breast cancer has been one of the main topics of breast cancer research in recent decades. The knowledge of risk factors for breast cancer has been increasing continuously just like the recommendations for risk management. Pathogenic germline variants (mutations, class 4/5) of risk genes are significant susceptibility factors in healthy individuals. At the same time, germline mutations serve as biomarkers for targeted therapy in breast cancer treatment. Therefore, management of healthy mutation carriers to enable primary prevention is in the focus as much as the consideration of pathogenic germline variants for therapeutic decisions. Since 1996, the German Consortium has provided quality-assured care for counselees and patients with familial burden of breast and ovarian cancer. Summary Currently, there are 23 university centers with over 100 cooperating DKG-certified breast and gynecological cancer centers. These centers provide standardized, evidence-based, and knowledge-generating care, which includes aspects of primary as well as secondary and tertiary prevention. An important aspect of quality assurance and development was the inclusion of the HBOC centers in the certification system of the German Cancer Society (GCS). Since 2020, the centers have been regularly audited and their quality standards continuously reviewed according to quality indicators adapted to the current state of research. The standard of care at GC-HBOC' centers involves the evaluation as well as evolution of various aspects of care like inclusion criteria, identification of new risk genes, management of variants of unknown significance (class 3), evaluation of risk-reducing options, intensified surveillance, and communication of risks. Among these, the possibility of intensified surveillance in the GC-HBOC for early detection of breast cancer is an important component of individual risk management for many counselees. As has been shown in recent years, in carriers of pathogenic variants in high-risk genes, this approach enables the detection of breast cancer at very early, more favorable stages although no reduction of mortality has been demonstrated yet. The key component of the intensified surveillance is annual contrast-enhanced breast MRI, supplemented by up to biannual breast ultrasound and mammography usually starting at age 40. Key Messages Apart from early detection, the central goal of care is the prevention of cancer. By utilizing individualized risk calculation, the optimal timeframe for risk-reducing surgery can be estimated, and counselees can be supported in reaching preference-sensitive decisions.
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Affiliation(s)
- Dorothee Speiser
- HBOC-Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Bick
- HBOC-Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Afshar-Bakshloo M, Albers S, Richter C, Berninger O, Blohmer JU, Roehle R, Speiser D, Karsten MM. How breast cancer therapies impact body image - real-world data from a prospective cohort study collecting patient-reported outcomes. BMC Cancer 2023; 23:705. [PMID: 37507687 PMCID: PMC10375629 DOI: 10.1186/s12885-023-11172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND In breast cancer patients body image (BI) is a crucial aspect of quality of life (QoL). This study examined the postoperative impact of different surgical approaches on long-term BI analyzing real-world data to guide pre- and postoperative patient care and preserve QoL. METHODS EORTC QLQ-BR23 BI scores were collected electronically in 325 breast cancer patients within routine clinical care for a duration of 41.5 months (11/17/2016 - 4/30/2020) at predefined time points preoperatively and repeatedly up to two years after breast-conserving surgery (BCS) (n = 212), mastectomy alone (M) (n = 27) or mastectomy with immediate breast reconstruction (MIBR) (n = 86). Higher scores indicated better BI. A linear mixed regression model was used to analyze the impact of BCS, M and MIBR, as well as non-surgical therapies on BI at treatment initiation and over time. RESULTS BI scores deteriorated by 5 points (95%-confidence interval (CI) -8.94 to -1.57, p≈0.005) immediately after BCS, by 7 points (95%-CI -12.13 to -1.80, p≈0.008) after MIBR and by 19 points (95%-CI -27.34 to -10.34, p < 0.001) after M. The change over time after BCS (+ 0.10 points per week, 95%-CI -0.17 to 0.38), MIBR (-0.07 points per week, 95%-CI -0.35 to 0.20) and M (+ 0.14 points per week, 95%-CI -0.19 to 0.48) were not statistically significant (each p > 0.05). At treatment initiation chemotherapy was associated with a 22-point decline (95%-CI -25.39 to -17.87, p < 0.001) in BI score, while radiotherapy was associated with a 5-point increase (95%-CI 1.74 to 9.02, p≈0.004). However, over time chemotherapy was associated with a score recovery (+ 0.28 points per week, 95%-CI 0.19 to 0.37, p < 0.001), whereas for radiotherapy a trend towards BI deterioration was observed (-0.11 points per week, 95%-CI -0.23 to 0.02, p≈0.101). CONCLUSIONS Breast cancer surgery negatively affects BI. BCS and MIBR presumably harm BI less than M in the early postoperative period. Our data suggests BI to be deteriorating in the long term after MIBR while improving after BCS or M. Radiotherapy seems to have an additional negative long-term impact on BI. These findings should be confirmed in further studies to enable evidence-based patient information as part of preoperative shared decision-making and postoperative patient care.
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Affiliation(s)
- Melissa Afshar-Bakshloo
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Albers
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Chiara Richter
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ottilia Berninger
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Robert Roehle
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dorothee Speiser
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maria Margarete Karsten
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Rhiem K, Zachariae S, Waha A, Grill S, Hester A, Golatta M, van Mackelenbergh M, Fehm T, Schlaiß T, Ripperger T, Ledig S, Meisel C, Speiser D, Veselinovic K, Schröder C, Witzel I, Gallwas J, Weber BH, Solbach C, Aktas B, Hahnen E, Engel C, Schmutzler R. Prevalence of Pathogenic Germline Variants in Women with Non-Familial Unilateral Triple-Negative Breast Cancer. Breast Care (Basel) 2023; 18:106-112. [PMID: 37261134 PMCID: PMC10228253 DOI: 10.1159/000528972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION International guidelines recommend genetic testing for women with familial breast cancer at an expected prevalence of pathogenic germline variants (PVs) of at least 10%. In a study sample of the German Consortium for Hereditary Breast and Ovarian Cancer (GC-HBOC), we have previously shown that women with TNBC diagnosed before the age of 50 years but without a family history of breast or ovarian cancer (sTNBC) meet this criterion. The present study investigates the PV prevalence in BRCA1, BRCA2, and nine additional cancer predisposition genes in an extended sTNBC study sample including a cohort of women with a later age at sTNBC diagnosis. PATIENTS AND METHODS In 1,600 women with sTNBC (median age at diagnosis: 41 years, range 19-78 years), we investigated the association between age at diagnosis and PV occurrence in cancer predisposition genes using logistic regression. RESULTS 260 sTNBC patients (16.2%) were found to have a PV in cancer predisposition genes (BRCA1: n = 170 [10.6%]; BRCA2: n = 46 [2.9%], other: n = 44 [2.8%]). The PV prevalence in women diagnosed between 50 and 59 years (n = 194) was 11.3% (22/194). Logistic regression showed a significant increase in PV prevalence with decreasing age at diagnosis (OR 1.41 per 10 years younger age at diagnosis; 95% confidence interval: 1.21-1.65; p < 0.001). The PV prevalence predicted by the model was above 10% for diagnoses before the age of 56.8 years. CONCLUSION Based on the data presented, we recommend genetic testing by gene panel analysis for sTNBC patients diagnosed before the age of 60 years. Due to the still uncertain estimate for women with sTNBC diagnosed above the age of 60 years, further studies are needed.
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Affiliation(s)
- Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Silke Zachariae
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - Anke Waha
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Sabine Grill
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Anna Hester
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Marion van Mackelenbergh
- Department Gynecology and Obstetrics, University Hospital Schleswig Holstein (UKSH) Campus Kiel, Kiel, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tanja Schlaiß
- Institute for Gynecology and Obstetrics and Center for Hereditary Breast and Ovarian Can-cer, Medical Faculty, University Hospital Würzburg, Würzburg, Germany
| | - Tim Ripperger
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Susanne Ledig
- Institute of Human Genetics, University of Münster, Münster, Germany
| | - Cornelia Meisel
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Centre Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Dorothee Speiser
- Department of Gynecology and Breast Centre, Centre for Hereditary Breast and Ovarian Cancer Charité, Charité University Hospital, Berlin, Germany
| | | | - Christopher Schröder
- Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Isabell Witzel
- Department of Gynecology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Gallwas
- Department of Gynecology and Obstetrics, University Medicine Göttingen, Göttingen, Germany
| | - Bernhard H.F. Weber
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
- Institute of Clinical Human Genetics, University Hospital Regensburg, Regensburg, Germany
| | - Christine Solbach
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Frankfurt, Frankfurt, Germany
| | - Bariyhe Aktas
- Department of Gynecology, University of Leipzig Medical Center, Leipzig, Germany
| | - Eric Hahnen
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
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8
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Speiser D, Heibges M, Besch L, Hilger C, Keinert M, Klein K, Rauwolf G, Schmid C, Schulz-Niethammer S, Stegen S, Westfal V, Witzel I, Zang B, Kendel F, Feufel MA. iKNOW - a paradigmatic approach to support personalized counseling with digital health (Preprint). JMIR Form Res 2022; 7:e41179. [PMID: 37083496 PMCID: PMC10163406 DOI: 10.2196/41179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
iKNOW is the first evidence-based digital tool to support personalized counseling for women in Germany with a hereditary cancer risk. The counseling tool is designed for carriers of pathogenic gBRCA (germline breast cancer gene) variants that increase the lifetime risk of breast and ovarian cancer. Carriers of pathogenic variants are confronted with complex, individualized risk information, and physicians must be able to convey this information in a comprehensible way to enable preference-sensitive health decisions. In this paper, we elaborate on the clinical, regulatory, and practical premises of personalized counseling in Germany. By operationalizing these premises, we formulate 5 design principles that, we suggest, are specific enough to develop a digital tool (eg, iKNOW), yet wide-ranging enough to inform the development of counseling tools for personalized medicine more generally: (1) digital counseling tools should implement the current standard of care (eg, based on guidelines); (2) digital counseling tools should help to both standardize and personalize the counseling process (eg, by enabling the preference-sensitive selection of counseling contents from a common information base); (3) digital counseling tools should make complex information easy to access both cognitively (eg, by using evidenced-based risk communication formats) and technically (eg, by means of responsive design for various devices); (4) digital counseling tools should respect the counselee's data privacy rights (eg, through strict pseudonymization and opt-in consent); and (5) digital counseling tools should be systematically and iteratively evaluated with the users in mind (eg, using formative prototype testing to ensure a user-centric design and a summative multicenter, randomized controlled trial). On the basis of these paradigmatic design principles, we hope that iKNOW can serve as a blueprint for the development of more digital innovations to support personalized counseling approaches in cancer medicine.
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Affiliation(s)
- Dorothee Speiser
- Department of Gynecology with Breast Center, Hereditary Breast and Ovarian Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maren Heibges
- Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Laura Besch
- Department of Gynecology with Breast Center, Hereditary Breast and Ovarian Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Caren Hilger
- Gender in Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marie Keinert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen-Nuernberg, Germany
| | - Katharina Klein
- Gender in Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gudrun Rauwolf
- Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Christine Schmid
- Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Sven Schulz-Niethammer
- Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Steffi Stegen
- BRCA-Netzwerk e.V., Hilfe bei familiären Krebserkrankungen, Bonn, Germany
| | - Viola Westfal
- Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Isabell Witzel
- Department of Gynecology, Hereditary Breast and Ovarian Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt Zang
- Department of Gynecology with Breast Center, Hereditary Breast and Ovarian Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Friederike Kendel
- Gender in Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus A Feufel
- Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
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9
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Pross T, Karsten MM, Blohmer JU, Speiser D. Role of Routine Peritoneal Biopsies During Risk Reducing Salpingo-Oophorectomy (RRSO). Geburtshilfe Frauenheilkd 2021; 81:1031-1038. [PMID: 34531609 PMCID: PMC8437580 DOI: 10.1055/a-1395-7715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Objective
The objective of this retrospective study was to assess the role of routine peritoneal biopsies during risk reducing salpingo-oophorectomy (RRSO).
Methods
Data of 204 women who underwent RRSO between January 1, 2014 and February 20, 2020 at Charité – Universitätsmedizin Berlin, Campus Mitte were retrospectively analyzed. RRSO was done according to the standard operating procedures of the German Consortium Hereditary Breast and Ovarian Cancer (GC-HBOC) with peritoneal washing and several peritoneal biopsies. Specimen collected during RRSO were analyzed using the protocol for Sectioning and Extensively Examining the FIMbria (SEE-FIM). Perioperative complications were classified using the Clavien-Dindo-Classification.
Results
147 women who underwent RRSO had peritoneal biopsies and pelvic washing, 44 women had none of that. 123 patients (64.4%) carried a pathologic variant in
gBRCA1
, 53 (27.7%) carried a pathologic variant in
gBRCA2
. Histopathological evaluation identified four patients (2.1%) with pathological findings. Neither peritoneal biopsies nor pelvic washings revealed additional information after histological examination. There was no statistically significant difference in complication rate between the two groups. The mean surgery time for RRSO without peritoneal biopsies was 64.3 minutes compared to 77.8 minutes with peritoneal biopsies. That shows a statistically significant prolongation of 16% (13.5 minutes, p = 0.0383).
Conclusions
The routine use of peritoneal biopsies during RRSO does not improve detection of occult ovarian cancer or STIC but prolongs the operation time significantly. By omitting peritoneal biopsies in RRSO not only perioperative risks are diminished but also costs could be reduced by shortening of surgery time as well as decreased number of pathological samples.
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Affiliation(s)
- Therese Pross
- Charité - Universitätsmedizin Berlin, Department of Gynecology and breast center, Berlin, Germany
| | - Maria Margarete Karsten
- Charité - Universitätsmedizin Berlin, Department of Gynecology and breast center, Berlin, Germany
| | - Jens-Uwe Blohmer
- Charité - Universitätsmedizin Berlin, Department of Gynecology and breast center, Berlin, Germany
| | - Dorothee Speiser
- Charité - Universitätsmedizin Berlin, Department of Gynecology and breast center, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Hereditary Breast and Ovarian Cancer Center, Berlin, Germany
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10
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Kühn F, Karsten MM, Kendel F, Feufel MA, Speiser D. Training courses on hereditary breast and ovarian cancer to strengthen cross-sectoral care in underserved areas. Patient Educ Couns 2021; 104:1431-1437. [PMID: 33162275 DOI: 10.1016/j.pec.2020.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/08/2020] [Accepted: 10/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To strengthen cross-sectoral care by disseminating specialized knowledge about hereditary breast and ovarian cancer across underserved areas. METHODS We report on a training course about genetic counseling and testing of hereditary breast and ovarian cancer patients for gynecologists from certified cancer centers. In total, 50 gynecologists attended the course which was offered once annually between 2017 and 2019. Before and after the course, participants were asked to answer a self-assessment questionnaire and completed the training with a multiple-choice test. The results of the self-assessments and knowledge tests were analyzed to steadily improve the training. RESULTS The self-assessments imply a perceived increase in certainty regarding the inclusion criteria for specialized genetic counseling, pedigree analysis, and contents of the initial consultation. Both the knowledge tests and self-assessments showed that participants had difficulties in interpreting and differentiating between age-specific and lifetime risks. CONCLUSION The courses successfully conveyed knowledge necessary to identify patients at risk and to provide timely genetic analyses even in rural areas. PRACTICE IMPLICATIONS The results are a promising basis for creating additional training courses addressing specialists in hospitals and gynecological practices. Further education of physicians might improve cross-sectoral cooperation and thereby enable specialized care supply in rural areas.
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Affiliation(s)
- Friedrich Kühn
- Charité - Universitätsmedizin Berlin, Department of Gynecology, Berlin, Germany
| | | | - Friederike Kendel
- Charité - Universitätsmedizin Berlin, Department of Gender in Medicine, Berlin, Germany
| | - Markus A Feufel
- Technische Universität Berlin, Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Berlin, Germany
| | - Dorothee Speiser
- Charité - Universitätsmedizin Berlin, Department of Gynecology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Hereditary Breast and Ovarian Cancer Center, Berlin, Germany.
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11
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Peters R, Karsten M, Röhle R, Blohmer JU, Speiser D. Assoziierte Tumore bei Familien mit BRCA1/BRCA2-Mutation im FBREK-Zentrum der Charité-Universitätsmedizin Berlin. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- R Peters
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
| | - M.M Karsten
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
| | - R Röhle
- Charité – Universitätsmedizin Berlin, Institut für Biometrie und Klinische Epidemiologie
| | - J.-U Blohmer
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
| | - D Speiser
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
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12
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Zilski N, Goerling U, Kalmbach N, Speiser D. Analyse der Lebensqualität mit und ohne prophylaktische Ovarektomie bei BRCA1/2- Mutationsträgerinnen – ALOB-Studie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- N. Zilski
- Charité – Universitätsmedizin Berlin, Zentrum für Familiären Brust- und Eierstockkrebs, Klinik für Gynäkologie mit Brustzentrum, CCM
| | - U. Goerling
- Charité Comprehensive Cancer Center, Psychoonkologie
| | - N. Kalmbach
- Charité – Universitätsmedizin Berlin, Zentrum für Familiären Brust- und Eierstockkrebs, Klinik für Gynäkologie mit Brustzentrum, CCM
| | - D. Speiser
- Charité – Universitätsmedizin Berlin, Zentrum für Familiären Brust- und Eierstockkrebs, Klinik für Gynäkologie mit Brustzentrum, CCM
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13
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Albers S, Speiser D, Pachal LWR, Pohany LA, Afshar-Bakshloo M, Blohmer JU, Karsten MM. Changes in physical functioning of breast cancer patients following breast-conserving surgery, mastectomy with immediate breast reconstruction and mastectomy alone within the first 18 months after surgery. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- S Albers
- Charité – Universitätsmedizin Berlin
| | - D Speiser
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
| | | | - LA Pohany
- Charité – Universitätsmedizin Berlin
| | | | - JU Blohmer
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
| | - MM Karsten
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
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14
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Fechner K, Häring S, Kendel F, Feufel M, Olbrich C, Speiser D. Die Rolle der niedergelassenen Gynäkologinnen und Gynäkologen in der Versorgung von Patientinnen mit familiärer Brust- und Eierstockkrebsbelastung: eine Bedarfsanalyse. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- K Fechner
- Charité – Universitätsmedizin Berlin, Zentrum für Familiären Brust- und Eierstockkrebs FBREK
| | - S Häring
- Charité – Universitätsmedizin Berlin, Institut für Geschlechterforschung in der Medizin (GiM)
| | - F Kendel
- Charité – Universitätsmedizin Berlin, Institut für Geschlechterforschung in der Medizin (GiM)
| | - M.A Feufel
- Technische Universität Berlin, Institut für Psychologie und Arbeitswissenschaft (IPA), Fachbereich Arbeitswissenschaft
| | - C Olbrich
- Charité – Universitätsmedizin Berlin, Zentrum für Familiären Brust- und Eierstockkrebs FBREK
| | - D Speiser
- Charité – Universitätsmedizin Berlin, Zentrum für Familiären Brust- und Eierstockkrebs FBREK
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15
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Daniel M, Karsten M, Hage A, Blohmer JU, Speiser D. Brustkrebserkrankungen bei Frauen unter 40 Jahren – die Berlin Young Patients-Register-Studie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- M.E Daniel
- Klinik für Gynäkologie mit Brustzentrum der Charité, CCM
| | - M.M Karsten
- Klinik für Gynäkologie mit Brustzentrum der Charité, CCM
| | - A.M Hage
- Klinik für Gynäkologie mit Brustzentrum der Charité, CCM
| | - J.-U Blohmer
- Klinik für Gynäkologie mit Brustzentrum der Charité, CCM
| | - D Speiser
- Klinik für Gynäkologie mit Brustzentrum der Charité, CCM
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16
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Pross T, Kühn F, Karsten M, Kendel F, Feufel M, Speiser D. Fortbildung von Kooperationspartnern zur Stärkung der transsektoralen Versorgung am Zentrum Berlin des Deutschen Konsortiums Familiärer Brust- und Eierstockkrebs. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- T. Pross
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
| | - F. Kühn
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
| | - M.M. Karsten
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
| | - F. Kendel
- Charité – Universitätsmedizin Berlin, Institut für Geschlechterforschung in der Medizin
| | - M.A. Feufel
- Technische Universität Berlin, Institut für Psychologie und Arbeitswissenschaft
| | - D. Speiser
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
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17
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Pachal LWR, Albers S, Pohany LA, Speiser D, Blohmer JU, Karsten MM. Veränderungen im Ausmaß an Fatigue bei Brustkrebspatientinnen nach 1.5, 3, 6 und 12 Monaten. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Affiliation(s)
- LWR Pachal
- Charité Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
| | - S Albers
- Charité Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
| | - LA Pohany
- Charité Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
| | - D Speiser
- Charité Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
| | - JU Blohmer
- Charité Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
| | - MM Karsten
- Charité Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum
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18
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Rippinger N, Fischer C, Haun MW, Rhiem K, Grill S, Kiechle M, Cremer FW, Kast K, Nguyen HP, Ditsch N, Kratz CP, Vogel J, Speiser D, Hettmer S, Glimm H, Fröhling S, Jäger D, Seitz S, Hahne A, Maatouk I, Sutter C, Schmutzler RK, Dikow N, Schott S. Cancer surveillance and distress among adult pathogenic TP53 germline variant carriers in Germany: A multicenter feasibility and acceptance survey. Cancer 2020; 126:4032-4041. [PMID: 32557628 DOI: 10.1002/cncr.33004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/06/2020] [Accepted: 05/04/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Li-Fraumeni syndrome (LFS) is a high-risk cancer predisposition syndrome caused by pathogenic germline variants of TP53. Cancer surveillance has noted a significant survival advantage in individuals with LFS; however, little is known about the feasibility, acceptance, and psychosocial effects of such a program. METHODS Pathogenic TP53 germline variant carriers completed a 7-part questionnaire evaluating sociodemographics, cancer history, surveillance participation, reasons for nonadherence, worries, and distress adapted from the Cancer Worry Scale. Counselees' common concerns and suggestions were assessed in MAXQDA Analytics Pro 12. RESULTS Forty-nine participants (46 females and 3 males), aged 40.0 ± 12.6 years, formed the study population; 43 (88%) had a personal cancer history (including multiple cancers in 10 [20%]). Forty-three individuals participated (88%) in surveillance during the study or formerly. Willingness to undergo surveillance was influenced by satisfaction with genetic testing and counseling (P = .019 [Fisher-Yates test]) but not by sociodemographics, cancer history, or distress level. Almost one-third of the participants reported logistical difficulties in implementing surveillance because of the high frequency of medical visits, scheduling difficulties, and the travel distance to their surveillance providers. Self-reported distress and perceived emotional burden for family members and partners were moderate (median for self-reported distress, 3.3; median for perceived emotional burden, 3.0). For both, the interquartile range was moderate to very high (2.7-3.7 and 3.0-3.7, respectively). CONCLUSIONS Individuals with LFS require efficient counseling as well as an accessible, well-organized, interdisciplinary, standardized surveillance program to increase adherence and psychological coping.
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Affiliation(s)
- Nathalie Rippinger
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christine Fischer
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Sabine Grill
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Comprehensive Cancer Center, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Comprehensive Cancer Center, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Karin Kast
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.,National Center for Tumor Diseases, Partner Site Dresden, Dresden, Germany.,German Cancer Consortium and German Cancer Research Center, Dresden, Germany
| | - Huu P Nguyen
- Institute of Medical Genetics and Applied Genomics, University Hospital of Tübingen, Tübingen, Germany.,Department of Human Genetics, University of Bochum, Bochum, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, Ludwig Maximilian University, University Hospital of Munich, Munich, Germany.,Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Christian P Kratz
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Julia Vogel
- Department of Gynecology and Obstetrics, University Hospital Charité Berlin, Berlin, Germany
| | - Dorothee Speiser
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simone Hettmer
- Translational Functional Cancer Genomics, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
| | - Hanno Glimm
- German Cancer Consortium and German Cancer Research Center, Dresden, Germany.,Translational Functional Cancer Genomics, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany.,Department of Translational Medical Oncology, National Center for Tumor Diseases, University Hospital Carl Gustav Carus, Technical University Dresden and German Cancer Research Center, Heidelberg, Germany
| | - Stefan Fröhling
- Department of Translational Medical Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium and German Cancer Research Center, Heidelberg, Germany
| | - Dirk Jäger
- German Cancer Consortium and German Cancer Research Center, Heidelberg, Germany.,Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephan Seitz
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - Andrea Hahne
- BRCA Network-Support for People with Hereditary Cancers
| | - Imad Maatouk
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Sutter
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Rita K Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Nicola Dikow
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Sarah Schott
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
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19
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Speiser D, Rebitschek FG, Feufel MA, Brand H, Besch L, Kendel F. Accuracy in risk understanding among BRCA1/2-mutation carriers. Patient Educ Couns 2019; 102:1925-1931. [PMID: 31079956 DOI: 10.1016/j.pec.2019.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/07/2019] [Accepted: 05/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE BRCA1/2-mutation carriers are at high risk of developing cancer. Since they must weigh clinical recommendations and decide on risk-reducing measures, the correct understanding of their 10-year cancer risks is essential. This study focused on the accuracy of women's subjective estimates of developing breast and ovarian cancer within ten years as prerequisite to reduce unnecessary prevention. METHODS 59 and 52 BRCA1/2-mutation carriers provided their individual risks of developing breast or ovarian cancer in the next 10 years, along with self-reported sociodemographic and psychosocial variables. Women's risk estimates were compared with their objective cancer risks that had been communicated before. RESULTS 22.6% of counselees under- and 53.2% of the counselees overestimated their 10-year risk of developing breast cancer. As for ovarian cancer, 5.6% under- whereas 51.9% overestimated their risk. Neither demographic factors such as education, parenthood and age, nor a prior diagnosis of breast cancer or prophylactic surgery accounted for these variations in risk accuracy. CONCLUSION Currently, risk communication during genetic counseling does not guarantee accurate risk estimation in BRCA-mutation carriers. PRACTICE IMPLICATIONS Counselors must be prepared to prevent overestimation. Counselees' risk estimates need to be assessed and corrected to enable informed decision-making and reduce risks of unnecessary preventive efforts.
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Affiliation(s)
- Dorothee Speiser
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Felix G Rebitschek
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Lentzeallee 94, 14195 Berlin, Germany.
| | - Markus A Feufel
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Lentzeallee 94, 14195 Berlin, Germany; Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Marchstr. 23, 10587 Berlin, Germany.
| | - Hannah Brand
- Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Laura Besch
- Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Friederike Kendel
- Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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Engel C, Fischer C, Zachariae S, Bucksch K, Rhiem K, Giesecke J, Herold N, Wappenschmidt B, Hübbel V, Maringa M, Reichstein-Gnielinski S, Hahnen E, Bartram CR, Dikow N, Schott S, Speiser D, Horn D, Fallenberg EM, Kiechle M, Quante AS, Vesper AS, Fehm T, Mundhenke C, Arnold N, Leinert E, Just W, Siebers-Renelt U, Weigel S, Gehrig A, Wöckel A, Schlegelberger B, Pertschy S, Kast K, Wimberger P, Briest S, Loeffler M, Bick U, Schmutzler RK. Breast cancer risk in BRCA1/2 mutation carriers and noncarriers under prospective intensified surveillance. Int J Cancer 2019; 146:999-1009. [PMID: 31081934 DOI: 10.1002/ijc.32396] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/17/2019] [Accepted: 04/25/2019] [Indexed: 01/15/2023]
Abstract
Comparably little is known about breast cancer (BC) risks in women from families tested negative for BRCA1/2 mutations despite an indicative family history, as opposed to BRCA1/2 mutation carriers. We determined the age-dependent risks of first and contralateral breast cancer (FBC, CBC) both in noncarriers and carriers of BRCA1/2 mutations, who participated in an intensified breast imaging surveillance program. The study was conducted between January 1, 2005, and September 30, 2017, at 12 university centers of the German Consortium for Hereditary Breast and Ovarian Cancer. Two cohorts were prospectively followed up for incident FBC (n = 4,380; 16,398 person-years [PY], median baseline age: 39 years) and CBC (n = 2,993; 10,090 PY, median baseline age: 42 years). Cumulative FBC risk at age 60 was 61.8% (95% CI 52.8-70.9%) for BRCA1 mutation carriers, 43.2% (95% CI 32.1-56.3%) for BRCA2 mutation carriers and 15.7% (95% CI 11.9-20.4%) for noncarriers. FBC risks were significantly higher than in the general population, with incidence rate ratios of 23.9 (95% CI 18.9-29.8) for BRCA1 mutation carriers, 13.5 (95% CI 9.2-19.1) for BRCA2 mutation carriers and 4.9 (95% CI 3.8-6.3) for BRCA1/2 noncarriers. Cumulative CBC risk 10 years after FBC was 25.1% (95% CI 19.6-31.9%) for BRCA1 mutation carriers, 6.6% (95% CI 3.4-12.5%) for BRCA2 mutation carriers and 3.6% (95% CI 2.2-5.7%) for noncarriers. CBC risk in noncarriers was similar to women with unilateral BC from the general population. Further studies are needed to confirm whether less intensified surveillance is justified in women from BRCA1/2 negative families with elevated risk.
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Affiliation(s)
- Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Christine Fischer
- Institute of Human Genetics, Ruprecht-Karls University, Heidelberg, Germany
| | - Silke Zachariae
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Karolin Bucksch
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Jutta Giesecke
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Natalie Herold
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Barbara Wappenschmidt
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Verena Hübbel
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Monika Maringa
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Simone Reichstein-Gnielinski
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Eric Hahnen
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Claus R Bartram
- Institute of Human Genetics, Ruprecht-Karls University, Heidelberg, Germany
| | - Nicola Dikow
- Institute of Human Genetics, Ruprecht-Karls University, Heidelberg, Germany
| | - Sarah Schott
- Department of Gynaecology, Ruprecht-Karls University, Heidelberg, Germany
| | - Dorothee Speiser
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Denise Horn
- Institute of Medical Genetics and Human Genetics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eva M Fallenberg
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany
| | - Anne S Quante
- Department of Gynecology and Obstetrics, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany
| | - Anne-Sophie Vesper
- Department of Obstetrics and Gynecology, University Hospital and Medical Faculty of the Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Tanja Fehm
- Department of Obstetrics and Gynecology, University Hospital and Medical Faculty of the Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Christoph Mundhenke
- Department of Gynecology and Obstetrics, University Hospital of Schleswig-Holstein, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Norbert Arnold
- Department of Gynecology and Obstetrics, Institute of Clinical Molecular Biology, University Hospital of Schleswig-Holstein, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Elena Leinert
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Walter Just
- Institute of Human Genetics, University of Ulm, Ulm, Germany
| | | | - Stefanie Weigel
- Institute of Clinical Radiology, Medical Faculty, University of Muenster, University Hospital Muenster, Muenster, Germany
| | - Andrea Gehrig
- Institute of Human Genetics, Würzburg University, Würzburg, Germany
| | - Achim Wöckel
- Department of Obstetrics and Gynecology, Würzburg University Hospital, Würzburg, Germany
| | | | - Stefanie Pertschy
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Karin Kast
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Susanne Briest
- Department of Obstetrics and Gynecology, University Hospital Leipzig, Leipzig, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Ulrich Bick
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Rita K Schmutzler
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
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Karsten MM, Speiser D, Hartmann C, Lippold K, Kirchberger V, Blohmer JU. Abstract P4-12-05: First implementation of the International Consortium of Health Outcomes Measurement standard for breast cancer at a major German university hospital using a web-based tool to measure patient reported outcomes. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-12-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose:
Collecting patient reported outcome (PRO) data in a systematic way enables an objective evaluation of treatments and its related outcomes. By using the disease specific questionnaires developed by the International Consortium of Health Outcome Measurement (ICHOM) this allows for comparison between physicians, hospitals and even different countries.
Methods
In November 2016 we implemented a web-based system to collect PRO data at the breast center at Charité University hospital using the ICHOM data set. All new patients who are seen at the breast center are enrolled and are answering a predefined set of questions using a tablet computer. Once they start their treatment at Charité automated emails are sent to the patient at predefined treatment points. Those emails contain a web-based link through which they can access their questionnaires.
Results
Until now we have enrolled 834 patients and initiated 2470 questionnaires. 9.44% of patients were under 40 years of age, 49.7% between 40 and 60, 39.6% between 60-80 and 1.3% over the age of 80 years. The average return rate of questionnaires is 72% without any additional intervention. When asked about preference regarding paper versus online 7.9% of the patients 50 to 60 years of age would prefer paper, 18% in the 60-70 years of age group and 21.2 % in the age group over 70 years.
Conclusion
Measuring PRO in breast cancer patients in an automated electronic version is possible across all age ranges while simultaneously achieving a high return rate.
Citation Format: Karsten MM, Speiser D, Hartmann C, Lippold K, Kirchberger V, Blohmer J-U. First implementation of the International Consortium of Health Outcomes Measurement standard for breast cancer at a major German university hospital using a web-based tool to measure patient reported outcomes [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-12-05.
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Affiliation(s)
- MM Karsten
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany; Ärztliches Direktorat, Charité Universitätsmedizin Berlin, Berlin, Germany; Strategische Unternehmensentwicklung Value Based Health Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - D Speiser
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany; Ärztliches Direktorat, Charité Universitätsmedizin Berlin, Berlin, Germany; Strategische Unternehmensentwicklung Value Based Health Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - C Hartmann
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany; Ärztliches Direktorat, Charité Universitätsmedizin Berlin, Berlin, Germany; Strategische Unternehmensentwicklung Value Based Health Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - K Lippold
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany; Ärztliches Direktorat, Charité Universitätsmedizin Berlin, Berlin, Germany; Strategische Unternehmensentwicklung Value Based Health Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - V Kirchberger
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany; Ärztliches Direktorat, Charité Universitätsmedizin Berlin, Berlin, Germany; Strategische Unternehmensentwicklung Value Based Health Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - J-U Blohmer
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany; Ärztliches Direktorat, Charité Universitätsmedizin Berlin, Berlin, Germany; Strategische Unternehmensentwicklung Value Based Health Care, Charité Universitätsmedizin Berlin, Berlin, Germany
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Karsten MM, Speiser D, Hartmann C, Zeuschner N, Lippold K, Kiver V, Gocke P, Kirchberger V, Blohmer JU. Web-Based Patient-Reported Outcomes Using the International Consortium for Health Outcome Measurement Dataset in a Major German University Hospital: Observational Study. JMIR Cancer 2018; 4:e11373. [PMID: 30573450 PMCID: PMC6320408 DOI: 10.2196/11373] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/10/2018] [Indexed: 12/16/2022] Open
Abstract
Background Collecting patient-reported outcome (PRO) data systematically enables objective evaluation of treatment and its related outcomes. Using disease-specific questionnaires developed by the International Consortium for Health Outcome Measurement (ICHOM) allows for comparison between physicians, hospitals, and even different countries. Objective This pilot project aimed to establish a digital system to measure PROs for new patients with breast cancer who attended the Charité Breast Center This approach should serve as a blueprint to further expand the PRO measurement to other disease entities and departments. Methods In November 2016, we implemented a Web-based system to collect PRO data at Charité Breast Center using the ICHOM dataset. All new patients at the Breast Center were enrolled and answered a predefined set of questions using a tablet computer. Once they started their treatment at Charité, automated emails were sent to the patients at predefined treatment points. Those emails contained a Web-based link through which they could access and answer questionnaires. Results By now, 541 patients have been enrolled and 2470 questionnaires initiated. Overall, 9.4% (51/541) of the patients were under the age of 40 years, 49.7% (269/541) between 40 and 60 years, 39.6% (214/541) between 60 and 80 years, and 1.3% (7/541) over the age of 80 years. The average return rate of questionnaires was 67.0%. When asked about the preference regarding paper versus Web-based questionnaires, 6.0% (8/134) of the patients between 50 and 60 years, 6.0% (9/150) between 60 and 70 years, and 12.7% (9/71) over the age of 70 years preferred paper versions. Conclusions Measuring PRO in patients with breast cancer in an automated electronic version is possible across all age ranges while simultaneously achieving a high return rate.
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Affiliation(s)
- Maria M Karsten
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dorothee Speiser
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Hartmann
- Ärztliches Direktorat, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nele Zeuschner
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kai Lippold
- Geschäftsstelle Vorstand, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Verena Kiver
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Gocke
- Stabstelle Digitale Transformation, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Valerie Kirchberger
- Value-Based Healthcare, Geschäftsbereich Strategische Unternehmensentwicklung, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany
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Rippinger N, Haun MW, Fischer C, Rhiem K, Hübbel A, Grill S, Kiechle M, Cremer FW, Kast K, Nguyen HP, Ditsch N, Kratz P, Pfister S, Pajtler KW, Speiser D, Seitz S, Glimm H, Maatouk I, Hahne A, Sutter C, Schmutzler RK, Dikow N, Sohn C, Schott S. Prophylactic surgery among germline TP53 mutation carriers in Germany – a multicentric observational study. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- N Rippinger
- University Hospital Heidelberg, Department of Gynaecology and Obstetrics, Heidelberg, Deutschland
| | - MW Haun
- University Hospital Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Deutschland
| | - C Fischer
- University Hospital Heidelberg, Institute of Human Genetics, Heidelberg, Deutschland
| | - K Rhiem
- University Hospital of Cologne, Department of Gynaecology and Obstetrics, Cologne, Deutschland
| | - A Hübbel
- University Hospital of Cologne, Department of Gynaecology and Obstetrics, Cologne, Deutschland
| | - S Grill
- Klinikum rechts der Isar; Technical University of Munich, Department of Gynaecology and Centre for Hereditary Breast and Ovarian Cancer, Munich, Deutschland
| | - M Kiechle
- Klinikum rechts der Isar; Technical University of Munich, Department of Gynaecology and Centre for Hereditary Breast and Ovarian Cancer, Munich, Deutschland
| | - FW Cremer
- SYNLAB Centre for Human Genetics, Mannheim, Deutschland
| | - K Kast
- Medical Faculty and University Hospital Carl Gustav Carus, Technical University Dresden, Department of Gynaecology and Obstetrics, Dresden, Deutschland
- National Center for Tumor Diseases, Partner Site Dresden, Dresden, Deutschland
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Dresden, Deutschland
| | - HP Nguyen
- University Hospital of Tuebingen, Institute of Medical Genetics and Applied Genomics, Tuebingen, Deutschland
- University of Bochum, Department of Human Genetics, Bochum, Deutschland
| | - N Ditsch
- Ludwig-Maximilians University, University Hospital of Munich, Department of Gynaecology and Obstetrics, Munich, Deutschland
| | - P Kratz
- Hannover Medical School, Paediatric Haematology and Oncology, Hannover, Deutschland
| | - S Pfister
- Hopp Children's Cancer Centre at the NCT Heidelberg (KiTZ), Heidelberg, Deutschland
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Division of Paediatric Neurooncology, Heidelberg, Deutschland
- University Hospital Heidelberg, Department of Paediatric Oncology, Hematology and Immunology, Heidelberg, Deutschland
| | - KW Pajtler
- Hopp Children's Cancer Centre at the NCT Heidelberg (KiTZ), Heidelberg, Deutschland
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Division of Paediatric Neurooncology, Heidelberg, Deutschland
- University Hospital Heidelberg, Department of Paediatric Oncology, Hematology and Immunology, Heidelberg, Deutschland
| | - D Speiser
- University Hospital Charité Berlin, Department of Gynaecology and Obstetrics, Berlin, Deutschland
| | - S Seitz
- University Medical Centre Regensburg, Department of Gynaecology and Obstetrics, Regensburg, Deutschland
| | - H Glimm
- National Center for Tumor Diseases (NCT), Heidelberg, Deutschland
| | - I Maatouk
- University Hospital Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Deutschland
| | - A Hahne
- BRCA Network, Hannover, Deutschland
| | - C Sutter
- University Hospital Heidelberg, Department of Human Genetics, Heidelberg, Deutschland
| | - RK Schmutzler
- University Hospital of Cologne, Department of Gynaecology and Obstetrics, Cologne, Deutschland
| | - N Dikow
- University Hospital Heidelberg, Department of Human Genetics, Heidelberg, Deutschland
| | - C Sohn
- University Hospital Heidelberg, Department of Gynaecology and Obstetrics, Heidelberg, Deutschland
| | - S Schott
- University Hospital Heidelberg, Department of Gynaecology and Obstetrics, Heidelberg, Deutschland
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Besch L, Kendel F, Feufel M, Brand H, Speiser D. Risikokompetenz von BRCA1/2-Mutationsträgerinnen. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1670999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- L Besch
- Charité Universitätsmedizin Berlin, Institut für Medizinische Psychologie, Berlin, Deutschland
| | - F Kendel
- Charité Universitätsmedizin Berlin, Institut für Medizinische Psychologie, Berlin, Deutschland
| | - M Feufel
- Technische Universität Berlin, Institut für Psychologie und Arbeitswissenschaft, Berlin, Deutschland
| | - H Brand
- Charité Universitätsmedizin Berlin, Institut für Medizinische Psychologie, Berlin, Deutschland
| | - D Speiser
- Charité Universitätsmedizin Berlin, Klinik für Gynäkologie mit Brustzentrum, Berlin, Deutschland
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Di Domizio J, Belkhodja C, Chenuet P, Murray T, Demaria O, Conrad C, Speiser D, Ryffel B, Gilliet M. 997 Skin commensal bacteria drive the wound healing response by initiating pDC recruitment and activation in injured skin. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Waha A, Versmold B, Kast K, Kiechle M, Ditsch N, Meindl A, Niederacher D, Hahnen E, Arnold N, Mundhenke C, Horvath J, Auber B, Dikow N, Hauke J, Wappenschmidt B, Riess O, Schott S, Speiser D, Faust U, Sutter C, Rhiem K, Schmutzler R. Konsensusempfehlung des Deutschen Konsortiums Familiärer Brust- und Eierstockkrebs zum Umgang mit Ergebnissen der Multigenanalyse. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/a-0574-4879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungDas Deutsche Konsortium Familiärer Brust- und Eierstockkrebs (GC-HBOC) hat für die Analyse von Risikogenen für das familiäre Mamma- und Ovarialkarzinom ein Multigen-Panel (TruRisk®) etabliert, das derzeit die Kerngene („core genes“) ATM, BRCA1, BRCA2, CDH1, CHEK2, NBN, PALB2, RAD51C, RAD51 D und TP53 enthält, sowie weitere Gene, die aus aktuellen Forschungsarbeiten hervorgegangen sind und noch validiert werden müssen. Das syndromassoziierte Gen PTEN befindet sich hinsichtlich seiner Bedeutung in Familien mit prädominantem Brust- und Eierstockkrebs-Phänotyp derzeit ebenfalls in der Evaluation. Ein interdisziplinäres Expertenteam des GC-HBOC hat die verfügbaren Daten zur Risikomodifikation bei Vorliegen einer pathogenen (krankheitsverursachenden) Mutation in diesen Genen basierend auf einer strukturierten Literaturrecherche (Abb. 1S) und im Rahmen eines formalen Konsensusprozesses bewertet. Ziel dieser Arbeit ist es, das individuelle Erkrankungsrisiko besser einschätzen und auf dieser Basis klinische Empfehlungen ableiten zu können. Auf der Grundlage dieser evidenzbasierten Bewertung werden die Ratsuchenden in den Zentren des Deutschen Konsortiums vom Erstgespräch vor Gentest bis zur Inanspruchnahme individueller risikoadaptierter präventiver/therapeutischer Maßnahmen beraten und betreut. Dieser Artikel fasst die konsentierten Inhalte zusammen.
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Affiliation(s)
- Anke Waha
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln (AöR)
| | - Beatrix Versmold
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln (AöR)
| | - Karin Kast
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, Medizinische Fakultät und Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden,
| | - Marion Kiechle
- Frauenklinik, Klinikum rechts der Isar der Technischen Universität München (TUM)
| | - Nina Ditsch
- Poliklinik und Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität München
| | - Alfons Meindl
- Frauenklinik Abt. Gyn. Tumorgenetik, Klinikum rechts der Isar der Technischen Universität München (TUM), Frauenklinik, München
| | - Dieter Niederacher
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf
| | - Eric Hahnen
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln (AöR)
| | - Norbert Arnold
- Institut für Klinische Molekularbiologie, Klinik für Gynäkologie und Geburtshilfe, UKSH Campus Kiel, Christian-Albrechts-Universität Kiel
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, UKSH Campus Kiel, Christian-Albrechts-Universität Kiel
| | | | - Bernd Auber
- Institut für Humangenetik, Medizinische Hochschule Hannover
| | - Nicola Dikow
- Institut für Humangenetik, Universitätsklinikum Heidelberg
| | - Jan Hauke
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln (AöR)
| | | | - Olaf Riess
- Institut für Medizinische Genetik und angewandte Genomik, Universitätsklinikum Tübingen
| | - Sarah Schott
- Frauenklinik und Geburtsheilkunde Universitätsklinikum Heidelberg
| | - Dorothee Speiser
- Klinik für Gynäkologie mit Brustzentrum der Charité, Campus Charité Mitte, Berlin
| | - Ulrike Faust
- Institut für Medizinische Genetik und angewandte Genomik, Universitätsklinikum Tübingen
| | | | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln (AöR)
| | - Rita Schmutzler
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln (AöR)
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Engel C, Rhiem K, Hahnen E, Loibl S, Weber KE, Seiler S, Zachariae S, Hauke J, Wappenschmidt B, Waha A, Blümcke B, Kiechle M, Meindl A, Niederacher D, Bartram CR, Speiser D, Schlegelberger B, Arnold N, Wieacker P, Leinert E, Gehrig A, Briest S, Kast K, Riess O, Emons G, Weber BHF, Engel J, Schmutzler RK. Prevalence of pathogenic BRCA1/2 germline mutations among 802 women with unilateral triple-negative breast cancer without family cancer history. BMC Cancer 2018. [PMID: 29514593 PMCID: PMC5842578 DOI: 10.1186/s12885-018-4029-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background There is no international consensus up to which age women with a diagnosis of triple-negative breast cancer (TNBC) and no family history of breast or ovarian cancer should be offered genetic testing for germline BRCA1 and BRCA2 (gBRCA) mutations. Here, we explored the association of age at TNBC diagnosis with the prevalence of pathogenic gBRCA mutations in this patient group. Methods The study comprised 802 women (median age 40 years, range 19–76) with oestrogen receptor, progesterone receptor, and human epidermal growth factor receptor type 2 negative breast cancers, who had no relatives with breast or ovarian cancer. All women were tested for pathogenic gBRCA mutations. Logistic regression analysis was used to explore the association between age at TNBC diagnosis and the presence of a pathogenic gBRCA mutation. Results A total of 127 women with TNBC (15.8%) were gBRCA mutation carriers (BRCA1: n = 118, 14.7%; BRCA2: n = 9, 1.1%). The mutation prevalence was 32.9% in the age group 20–29 years compared to 6.9% in the age group 60–69 years. Logistic regression analysis revealed a significant increase of mutation frequency with decreasing age at diagnosis (odds ratio 1.87 per 10 year decrease, 95%CI 1.50–2.32, p < 0.001). gBRCA mutation risk was predicted to be > 10% for women diagnosed below approximately 50 years. Conclusions Based on the general understanding that a heterozygous mutation probability of 10% or greater justifies gBRCA mutation screening, women with TNBC diagnosed before the age of 50 years and no familial history of breast and ovarian cancer should be tested for gBRCA mutations. In Germany, this would concern approximately 880 women with newly diagnosed TNBC per year, of whom approximately 150 are expected to be identified as carriers of a pathogenic gBRCA mutation.
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Affiliation(s)
- Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany
| | - Eric Hahnen
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany.,Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
| | | | | | - Silke Zachariae
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Jan Hauke
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany
| | - Barbara Wappenschmidt
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany
| | - Anke Waha
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany
| | - Britta Blümcke
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany
| | - Marion Kiechle
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Alfons Meindl
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Dieter Niederacher
- Department of Gynecology and Obstetrics, University Hospital of the Heinrich-Heine University, Düsseldorf, Germany
| | - Claus R Bartram
- Institute of Human Genetics, University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Dorothee Speiser
- Zentrum für Familiären Brust- und Eierstockkrebs, Klinik für Gynäkologie mit Brustzentrum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Norbert Arnold
- Institute of Clinical Molecular Biology/Department of Gynecology and Obstetrics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
| | - Peter Wieacker
- Institute of Human Genetics, University Hospital Münster, Münster, Germany
| | - Elena Leinert
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Andrea Gehrig
- Institute of Human Genetics, University Würzburg, Würzburg, Germany
| | - Susanne Briest
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Leipzig, Leipzig, Germany
| | - Karin Kast
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Günter Emons
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin, Göttingen, Germany
| | - Bernhard H F Weber
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Rita K Schmutzler
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Strasse 34, 50931, Cologne, Germany.
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Mangler M, Lanowska M, Bartens A, Schindler A, Blohmer JU, Speiser D. Closure of the cervical os in patients after fertility preserving treatment for early cervical cancer - results of a prospective observational study. J Perinat Med 2017; 45:941-945. [PMID: 27888650 DOI: 10.1515/jpm-2016-0231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/20/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Up to 50% of the infants delivered after radical vaginal trachelectomy (RVT) are born prematurely. An effective strategy to reduce this number could be the closure of the cervical os (CCO). PATIENTS AND METHODS Fifteen pregnant patients who had a RVT due to early cervical cancer were included in this prospective case control study. All patients were scheduled for CCO early in the second trimester. CCO was performed in 12 patients. Their data were compared to data from 125 pregnancies after a RVT without CCO. RESULTS The patients who had CCO were compared to patients without CCO. One patient had an early rupture of the amniotic membranes prior to CCO. Two patients chose not to undergo CCO. In 12 patients CCO was performed without complications. There was no early preterm delivery in the CCO group as compared to a rate of 5% in 125 pregnancies in the non-CCO group. DISCUSSION We developed a protocol to reduce the risk of preterm deliveries after a RVT. Digital examinations should be avoided. Vaginal checks for pH can discover ascending infections - the main cause of preterm deliveries after a RVT. Infections should be treated adequately. CCO can further reduce the risk of preterm deliveries after a RVT.
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Chevalier M, Trabanelli S, Gharbi D, Cesson V, Domingos-Pereira S, Dartiguenave F, Fritschi A, Speiser D, Romero P, Jandus C, Nardelli-Haefliger D, Derré L, Jichlinski P. Analyse de l’infiltration immunitaire au cours des instillations intravésicales de BCG : identification d’un profil immunosuppressif prédictif de la récidive tumorale. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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De Ruysscher D, Pujol JL, Popat S, Reck M, Le Pechoux C, Liston A, Speiser D, Coukos G, Kammler R, Dafni O, Tsourti Z, Roschitzki H, Finlayson M, Piguet AC, Ruepp B, Maibach R, Stahel R, Peters S. STIMULI: A randomised open-label phase II trial of consolidation with nivolumab and ipilimumab in limited-stage SCLC after standard of care chemo-radiotherapy conducted by ETOP and IFCT. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw389.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Kast K, Rhiem K, Wappenschmidt B, Hahnen E, Hauke J, Bluemcke B, Zarghooni V, Herold N, Ditsch N, Kiechle M, Braun M, Fischer C, Dikow N, Schott S, Rahner N, Niederacher D, Fehm T, Gehrig A, Mueller-Reible C, Arnold N, Maass N, Borck G, de Gregorio N, Scholz C, Auber B, Varon-Manteeva R, Speiser D, Horvath J, Lichey N, Wimberger P, Stark S, Faust U, Weber BHF, Emons G, Zachariae S, Meindl A, Schmutzler RK, Engel C. Prevalence of BRCA1/2 germline mutations in 21 401 families with breast and ovarian cancer. J Med Genet 2016; 53:465-71. [PMID: 26928436 DOI: 10.1136/jmedgenet-2015-103672] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 02/02/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE To characterise the prevalence of pathogenic germline mutations in BRCA1 and BRCA2 in families with breast cancer (BC) and ovarian cancer (OC) history. PATIENTS AND METHODS Data from 21 401 families were gathered between 1996 and 2014 in a clinical setting in the German Consortium for Hereditary Breast and Ovarian Cancer, comprising full pedigrees with cancer status of all individual members at the time of first counselling, and BRCA1/2 mutation status of the index patient. RESULTS The overall BRCA1/2 mutation prevalence was 24.0% (95% CI 23.4% to 24.6%). Highest mutation frequencies were observed in families with at least two OCs (41.9%, 95% CI 36.1% to 48.0%) and families with at least one breast and one OC (41.6%, 95% CI 40.3% to 43.0%), followed by male BC with at least one female BC or OC (35.8%; 95% CI 32.2% to 39.6%). In families with a single case of early BC (<36 years), mutations were found in 13.7% (95% CI 11.9% to 15.7%). Postmenopausal unilateral or bilateral BC did not increase the probability of mutation detection. Occurrence of premenopausal BC and OC in the same woman led to higher mutation frequencies compared with the occurrence of these two cancers in different individuals (49.0%; 95% CI 41.0% to 57.0% vs 31.5%; 95% CI 28.0% to 35.2%). CONCLUSIONS Our data provide guidance for healthcare professionals and decision-makers to identify individuals who should undergo genetic testing for hereditary breast and ovarian cancer. Moreover, it supports informed decision-making of counselees on the uptake of genetic testing.
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Affiliation(s)
- Karin Kast
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Barbara Wappenschmidt
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Eric Hahnen
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Jan Hauke
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Britta Bluemcke
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Verena Zarghooni
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Natalie Herold
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Nina Ditsch
- Department for Gynecology and Obstetrics, LMU Munich, Munich, Germany
| | - Marion Kiechle
- Department for Gynecology and Obstetrics, Technical University of Munich, Munich, Germany
| | - Michael Braun
- Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany
| | - Christine Fischer
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Nicola Dikow
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Sarah Schott
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany German Cancer Consortium (DKTK), NCT Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nils Rahner
- Medical Faculty, Institute of Human Genetics and Anthropology, Heinrich-Heine University, Düsseldorf, Germany
| | - Dieter Niederacher
- Department of Gynecology and Obstetrics, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Andrea Gehrig
- Department of Human Genetics, University of Wuerzburg, Würzburg, Germany
| | | | - Norbert Arnold
- Department of Gynaecology and Obstetrics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
| | - Nicolai Maass
- Department of Gynaecology and Obstetrics, University Hospital of Schleswig-Holstein, Campus Kiel, Christian-Albrechts University Kiel, Kiel, Germany
| | - Guntram Borck
- Institute of Human Genetics, University of Ulm, Ulm, Germany
| | - Nikolaus de Gregorio
- Department of Gynecology and Obstetrics, University Hospital, Universität Ulm, Ulm, Germany
| | - Caroline Scholz
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Bernd Auber
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | | | - Dorothee Speiser
- Department of Gynecology, Charité University Medicine Berlin, Berlin, Germany
| | - Judit Horvath
- Institute for Human Genetics, University of Muenster, Münster, Germany
| | - Nadine Lichey
- Institute for Human Genetics, University of Muenster, Münster, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sylvia Stark
- Department of Gynecology and Obstetrics, University of Leipzig, Leipzig, Germany
| | - Ulrike Faust
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tübingen, Germany
| | - Bernhard H F Weber
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
| | - Gunter Emons
- Department of Obstetrics and Gynecology, University of Göttingen, Göttingen, Germany
| | - Silke Zachariae
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Alfons Meindl
- Department for Gynecology and Obstetrics, Technical University of Munich, Munich, Germany
| | - Rita K Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO) and Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
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Martin K, Mueller P, Schreiner J, Theurich S, Savic S, Lardinois D, Heinzelmann-Schwarz V, Speiser D, von Bergwelt-Baildon M, Zippelius A. Microtubule-Depolymerizing Agents Used in Antibody-Drug-Conjugates Induce Antitumor Activity by Stimulation of Dendritic Cells. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu467.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kyeyamwa S, Bartens A, Vasiljeva J, Lanowska M, Speiser D, Ingold-Heppner B, Mangler M. Standardisierte histologische Aufarbeitung von radikalen Trachelektomiepräparaten. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Speiser D, Jahn M, Lanowska M, Mangler M, Ingold-Heppner B. Expression von Zellzyklusregulatoren und ki67 bei Patientinnen mit Rezidiv nach radikaler vaginaler Trachelektomie (RVT). Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Schmidt JK, Mangler M, Tucher EV, Speiser D, Lanowska M. Nachsorge und Therapie bei Patientinnen nach non-in-sano Konisation bei zervikaler intraepithelialer Neoplasie (CIN). Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bartens A, Speiser D, Stiefel J, Rosenthal K, Lanowska M, Mangler M. Entwicklung SIMRA – Prospektive und randomisierende Therapieoptimierungsstudie zur Untersuchung der operativen Therapie bei Patientinnen mit Zervixfrühkarzinomen. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Speiser D, Kim A, Goerling U, Lanowska M, Mangler M. Lebensqualität, psychologische Nebeneffekte und Verlauf des Kinderwunsches nach radikaler vaginaler Trachelektomie (RVT) bei Patientinnen mit Zervixkarzinom. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Speiser D. Anti-Cancer T Cells Can Target the Two Pillars of Malignancy, I.E. Cancer Cell-Internal and -External Disease Mechanisms. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu311.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kast K, Schmutzler RK, Rhiem K, Kiechle M, Fischer C, Niederacher D, Arnold N, Grimm T, Speiser D, Schlegelberger B, Varga D, Horvath J, Beer M, Briest S, Meindl A, Engel C. Validation of the Manchester scoring system for predictingBRCA1/2mutations in 9,390 families suspected of having hereditary breast and ovarian cancer. Int J Cancer 2014; 135:2352-61. [DOI: 10.1002/ijc.28875] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 02/27/2014] [Accepted: 03/06/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Karin Kast
- Department of Gynecology and Obstetrics; University Hospital Carl Gustav Carus; Technische Universität Dresden; Germany
| | - Rita K. Schmutzler
- Center of Familial Breast and Ovarian Cancer; Department of Gynecology and Obstetrics; University Hospital Cologne; Germany
| | - Kerstin Rhiem
- Center of Familial Breast and Ovarian Cancer; Department of Gynecology and Obstetrics; University Hospital Cologne; Germany
| | - Marion Kiechle
- Department for Gynecology and Obstetrics; Technical University of Munich; Germany
| | - Christine Fischer
- Institute of Human Genetics; Ruprecht-Karls University; Heidelberg Germany
| | - Dieter Niederacher
- Department of Obstetrics and Gynecology; University Medical Center Düsseldorf; Heinrich-Heine-University; Düsseldorf Germany
| | - Norbert Arnold
- Department of Obstetrics and Gynecology; University Hospital of Schleswig-Holstein; University Kiel; Kiel Germany
| | - Tiemo Grimm
- Department of Human Genetics; University Würzburg; Biozentrum Würzburg Germany
| | - Dorothee Speiser
- Department of Gynecology and Obstetrics; Charité University Medicine Berlin; Germany
| | | | - Dominic Varga
- Department of Gynecology and Obstetrics; University Hospital; Universität Ulm; Germany
| | - Judit Horvath
- Institute for Human Genetics; University of Münster; Münster Germany
| | - Marit Beer
- Institute for Clinical Genetics; Technische Universität Dresden; Dresden Germany
| | - Susanne Briest
- Department of Gynecology and Obstetrics; University of Leipzig; Leipzig Germany
| | - Alfons Meindl
- Department for Gynecology and Obstetrics; Technical University of Munich; Germany
| | - Christoph Engel
- Institute for Medical Informatics; Statistics and Epidemiology; University of Leipzig; Leipzig Germany
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Lanowska M, Mangler M, Grittner U, Akbar GR, Speiser D, Tucher E, Köhler C, Schneider A, Kühn W. Isthmic‐vaginal smear cytology in the follow‐up after radical vaginal trachelectomy for early stage cervical cancer: Is it safe? Cancer Cytopathol 2014; 122:349-58. [DOI: 10.1002/cncy.21402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/13/2014] [Accepted: 01/06/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Malgorzata Lanowska
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Mandy Mangler
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Ulrike Grittner
- Department of Biostatistics and Clinical EpidemiologyCharité University Hospital BerlinBerlin Germany
| | - Gerta Rose Akbar
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Dorothee Speiser
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Elisabeth Tucher
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Christhardt Köhler
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Achim Schneider
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Wolfgang Kühn
- Division of Cytology and Gynecologic MorphologyCharité University Hospital Berlin Germany
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Mangler M, Medrano N, Bartley J, Mechsner S, Speiser D, Schneider A, Köhler C. Value of diagnostic procedures in rectovaginal endometriosis. Aust N Z J Obstet Gynaecol 2013; 53:389-94. [DOI: 10.1111/ajo.12108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 05/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Mandy Mangler
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
| | - Natalie Medrano
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
| | - Julia Bartley
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
| | - Sylvia Mechsner
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
| | | | - Achim Schneider
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
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Speiser D, Köhler C, Schneider A, Mangler M. Radical vaginal trachelectomy: a fertility-preserving procedure in early cervical cancer in young women. Dtsch Arztebl Int 2013; 110:289-95. [PMID: 23671476 DOI: 10.3238/arztebl.2013.0289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 01/23/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Radical vaginal trachelectomy (RVT) is a fertility-preserving operation for young women who have cervical cancer in an early stage and want to have children. The demand for RVT is increasing, because more than 40% of all cases of cervical carcinoma affect women under the age of 44. Women are increasingly having their first child at later ages. METHODS We present the results of RVT in more than 300 patients whom we operated on, review pertinent literature retrieved by a selective PubMed search, and evaluate treatment recommendations. RESULTS The literature contains data on more than 1000 women treated with RVT and nearly 300 pregnancies after RVT. The 5-year recurrence and mortality rates are 2%-5% and 3%-6%, respectively. RVT is an oncologically safe treatment for women who want to have children. The main criteria for treatment with RVT are that the tumor should be no greater than 2 cm in diameter and that the lymph nodes should be histopathologically free of tumor tissue. The laparoscopic-vaginal technique is the best operative approach to assure a high rate of healing. Only one-third of all patients want to have children a short time after RVT. Their pregnancy rates resemble those of women in the general population. 50% of the children are born prematurely, mainly because of premature rupture of the membranes. Thus, pregnancies after RVT are considered high-risk pregnancies. CONCLUSION As many as 48% of women with early-stage cervical carcinoma meet the criteria for RVT. RVT is an oncologically safe method that enables women with early-stage cervical carcinoma to become pregnant and have children. Pregnancy after RVT is associated with an elevated risk of preterm birth and should be managed according to standardized procedures.
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Affiliation(s)
- Dorothee Speiser
- Department of Gynecology and Gynecological Oncology including Breast Center, Charité-Universitätsmedizin Berlin, Germany.
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Mangler M, Freitag C, Lanowska M, Staeck O, Schneider A, Speiser D. Volatile organic compounds (VOCs) in exhaled breath of patients with breast cancer in a clinical setting. Ginekol Pol 2012; 83:730-736. [PMID: 23383557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Carcinogenic products in the exhaled breath of cancer patients are of growing medical interest as they can serve as noninvasive disease markers. Breath analysis can be used as an alternative or complementary diagnostic tool in breast cancer patients who have a different pattern of chemical composition in their breath. This study aims to verify the existence of specific volatile organic compounds (VOCs) in the breath of breast cancer patients. METHODS This prospective study included ten patients suffering from breast cancer and ten healthy pair-matched women. Breath samples of each member of the two respective groups were taken and scanned by gas chromatography/mass spectometry for the presence of volatile organic compounds such as alkanes, ketones, halogenated hydrocarbon, aldehydes, and esters. RESULTS The spectrum of VOCs differed significantly within the two groups. Five specific VOCs could be identified as typical discriminatory markers in the breath samples. Four VOCs were elevated in the healthy controls, one specific VOC was found to be elevated in women affected by breast cancer CONCLUSIONS This pilot study revealed a specific VOC pattern using gas chromatography in the breath of breast cancer patients. Five specific breast cancer-VOCs were identified. At relatively low cost the identification of VOCs may be used to detect breast cancer.
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Affiliation(s)
- Mandy Mangler
- Department of Gynecology, Charité Campus Mitte, Berlin, Germany.
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Vercellino GF, Piek JM, Schneider A, Köhler C, Mangler M, Speiser D, Chiantera V. Laparoscopic lymph node dissection should be performed before fertility preserving treatment of patients with cervical cancer. Gynecol Oncol 2012; 126:325-9. [DOI: 10.1016/j.ygyno.2012.05.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 05/21/2012] [Accepted: 05/26/2012] [Indexed: 11/15/2022]
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Mangler M, Speiser D, Nguyen BD, Cremer M, Koehler C, Schneider A, Lanowska M. Neonatal outcome in infants of patients with radical vaginal trachelectomy. J Perinat Med 2012; 40:503-9. [PMID: 23120758 DOI: 10.1515/jpm-2012-0045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Radical vaginal trachelectomy (RVT) as a fertility-preserving surgery in patients with early-stage cervical cancer is proven to be oncologically safe. After RVT, pregnancy rates vary between 40 % and 80 %. Outcome of infants is complicated by a preterm delivery rate of 30 – 50 %. We investigated pregnancy and neonatal outcome after RVT. METHODS A total of 154 patients with cervical cancer underwent RVT between March 1995 and February 2008. Desire to conceive, pregnancy data, and neonatal outcome were prospectively recorded. Infants’ data were pair-matched to data of a control group according to weeks of gestation. Bayley scales of infant development scores were recorded in the group of preterm-delivered infants. RESULTS Fifty-five women who underwent RVT gave birth to 58 children. Twenty-five (43 %) pregnancies were complicated by preterm rupture of membranes. Thirty infants (52 %) were born preterm, of with 17 (29 %) were < 32 gestational weeks (GW) and seven (12 %) were < 28 GW. There were significantly more premature rupture of membranes in pregnancies after RVT. Despite a higher occurrence of postnatal infections in newborns of mothers who underwent RVT, long-term outcomes are not affected negatively. Regarding overall morbidity, a trend to fewer postnatal complications, compared with the control group, was found. CONCLUSION Postnatal morbidity in infants of women who underwent RVT, based on trend, is decreased compared with controls. Intense medical observation and treatment during pregnancy, birth, and neonatal period may explain this finding. Neonates in the RVT group have a non-significantly elevated risk for postnatal infections. They do not show an additional risk due to the maternal operation. Their long-term postnatal outcome is not affected negatively.
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Affiliation(s)
- Mandy Mangler
- Department of Gynecology, Charité-University Medicine Berlin, Berlin, Germany
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Nguyen BD, Lanowska M, Speiser D, Hasenbein K, Schneider A, Mangler M. Schwangerschaft und neonatologisches outcome der Kinder bei Patientinnen nach radikaler vaginaler Trachelektomie. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Rhiem K, Engel C, Graeser M, Kiechle M, Ditsch N, Mundhenke C, Kreienberg R, Tio J, Golatta M, Hönig A, Gadzicki D, Speiser D, Kast K, Briest S, Meindl A, Schmutzler R. Kontralaterales Mammakarzinom-Risiko bei BRCA1/2-negativen Patientinnen mit familiärer Hochrisikosituation. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Berthod G, Homicsko K, Bouchaab H, Matter M, Cerottini JP, Guggisberg D, Speiser D, Leyvraz S, Michielin O. [Melanoma: a new therapeutic era]. Rev Med Suisse 2011; 7:1126-1130. [PMID: 21721201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Melanoma is the cancer with the fastest incidence increase in Switzerland. 30% of the cases arise before the age of 50 years. Once metastatic, the median survival under current systemic therapies is about 8 months, with less than 5% of patients alive at 5 years. Many efforts in the understanding of cellular biology, intracellular signaling pathways, as well as the role of cellular immunity have been made in the recent years. This has resulted in the development of novel and very promising therapies. In this review, we will cover the results obtained with targeted therapies such as "tyrosin kinase inhibitors" (TKI), as well as those obtained with a monoclonal antibody directed against the CTLA-4 receptor of lymphocytes.
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Affiliation(s)
- G Berthod
- Centre pluridisciplinaire d'oncologie, CHUV, Lausanne.
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Rhiem K, Engel C, Graeser M, Janni W, Kiechle M, Ditsch N, Mundhenke C, Kreienberg R, Tio J, Golatta M, Honig A, Gadzicki D, Speiser D, Kast K, Briest S, Meindl A, Schmutzler R. Contralateral breast cancer risk in patients with familial breast cancer who tested negative for BRCA1 and BRCA2. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lanowska M, Morawietz L, Sikora A, Räber G, Mangler M, Speiser D, Hasenbein K, Chiantera V, Köhler C, Schneider A. Prevalence of lymph nodes in the parametrium of radical vaginal trachelectomy (RVT) specimen. Gynecol Oncol 2011; 121:298-302. [DOI: 10.1016/j.ygyno.2011.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 01/06/2011] [Accepted: 01/10/2011] [Indexed: 11/24/2022]
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