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Yala A, Hughes KS. Rethinking Risk Modeling with Machine Learning. Ann Surg Oncol 2023; 30:6950-6952. [PMID: 37574515 DOI: 10.1245/s10434-023-14144-5] [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] [Received: 06/15/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Adam Yala
- UC Berkeley, Berkeley, USA.
- UCSF, San Francisco, USA.
| | - Kevin S Hughes
- Surgical Oncology, Medical University of South Carolina, Charleston, USA
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Chai TS, Yin K, Wooters M, Shannon KM, Hughes KS. Mainstreamed genetic testing of breast cancer patients: experience from a single surgeon's practice in a large US Academic Center. Fam Cancer 2023; 22:467-474. [PMID: 37354306 DOI: 10.1007/s10689-023-00342-3] [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: 03/06/2023] [Accepted: 06/05/2023] [Indexed: 06/26/2023]
Abstract
This study evaluated the impact of mainstreamed genetic testing (MGT) on the timing and uptake of testing in an academic breast surgeon's practice. Before September 2019 (pre-MGT phase), a breast surgery practice at Massachusetts General Hospital followed a traditional model of a pre-test consultation with a genetic counselor (GC) following a referral. After September 2019 (post-MGT phase), the same practice offered patients genetic testing in a single clinical encounter with a breast surgeon. We evaluated the waiting time between referral and GC visit in the pre-MGT phase and compared the uptake and positivity rates between both phases. In the pre-MGT phase (204 patients), the median waiting time for GC visit was seven days for patients with a newly diagnosed cancer, 211 days for patients with a personal history of cancer, and 224 days for non-cancer patients who had a family history. A total of 105 (51.5%) patients completed a GC appointment. In the post-MGT phase (202 patients), a significantly higher proportion of patients (88.1%, p < 0.001) consented to genetic testing, while the proportion of patients who tested positive was lower (pathogenic variant: 11.9% vs. 20.0%; variant of uncertain significance: 19.9% vs. 28.0%; p = 0.047). Implementing MGT can reduce the number of clinical visits, significantly shorten patients' wait time to test initiation, and increase the completion of genetic testing. Successful integration of this model relied on the genetic expertise of the breast surgeon involved and the support of the GC team.
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Affiliation(s)
- Teresa S Chai
- Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Kanhua Yin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Mackenzie Wooters
- Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Kristen M Shannon
- Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Kevin S Hughes
- Division of Oncologic & Endocrine Surgery, Department of Surgery, Medical University of South Carolina, 30 Courtenay Drive, Ste. 246 MSC 295, Charleston, SC, 29425, USA.
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Hughes KS, Yin K. Cancer Genetics Moves out of Its Winter of Discontent. Ann Surg Oncol 2022; 29:5341-5343. [PMID: 35688949 DOI: 10.1245/s10434-022-11988-1] [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] [Received: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Kevin S Hughes
- Division of Oncologic & Endocrine Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - Kanhua Yin
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Valentín López JC, Ho AY, Moy B, Isakoff SJ, Juric D, Ellisen LW, Peppercorn JM, Bardia A, Hughes KS, Vidula N. Utilizing Natural Language Processing (NLP) to identify breast cancer associated-lung metastases from pathology reports to delineate characteristics and challenges of this common site of breast cancer recurrence. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13592] [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: 11/20/2022] Open
Abstract
e13592 Background: NLP (artificial intelligence) can automate the identification of records in large datasets. The purpose of this study was to evaluate the feasibility of NLP to identify breast cancer-associated lung metastases to understand clinical characteristics and challenges posed by this common site of breast cancer recurrence. Methods: Patients with pathologically confirmed breast cancer associated-lung metastases seen at a large academic center between 3/2012-5/2019 were identified using NLP of institutional pathology reports, with an IRB approved protocol. Chart review was performed to confirm breast cancer associated-lung metastases and determine clinical and pathological features. Results: Using NLP, 32 patients with pathology reports denoting breast cancer associated-lung metastases were identified, with pathologic confirmation of lung biopsy tissue in the majority of cases (24), and pleural fluid specimens (8) on the remainder. Ten of 32 (31%) were HR+/HER2-, 3/32 (9.3%) HER2+, and 19/32 (59%) TNBC. The majority were invasive ductal carcinoma (21/26) with the remainder invasive lobular carcinoma (2/26) or mixed histology (3/26). Median age at lung metastasis diagnosis was 62 years (range 31-88). The median time to development of lung metastasis following primary breast cancer was 5.6 years (range 0-24.8 years). Fifty six percent of lung metastases were detected on imaging and 44% by symptoms including dyspnea, cough, or pain. Tumor tissue genotyping results on the lung metastases were available for 8 patients showing PI3KCA (5), TP53 (3), SMARCA4 (2), ERBB2 (1), FGFR3 (1), ATM (1), CDK4 (1), MYC (1), and ESR1 (1). Treatment after diagnosis of lung metastases included hormone therapy (61%), chemotherapy (84%), lung irradiation (26%), and surgical resection of lung metastases (6%). Lung metastases were associated with considerable morbidity including pleural effusion (15%), dyspnea (6%), pneumothorax (3%), hemothorax (3%), and atelectasis (3%). Patients diagnosed with lung metastases had brain (32%), bone (35%), renal (6%), skin (3%) and adrenal (3%) metastases during disease course. Conclusions: NLP can help identify organ specific metastases from pathology reports, such as breast cancer associated-lung metastases, which can then facilitate observational, translational, and clinical research to characterize and address challenges posed by this common site of breast cancer recurrence. This cohort of patients highlights the morbidity of breast cancer associated-lung metastases and potential role of NLP for disease characterization and clinical research. (Support from ASCO Medical Student Rotation for Underrepresented Populations Award.)
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Affiliation(s)
| | | | - Beverly Moy
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - Dejan Juric
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | | | | | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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Pujol P, Yauy K, Coffy A, Duforet-Frebourg N, Gabteni S, Daurès JP, Penault-Llorca FM, Collet L, Thomas F, Turnbull C, Galibert V, Rideau C, You B, Geneviève D, Hughes KS, Philippe N. Predominance of BRCA2 mutation and estrogen receptor-positive breast cancer among BRCA1/2 mutation carriers. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.551] [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: 11/20/2022] Open
Abstract
551 Background: PARP inhibitor (PARPi) agents can improve progression-free survival of patients with breast cancer (BC) who carry a germline BRCA1 or BRCA2 pathogenic or likely pathogenic variant (gBRCA1/2) in both the metastatic and adjuvant setting. Therefore, we need to redefine the criteria of women and tumor phenotype that should be tested for gBRCA1/2. Methods: We studied the relative distribution of gBRCA1 and gBRCA2 in unselected populations of women with BC and in unaffected individuals. We also analyzed the proportion of estrogen receptor (ER)-positive (ER+) tumors in unselected BC patients with gBRCA1/2.We performed a meta-analysis of studies of unselected BC that analyzed the relative contribution of gBRCA1 versus gBRCA2 and ER+ tumors among gBRCA1/2 carriers. We then performed a meta-analysis of gBRCA1/2 carriage in unaffected individuals, from genome-wide population studies, the gnomAD databank, and case–control studies. Results: The BRCA2 gene was involved in 54% of BC in unselected patients with gBRCA1/2 (n=108,699) and 59% of unaffected individuals (n=238,973) as compared with 38% of gBRCA1/2 family cohorts (n=29,700). The meta-analysis showed that 1.66% (95% CI 1.08-2.54) and 1.71% (95% CI 1.33-2.2) of unselected BC patients carried a gBRCA1 and gBRCA2, respectively. In unaffected individuals, the frequency of heterozygosity for gBRCA1 and gBRCA2 was estimated at 1/434 and 1/288, respectively. Nearly 0.5% of unaffected individuals in the studied populations carried a gBRCA1/2. Carriage of a gBRCA was 2.5% for patients with ER+ tumors (95% CI 1.5-4.1) and 5.7% (95% CI 5.1-6.2) for those with ER- tumors. Overall, 58% of breast tumors occurring in women carrying a gBRCA1/2 were ER+ (n=86,870). Conclusions: This meta-analysis showed that gBRCA2 carriage is predominant in unselected BC and in unaffected individuals. ER+ tumors among women with gBRCA1/2-related BC is predominant and has been underestimated. Because PARPi agents improve progression-free survival with ER+ gBRCA1/2 BC in both the adjuvant and metastatic setting, BC should be considered regardless of ER status for BRCA1/2 screening for therapeutic purposes.
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Affiliation(s)
- Pascal Pujol
- CREEC, UMR IRD 224-CNRS 5290 Université Montpellier, Montpellier, France
| | | | | | | | | | | | | | | | - Frédéric Thomas
- CREEC, UMR IRD 224-CNRS 5290 Université Montpellier, Montpellier, France
| | - Clare Turnbull
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Benoit You
- Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Lyon, France
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Yin K, Chai TS, Wooters M, Shannon KM, Hughes KS. Mainstreamed genetic testing of patients with breast cancer: Experience from a single surgeon’s practice in a large U.S. academic center. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10577] [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: 11/20/2022] Open
Abstract
10577 Background: Germline genetic testing for cancer susceptibility has proven to be a powerful tool in cancer risk assessment, screening, and prevention but a huge gap exists between the number of germline genetic testing candidates and the number of patients actually tested. This study aimed to evaluate the impact of mainstreamed genetic testing (MGT) model into a single academic breast surgeon’s practice on genetic test completion. Methods: Before September 2019 (pre-MGT phase), a breast surgery practice at Massachusetts General Hospital followed a traditional model of pre-test consultation with a genetic professional. After September 2019 (post-MGT phase), the same practice offered eligible patients with immediate testing in the same visit. We evaluated the appointment completion in the pre-MGT phase and compared the test uptake and test results between the two phases. Results: We identified 204 patients in the pre-MGT phase and 202 patients in the post-MGT phase. In the pre-MGT phase, the median waiting time for genetic counseling was seven days for patients with a newly diagnosed cancer, 211 days for patients with a remote personal history of cancer, and 224 days for non-cancer patients who had a family history. A total of 105 (51.5%) patients completed a genetic counseling appointment (Table). In the post-MGT phase, a significantly higher proportion of patients (88.1%, p < 0.001) consented to genetic testing, while the proportion of patients who tested positive was lower (pathogenic variant: 11.9% vs. 20.0%; variant of uncertain significance: 19.9% vs. 28.0%; p = 0.047). Conclusions: Implementing MGT can reduce the number of clinical visits, significantly shorten patients’ wait time to test initiation, and increase the completion of genetic testing. [Table: see text]
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Affiliation(s)
- Kanhua Yin
- Massachusetts General Hospital, Boston, MA
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Hughes KS, Yin K. A Woman Needs to Know She Is a BRCA Carrier Before She Develops Breast Cancer. Ann Surg Oncol 2022; 29:4667-4669. [PMID: 35552928 DOI: 10.1245/s10434-022-11860-2] [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] [Received: 04/04/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Kevin S Hughes
- Division of Oncologic and Endocrine Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - Kanhua Yin
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Dillon J, Ademuyiwa FO, Barrett M, Moss HA, Wignall E, Menendez C, Hughes KS, Plichta JK. Disparities in Genetic Testing for Heritable Solid-Tumor Malignancies. Surg Oncol Clin N Am 2021; 31:109-126. [PMID: 34776060 DOI: 10.1016/j.soc.2021.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Genetic testing offers providers a potentially life saving tool for identifying and intervening in high-risk individuals. However, disparities in receipt of genetic testing have been consistently demonstrated and undoubtedly have significant implications for the populations not receiving the standard of care. If correctly used, there is the potential for genetic testing to play a role in decreasing health disparities among individuals of different races and ethnicities. However, if genetic testing continues to revolutionize cancer care while being disproportionately distributed, it also has the potential to widen the existing mortality gap between various racial and ethnic populations.
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Affiliation(s)
- Jacquelyn Dillon
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Foluso O Ademuyiwa
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Megan Barrett
- Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Haley A Moss
- Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA. https://twitter.com/haleyarden1
| | | | - Carolyn Menendez
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Clinical Cancer Genetics, Duke Cancer Institute, Durham, NC, USA. https://twitter.com/@CSMenendez
| | - Kevin S Hughes
- Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Kelly BN, Faulkner HR, Smith BL, Korotkin JE, Lanahan CR, Brown C, Gadd MA, Specht MC, Hughes KS, Oseni TS, Colwell AS, Coopey SB. ASO Visual Abstract: Nipple-Sparing Mastectomy Versus Skin-Sparing Mastectomy-Does Saving the Nipple Have an Impact on Short- and Long-Term Patient Satisfaction? Ann Surg Oncol 2021. [PMID: 34661777 DOI: 10.1245/s10434-021-10843-z] [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: 11/18/2022]
Affiliation(s)
- Bridget N Kelly
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Heather R Faulkner
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Barbara L Smith
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Jenna E Korotkin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Conor R Lanahan
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Carson Brown
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Michele A Gadd
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle C Specht
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - T Salewa Oseni
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Amy S Colwell
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Suzanne B Coopey
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
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Chamseddine RS, Wang C, Yin K, Wang J, Singh P, Zhou J, Robson ME, Braun D, Hughes KS. Penetrance of male breast cancer susceptibility genes: a systematic review. Breast Cancer Res Treat 2021; 191:31-38. [PMID: 34642874 DOI: 10.1007/s10549-021-06413-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/30/2021] [Accepted: 09/30/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE Several male breast cancer (MBC) susceptibility genes have been identified, but the MBC risk for individuals with a pathogenic variant in each of these genes (i.e., penetrance) remains unclear. We conducted a systematic review of studies reporting the penetrance of MBC susceptibility genes to better summarize current estimates of penetrance. METHODS A search query was developed to identify MBC-related papers indexed in PubMed/MEDLINE. A validated natural language processing method was applied to identify papers reporting penetrance estimates. These penetrance studies' bibliographies were reviewed to ensure comprehensiveness. We accessed the potential ascertainment bias for each enrolled study. RESULTS Fifteen penetrance studies were identified from 12,182 abstracts, covering five purported MBC susceptibility genes: ATM, BRCA1, BRCA2, CHEK2, and PALB2. Cohort (n = 6, 40%) and case-control (n = 5, 33%) studies were the two most common study designs, followed by family-based (n = 3, 20%), and a kin-cohort study (n = 1, 7%). Seven of the 15 studies (47%) adjusted for ascertainment adequately and therefore the MBC risks reported by these seven studies can be considered applicable to the general population. Based on these seven studies, we found pathogenic variants in ATM, BRCA2, CHEK2 c.1100delC, and PALB2 show an increased risk for MBC. The association between BRCA1 and MBC was not statistically significant. CONCLUSION This work supports the conclusion that pathogenic variants in ATM, BRCA2, CHEK2 c.1100delC, and PALB2 increase the risk of MBC, whereas pathogenic variants in BRCA1 may not be associated with increased MBC risk.
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Affiliation(s)
- Reem S Chamseddine
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.,Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Cathy Wang
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kanhua Yin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Jin Wang
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA. .,Department of Breast Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China.
| | - Preeti Singh
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Jingan Zhou
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.,Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mark E Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Danielle Braun
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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Kelly BN, Faulkner HR, Smith BL, Korotkin JE, Lanahan CR, Brown C, Gadd MA, Specht MC, Hughes KS, Oseni TS, Colwell AS, Coopey SB. Nipple-Sparing Mastectomy versus Skin-Sparing Mastectomy: Does Saving the Nipple Impact Short- and Long-Term Patient Satisfaction? Ann Surg Oncol 2021; 29:1033-1040. [PMID: 34498158 DOI: 10.1245/s10434-021-10767-8] [Citation(s) in RCA: 3] [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: 06/14/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) is an oncologically safe alternative to skin-sparing mastectomy (SSM). This study evaluated whether NSM patients were more satisfied than SSM patients in short- and long-term follow-up. METHODS Women who underwent NSM or SSM between 2009 and 2019 completed a postoperative BREAST-Q survey at least 1 year after surgery and patient characteristics were compared. Patient satisfaction at 1-5 years and 6-10 years after NSM and SSM were analyzed. RESULTS Overall, 431 patients were included; 247 had NSM and 184 had SSM 1-10 years prior to BREAST-Q survey completion. SSM patients were older, had higher body mass index (BMI), larger breast weight, and more hypertension than NSM patients, but oncologic treatments were similar between groups. BREAST-Q Psychosocial Well-Being and Sexual Well-Being scores were significantly higher in NSM patients compared with SSM patients in the 1-5 years cohort; however, scores attenuated in the 6-10 years cohort. Satisfaction with breasts was nearly significantly higher in NSM patients compared with SSM patients in the 1-5 years cohort (p = 0.056), but no different in the 6-10 years cohort. Receipt of adjuvant chemotherapy, receipt of postmastectomy radiation therapy, and BMI ≥30 were independent risk factors for dissatisfaction with breasts. CONCLUSIONS Women who are not candidates for NSM should be reassured that long-term qualify of life is not significantly different between SSM and NSM. Dissatisfaction with reconstructed breasts is linked with other factors (besides the nipple), which patients should be made aware of at the time of surgical decision making.
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Affiliation(s)
- Bridget N Kelly
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Heather R Faulkner
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Barbara L Smith
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Jenna E Korotkin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Conor R Lanahan
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Carson Brown
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Michele A Gadd
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle C Specht
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - T Salewa Oseni
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Amy S Colwell
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Suzanne B Coopey
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
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Yin K, Zhou J, Singh P, Wang J, Braun D, Hughes KS. Search Behavior Regarding Cancer Susceptibility Genes Using a Clinical Decision Support Tool for Gene-Specific Penetrance: Content Analysis. JMIR Cancer 2021; 7:e28527. [PMID: 34255640 PMCID: PMC8317039 DOI: 10.2196/28527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/05/2021] [Revised: 05/10/2021] [Accepted: 05/16/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Genetic testing for germline cancer susceptibility genes is widely available. The Ask2Me.org (All Syndromes Known to Man Evaluator) tool is a clinical decision support tool that provides evidence-based risk predictions for individuals with pathogenic variants in cancer susceptibility genes. OBJECTIVE The aim of this study was to understand the search behavior of the Ask2Me.org tool users, identify the patterns of queries entered, and discuss how to further improve the tool. METHODS We analyzed the Ask2Me.org user-generated queries collected between December 12, 2018, and October 8, 2019. The gene frequencies of the user-generated queries were compared with previously published panel testing data to assess the correspondence between usage and prevalence of pathogenic variants. The frequencies of prior cancer in the user-generated queries were compared with the most recent US population-based cancer incidence. RESULTS A total of 10,085 search queries were evaluated. The average age submitted in the queries was 48.8 (SD 16.5) years, and 84.1% (8478/10,085) of the submitted queries were for females. BRCA2 (1671/10,085, 16.6%), BRCA1 (1627/10,085, 16.1%), CHEK2 (994/10,085, 9.9%), ATM (662/10,085, 6.6%), and APC (492/10,085, 4.9%) were the top 5 genes searched by users. There was a strong linear correlation between genes queried by users and the frequency of pathogenic variants reported in published panel testing data (r=0.95, r2=0.90, P<.001). Over half of the queries (5343/10,085, 53.0%) included a prior personal history of cancer. The frequencies of prior cancers in the queries on females were strongly correlated with US cancer incidences (r=0.97, r2=0.95, P<.001), while the same correlation was weaker among the queries on males (r=0.69, r2=0.47, P=.02). CONCLUSIONS The patients entered in the Ask2Me.org tool are a representative cohort of patients with pathogenic variants in cancer susceptibility genes in the United States. While a majority of the queries were on breast cancer susceptibility genes, users also queried susceptibility genes with lower prevalence, which may represent a transformation from single gene testing to multigene panel testing. Owing to these changing tides, more efforts are needed to improve evidence-based clinical decision support tools to better aid clinicians and their practice.
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Affiliation(s)
- Kanhua Yin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, United States
- Department of Surgery, Harvard Medical School, Boston, MA, United States
| | - Jingan Zhou
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, United States
- Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Preeti Singh
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Jin Wang
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, United States
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Danielle Braun
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, United States
- Department of Surgery, Harvard Medical School, Boston, MA, United States
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Wang J, Tang H, Yin K, Li X, Xie X, Hughes KS. Second invasive breast cancers in patients treated with breast-conserving therapy. Eur J Surg Oncol 2021; 47:2492-2498. [PMID: 34134902 DOI: 10.1016/j.ejso.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/14/2021] [Revised: 05/18/2021] [Accepted: 06/05/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Second breast cancers after breast-conserving therapy (BCT) include ipsilateral breast tumor recurrence (IBTR) and metachronous contralateral breast cancer (CBC). Each IBTR is further classified as true recurrence (TR) or new primary tumor (NP). We aim to compare survival outcomes of TR, NP and CBC, and explore the optimal treatments. METHODS 168,427 patients with primary breast cancer who underwent BCT between 1990 and 2005 were identified in the SEER database. The risks of IBTR and CBC were estimated by annual hazard rate. The breast cancer-specific survival (BCSS) were assessed using multivariable Cox regression analysis. RESULTS With median follow-up of 13 years after BCT, 5413 patients developed an IBTR and 4050 patients had a CBC. The risk of IBTR peaked between 10 and 15 years after BCT, while the risk of CBC distributed evenly. 45.9% of IBTRs were classified as a TR and 54.1% as an NP. The time interval from primary breast cancer to NP was longer than to TR and CBC (P < 0.001). Patients with TR had a poorer BCSS than NP (P = 0.003) and CBC (P = 0.002). There was no difference in BCSS between mastectomy and repeat BCT for treating TR (P = 0.584) or NP (P = 0.243). The BCSS of CBCs treated with BCT was better than mastectomy (P = 0.010). Chemotherapy didn't improve the survival of patients with TR (P = 0.058). However, TRs with grade III or negative hormone receptors benefited from chemotherapy significantly. CONCLUSION Patients with TR had a poorer BCSS than NP and CBC. Classifying IBTR may provide clinical significance for treatments.
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Affiliation(s)
- Jin Wang
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China; Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Hailin Tang
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Kanhua Yin
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Xing Li
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Xiaoming Xie
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Wang J, Singh P, Yin K, Zhou J, Bao Y, Wu M, Pathak K, McKinley SK, Braun D, Hughes KS. Disease Spectrum of Breast Cancer Susceptibility Genes. Front Oncol 2021; 11:663419. [PMID: 33959510 PMCID: PMC8093501 DOI: 10.3389/fonc.2021.663419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 02/02/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022] Open
Abstract
Background Pathogenic variants in cancer susceptibility genes can increase the risk of a spectrum of diseases, which clinicians must manage for their patients. We evaluated the disease spectrum of breast cancer susceptibility genes (BCSGs) with the aim of developing a comprehensive resource of gene-disease associations for clinicians. Methods Twelve genes (ATM, BARD1, BRCA1, BRCA2, CDH1, CHEK2, NF1, PALB2, PTEN, RECQL, STK11, and TP53), all of which have been conclusively established as BCSGs by the Clinical Genome Resource (ClinGen) and/or the NCCN guidelines, were investigated. The potential gene-disease associations for these 12 genes were verified and evaluated based on six genetic resources (ClinGen, NCCN, OMIM, Genetics Home Reference, GeneCards, and Gene-NCBI) and an additional literature review using a semiautomated natural language processing (NLP) abstract classification procedure. Results Forty-two diseases were found to be associated with one or more of the 12 BCSGs for a total of 86 gene-disease associations, of which 90% (78/86) were verified by ClinGen and/or NCCN. Four gene-disease associations could not be verified by either ClinGen or NCCN but were verified by at least three of the other four genetic resources. Four gene-disease associations were verified by the NLP procedure alone. Conclusion This study is unique in that it systematically investigates the reported disease spectrum of BCSGs by surveying multiple genetic resources and the literature with the aim of developing a single consolidated, comprehensive resource for clinicians. This innovative approach provides a general guide for evaluating gene-disease associations for BCSGs, potentially improving the clinical management of at-risk individuals.
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Affiliation(s)
- Jin Wang
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.,Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Preeti Singh
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Kanhua Yin
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.,Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Jingan Zhou
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.,Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujia Bao
- Computer Science & Artificial Intelligence, Massachusetts Institute of Technology, Boston, MA, United States
| | - Menghua Wu
- Computer Science & Artificial Intelligence, Massachusetts Institute of Technology, Boston, MA, United States
| | - Kush Pathak
- Department of Surgical Oncology, P. D Hinduja Hospital, Mumbai, India
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Danielle Braun
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, MA, United States
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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McKinley SK, Singh P, Yin K, Wang J, Zhou J, Bao Y, Wu M, Pathak K, Mullen JT, Braun D, Hughes KS. Disease spectrum of gastric cancer susceptibility genes. Med Oncol 2021; 38:46. [PMID: 33760988 DOI: 10.1007/s12032-021-01495-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/31/2020] [Accepted: 03/09/2021] [Indexed: 12/26/2022]
Abstract
Pathogenic variants in germline cancer susceptibility genes can increase the risk of a large number of diseases. Our study aims to assess the disease spectrum of gastric cancer susceptibility genes and to develop a comprehensive resource of gene-disease associations for clinicians. Twenty-seven potential germline gastric cancer susceptibility genes were identified from three review articles and from six commonly used genetic information resources. The diseases associated with each gene were evaluated via a semi-structured review of six genetic resources and an additional literature review using a natural language processing (NLP)-based procedure. Out of 27 candidate genes, 13 were identified as gastric cancer susceptibility genes (APC, ATM, BMPR1A, CDH1, CHEK2, EPCAM, MLH1, MSH2, MSH6, MUTYH-Biallelic, PALB2, SMAD4, and STK11). A total of 145 gene-disease associations (with 45 unique diseases) were found to be associated with these 13 genes. Other gastrointestinal cancers were prominent among identified associations, with 11 of 13 gastric cancer susceptibility genes also associated with colorectal cancer, eight genes associated with pancreatic cancer, and seven genes associated with small intestine cancer. Gastric cancer susceptibility genes are frequently associated with other diseases as well as gastric cancer, with potential implications for how carriers of these genes are screened and managed. Unfortunately, commonly used genetic resources provide heterogeneous information with regard to these genes and their associated diseases, highlighting the importance of developing guides for clinicians that integrate data across available resources and the medical literature.
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Affiliation(s)
- Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Preeti Singh
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA
| | - Kanhua Yin
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA.,Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jin Wang
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA.,Department of Breast Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jingan Zhou
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA.,Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujia Bao
- Computer Science & Artificial Intelligence, Massachusetts Institute of Technology, Boston, MA, USA
| | - Menghua Wu
- Computer Science & Artificial Intelligence, Massachusetts Institute of Technology, Boston, MA, USA
| | - Kush Pathak
- Department of Surgical Oncology, P. D Hinduja Hospital, Mumbai, India
| | - John T Mullen
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA
| | - Danielle Braun
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA.
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Kartal K, Guan Z, Tang R, Griffin M, Wang Y, Braun D, Klein AP, Hughes KS. Familial pancreatic cancer: who should be considered for genetic testing? Ir J Med Sci 2021; 191:641-650. [PMID: 33733397 DOI: 10.1007/s11845-021-02572-9] [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: 01/31/2021] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Determining how many female patients who underwent breast imaging meet the eligibility criteria for genetic testing for familial pancreatic cancer (FPC). METHODS A total of 42,904 patients seen at the Newton-Wellesley Hospital between 2007 and 2009 were retrospectively reviewed. The first four categories were based on pancreatic cancer-associated syndromes: (1) hereditary breast and ovarian cancer (HBOC), (2) Lynch syndrome (LS), (3) familial atypical multiple mole melanoma (FAMMM), and (4) family history of FPC (FH-FPC). PancPRO (5) and MelaPRO (6) categories were based on risk scores from Mendelian risk prediction tool. RESULTS Exactly 4445 of 42,904 patients were found to be in at least one of the six risk categories. About 5.7% of patients were classified as being at high risk for HBOC, 2.3% as being at high risk for LS, 0.1% as being at high risk for FAMMM, 0.1% as being at high risk for FH-FPC, 2.7% as being at high risk based on PancPRO, and 0.2% as being at high risk based on MelaPRO. CONCLUSION About 10.4% of the female patients were classified as being at high risk for FPC. This finding emphasizes the importance of applying criteria to the general population, in order to ensure that individuals with high risk are identified early.
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Affiliation(s)
- Kinyas Kartal
- Division of Surgical Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA. .,Department of General Surgery, Koc University Hospital, Istanbul, Turkey.
| | - Zoe Guan
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rong Tang
- Division of Surgical Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Molly Griffin
- Division of Surgical Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | - Yan Wang
- Division of Surgical Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.,Department of Breast Surgery, Shanghai Cancer Hospital, Fudan University, Shanghai, China
| | - Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alison P Klein
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
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Zhou J, Singh P, Yin K, Wang J, Bao Y, Wu M, Pathak K, McKinley SK, Braun D, Lubitz CC, Hughes KS. Non-medullary Thyroid Cancer Susceptibility Genes: Evidence and Disease Spectrum. Ann Surg Oncol 2021; 28:6590-6600. [PMID: 33660127 DOI: 10.1245/s10434-021-09745-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/31/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The prevalence of non-medullary thyroid cancer (NMTC) is increasing worldwide. Although most NMTCs grow slowly, conventional therapies are less effective in advanced tumors. Approximately 5-15% of NMTCs have a significant germline genetic component. Awareness of the NMTC susceptibility genes may lead to earlier diagnosis and better cancer prevention. OBJECTIVE The aim of this study was to provide the current panorama of susceptibility genes associated with NMTC and the spectrum of diseases associated with these genes. METHODS Twenty-five candidate genes were identified by searching for relevant studies in PubMed. Each candidate gene was carefully checked using six authoritative genetic resources: ClinGen, National Comprehensive Cancer Network guidelines, Online Mendelian Inheritance in Man, Genetics Home Reference, GeneCards, and Gene-NCBI, and a validated natural language processing (NLP)-based literature review protocol was used to further assess gene-disease associations where there was ambiguity. RESULTS Among 25 candidate genes, 10 (APC, DICER1, FOXE1, HABP2, NKX2-1, PRKAR1A, PTEN, SDHB, SDHD, and SRGAP1) were verified among the six genetic resources. Two additional genes, CHEK2 and SEC23B, were verified using the NLP protocol. Seventy-nine diseases were found to be associated with these 12 NMTC susceptibility genes. The following diseases were associated with more than one NMTC susceptibility gene: colorectal cancer, breast cancer, gastric cancer, kidney cancer, gastrointestinal stromal tumor, paraganglioma, pheochromocytoma, and benign skin conditions. CONCLUSION Twelve genes predisposing to NMTC and their associated disease spectra were identified and verified. Clinicians should be aware that patients with certain pathogenic variants may require more aggressive surveillance beyond their thyroid cancer risk.
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Affiliation(s)
- Jingan Zhou
- Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Preeti Singh
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Kanhua Yin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.,Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jin Wang
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.,Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Yujia Bao
- Computer Science and Artificial Intelligence, Massachusetts Institute of Technology, Boston, MA, USA
| | - Menghua Wu
- Computer Science and Artificial Intelligence, Massachusetts Institute of Technology, Boston, MA, USA
| | - Kush Pathak
- Department of Surgical Oncology, P. D Hinduja Hospital, Mumbai, India
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Danielle Braun
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Carrie C Lubitz
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.,Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
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Yin K, Zhou J, Singh P, Hughes KS. ASO Author Reflections: Developing a Clinician-Friendly Resource to Promote Awareness of Non-Medullary Thyroid Cancer Susceptibility Genes and Their Associated Diseases. Ann Surg Oncol 2021; 28:6601-6602. [PMID: 33651212 DOI: 10.1245/s10434-021-09783-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Kanhua Yin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.,Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jingan Zhou
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.,Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Preeti Singh
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
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19
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Jimenez RB, Wong SM, Johnson A, Lalani N, Hughes KS. The Association Between Cardiac Mortality and Adjuvant Radiation Therapy Among Older Patients With Stage I Estrogen Positive Breast Cancer: A Surveillance, Epidemiology, and End Results (SEER)-Based Study on Cardiac Mortality and Radiation Therapy. Adv Radiat Oncol 2021; 6:100633. [PMID: 33912735 PMCID: PMC8071719 DOI: 10.1016/j.adro.2020.100633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We evaluated the risk of cardiac mortality in older patients who receive adjuvant radiation therapy (RT) for stage I breast cancer to determine whether this risk persists in the modern era. METHODS AND MATERIALS Using the 2000 to 2015 Surveillance, Epidemiology, and End Results program data, we performed a population-based cohort study to evaluate the association between adjuvant breast RT, tumor laterality, and cardiac-specific survival (CSS) among patients 60 and older with stage I estrogen receptor positive breast cancer who received breast-conserving surgery and RT. RESULTS At a median follow-up of 6 years (range, 0-15.9 years), patients receiving RT for left-sided breast cancer demonstrated no difference in 5- and 10-year CSS compared with those with right-sided breast cancer (5 year 98.3% vs 98.2%, 10 year 94.3% vs 93.9%; log-rank P = .56). Cox proportional hazards regression analysis confirmed the lack of association of tumor laterality on adjusted 5-year CSS (hazard ratio [HR] = 0.96; 95% confidence interval [CI] = 0.87-1.06), breast-cancer specific survival (HR = 0.96; 95% CI = 0.85-1.09), and overall survival (HR = 0.98; 95% CI = 0.94-1.03). There was also no association of inner versus outer quadrant location on adjusted 5-year CSS for right-sided (HR = 1.06; 95% CI = 0.89-1.12) and left-sided breast cancer (HR = 0.95; 95% CI = 0.79-1.15). CONCLUSIONS With modern radiation therapy techniques, older patients who received left-sided RT for stage I estrogen-receptor positive breast cancer do not demonstrate an increased risk of cardiac mortality compared with patients with right-sided breast cancer. RT can be offered to older patients without concern for inducing cardiac-related death.
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Affiliation(s)
- Rachel B. Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Masschusetts
| | - Stephanie M. Wong
- Department of Surgery, McGill University, JGH Segal Cancer Centre, Montreal, Canada
| | - Andrew Johnson
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Masschusetts
| | - Nafisha Lalani
- Department of Radiation Oncology, University of British Columbia, Vancouver, Canada
| | - Kevin S. Hughes
- Department of Surgery, Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts
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20
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Chamseddine RS, Wang J, Yin K, Singh P, Zhou J, Braun D, Robson ME, Hughes KS. Abstract PS8-40: Penetrance of male breast cancer susceptibility genes: A systematic review. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps8-40] [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
Background: Family history is one of the strongest predisposing factors for male breast cancer (MBC). Several MBC susceptibility genes have been identified, but the risk of MBC for individuals with a pathogenic variant in these genes (i.e., penetrance) remains unclear. We conducted a systematic review of studies reporting the penetrance of MBC susceptibility genes.
Methods: A search query was developed to identify MBC-related abstracts indexed in PubMed, with the followings structure: "Breast Neoplasms, Male"[Mesh] OR (((“Men”[MESH]) OR (male*[TIAB]) OR (man[TIAB]) OR (men[TIAB])) AND ((“Breast Neoplasms”[MESH]) OR (Breast Cancer*[TIAB]) OR (Breast neoplasm*[TIAB]))). A validated natural language processing (NLP) method was applied to retrieve and classify abstracts reporting penetrance estimates. Abstracts labeled as relevant were manually reviewed. The full-text papers of identified penetrance studies were then annotated to extract MBC risk data. These penetrance studies’ bibliographies were also reviewed to ensure comprehensiveness.
Results: We identified 17 penetrance studies from 11,799 abstracts, covering five MBC susceptibility genes: ATM, BRCA1, BRCA2, CHEK2, and PALB2 (Table 1). 53% of these studies were case-control studies, while the rest were cohort studies. Odds ratio (OR), cumulative risk (CR), and relative risk (RR) were three commonly reported risk measures. For BRCA2, eight out of nine studies reported significantly increased risk of MBC or a lifetime CR of over 6%; only one study reported an increased but not statistically significant risk. For BRCA1, one out of six studies reported an elevated lifetime CR of 5.8%, while a second reported a minor increase (OR=1.49) that was statistically significant. The risks reported in the remaining four studies showed no statistically significant increase in risk. Seven studies reported the penetrance of CHEK2, but the risks diverge between the variants tested (Table 2). All three PALB2 studies reported significantly increased risk, while only one ATM study reported an increased risk of MBC, which did not reach statistical significance.
Conclusion: To our knowledge, this review provides the first complete set of reported penetrance data for five MBC susceptibility genes. Contradictory MBC risks (significantly increased risk vs. risks that were not statistically significant) were common, which may be due to the studies’ different ascertainment criteria resulting in risk estimates for differing populations. Risk across these studies cannot be directly compared unless studies adjust for ascertainment, though this cataloging of risk defines our current understanding.
Table 1: MBC penetrance studiesGeneNumber of StudiesStudy TypeRisk Estimate ReportedMBC RiskBRCA296 Cohort, 3 Case-controlOR, RR, CRStatistically significant increased risk (or lifetime CR > 6%) in 8/9 studiesCHEK277 Case-controlOR, RRVarying risk by variantBRCA163 Cohort, 3 Case-controlOR, RR, CR, HRStatistically significant increased risk in 1/6 studies, one study report lifetime CR = 5.8%PALB231 Cohort, 2 Case-controlOR, RRStatistically significant increased risk in 3/3 studiesATM11 Case-controlORStatistically significant increased risk in 0/1 studyOR: odds ratio; RR: relative risk; CR: cumulative risk; HR: hazard ratio
Table 2: As an example: Reported penetrance of CHEK2 for male breast cancer in studies with varying ascertainment criteriaFirst Author, Year of Publication, Patient Population*Pathogenic VariantNumber of CarriersRisk TypeRisk Estimate (95% CI)Statistical SignificanceMeijers-Heijboer H, 2002, Multiple Countries1100delC57RR10.28 (3.54-29.87)YesSyrjakoski K, 2004, Finland1100delC28OR1.27 (0.04-7.92)NoWasielewski M, 2009, Netherlands1100delC21OR4.1 (1.2-14.3)YesPritzlaff M, 2017, USAAll441OR2.4 (1.4-3.9)Yes1100delC135OR3.8 (1.7-7.8)YesI157T238OR1.3 (0.5-3.0)NoHallamies S, 2017, Finland1100delC30OR4.47 (1.51-13.18)YesI157T104OR1.12 (0.4-3.13)NoLu HM, 2019, USANot specifiedNot specifiedOR1.66 (0.04-10.34)NoKleiblova P, 2019, Czech RepublicTruncations3OR20.21 (3.5-80.0)YesDeleterious missense1OR11.87 (0.25-100.83)NoIntermediate missense2OR1.3 (0.15-5.07)NoNeutral missense2OR9.07 (0.98-40.41)NoOR: odds ratio; RR: relative risk* All studies in Table 2 are case-control studies
Citation Format: Reem S Chamseddine, Jin Wang, Kanhua Yin, Preeti Singh, Jingan Zhou, Danielle Braun, Mark E Robson, Kevin S Hughes. Penetrance of male breast cancer susceptibility genes: A systematic review [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-40.
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Affiliation(s)
| | - Jin Wang
- 1Massachusetts General Hospital, Boston, MA
| | - Kanhua Yin
- 1Massachusetts General Hospital, Boston, MA
| | | | | | | | - Mark E Robson
- 3Memorial Sloan Kettering Cancer Center, New York, NY
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Pujol P, Barberis M, Beer P, Friedman E, Piulats JM, Capoluongo ED, Garcia Foncillas J, Ray-Coquard I, Penault-Llorca F, Foulkes WD, Turnbull C, Hanson H, Narod S, Arun BK, Aapro MS, Mandel JL, Normanno N, Lambrechts D, Vergote I, Anahory M, Baertschi B, Baudry K, Bignon YJ, Bollet M, Corsini C, Cussenot O, De la Motte Rouge T, Duboys de Labarre M, Duchamp F, Duriez C, Fizazi K, Galibert V, Gladieff L, Gligorov J, Hammel P, Imbert-Bouteille M, Jacot W, Kogut-Kubiak T, Lamy PJ, Nambot S, Neuzillet Y, Olschwang S, Rebillard X, Rey JM, Rideau C, Spano JP, Thomas F, Treilleux I, Vandromme M, Vendrell J, Vintraud M, Zarca D, Hughes KS, Alés Martínez JE. Clinical practice guidelines for BRCA1 and BRCA2 genetic testing. Eur J Cancer 2021; 146:30-47. [PMID: 33578357 DOI: 10.1016/j.ejca.2020.12.023] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022]
Abstract
BRCA1 and BRCA2 gene pathogenic variants account for most hereditary breast cancer and are increasingly used to determine eligibility for PARP inhibitor (PARPi) therapy of BRCA-related cancer. Because issues of BRCA testing in clinical practice now overlap with both preventive and therapeutic management, updated and comprehensive practice guidelines for BRCA genotyping are needed. The integrative recommendations for BRCA testing presented here aim to (1) identify individuals who may benefit from genetic counselling and risk-reducing strategies; (2) update germline and tumour-testing indications for PARPi-approved therapies; (3) provide testing recommendations for personalised management of early and metastatic breast cancer; and (4) address the issues of rapid process and tumour analysis. An international group of experts, including geneticists, medical and surgical oncologists, pathologists, ethicists and patient representatives, was commissioned by the French Society of Predictive and Personalised Medicine (SFMPP). The group followed a methodology based on specific formal guidelines development, including (1) evaluating the likelihood of BRCAm from a combined systematic review of the literature, risk assessment models and expert quotations, and (2) therapeutic values of BRCAm status for PARPi therapy in BRCA-related cancer and for management of early and advanced breast cancer. These international guidelines may help clinicians comprehensively update and standardise BRCA testing practices.
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Affiliation(s)
- Pascal Pujol
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France; CREEC, UMR IRD 224-CNRS 5290 Université Montpellier, Montpellier, France.
| | | | - Philp Beer
- Wellcome Trust Sanger institute, Cambridge, United Kingdom; Glasgow Precision Oncology Laboratory, United Kingdom.
| | - Eitan Friedman
- The Susanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - Josep M Piulats
- Unidad Funcional de Cáncer de Próstata, Servicio de Oncología Médica, Hospital Universitari de Bellvitge-Institut Català d'Oncologia (ICO), Hospitalet de Llobregat, Spain; Servicio de Oncología Médica, Institut Català d'Oncologia (ICO), Hospitalet de Llobregat, Spain.
| | - Ettore D Capoluongo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università Federico II, CEINGE Biotecnologie Avanzate, Naples, 80145, Italy.
| | - Jesus Garcia Foncillas
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jimenez Diaz-UAM, Madrid, Spain.
| | - Isabelle Ray-Coquard
- Oncologie Médicale, Centre Leon Bérard; Univ Lyon, Université Claude Bernard Lyon1, Hesper EA 7425, F - 69003, Lyon, France.
| | - Frédérique Penault-Llorca
- Department of Biology and Pathology, Centre Jean Perrin, Clermont Ferrand, France; UMR INSERM 1240, Université Clermont Auvergne, Clermont Ferrand, France.
| | - William D Foulkes
- McGill University, Division of Medical Genetics, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
| | - Clare Turnbull
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK; Genomics England, Queen Mary University of London, London, UK; Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK.
| | - Helen Hanson
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.
| | - Steven Narod
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada; Canada Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Banu K Arun
- Anderson Cancer Center, The University of Texas, Department of Breast Medical Oncology, Division of Cancer Medicine, USA.
| | | | - Jean-Louis Mandel
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch, France; Université de Strasbourg, Illkirch, France.
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy.
| | - Diether Lambrechts
- Laboratory of Translational Genetics (VIB-KU Leuven), ON IV Herestraat 49 - box 912, 3000, Leuven Belgium.
| | - Ignace Vergote
- Department of Gynaecologic Oncology University Hospitals Leuven, Gasthuisberg Herestraat 49, 3000 Leuven, Belgium.
| | - Michèle Anahory
- Pech de Laclause, Bathmanabane & Associés Law Firm, Paris, France.
| | - Bernard Baertschi
- French National Institute for Health and Medical Research (INSERM) Ethics Committee, France University of Geneva, Geneva, Switzerland.
| | - Karen Baudry
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Yves-Jean Bignon
- Department of Oncogenetics, Centre Jean Perrin, CBRV, Clermont-Ferrand, France; INSERM-U1240-Molecular Imaging and Theranostic Strategies (IMOST), Clermont-Ferrand, France.
| | - Marc Bollet
- Institut Hartmann, 4, rue Kléber, et Institut Rafael, 3 bd Bineau, 92309 Levallois-Perret cedex, France.
| | - Carole Corsini
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Olivier Cussenot
- CeRePP, Hopital Tenon, Paris, France; Sorbonne Université, Institut Universitaire de Cancérologie, GRC n°5 ONCOTYPE-URO, Hopital Tenon, APHP, Paris, France; Department of Urology, Assistance Publique- Hôpitaux de Paris, Hopital Tenon, Paris, France.
| | - Thibault De la Motte Rouge
- Inserm, Oncogenesis, Stress and Signaling, 35000 Rennes, France; Service d'oncologie médicale, CRLCC Eugène-Marquis, 35000 Rennes, France; UMR 1242, Inserm, Univ Rennes, CLCC Eugène Marquis, Rue Bataille Flandres Dunkerque, 35042, Rennes, France.
| | | | - Florence Duchamp
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | | | - Karim Fizazi
- Institut Gustave Roussy and University of Paris Sud, Villejuif, France.
| | - Virginie Galibert
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France.
| | | | - Pascal Hammel
- Department of Pancreatology, Hôpital Beaujon (AP-HP), Université Denis Diderot-Paris VII, Clichy, France.
| | | | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), Univ. Montpellier, 208 rue des Apothicaires, 34298, Montpellier Cedex 5, France; Translational Research Unit, Institut du Cancer de Montpellier (ICM), Univ. Montpellier, Montpellier, France.
| | - Tatiana Kogut-Kubiak
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Pierre-Jean Lamy
- Institut d'analyse génomique-Imagenome, Labosud, Montpellier, France.
| | - Sophie Nambot
- Centre de Génétique et Centre de Référence Maladies Rares (Anomalies du Développement de l'Interrégion Est), Hôpital d'Enfants, CHU Dijon Bourgogne, Dijon, France; Inserm UMR 1231 GAD (Génétique des Anomalies du Développement), Université de Bourgogne, Dijon, France; Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (FHU TRANSLAD), CHU Dijon Bourgogne et Université de Bourgogne-Franche Comté, Dijon, France.
| | - Yann Neuzillet
- Service d'urologie et de transplantation rénale, hôpital Foch, université de Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
| | - Sylviane Olschwang
- Aix Marseille Université, INSERM GMGF UMR 1251, France; Département de Génétique Médicale, Hôpital Européen & Groupe Ramsay Générale de Santé, Hôpital Clairval, Aix Marseille Université, Marseille, France.
| | | | - Jean-Marc Rey
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Chloé Rideau
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Jean-Philippe Spano
- Department of Medical Oncology, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, Paris, France; Inserm UMRS 1136, Sorbonne Université, Paris, France.
| | - Frédéric Thomas
- IRD, CREEC et MIVE911 avenue Agropolis, BP 64501, Montpellier 34 394, France.
| | - Isabelle Treilleux
- Department of Pathology, Centre Léon Bérard, 28 rue Laënnec, 69373, Lyon Cédex 08, France.
| | | | - Julie Vendrell
- IRCM, INSERM 1194, Department of Pathology and Oncobiology, Laboratoire de biologie des tumeurs solides, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Michèle Vintraud
- Department of Radiotherapy, Hartmann Radiotherapy Center, Levallois-Perret, France.
| | - Daniel Zarca
- The Paris Breast Centre- L'Institut Français du Sein- 15 rue Jean Nicot, 75007, Paris, France.
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Jose E Alés Martínez
- Medical Oncology Department, Hospital Nuestra Señora de Sonsoles, Ávila, Ávila, Spain.
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22
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McCarthy AM, Guan Z, Welch M, Griffin ME, Sippo DA, Deng Z, Coopey SB, Acar A, Semine A, Parmigiani G, Braun D, Hughes KS. Performance of Breast Cancer Risk-Assessment Models in a Large Mammography Cohort. J Natl Cancer Inst 2021; 112:489-497. [PMID: 31556450 DOI: 10.1093/jnci/djz177] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/23/2019] [Accepted: 09/04/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Several breast cancer risk-assessment models exist. Few studies have evaluated predictive accuracy of multiple models in large screening populations. METHODS We evaluated the performance of the BRCAPRO, Gail, Claus, Breast Cancer Surveillance Consortium (BCSC), and Tyrer-Cuzick models in predicting risk of breast cancer over 6 years among 35 921 women aged 40-84 years who underwent mammography screening at Newton-Wellesley Hospital from 2007 to 2009. We assessed model discrimination using the area under the receiver operating characteristic curve (AUC) and assessed calibration by comparing the ratio of observed-to-expected (O/E) cases. We calculated the square root of the Brier score and positive and negative predictive values of each model. RESULTS Our results confirmed the good calibration and comparable moderate discrimination of the BRCAPRO, Gail, Tyrer-Cuzick, and BCSC models. The Gail model had slightly better O/E ratio and AUC (O/E = 0.98, 95% confidence interval [CI] = 0.91 to 1.06, AUC = 0.64, 95% CI = 0.61 to 0.65) compared with BRCAPRO (O/E = 0.94, 95% CI = 0.88 to 1.02, AUC = 0.61, 95% CI = 0.59 to 0.63) and Tyrer-Cuzick (version 8, O/E = 0.84, 95% CI = 0.79 to 0.91, AUC = 0.62, 95% 0.60 to 0.64) in the full study population, and the BCSC model had the highest AUC among women with available breast density information (O/E = 0.97, 95% CI = 0.89 to 1.05, AUC = 0.64, 95% CI = 0.62 to 0.66). All models had poorer predictive accuracy for human epidermal growth factor receptor 2 positive and triple-negative breast cancers than hormone receptor positive human epidermal growth factor receptor 2 negative breast cancers. CONCLUSIONS In a large cohort of patients undergoing mammography screening, existing risk prediction models had similar, moderate predictive accuracy and good calibration overall. Models that incorporate additional genetic and nongenetic risk factors and estimate risk of tumor subtypes may further improve breast cancer risk prediction.
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Affiliation(s)
- Anne Marie McCarthy
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Zoe Guan
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, MA.,Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Michaela Welch
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Molly E Griffin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Dorothy A Sippo
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Zhengyi Deng
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Suzanne B Coopey
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Ahmet Acar
- Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Alan Semine
- Department of Radiology, Newton-Wellesley Hospital, Newton, MA
| | - Giovanni Parmigiani
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, MA.,Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Danielle Braun
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, MA.,Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
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23
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Wang C, Wang Y, Hughes KS, Parmigiani G, Braun D. Penetrance of Colorectal Cancer Among Mismatch Repair Gene Mutation Carriers: A Meta-Analysis. JNCI Cancer Spectr 2020; 4:pkaa027. [PMID: 32923933 PMCID: PMC7476651 DOI: 10.1093/jncics/pkaa027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Lynch syndrome, the most common colorectal cancer (CRC) syndrome, is caused by germline mismatch repair (MMR) genes. Precise estimates of age-specific risks are crucial for sound counseling of individuals managing a genetic predisposition to cancer, but published risk estimates vary. The objective of this work is to provide gene-, sex-, and age-specific risk estimates of CRC for MMR mutation carriers that comprehensively reflect the best available data. Methods We conducted a meta-analysis to combine risk information from multiple studies on Lynch syndrome-associated CRC. We used a likelihood-based approach to integrate reported measures of CRC risk and deconvolved aggregated information to estimate gene- and sex-specific risk. Results Our comprehensive search identified 10 studies (8 on MLH1, 9 on MSH2, and 3 on MSH6). We estimated the cumulative risk of CRC by age and sex in heterozygous mutation carriers. At age 70 years, for male and female carriers, respectively, risks for MLH1 were 43.9% (95% confidence interval [CI] = 39.6% to 46.6%) and 37.3% (95% CI = 32.2% to 40.2%), for MSH2 were 53.9% (95% CI = 49.0% to 56.3%) and 38.6% (95% CI = 34.1% to 42.0%), and for MSH6 were 12.0% (95% CI = 2.4% to 24.6%) and 12.3% (95% CI = 3.5% to 23.2%). Conclusions Our results provide up-to-date and comprehensive age-specific CRC risk estimates for counseling and risk prediction tools. These will have a direct clinical impact by improving prevention and management strategies for both individuals who are MMR mutation carriers and those considering testing.
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Affiliation(s)
- Cathy Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
- Correspondence to: Cathy Wang, MS, Department of Biostatistics, Harvard T.H. Chan School of Public Health, Building II, 4th Floor, 655 Huntington Ave, Boston, MA 02215, USA (e-mail: )
| | - Yan Wang
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
- Department of Breast Surgery, Shanghai Cancer Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Giovanni Parmigiani
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
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24
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Yin K, Singh P, Drohan B, Hughes KS. Breast imaging, breast surgery, and cancer genetics in the age of COVID-19. Cancer 2020; 126:4466-4472. [PMID: 32749697 PMCID: PMC7436610 DOI: 10.1002/cncr.33113] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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] [Received: 05/27/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 01/12/2023]
Abstract
Background The objective of the current study was to provide insight into the effect of coronavirus disease 2019 (COVID‐19) on breast cancer screening, breast surgery, and genetics consultations. Methods User data from a risk assessment company were collected from February 2 to April 11, 2020. The use of risk assessment was used as a proxy for the use of 3 breast cancer services, namely, breast imaging, breast surgery, and genetics consultation. Changes in the use of these services during the study period were analyzed. Results All 3 services experienced significant declines after the COVID‐19 outbreak. The decline in breast surgery began during the week of March 8, followed by breast imaging and genetics consultation (both of which began during the week of March 15). Breast imaging experienced the most significant reduction, with an average weekly decline of 61.7% and a maximum decline of 94.6%. Breast surgery demonstrated an average weekly decline of 20.5%. When surgical consultation was stratified as breast cancer versus no breast cancer, the decrease among in non–breast cancer patients was more significant than that of patients with breast cancer (a decline of 66.8% vs 11.5% from the pre‐COVID average weekly volume for non–breast cancer patients and patients with breast cancer, respectively). During the week of April 5, use of genetics consultations dropped to 39.9% of the average weekly volumes before COVID‐19. Conclusions COVID‐19 has had a significant impact on the number of patients undergoing breast cancer prevention, screening, diagnosis, and treatment. Coronavirus disease 2019 (COVID‐19) has had a significant impact on the number of patients undergoing breast cancer prevention, screening, diagnosis, and treatment in the United States. In the current study, user data from a risk assessment company were collected from February 2 to April 11, 2020, with the use of risk assessment used as a proxy to analyze changes in the use of 3 breast cancer services: breast imaging, breast surgery, and genetics consultation.
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Affiliation(s)
- Kanhua Yin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts.,Department of Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Preeti Singh
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts.,Department of Surgery, Harvard Medical School, Boston, Massachusetts
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25
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Laws A, Dillon K, Kelly BN, Kantor O, Hughes KS, Gadd MA, Smith BL, Lamb LR, Specht M. Node-Positive Patients Treated with Neoadjuvant Chemotherapy Can Be Spared Axillary Lymph Node Dissection with Wireless Non-Radioactive Localizers. Ann Surg Oncol 2020; 27:4819-4827. [PMID: 32740737 DOI: 10.1245/s10434-020-08902-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 05/27/2020] [Accepted: 06/30/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Targeted axillary dissection (TAD) involves sentinel lymph node biopsy (SLNB) and excision of a biopsy-proven node marked by a clip. This study evaluates the feasibility of non-radioactive wireless localizers for targeted excision of clipped axillary lymph nodes. METHODS We identified biopsy-proven, node-positive breast cancer patients treated with neoadjuvant therapy (NAT) and TAD from 2016 to 2020, and included those with a clipped node localized using SAVI SCOUT, Magseed, or RFID Tag. Primary outcome measures were (1) successful localization (ultrasound or mammographic-guided placement < 10 mm from target), and (2) retrieval of the clipped node during TAD, documented by specimen radiography or gross visualization. Secondary outcomes included rates of completion axillary lymph node dissection (cALND) and complications. RESULTS Overall, 57 patients were included; 1 (1.8%) patient had no clip visible at the time of localization, and no radiographic confirmation of clip placement at the time of biopsy, and was therefore excluded. In the remaining 56 patients, localization was successful in 53 (94.6%) patients and the clipped node was retrieved during TAD in 51 (91.1%) patients. Twenty-three of 27 (85.2%) ypN0 patients were spared cALND; 3 (11.1%) patients had cALND for failed clipped node retrieval during TAD, and 1 (3.7%) for false-positive frozen section. In patients with TAD alone, the rates of axillary seroma and infection were 20.0% and 8.6%, respectively. CONCLUSIONS Wireless non-radioactive localizers are feasible for axillary localization after NAT, with high success rates of retrieving clipped nodes. The lack of signal decay is an advantage of these devices, allowing flexibility in timing of placement.
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Affiliation(s)
- Alison Laws
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Kayla Dillon
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Bridget N Kelly
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Olga Kantor
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Kevin S Hughes
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Michele A Gadd
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Barbara L Smith
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Leslie R Lamb
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle Specht
- Department of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA.
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26
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Deng Z, Yin K, Bao Y, Armengol VD, Wang C, Tiwari A, Barzilay R, Parmigiani G, Braun D, Hughes KS. Validation of a Semiautomated Natural Language Processing-Based Procedure for Meta-Analysis of Cancer Susceptibility Gene Penetrance. JCO Clin Cancer Inform 2020; 3:1-9. [PMID: 31419182 DOI: 10.1200/cci.19.00043] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Quantifying the risk of cancer associated with pathogenic mutations in germline cancer susceptibility genes-that is, penetrance-enables the personalization of preventive management strategies. Conducting a meta-analysis is the best way to obtain robust risk estimates. We have previously developed a natural language processing (NLP) -based abstract classifier which classifies abstracts as relevant to penetrance, prevalence of mutations, both, or neither. In this work, we evaluate the performance of this NLP-based procedure. MATERIALS AND METHODS We compared the semiautomated NLP-based procedure, which involves automated abstract classification and text mining, followed by human review of identified studies, with the traditional procedure that requires human review of all studies. Ten high-quality gene-cancer penetrance meta-analyses spanning 16 gene-cancer associations were used as the gold standard by which to evaluate the performance of our procedure. For each meta-analysis, we evaluated the number of abstracts that required human review (workload) and the ability to identify the studies that were included by the authors in their quantitative analysis (coverage). RESULTS Compared with the traditional procedure, the semiautomated NLP-based procedure led to a lower workload across all 10 meta-analyses, with an overall 84% reduction (2,774 abstracts v 16,941 abstracts) in the amount of human review required. Overall coverage was 93%-we are able to identify 132 of 142 studies-before reviewing references of identified studies. Reasons for the 10 missed studies included blank and poorly written abstracts. After reviewing references, nine of the previously missed studies were identified and coverage improved to 99% (141 of 142 studies). CONCLUSION We demonstrated that an NLP-based procedure can significantly reduce the review workload without compromising the ability to identify relevant studies. NLP algorithms have promising potential for reducing human efforts in the literature review process.
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Affiliation(s)
| | - Kanhua Yin
- Massachusetts General Hospital, Boston, MA
| | - Yujia Bao
- Massachusetts Institute of Technology, Boston, MA
| | | | - Cathy Wang
- Harvard TH Chan School of Public Health, Boston, MA.,Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Giovanni Parmigiani
- Harvard TH Chan School of Public Health, Boston, MA.,Dana-Farber Cancer Institute, Boston, MA
| | - Danielle Braun
- Harvard TH Chan School of Public Health, Boston, MA.,Dana-Farber Cancer Institute, Boston, MA
| | - Kevin S Hughes
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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27
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Bao Y, Deng Z, Wang Y, Kim H, Armengol VD, Acevedo F, Ouardaoui N, Wang C, Parmigiani G, Barzilay R, Braun D, Hughes KS. Using Machine Learning and Natural Language Processing to Review and Classify the Medical Literature on Cancer Susceptibility Genes. JCO Clin Cancer Inform 2020; 3:1-9. [PMID: 31545655 DOI: 10.1200/cci.19.00042] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The medical literature relevant to germline genetics is growing exponentially. Clinicians need tools that help to monitor and prioritize the literature to understand the clinical implications of pathogenic genetic variants. We developed and evaluated two machine learning models to classify abstracts as relevant to the penetrance-risk of cancer for germline mutation carriers-or prevalence of germline genetic mutations. MATERIALS AND METHODS We conducted literature searches in PubMed and retrieved paper titles and abstracts to create an annotated data set for training and evaluating the two machine learning classification models. Our first model is a support vector machine (SVM) which learns a linear decision rule on the basis of the bag-of-ngrams representation of each title and abstract. Our second model is a convolutional neural network (CNN) which learns a complex nonlinear decision rule on the basis of the raw title and abstract. We evaluated the performance of the two models on the classification of papers as relevant to penetrance or prevalence. RESULTS For penetrance classification, we annotated 3,740 paper titles and abstracts and evaluated the two models using 10-fold cross-validation. The SVM model achieved 88.93% accuracy-percentage of papers that were correctly classified-whereas the CNN model achieved 88.53% accuracy. For prevalence classification, we annotated 3,753 paper titles and abstracts. The SVM model achieved 88.92% accuracy and the CNN model achieved 88.52% accuracy. CONCLUSION Our models achieve high accuracy in classifying abstracts as relevant to penetrance or prevalence. By facilitating literature review, this tool could help clinicians and researchers keep abreast of the burgeoning knowledge of gene-cancer associations and keep the knowledge bases for clinical decision support tools up to date.
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Affiliation(s)
- Yujia Bao
- Massachusetts Institute of Technology, Boston, MA
| | | | - Yan Wang
- Massachusetts General Hospital, Boston, MA
| | - Heeyoon Kim
- Massachusetts Institute of Technology, Boston, MA
| | | | | | | | - Cathy Wang
- Harvard T.H. Chan School of Public Health, Boston, MA.,Dana-Farber Cancer Institute, Boston, MA
| | - Giovanni Parmigiani
- Harvard T.H. Chan School of Public Health, Boston, MA.,Dana-Farber Cancer Institute, Boston, MA
| | | | - Danielle Braun
- Harvard T.H. Chan School of Public Health, Boston, MA.,Dana-Farber Cancer Institute, Boston, MA
| | - Kevin S Hughes
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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28
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Yin K, Braun D, Tiwari A, Wang J, Singh P, Zhou J, Parmigiani G, Hughes KS. Comparing and assessing the reported penetrance of cancer susceptibility genes for breast cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1520] [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: 11/20/2022] Open
Abstract
1520 Background: It is critical for oncologists to be aware of unbiased and interpretable cancer risks (i.e., penetrance) in carriers with germline pathogenic variants in cancer susceptibility genes. However, relevant literature is large and varies significantly in study design, patient ascertainment, and types of risk estimates reported. This heterogeneity can cause inconsistent conclusions between studies and create barriers for clinicians to understand and apply them in practice. To further understand the current literature, we assessed penetrance studies associated with non-BRCA breast cancer susceptibility genes based on study design and ascertainment adjustment. Methods: We used a validated natural language processing-based abstract classifier to identify all penetrance studies regarding eleven genes: ATM, BARD1, CDH1, CHEK2, NBN, NF1, PALB2, PTEN, RECQL, STK11, and TP53. Relevant studies were then manually annotated as “with ascertainment adjustment” if a study was based on: (1) a general population; (2) a pedigree analysis or a family-based study with appropriate ascertainment adjustment; or (3) a hospital-based study or a panel testing analysis with well-matched cases and controls. Results: A total of 49 penetrance studies were identified, with a median of nine studies for each gene (range: 4-16). The case-control study was the dominant study type, accounting for over 80% in five genes, 50% in two genes, and 18% to 43% in the other four genes. The proportion of studies with ascertainment adjustment was generally low (mean: 33%) and varied widely between different genes (7% to 80%). Contradictory breast cancer risks (no increased risk vs. significantly increased risk) were found in eight genes (73%) (Table). The most common ascertainment bias identified was a case-control study with cases (patients) who had a strong family history but using general population controls. Conclusions: Ascertainment bias is common in penetrance studies, but few studies adjust for it appropriately. Clinicians should be aware of this issue, and new methods are warranted to select unbiased risk estimates, synthesize them, and provide the accurate general-population penetrance. [Table: see text]
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Affiliation(s)
- Kanhua Yin
- Massachusetts General Hospital, Boston, MA
| | | | | | - Jin Wang
- Massachusetts General Hospital, Boston, MA
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Yin K, Liu Y, Lamichhane B, Sandbach JF, Patel G, Compagnoni G, Kanak RH, Rosen B, Ondrula DP, Smith L, Brown E, Gold L, Whitworth P, App C, Euhus D, Semine A, Dwight Lyons S, Lazarte MAC, Parmigiani G, Braun D, Hughes KS. Legacy Genetic Testing Results for Cancer Susceptibility: How Common are Conflicting Classifications in a Large Variant Dataset from Multiple Practices? Ann Surg Oncol 2020; 27:2212-2220. [PMID: 32342295 DOI: 10.1245/s10434-020-08492-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE The classification of germline variants may differ between labs and change over time. We apply a variant harmonization tool, Ask2Me VarHarmonizer, to map variants to ClinVar and identify discordant variant classifications in a large multipractice variant dataset. METHODS A total of 7496 variants sequenced between 1996 and 2019 were collected from 11 clinical practices. Variants were mapped to ClinVar, and lab-reported and ClinVar variant classifications were analyzed and compared. RESULTS Of the 4798 unique variants identified, 3699 (77%) were mappable to ClinVar. Among mappable variants, variants of unknown significance (VUS) accounted for 74% of lab-reported classifications and 60% of ClinVar classifications. Lab-reported and ClinVar discordances were present in 783 unique variants (21.2% of all mappable variants); 121 variants (2.5% of all unique variants) had within-practice lab-reported discordances; and 56 variants (1.2% of all unique variants) had lab-reported discordances across practices. The unmappable variants were associated with a higher proportion of lab-reported pathogenic classifications (50% vs. 21%, p < 0.0001) and a lower proportion of lab-reported VUS classifications (46% vs. 74%, p < 0.0001). CONCLUSIONS Our study shows that discordant variant classification occurs frequently, which may lead to inappropriate recommendations for prophylactic treatments or clinical management.
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Affiliation(s)
- Kanhua Yin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA.,Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yuxi Liu
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Gia Compagnoni
- Advanced Surgical Care of Northern Illinois, Advocate Health Care, Barrington, IL, USA
| | - Richard H Kanak
- Advanced Surgical Care of Northern Illinois, Advocate Health Care, Barrington, IL, USA
| | - Barry Rosen
- Advanced Surgical Care of Northern Illinois, Advocate Health Care, Barrington, IL, USA
| | - David P Ondrula
- Advanced Surgical Care of Northern Illinois, Advocate Health Care, Barrington, IL, USA
| | - Linda Smith
- New Mexico Comprehensive Breast Care, Albuquerque, NM, USA
| | - Eric Brown
- Comprehensive Breast Care, A Division of Michigan Healthcare Professionals, Troy, MI, USA
| | - Linsey Gold
- Comprehensive Breast Care, A Division of Michigan Healthcare Professionals, Troy, MI, USA
| | | | - Colleen App
- The Breast Health and Wellness Center, Grand Rapids, MI, USA
| | - David Euhus
- Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Giovanni Parmigiani
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Danielle Braun
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
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Rosenberg SM, Hendrix LH, Schreiber KL, Thompson AM, Bedrosian I, Hughes KS, Lynch T, Basila D, Collyar DE, Frank ES, Darai S, Lanahan C, Marks JR, Plichta JK, Hyslop T, Partridge AH, Hwang ES. Abstract P1-21-07: The Patient-reported Outcomes after Routine Treatment of Atypical Lesions (PORTAL) study: Pain, psychosocial wellbeing, and quality of life among women undergoing guideline concordant care for DCIS vs. active surveillance for in situ and atypical lesions. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-21-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Background: Guideline-concordant care (GCC) for DCIS includes surgery, radiation, and endocrine treatment. Active surveillance (AS) is a strategy under study for management of low risk DCIS. The PORTAL Study was designed to evaluate patient reported outcomes (PROs) after GCC for DCIS compared to women who received AS for DCIS combined with women with a history of other atypical lesions (atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia/lobular carcinoma in situ (LN), as proxies for AS-managed DCIS. Methods: The PORTAL Study invited women age≥ 18, diagnosed with DCIS, ADH, or LN between 2012-2017 from 4 academic centers to complete a one-time, cross-sectional survey. Clinical, pathological, and treatment information was obtained from medical record review. The primary outcome was breast/chest wall pain assessed with the Breast Cancer Pain Questionnaire (BCPQ) including severity (10-point scale, ≥3=clinically relevant), a Pain Burden Index (PBI), which is a composite of severity, frequency, and location (breast, arm, side, axilla) and assessments of sensory disturbances, and impact of pain on emotional and physical functioning. Additional PROs included measures of generalized pain (Brief Pain Inventory), anxiety (STAI-Short Form), depression (CES-D), and QOL (Quality of Life in Adult Cancer Survivors). Pain, psychosocial, and QOL outcomes were compared between the GCC vs. AS groups using Wilcoxon Rank Sum and Chi-Square tests. Results: Of 1565 patients invited and sent a survey, 927 (59%) responded to the survey with evaluable pain outcome data. Median time from diagnosis was 3.8 years. Median age at survey completion was 58 (range: 26-94) years; 13% identified as non-White; 4% Hispanic. Among those with DCIS (n=554), 97% had GCC (62%, lumpectomy, 38%, mastectomy; 48%, radiation), representing 58% of participants vs 42% representing AS. The prevalence of clinically relevant pain was higher in the GCC vs. AS group (16.5% vs 9%, p=.0009). Median BCPQ-PBI, sensory disturbance, physical, and emotional impact scores were all higher (p<.0001) in the GCC vs. AS group (Table); BPI scores for pain severity and interference were similar between groups. QOL, anxiety and depressive symptoms were similar among women who had GCC compared to the AS group. Conclusion: Women with DCIS who have undergone GCC experience more breast/chest wall pain and report greater impact of pain on physical and emotional functioning in long term follow-up, compared to women who have undergone AS for DCIS or are managed for other atypical lesions. Given that many women with low risk DCIS may be unlikely to develop invasive cancer, improved understanding of the potential trade-offs of GCC vs AS can help support informed decision making in women with DCIS who are considering their treatment options. Ongoing prospective trials will provide further information regarding risks and benefits of AS vs GCC for women with low risk DCIS.
BCPQ Scores, GCC vs. ASGCCASMean (range)Median (IQR)Mean (range)Median (IQR)p*PBI6.4 (0-80)0 (0-9)2.9 (0-64)0 (0-0)<.0001Sensory disturbance1.4 (0-9)0 (0-2)0.6 (0-9)0 (0-0)<.0001Physical impact9.6 (0-67)0 (0-19)4.4 (0-56)0 (0-0)<.0001Emotional impact1.4 (0-33)0 (0-1)0.6 (0-38)0 (0-0)<.0001*Wilcoxon rank sum test comparing median scores
Citation Format: Shoshana M Rosenberg, Laura H Hendrix, Kristin L Schreiber, Alastair M Thompson, Isabelle Bedrosian, Kevin S Hughes, Thomas Lynch, Desiree Basila, Deborah E Collyar, Elizabeth S Frank, Sonja Darai, Conor Lanahan, Jeffrey R Marks, Jennifer K Plichta, Terry Hyslop, Ann H Partridge, E. Shelley Hwang. The Patient-reported Outcomes after Routine Treatment of Atypical Lesions (PORTAL) study: Pain, psychosocial wellbeing, and quality of life among women undergoing guideline concordant care for DCIS vs. active surveillance for in situ and atypical lesions [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-21-07.
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Hughes KS, Zhou J, Bao Y, Singh P, Wang J, Yin K. Natural language processing to facilitate breast cancer research and management. Breast J 2019; 26:92-99. [PMID: 31854067 DOI: 10.1111/tbj.13718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 12/23/2022]
Abstract
The medical literature has been growing exponentially, and its size has become a barrier for physicians to locate and extract clinically useful information. As a promising solution, natural language processing (NLP), especially machine learning (ML)-based NLP is a technology that potentially provides a promising solution. ML-based NLP is based on training a computational algorithm with a large number of annotated examples to allow the computer to "learn" and "predict" the meaning of human language. Although NLP has been widely applied in industry and business, most physicians still are not aware of the huge potential of this technology in medicine, and the implementation of NLP in breast cancer research and management is fairly limited. With a real-world successful project of identifying penetrance papers for breast and other cancer susceptibility genes, this review illustrates how to train and evaluate an NLP-based medical abstract classifier, incorporate it into a semiautomatic meta-analysis procedure, and validate the effectiveness of this procedure. Other implementations of NLP technology in breast cancer research, such as parsing pathology reports and mining electronic healthcare records, are also discussed. We hope this review will help breast cancer physicians and researchers to recognize, understand, and apply this technology to meet their own clinical or research needs.
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Affiliation(s)
- Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jingan Zhou
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujia Bao
- Computer Science & Artificial Intelligence, Massachusetts Institute of Technology, Boston, MA
| | - Preeti Singh
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jin Wang
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.,Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Kanhua Yin
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Brown CL, McEvoy MP, Smith BL, Lanahan CR, Kelly BN, Coopey SB, Hughes KS, Oseni TS, McGugin C, Wong SM, Gadd MA, Specht MC. Long-Term Outcomes of Multiple-Wire Localizations for More Extensive Breast Cancer: Multiple-Wire Excision Does Not Increase Recurrence, Unplanned Imaging, or Biopsies. Clin Breast Cancer 2019; 20:215-219. [PMID: 31859233 DOI: 10.1016/j.clbc.2019.11.006] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/11/2019] [Accepted: 11/16/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND We previously reported that breast conservation was feasible for women with large or irregularly shaped breast cancers when tumor resection was guided by multiple localizing wires. We now report long-term outcomes of multiple-wire versus single-wire localized lumpectomies for breast cancer. PATIENTS AND METHODS We retrospectively reviewed wire-localized lumpectomies at our institution from May 2000 to November 2006. Rates of ipsilateral in-breast tumor recurrence, metastasis, and subsequent unplanned diagnostic imaging and biopsy were compared between multiple-wire and single-wire cohorts. RESULTS We identified 112 multiple-wire and 160 single-wire breast cancer lumpectomies that achieved clear margins. Median age was 64 years in the multiple-wire cohort and 57 years in the single-wire cohort. Mean lumpectomy volume was 75 mL in multiple-wire patients and 49 mL in single-wire patients (P = .003). Invasive tumor size, axillary node status, and use of radiation and systemic therapy were similar, but the multiple-wire group had more patients with ductal carcinoma-in-situ only (38% vs. 28%). At 108 months' median follow-up, there was no significant difference in local or distant recurrence rates between multiple-wire and single-wire cohorts. Six (5%) multiple-wire patients and 6 (4%) single-wire patients had local recurrences and 3 (3%) multiple-wire and 5 (3%) single-wire patients developed metastatic disease. Unplanned diagnostic imaging was required for 53 (47%) multiple-wire and 65 (41%) single-wire patients. Subsequent ipsilateral biopsy occurred in 15 (13%) multiple-wire and 19 (12%) single-wire patients. CONCLUSION Breast-conserving surgery with multiple localizing wires is a safe alternative to mastectomy for breast cancer patients with large mammographic lesions.
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Affiliation(s)
- Carson L Brown
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Maureen P McEvoy
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Barbara L Smith
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA.
| | - Conor R Lanahan
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Bridget N Kelly
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Suzanne B Coopey
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - T Salewa Oseni
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Caroline McGugin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Stephanie M Wong
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Michele A Gadd
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Michelle C Specht
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
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Manahan ER, Kuerer HM, Sebastian M, Hughes KS, Boughey JC, Euhus DM, Boolbol SK, Taylor WA. Consensus Guidelines on Genetic` Testing for Hereditary Breast Cancer from the American Society of Breast Surgeons. Ann Surg Oncol 2019; 26:3025-3031. [PMID: 31342359 PMCID: PMC6733830 DOI: 10.1245/s10434-019-07549-8] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this consensus guideline is to outline recommendations for genetic testing that medical professionals can use to assess hereditary risk for breast cancer. METHODS Literature review included large datasets, basic and clinical science publications, and recent updated national guidelines. Genetic testing to assess hereditary risk of cancer is a complex, broad, and dynamic area of medical research. The dominant focus of this guideline is limited in scope to breast cancer. RESULTS There is a lack of consensus among experts regarding which genes among many should be tested in different clinical scenarios. There is also variation in the degree of consensus regarding the understanding of risk and appropriate clinical management of mutations in many genes. CONCLUSIONS Genetic testing should be made available to all patients with a personal history of breast cancer. Recent data are reviewed that support genetic testing being offered to each patient with breast cancer (newly diagnosed or with a personal history). If genetic testing is performed, such testing should include BRCA1/BRCA2 and PALB2, with other genes as appropriate for the clinical scenario and family history. For patients with newly diagnosed breast cancer, identification of a mutation may impact local treatment recommendations. Patients who had genetic testing previously may benefit from updated testing. Genetic testing should be made available to patients without a history of breast cancer who meet National Comprehensive Cancer Network guidelines. Finally, variants of uncertain significance are not clinically actionable and these patients should be managed based on their individual risk factors.
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Affiliation(s)
- Eric R Manahan
- Department of Surgery, Hamilton Medical Center, Dalton, GA, USA.
| | - Henry M Kuerer
- Department Breast Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Molly Sebastian
- Reinsch Pierce Family Center for Breast Health, Virginia Hospital Center, Arlington, VA, USA
| | - Kevin S Hughes
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | - David M Euhus
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Susan K Boolbol
- Department of Surgery, Mount Sinai Beth Israel, New York, NY, USA
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McGugin CJ, Coopey SB, Smith BL, Kelly BN, Brown CL, Gadd MA, Hughes KS, Specht MC. Enhanced Recovery Minimizes Opioid Use and Hospital Stay for Patients Undergoing Mastectomy with Reconstruction. Ann Surg Oncol 2019; 26:3464-3471. [DOI: 10.1245/s10434-019-07710-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Indexed: 11/18/2022]
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Zhang B, Coopey SB, Gadd MA, Hughes KS, Chang DC, Oseni TO. Trends in Unilateral and Contralateral Prophylactic Mastectomy Use in Ductal Carcinoma In Situ of the Breast: Patterns and Predictors. Ann Surg Oncol 2019; 26:3863-3873. [PMID: 31325048 DOI: 10.1245/s10434-019-07628-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increased use of contralateral prophylactic mastectomy (CPM) as treatment for ductal carcinoma in situ (DCIS) in the US was first noted in the early 2000s. Optimization of treatment guidelines for DCIS requires an understanding of current surgical treatment trends, particularly as they may differ by patient sociodemographic and community resource factors. OBJECTIVE The aim of this study was to evaluate surgical treatment trends among US women with DCIS and to assess the impact of sociodemographic and community resource factors on surgical treatment choice. METHODS The Surveillance, Epidemiology, and End Results dataset was queried for women aged 40 years and older who were diagnosed with unilateral DCIS between 2000 and 2014. Annual mastectomy rates were compared over time by age and race/ethnicity. Multivariable logistic regressions were performed to identify predictors of mastectomy use, with patient sociodemographics, tumor characteristics, and community resource factors (i.e. plastic surgeon density) as covariates. RESULTS A total of 130,731 women with DCIS met the inclusion criteria. Overall mastectomy rates remained relatively unchanged over the study period (25-30%). CPM use increased for all age and race/ethnic groups, with the greatest increase exhibited by women aged 40-49 years [relative to 2000; 2014 odds ratio (OR) 10.6]. With respect to community resource factors, CPM use, as opposed to unilateral mastectomy, was associated with counties of higher education level (OR 1.52), higher income level (OR 1.22), and lower plastic surgeon density (OR 1.26). CONCLUSION AND RELEVANCE While the popularity of mastectomy in the management of DCIS has remained relatively unchanged since the turn of the century, the use of CPM has risen substantially. Younger women with DCIS have seen the greatest increase in CPM use, a choice that remains influenced by race/ethnicity as well as income, education, and health resource availability. Until clinical risk stratifiers of DCIS are identified, the surgical decision-making paradigm must be improved so that treatment choice remains sensitive to cultural differences but becomes independent of income, education, and health resource availability.
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Affiliation(s)
- Biqi Zhang
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Suzanne B Coopey
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Michele A Gadd
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Kevin S Hughes
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Tawakalitu O Oseni
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
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Tang R, Acevedo F, Lanahan C, Coopey SB, Yala A, Barzilay R, Li C, Colwell A, Guidi AJ, Cetrulo C, Garber J, Smith BL, Gadd MA, Specht MC, Hughes KS. Incidental breast carcinoma: incidence, management, and outcomes in 4804 bilateral reduction mammoplasties. Breast Cancer Res Treat 2019; 177:741-748. [PMID: 31317348 DOI: 10.1007/s10549-019-05335-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Bilateral reduction mammoplasty is one of the most common plastic surgery procedures performed in the U.S. This study examines the incidence, management, and prognosis of incidental breast cancer identified in reduction specimens from a large cohort of reduction mammoplasty patients. METHODS Breast pathology reports were retrospectively reviewed for evidence of incidental cancers in bilateral reduction mammoplasty specimens from five institutions between 1990 and 2017. RESULTS A total of 4804 women met the inclusion criteria of this study; incidental cancer was identified in 45 breasts of 39 (0.8%) patients. Six patients (15%) had bilateral cancer. Overall, the maximum diagnosis by breast was 16 invasive cancers and 29 ductal carcinomas in situs. Thirty-three patients had unilateral cancer, 15 (45.5%) of which had high-risk lesions in the contralateral breast. Twenty-one patients underwent mastectomy (12 bilateral and nine unilateral), residual cancer was found in 10 in 25 (40%) therapeutic mastectomies. Seven patients did not undergo mastectomy received breast radiation. The median follow-up was 92 months. No local recurrences were observed in the patients undergoing mastectomy or radiation. Three of 11 (27%) patients who did not undergo mastectomy or radiation developed a local recurrence. The overall survival rate was 87.2% and disease-free survival was 82.1%. CONCLUSIONS Patients undergoing reduction mammoplasty for macromastia have a small but definite risk of incidental breast cancer. The high rate of bilateral cancer, contralateral high-risk lesions, and residual disease at mastectomy mandates thorough pathologic evaluation and careful follow-up of these patients. Mastectomy or breast radiation is recommended for local control given the high likelihood of local recurrence without either.
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Affiliation(s)
- Rong Tang
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Francisco Acevedo
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Conor Lanahan
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Suzanne B Coopey
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Adam Yala
- Department of Electrical Engineering and Computer Science, CSAIL MIT, Cambridge, 02142, USA
| | - Regina Barzilay
- Department of Electrical Engineering and Computer Science, CSAIL MIT, Cambridge, 02142, USA
| | - Clara Li
- Department of Electrical Engineering and Computer Science, CSAIL MIT, Cambridge, 02142, USA
| | - Amy Colwell
- Plastic Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Anthony J Guidi
- Department of Pathology, Newton-Wellesley Hospital, Newton, MA, 02462, USA
| | - Curtis Cetrulo
- Plastic Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Judy Garber
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Barbara L Smith
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Michele A Gadd
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Michelle C Specht
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
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Sippo DA, Burk KS, Mercaldo SF, Rutledge GM, Edmonds C, Guan Z, Hughes KS, Lehman CD. Performance of Screening Breast MRI across Women with Different Elevated Breast Cancer Risk Indications. Radiology 2019; 292:51-59. [DOI: 10.1148/radiol.2019181136] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Dorothy A. Sippo
- From the Department of Radiology, Massachusetts General Hospital, Avon Comprehensive Breast Evaluation Center, Wang Ambulatory Care Building, Suite 240, 15 Parkman St, Boston, MA 02114
| | - Kristine S. Burk
- From the Department of Radiology, Massachusetts General Hospital, Avon Comprehensive Breast Evaluation Center, Wang Ambulatory Care Building, Suite 240, 15 Parkman St, Boston, MA 02114
| | - Sarah F. Mercaldo
- From the Department of Radiology, Massachusetts General Hospital, Avon Comprehensive Breast Evaluation Center, Wang Ambulatory Care Building, Suite 240, 15 Parkman St, Boston, MA 02114
| | - Geoffrey M. Rutledge
- From the Department of Radiology, Massachusetts General Hospital, Avon Comprehensive Breast Evaluation Center, Wang Ambulatory Care Building, Suite 240, 15 Parkman St, Boston, MA 02114
| | - Christine Edmonds
- From the Department of Radiology, Massachusetts General Hospital, Avon Comprehensive Breast Evaluation Center, Wang Ambulatory Care Building, Suite 240, 15 Parkman St, Boston, MA 02114
| | - Zoe Guan
- From the Department of Radiology, Massachusetts General Hospital, Avon Comprehensive Breast Evaluation Center, Wang Ambulatory Care Building, Suite 240, 15 Parkman St, Boston, MA 02114
| | - Kevin S. Hughes
- From the Department of Radiology, Massachusetts General Hospital, Avon Comprehensive Breast Evaluation Center, Wang Ambulatory Care Building, Suite 240, 15 Parkman St, Boston, MA 02114
| | - Constance D. Lehman
- From the Department of Radiology, Massachusetts General Hospital, Avon Comprehensive Breast Evaluation Center, Wang Ambulatory Care Building, Suite 240, 15 Parkman St, Boston, MA 02114
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Acevedo F, Armengol VD, Deng Z, Tang R, Coopey S, Mazzola E, Lanahan C, Braun D, Yala A, Barzilay R, Li C, Santus E, Colwell A, Guidi A, Cetrulo C, Garber JE, Smith BL, King TA, Hughes KS. Incidental atypical hyperplasia/LCIS in mammoplasty specimens and subsequent risk of breast cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1561] [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: 11/20/2022] Open
Abstract
1561 Background: Proliferative breast lesions with atypia (atypical hyperplasia and lobular carcinoma in-situ (LCIS)) increase the risk of breast cancer (BC). Most cases are diagnosed in the context of an abnormal mammogram. Little is known about BC risk for patients with these lesions who are asymptomatic. Mammoplasty specimens allow us to study breast tissue in asymptomatic healthy women. We previously published the rate of atypia in the largest reported mammoplasty cohort. The aim of this study is to examine the risk of BC in the atypia cohort. Methods: Breast pathology reports were retrospectively reviewed for evidence of atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH) or LCIS in bilateral reduction mammoplasty specimens from five institutions within a single healthcare system between 1990 to 2017. Patients with prior or concurrent BC or prior atypia were excluded. Data was extracted from electronic medical records using natural language processing and manual review to assess subsequent risk of BC. Results: From our mammoplasty cohort of 4771 patients, 295 patients were found to have atypia (6.2%) at baseline. 40 of these patients were lost to follow-up and excluded from the study. For the remaining 255 patients, 13 had severe ADH bordering on ductal carcinoma in situ, 52 had LCIS, 119 had ALH, and 71 had ADH at baseline. The median age at baseline was 52.1 (range 17.9 – 74.3). With a median follow-up of 7.7 years, of the 255 patients 9 patients developed BC (8 invasive carcinomas, 1 ductal carcinoma in situ). 81.3% of the cohort did not receive chemoprevention. Only one patient out of the nine who developed BC received chemoprevention. The risk of developing BC among women with atypia at baseline was 0.5%, 2.9% and 4.1%, at 3, 5 and 10 years respectively. Conclusions: Patients with asymptomatic atypias found in reduction mammoplasty specimens appear to be at lower risk of developing BC than those diagnosed with atypia in the context of an abnormal mammogram. These results may provide guidance on how to manage this group of patients related to future screening and/or chemoprevention.
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Affiliation(s)
| | | | | | - Rong Tang
- Massachusetts General Hospital, Boston, MA
| | | | | | | | | | - Adam Yala
- Massachusetts Institute of Technology, Cambridge, MA
| | | | - Clara Li
- Massachusetts General Hospital, Boston, MA
| | | | | | | | | | - Judy Ellen Garber
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA
| | | | - Tari A. King
- Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA
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Beitsch PD, Whitworth PW, Hughes KS, Patel R, Baron P, Rosen B, Grady I, Holmes D, Simmons RM, Smith LA, Compagnoni G, Coomer CL, Brown EA, Barbosa K, Clark P, Gold LP, Riley LB, Esplin ED, Yang S, Nussbaum RL. Comprehensive germline multigene panel testing changes clinical care for patients with breast cancer: Untapped clinical utility and PARP inhibitor trial eligibility. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1583] [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: 11/20/2022] Open
Abstract
1583 Background: HBOC testing guidelines were established to identify patients with clinically actionable variants and limit economic burden. We report the impact of germline results on health outcome based on clinical decision making and treatment interventions, regardless of guidelines, in a multi-center registry. Methods: 20 community-based and academic participated in an IRB approved registry. Patients with breast cancer were tested with an 80-gene panel; clinical information was collected. Results: Data on 912 patients has been analyzed to date. 50.5% met NCCN criteria; 49.5% did not. Pathogenic/likely pathogenic (P/LP) germline mutations were found in 8.65% of patients. Of all patients with P/LP findings, 85% had variants in cancer-risk genes with established management recommendations and 80% had germline variants conferring eligibility for clinical trials and precision medicine-based cancer treatments, such as PARP inhibitors. For 62% of patients with P/LP germline mutations, clinicians reported results impacted patients’ health outcome. And for 69%, results impacted the health outcome of patients’ relatives. There was no significant association between BRCAPRO scores and patients having a P/LP finding, whether in BRCA1/2 alone (p = 0.42) or for any cancer gene (p = 0.57). Physician reported impact on patient outcome associated significantly with the presence of P/LP germline findings (p < 0.00001). There was no significant difference in the clinician reported clinical utility of variants of uncertain significance (VUS) compared to negative results (p = 0.467). Conclusions: Comprehensive panel testing of breast cancer patients impacts physician assessed patient outcomes and informs changes in surgical treatment strategy, medical therapies and proactive screening. The data suggest that BRCAPRO calculators are poor predictors of germline presence of P/LP findings. Physicians in this study demonstrate the ability to discern the clinically actionable value of P/LP mutations from non-actionable VUS. Multigene panels impact breast cancer patient care by identifying precision medicine treatment interventions, and guiding long-term medical management and preventive surveillance for patients and family members.
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Affiliation(s)
| | | | | | | | - Paul Baron
- Cancer Specialists of Charleston, Charleston, SC
| | | | - Ian Grady
- North Valley Breast Clinic, Redding, CA
| | | | - Rache M. Simmons
- New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | | | - Gia Compagnoni
- Advanced Surgical Care of Northern Illinois, Barrington, IL
| | | | | | | | | | | | - Lee B. Riley
- St Luke's Hosp and Health Network, Bethlehem, PA
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Plichta JK, Hughes KS. ASO Author Reflections: The Pressing Need for Germline Genetic Testing. Ann Surg Oncol 2019; 26:612-613. [PMID: 31098782 DOI: 10.1245/s10434-019-07428-2] [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] [Received: 04/25/2019] [Indexed: 11/18/2022]
Affiliation(s)
| | - Kevin S Hughes
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
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Plichta JK, Sebastian ML, Smith LA, Menendez CS, Johnson AT, Bays SM, Euhus DM, Clifford EJ, Jalali M, Kurtzman SH, Taylor WA, Hughes KS. Germline Genetic Testing: What the Breast Surgeon Needs to Know. Ann Surg Oncol 2019; 26:2184-2190. [PMID: 30941656 DOI: 10.1245/s10434-019-07341-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE The American Society of Breast Surgeons (ASBrS) sought to provide educational guidelines for breast surgeons on how to incorporate genetic information and genomics into their practice. METHODS A comprehensive nonsystematic review was performed of selected peer-reviewed literature. The Genetics Working Group of the ASBrS convened to develop guideline recommendations. RESULTS Clinical and educational guidelines were prepared to outline the essential knowledge for breast surgeons to perform germline genetic testing and to incorporate the findings into their practice, which have been approved by the ASBrS Board of Directors. RECOMMENDATIONS Thousands of women in the USA would potentially benefit from genetic testing for BRCA1, BRCA2, and other breast cancer genes that markedly increase their risk of developing breast cancer. As genetic testing is now becoming more widely available, women should be made aware of these tests and consider testing. Breast surgeons are well positioned to help facilitate this process. The areas where surgeons need to be knowledgeable include: (1) identification of patients for initial breast cancer-related genetic testing, (2) identification of patients who tested negative in the past but now need updated testing, (3) initial cancer genetic testing, (4) retesting of patients who need their genetic testing updated, (5) cancer genetic test interpretation, posttest counseling and management, (6) management of variants of uncertain significance, (7) cascade genetic testing, (8) interpretation of genetic tests other than clinical cancer panels and the counseling and management required, and (9) interpretation of somatic genetic tests and the counseling and management required.
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Affiliation(s)
| | - Molly L Sebastian
- Reinsch Pierce Family Center for Breast Health, Virginia Hospital Center, Arlington, VA, USA
| | | | | | - Anita T Johnson
- Cancer Treatment Centers of America, Atlanta, GA, USA.,Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - David M Euhus
- Department of Surgery, Johns Hopkins University Hospital, Baltimore, MD, USA
| | | | - Mena Jalali
- American Society of Breast Surgeons, Dallas, TX, USA
| | | | | | - Kevin S Hughes
- Department of Surgery, Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
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Hoda RS, Arpin Iii RN, Gottumukkala RV, Hughes KS, Ly A, Brachtel EF. Diagnostic Value of Fine-Needle Aspiration in Male Breast Lesions. Acta Cytol 2019; 63:319-327. [PMID: 30904908 DOI: 10.1159/000494486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/05/2018] [Accepted: 10/12/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Differentiation between gynecomastia, a common cause of male breast enlargement, and breast cancer is crucial for appropriate management. Fine-needle aspiration biopsy has been shown to be sensitive and specific in assessing female breast lesions, comparable to core needle biopsy. Few such studies have been conducted in men. We assessed its diagnostic value in a male patient cohort. STUDY DESIGN Men who underwent fine-needle aspiration (FNA) for palpable breast lesions at Massachusetts General Hospital from January 2007 to December 2016 were evaluated. Clinical data, radiographic findings, and cytologic diagnoses of 74 breast FNA from 71 men were reviewed. Breast aspirates were classified as nondiagnostic, benign, atypical, suspicious for malignancy, or malignant. Histology was obtained in 37 cases, and clinical and radiological data were used as follow-up in 37 patients. RESULTS Most FNA biopsies (73%) were performed by cytopathologists, and 93.2% of the breast FNA in men were adequate; 58% showed benign processes, mostly gynecomastia (n = 22), and 28.4% (n = 21) were malignant, most often ductal carcinoma. No false-positive cytologies were obtained, and there was 1 false-negative cytology. In our study, FNA of palpable male breast lesions was 95.8% sensitive and 100% specific. CONCLUSIONS FNA allows sensitive, specific, and safe evaluation and diagnosis of palpable male breast lesions.
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Affiliation(s)
- Raza S Hoda
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ronald N Arpin Iii
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ravi V Gottumukkala
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin S Hughes
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elena F Brachtel
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA,
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43
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Tang R, Kelly BN, Smith BL, Lanahan CR, Brown CL, Gadd MA, Hughes KS, Oseni TO, McGugin C, Specht MC, Coopey SB. Nipple Discharge After Nipple-Sparing Mastectomy With and Without Associated Pregnancy. Clin Breast Cancer 2019; 19:e534-e539. [PMID: 31053520 DOI: 10.1016/j.clbc.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/15/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Nipple-sparing mastectomies (NSMs) preserve the intact nipple, including nipple duct orifices. Retained orifices might remain patent and communicate with the underlying reconstruction. We report the incidence and outcomes of nipple discharge after NSM in pregnant and nonpregnant women. PATIENTS AND METHODS Retrospective review of all NSMs at our institution from June 2007 to June 2018 was performed. Subsequent pregnancies and nipple discharge were documented. Patient demographic, operative, histopathology, and cancer treatment data were collected. Descriptive analysis was performed for patients who developed nipple discharge. RESULTS From June 2007 to June 2018, 2778 NSM procedures were performed in 1620 patients, with a mean age of 48 (range, 20-80) years. Fifteen hundred sixty-eight NSMs were therapeutic and 1210 were for risk reduction. Thirty-three subsequent pregnancies were observed in 27 patients, with a mean age of 33 (range, 26-42) years at NSM. Bilateral or unilateral discharge occurred in 6 of 27 (22%) postpartum patients and resolved spontaneously. At 54 months mean follow-up after NSM (range, 16-98 months) and 23 (range, 1-61) months after delivery, no local-regional recurrences were observed. In 1593 patients without subsequent pregnancy, there were 4 patients (0.25%) treated with bilateral NSM with subsequent unilateral watery nipple discharge. There was no evidence of associated malignancy on physical exam, imaging, or cytology, and with 55 to 110 months follow-up, no new or recurrent cancers have been observed. CONCLUSION Despite extensive removal of nipple and subareolar duct tissue during NSM, milky nipple discharge is possible postpartum. Watery, acellular discharge occurs rarely in nonpregnant patients. To date, no patient with discharge has developed a local recurrence or new breast cancer.
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Affiliation(s)
- Rong Tang
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Bridget N Kelly
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Barbara L Smith
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA.
| | - Conor R Lanahan
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Carson L Brown
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Michele A Gadd
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Tawakalitu O Oseni
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Caroline McGugin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Michelle C Specht
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Suzanne B Coopey
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
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44
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Hughes KS, Beitsch P, Chen S. Guidelines Do Not Proscribe Surgeons Performing Genetic Testing. JAMA Surg 2019; 154:269. [DOI: 10.1001/jamasurg.2018.4882] [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: 11/14/2022]
Affiliation(s)
- Kevin S. Hughes
- Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston
- Bermuda Cancer Genetics and Risk Assessment Clinic, Boston, Massachusetts
| | | | - Steven Chen
- OasisMD Lifestyle Healthcare, San Diego, California
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45
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Oseni TO, Zhang B, Coopey SB, Gadd MA, Hughes KS, Chang DC. Twenty-Five Year Trends in the Incidence of Ductal Carcinoma in Situ in US Women. J Am Coll Surg 2019; 228:932-939. [PMID: 30772444 DOI: 10.1016/j.jamcollsurg.2019.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/03/2018] [Accepted: 01/19/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The rising incidence of ductal carcinoma in situ (DCIS) since the widespread enactment of mammography screening has been well documented. Patterns in DCIS incidence among women of various ages and across different racial and ethnic groups have not been well described. STUDY DESIGN The Surveillance, Epidemiology, and End Results public-use data set was queried for all women aged 40 years and older diagnosed with DCIS between 1990 and 2014. Annual age-adjusted incidence rates were compared among white, black, Hispanic, and Asian-Pacific Islander women. Additionally, using mammography screening data obtained from the CDC, patterns in mammography screening over time and as they relate to DCIS incidence rates by race and ethnicity were evaluated. RESULTS We identified 200,400 women aged 40 years or older with DCIS. Between 1998 and 2014, a period that saw flux in national breast screening guidelines, DCIS incidence rates increased in blacks, Hispanics, and Asian-Pacific Islanders, but remained relatively unchanged in whites (increase in number of DCIS diagnoses per 100,000 individuals in the population per year among blacks +0.66/p < 0.01, Hispanics +3.0/p < 0.01, Asian-Pacific Islanders +0.53/p < 0.01, and whites +0.07/p = 0.21). After accounting for age, year of diagnosis, and mammography screening rates, DCIS incidence was found to be similar between white and black women (0.8 fewer diagnoses per 100,000 individuals compared with whites; p = 0.36) but lower for Hispanic women (9.7 fewer diagnoses per 100,000 individuals compared with whites; p < 0.01). CONCLUSIONS The DCIS incidence rates are influenced substantially by breast cancer mammography screening patterns. However, differences exist by race and ethnicity and are not fully explained by screening mammography trends alone. Consideration should be given to including race and ethnicity in determining optimal breast screening guidelines.
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Affiliation(s)
| | - Biqi Zhang
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Suzanne B Coopey
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Michele A Gadd
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Kevin S Hughes
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, MA; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA
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Haddad SA, Spring LM, Jimenez RB, Vidula N, Comander A, Shin JA, Coopey SB, Gadd MA, Hughes KS, Taghian A, Smith BL, Isakoff SJ, Moy B, Bardia A, Specht MC. Abstract P2-14-19: Surgical and long-term outcomes of patients receiving neoadjuvant pertuzumab-containing regimens for HER2-positive localized breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-14-19] [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
Background: The addition of pertuzumab to trastuzumab and chemotherapy significantly improves the pathologic complete response (pCR) rate in HER2+ localized breast cancer in the preoperative setting. Although many patients are converted to breast conserving therapy (BCT) candidates by neoadjuvant HER2-directed therapy, a significant proportion opt for a mastectomy for various reasons. Among mastectomy procedures, nipple sparing mastectomy (NSM) is frequently chosen instead of non-nipple sparing mastectomy (NNSM). In this study, we evaluated the surgical and long-term outcomes of HER2+ patients receiving neoadjuvant pertuzumab-containing regimens.
Methods: We performed a retrospective review of localized breast cancer patients treated with neoadjuvant pertuzumab-containing regimens from 2011 to 2016, who underwent BCT or mastectomy at an academic institution and two community-based practices. Disease characteristics, treatment regimens, surgical outcomes, and recurrence data were extracted from the electronic medical records.
Results: Among 90 patients with stage II-III HER2+ breast cancer, 45 received AC-THP (50.0%), 26 received THP (with adjuvant AC) (29.0%), and 19 received TCHP (21.0%). The majority of patients had grade 3 tumors (61.1%), clinical stage II disease (80.0%), invasive ductal carcinoma (86.7%), and ER+ disease (65.6%). Thirty-seven (41.0%) patients underwent BCT and 53 (59.0%) patients underwent mastectomy. Among the mastectomy patients, 38 (71.7%) patients underwent bilateral mastectomies, specifically 33 (62.0%) patients underwent a NSM and 20 (38.0%) patients underwent a NNSM. The type of surgery that patients underwent stratified by type of neoadjuvant regimen is outlined in the Table 1 below. Most patients who underwent BCT and mastectomy received radiation, including 36 (97.3%) BCT, 24 (72.7%) NSM, and 18 (95.0%) NNSM. Over a median follow-up period of 33 months, 6 patients (6.7%) had recurrences with 2 (2.2%) local recurrences and 4 (4.4%) distant recurrences. The 2 local recurrences occurred in one patient who underwent BCT and one patient who underwent NNSM followed by post-mastectomy radiation.
Conclusions: Among mastectomy patients, NSM was more commonly pursued than NNSM. Rates of local recurrence following pertuzumab-containing regimens for HER2-positive localized breast cancer were low overall, regardless of the type of surgery. Data on plastic surgery approaches and complication rates will be presented at the meeting.
Table 1.Type of surgery in patients receiving neoadjuvant HER2-directed therapy. AC-THP (N = 45)TCHP (N = 19)THP (N = 26)BCT46.7%47.4%26.9%NNSM26.7%10.5%23.1%NSM26.7%42.1%50.0%
Citation Format: Haddad SA, Spring LM, Jimenez RB, Vidula N, Comander A, Shin JA, Coopey SB, Gadd MA, Hughes KS, Taghian A, Smith BL, Isakoff SJ, Moy B, Bardia A, Specht MC. Surgical and long-term outcomes of patients receiving neoadjuvant pertuzumab-containing regimens for HER2-positive localized breast cancer [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 P2-14-19.
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Affiliation(s)
- SA Haddad
- Massachusetts General Hospital, Boston, MA
| | - LM Spring
- Massachusetts General Hospital, Boston, MA
| | - RB Jimenez
- Massachusetts General Hospital, Boston, MA
| | - N Vidula
- Massachusetts General Hospital, Boston, MA
| | - A Comander
- Massachusetts General Hospital, Boston, MA
| | - JA Shin
- Massachusetts General Hospital, Boston, MA
| | - SB Coopey
- Massachusetts General Hospital, Boston, MA
| | - MA Gadd
- Massachusetts General Hospital, Boston, MA
| | - KS Hughes
- Massachusetts General Hospital, Boston, MA
| | - A Taghian
- Massachusetts General Hospital, Boston, MA
| | - BL Smith
- Massachusetts General Hospital, Boston, MA
| | - SJ Isakoff
- Massachusetts General Hospital, Boston, MA
| | - B Moy
- Massachusetts General Hospital, Boston, MA
| | - A Bardia
- Massachusetts General Hospital, Boston, MA
| | - MC Specht
- Massachusetts General Hospital, Boston, MA
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Nakhlis F, Harrison BT, Giess CS, Lester SC, Hughes KS, Coopey SB, King TA. Evaluating the Rate of Upgrade to Invasive Breast Cancer and/or Ductal Carcinoma In Situ Following a Core Biopsy Diagnosis of Non-classic Lobular Carcinoma In Situ. Ann Surg Oncol 2018; 26:55-61. [DOI: 10.1245/s10434-018-6937-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Indexed: 12/27/2022]
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Zhang B, Oseni TO, Coopey SB, Gadd MA, Hughes KS, Chang DC. Beyond Breast Surgeons: Do Plastic Surgeon and Radiation Oncologist Availability Impact Mastectomy Use in Patients with Ductal Carcinoma in Situ? J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.210] [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: 10/28/2022]
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Acevedo F, Armengol VD, Deng Z, Tang R, Coopey SB, Braun D, Yala A, Barzilay R, Li C, Colwell A, Guidi A, Cetrulo CL, Garber J, Smith BL, King T, Hughes KS. Pathologic findings in reduction mammoplasty specimens: a surrogate for the population prevalence of breast cancer and high-risk lesions. Breast Cancer Res Treat 2018; 173:201-207. [PMID: 30238276 DOI: 10.1007/s10549-018-4962-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 09/03/2018] [Accepted: 09/06/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Mammoplasty removes random samples of breast tissue from asymptomatic women providing a unique method for evaluating background prevalence of breast pathology in normal population. Our goal was to identify the rate of atypical breast lesions and cancers in women of various ages in the largest mammoplasty cohort reported to date. METHODS We analyzed pathologic reports from patients undergoing bilateral mammoplasty, using natural language processing algorithm, verified by human review. Patients with a prior history of breast cancer or atypia were excluded. RESULTS A total of 4775 patients were deemed eligible. Median age was 40 (range 13-86) and was higher in patients with any incidental finding compared to patients with normal reports (52 vs. 39 years, p = 0.0001). Pathological findings were detected in 7.06% (337) of procedures. Benign high-risk lesions were found in 299 patients (6.26%). Invasive carcinoma and ductal carcinoma in situ were detected in 15 (0.31%) and 23 (0.48%) patients, respectively. The rate of atypias and cancers increased with age. CONCLUSION The overall rate of abnormal findings in asymptomatic patients undergoing mammoplasty was 7.06%, increasing with age. As these results are based on random sample of breast tissue, they likely underestimate the prevalence of abnormal findings in asymptomatic women.
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Affiliation(s)
- Francisco Acevedo
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA
| | - V Diego Armengol
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA
| | - Zhengyi Deng
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA
| | - Rong Tang
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA
| | - Suzanne B Coopey
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA
| | - Danielle Braun
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Adam Yala
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA.,Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard T.H Chan School of Public Health, Boston, MA, USA.,Massachusetts Institute of Technology, Boston, MA, USA
| | - Regina Barzilay
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA.,Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard T.H Chan School of Public Health, Boston, MA, USA.,Massachusetts Institute of Technology, Boston, MA, USA
| | - Clara Li
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA.,Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard T.H Chan School of Public Health, Boston, MA, USA.,Massachusetts Institute of Technology, Boston, MA, USA
| | - Amy Colwell
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA
| | - Anthony Guidi
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA
| | - Curtis L Cetrulo
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA
| | - Judy Garber
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Barbara L Smith
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA
| | - Tari King
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA
| | - Kevin S Hughes
- Massachusetts General Hospital, 55 Fruit Street, Yawkey 7, Boston, MA, 02114, USA.
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Braun D, Yang J, Griffin M, Parmigiani G, Hughes KS. A Clinical Decision Support Tool to Predict Cancer Risk for Commonly Tested Cancer-Related Germline Mutations. J Genet Couns 2018; 27:1187-1199. [PMID: 29500626 PMCID: PMC6240422 DOI: 10.1007/s10897-018-0238-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 02/05/2018] [Accepted: 02/08/2018] [Indexed: 01/07/2023]
Abstract
The rapid drop in the cost of DNA sequencing led to the availability of multi-gene panels, which test 25 or more cancer susceptibility genes for a low cost. Clinicians and genetic counselors need a tool to interpret results, understand risk of various cancers, and advise on a management strategy. This is challenging as there are multiple studies regarding each gene, and it is not possible for clinicians and genetic counselors to be aware of all publications, nor to appreciate the relative accuracy and importance of each. Through an extensive literature review, we have identified reliable studies and derived estimates of absolute risk. We have also developed a systematic mechanism and informatics tools for (1) data curation, (2) the evaluation of quality of studies, and (3) the statistical analysis necessary to obtain risk. We produced the risk prediction clinical decision support tool ASK2ME (All Syndromes Known to Man Evaluator). It provides absolute cancer risk predictions for various hereditary cancer susceptibility genes. These predictions are specific to patients' gene carrier status, age, and history of relevant prophylactic surgery. By allowing clinicians to enter patient information and receive patient-specific cancer risks, this tool aims to have a significant impact on the quality of precision cancer prevention and disease management activities relying on panel testing. It is important to note that this tool is dynamic and constantly being updated, and currently, some of its limitations include (1) for many gene-cancer associations risk estimates are based on one study rather than meta-analysis, (2) strong assumptions on prior cancers, (3) lack of uncertainty measures, and (4) risk estimates for a growing set of gene-cancer associations which are not always variant specific. All of these concerns are being addressed on an ongoing basis, aiming to make the tool even more accurate.
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Affiliation(s)
- Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Ave, CLSB 11051, Boston, MA, 02215, USA.
| | - Jiabei Yang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Ave, CLSB 11051, Boston, MA, 02215, USA
| | - Molly Griffin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Giovanni Parmigiani
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Ave, CLSB 11051, Boston, MA, 02215, USA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
- Surgery, Harvard Medical School, Boston, MA, USA
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