Effect of instrument type and one-handed versus two-handed grips on force application during simulated instrument-assisted soft tissue mobilisation

Objective

The purpose of this study was to examine whether the forces used by trained clinicians during a simulated instrument-assisted soft tissue mobilisation (IASTM) treatment varied across five different instruments during one-handed and two-handed IASTM grips.

Methods

Nine athletic trainers who previously completed IASTM training and used the technique in professional practice were included in the study. A skin simulant was attached to a force plate and used to evaluate force production during a simulated IASTM treatment scenario. Peak (F_peak) and mean (F_mean) forces were recorded for both one-handed and two-handed grips for each participant across the five instruments. Data were analysed using separate 2 (grip type) × 5 (IASTM instrument) repeated measures analysis of variance for both F_peak and F_mean.

Results

Data for F_peak demonstrated a significant main effect for grip type (F_{(1, 8)}=46.39, p<0.001, η p 2 =0.34), instrument (F_{(4, 32)}=4.61, p=0.005, η p 2 =0.06) and interaction (F_{(2, 16)}=10.23, p=0.001, η p 2 =0.07). For F_mean, there was also a statistically significant main effect for grip type (F_{(1, 8)}=60.47, p<0.001, η p 2 =0.32), instrument (F_{(4, 32)}=4.03, p=0.009, η p 2 =0.06) and interaction (F_{(2, 19)}=7.92, p=0.002, η p 2 =0.06).

Conclusions

Clinicians produced greater IASTM forces when applying a two-handed grip than a one-handed grip. Instrument weight may matter less than instrument shape, size and bevelling for influencing force production as instrument length appears to influence force production when using one-handed or two-handed grips. Although the effects of IASTM force variation on patient outcomes remains unknown, these findings may be considered by clinicians when making instrument and grip choices.

Short stature, hearing loss, retinitis pigmentosa, and distinctive facies syndrome: A case report

Short stature, hearing loss, retinitis pigmentosa, and distinctive facies (SHRF) Syndrome is a syndrome recently identified among three German patients. Clinical characteristics include eye disease, sensorineural hearing loss, distinct facial and phalangeal features, short stature, developmental delay, and cerebellar atrophy. In this case report, we discuss a fourth identified patient with genomic mutations in the EXOSC2 gene which codes for a cap protein in the RNA exosome. Whole exome sequencing identified two mutations of unknown clinical significance including: a heterozygous maternal variant, missense mutation NM_014285.7: c427G>A (p.Ala143Thr) in exon 6 and a heterozygous paternal variant, splice donor NM_014285.5: c.801+1G>A in intron 8. Our patient demonstrates a novel clinical presentation within the SHRF disease spectrum.

Agnogenic practices: an analysis of UK gambling industry-funded youth education programmes

Background

The corporate political activities of harmful industries, including the use of agnogenic (ignorance or doubt producing) practices and the construction of dystopian narratives, directed at influencing policymaking are well documented. However, the use of agnogenic practices by industry-funded organisations who deliver industry-favoured education-based measures remains unexplored. This study aims to build understanding of this by analysing three UK gambling industry-funded youth education programmes that represent key policy responses to gambling harms.

Methods

Using a published typology of corporate agnogenic practices the ways that evidence is used within the programmes’ resources to legitimise their content and implementation were analysed. Programme evaluations and claims about the programmes’ evidence base and effectiveness were also analysed.

Results

Agnogenic practices, including confounding referencing, misleading summaries and evidential landscaping, that resemble those adopted by harmful industries are used within gambling industry-funded youth education programmes and by the charities that oversee their delivery. These practices serve corporate interests, distort the limited evidence in support of youth gambling education measures, and legitimise industry favoured policies.

Conclusions

This novel study demonstrates that agnogenic practices are used to construct utopian narratives that claim that gambling industry-favoured youth education programmes are evidence-based and evaluation-led. These practices misrepresent the literature and evaluation findings and may undermine effective policymaking to protect children and young people from gambling harms.

Key messages

• Gambling industry-funded education programmes warrant greater scrutiny and conflicts of interest need to be addressed.

• The methods and findings of this study are of relevance to other contexts and areas in the field of the commercial determinants of health given other harmful industries adopt similar approaches.

Descriptive Analysis of Forces Applied by Trained Clinicians During Two-Handed Instrument-Assisted Soft Tissue Mobilization

Instrument-assisted soft tissue mobilization (IASTM) is a common intervention among clinicians. Despite the popularity, little is known about the forces applied by the clinician with the instruments during treatment. The purpose of this investigation was to examine the forces applied by trained clinicians using IASTM instruments during a simulated treatment. Eleven IASTM trained (Graston Technique, Técnica Gavilán, or RockBlades) clinicians (Physical Therapist = 2, Chiropractor = 2, Athletic Trainer = 7) participated in the study. Each clinician performed 75 two-handed strokes distributed evenly across five different IASTM instruments on a skin simulant attached to a force plate. IASTM stroke application was analyzed for peak normal forces (Fpeak) and mean normal forces (Fmean) by stroke. We observed an average Fpeak of 8.9N and Fmean of 6.0N across all clinicians and instruments. Clinicians and researchers may use the descriptive values as a reference for application of IASTM in practice and research.

The politics of ageing: how to get policymakers to support lifecourse policies

Background

Given that there is not much evidence that ageing imperils the finance and provision of health care, why do so many policymakers act like it does?

Methods

We break conventional wisdom down into myths and realities, identifying the evidence against them.

Results

A first myth is that ageing produces unsustainable health care costs, which in turn, creates intergenerational conflict over public policy. A second myth is that older people behave as a single group, always pursuing policies that benefit themselves. The final myth is that decisions about policy are made by politicians who pander to that elderly block. The first reality is that most of the problems ascribed to inequality between generations (intergenerational equity) are actually problems of inequality within society as a whole that span across age groups (intragenerational equity). The second reality is that policies that address these broader inequalities are built on the life-course perspective, which focuses on identifying the policies which can make people happier and healthier at all ages by drawing on the context and circumstances under which aging occurs. The third reality is that it is possible to construct coalitions of politicians and interests that can develop and support sophisticated life-course policies that lessen the burdens of ageing and health on everybody.

Conclusions

Intergenerational inequality is not, and need not be, a significant problem for rich countries. It is substantially a product of current and past intragenerational inequality, and in fact inequality between generations often goes with inequality within generations. Intergenerational conflict is a distraction from policies that promote greater equality within and between generations, and talk of an ageing crisis is frequently just another version of longstanding arguments against public social investment from cradle to grave.

How democracy alters our view of inequality and what this means for wellbeing

 

Income inequality is associated with poor health when economic disparities are especially salient. However, political institutions may alter this relationship because democracies (as opposed to autocracies) may be more inclined to frame inequalities in negative rather than positive ways. Living in a particular political system potentially alters the messages individuals receive about whether inequality is large or small, good or bad, and this, in turn, might affect whether beliefs about inequality influence health. Further, media coverage of economic inequality may negatively affect health if it contributes toward the general perception that the gap between rich and poor has gone up, even if there has been no change in income differentials. In this study, we explore the relationship between democracy, perceptions of inequality, and self-rated health across 28 post-communist countries using survey and macro-level data, multilevel regression models, and inverse probability weighting to estimate the average treatment effect on the treated. We find that self-rated health is higher in more democratic countries and lower among people who believe that inequality has risen in the last few years. Moreover, we observe that people in democracies are more likely to learn about rising inequality through watching television and that when they do it has a more harmful effect on their health than when people in autocracies learn about rising inequality through the same channel, suggesting that in countries where there is less trust in the television media learning about rising inequality is not as harmful for health. Our results indicate that while democracies are generally good for well-being, they may not be unambiguously positive for health. This does not mean, of course, that inequality is good for health nor that, on average, autocracies have better health than democracies; but rather that being more aware of inequality can negatively affect wellbeing

Key messages

While democracies are generally good for well-being, they may not be unambiguously positive for health. Being more aware of inequality can negatively affect wellbeing.

Is outsourcing healthcare to private providers associated with higher mortality rates in NHS England?

Background

Outsourcing services to for-profit organisations within a publicly funded healthcare service which runs parallel to private provision in a ‘two-tier' system aims to increase the competition between healthcare providers, driving up their performance. However, some worry that contracting out health services to for-profit providers may lead to cost-cutting and poorer outcomes for patients. We aim to assess whether increased outsourcing to the private sector is associated with changes to treatable mortality rates, and, therefore, with the quality of healthcare.

Methods

We construct a novel database compiling every procurement contract over 7 years (n = 646,938, total value = £204.1bn) across England's Clinical Commissioning Groups (regional health boards). We identify institutions registered on the Companies House registry which supply regional commissioners in England's NHS, and then aggregate this annually with local mortality data. By exploiting the commissioners' variation in spend on private sector providers, we estimate the association between outsourcing and treatable mortality rates in the following year. We account for year and individual fixed effects and control for multiple covariates, including average household income, Local Authority spending, and population size.

Results

Our sample comprised 173 Clinical Commissioning Groups between 2013 and 2020. In general, outsourcing increased over this period, but the extent of change varied substantially. Some areas, like East Riding of Yorkshire, saw very large increases but others saw reductions. We find an annual increase of one percentage point of outsourcing to the private sector corresponds with an annual increase in treatable mortality of 0.34% (95% CI 0·10% to 0·58%) in the following year.

Conclusions

The incorporation of private sector providers into England's NHS appears to be corresponding with a decline in the quality of healthcare services.

Key messages

The private provision of healthcare services has generally increased across England's NHS since 2013. Increased outsourcing of services to private sector providers is associated with increased treatable mortality rates.

Management and biosecurity practices by small to medium egg producers in Scotland

1. Information about procedures and biosecurity practices used by small and medium egg producers (SMEPs) is scarce. Anecdotal evidence suggests that biosecurity in such enterprises may be poor, as personnel and equipment move freely between sites and this may be compounded by personnel working on commercial units who keep their own poultry.2. To fill this knowledge gap, a questionnaire was designed and implemented targeting SMEPs in Scotland. Small enterprises were defined as egg producers that have ≥50 laying hens but <350 laying hens; while medium enterprises were defined as egg producers that have ≥350 laying hens but ≤32 000 laying hens. The questionnaire consisted of a total of 56 questions divided into multiple sections, covering the characteristics of the primary keeper, location of the enterprise and size of the flocks, husbandry, marketing of products and health/biosecurity.3. The questionnaire was posted to 375 holdings at the beginning of March 2017 and the survey remained open until the end of May 2017. In total 90 questionnaires were received by the cut-off date of which 76 questionnaires were from SMEPs. Forty were small enterprises and 36 were medium enterprises. For three questionnaires, it was not possible to identify the enterprise type.4. Differences were observed between SMEPs in terms of reported biosecurity and management practices, with medium enterprises reporting the adoption of more biosecurity measures than small enterprises. Furthermore, SMEPs behave differently from backyard poultry keepers and large commercial companies in terms of disease risk.5. In conclusion, it is important to ensure that SMEPs are considered in contingency plans and disease control programmes and that engagement with them is promoted so that the uptake of relevant information, such as awareness of disease control programmes, is optimised.

Abstract P6-08-39: Hereditary cancer risk assessment using a chatbot in women presenting to obstetrics and gynecology practices across the U.S

Background: Hereditary cancer risk assessment is standard of care in the obstetrics and gynecology (ob/gyn) practice. Historical data indicates 1 in 12 individuals have a family history consistent with hereditary cancer(1), however recent data from a small community practice found that 1 in 4 women met National Comprehensive Cancer Network (NCCN) criteria for genetic testing(2). The aim of this study was to assess the number of women who meet NCCN criteria for genetic testing in a diverse population across the United States (US) by using a computer program that conducts conversations with patients (a.k.a. chatbot) for risk assessment(3).

Method: We partnered with Clear Genetics Inc. (San Francisco, CA) to use a HIPAA compliant chatbot for collecting personal and family history of cancer from women in 28 ob/gyn practices across the US. Patients received a text message or email asking them to complete the chatbot five days before their scheduled appointment. Reminders were sent at three days and again one day prior if not completed. After history collection was complete, an algorithm determined if the patient had a known familial variant or met NCCN guidelines for hereditary cancer testing, including BRCA-Related Breast and/or Ovarian Cancer, Lynch, and Polyposis syndromes(3). Incomplete chats, minors under age 18 or those who declined to provide information were excluded. Additionally, some ob/gyn practices elected to exclude pregnant patients.

Results: Over 15,000 chatbots were sent to patients. Overall, 65% of patients completed the chatbot and 26% of these patients met NCCN criteria or had a known familial variant(3). 14.5% of completed assessments were excluded (1.2% declined, 1.4% minors and 11.9% pregnant patients). Some patients received the chatbot less than five days before their appointment due to administrative delays at the ob/gyn practice, and 15% of intended recipients did not receive the chatbot due to incorrect contact information. Patients reviewed their experience with an average rating of 4.6 out of 5.

Conclusions: A novel chatbot tool was used to collect pertinent cancer history and provide NCCN criteria assessment to identify patients for inherited cancer risk. This study population was nearly four times the size of the most recent study identifying 1 in 4 women met NCCN criteria for genetic testing. In addition, this study was more diverse - examining multiple ob/gyn practices across the US compared to a single community practice. Results of this study were consistent with newly reported data indicating 1 in 4 patients meet NCCN criteria for hereditary cancer testing. There is a need for increased education and tools to help ob/gyn practices identify these patients consistent with ACOG Practice Guideline 634(4), in light of a higher number of patients who need genetic testing.

References:

1. Scheuner MT, McNeel TS, Freeman AN. Population prevalence of familial cancer and common hereditary cancer syndromes. The 2005 California Health Interview Survey. Genet Med. 2010;12(11):726-35)

2. DeFrancesco MS, Walman RN, Pearlstone M, Karanik D, Bernhisel R, Logan J, Alico LA, Adkins RT. Hereditary Cancer Risk Assessment and Genteic Testing in the Community-Practice Setting. Cancer: Clinical Practice and Quality 2018;132(5):1121-1129.

3. National Comprehensive Cancer Network. Genetic/Familial High-Risk Assessment: Breast and Ovarian (Version 2.2019) and Colorectal (Version 1.2018). Available from: Http://www.nccn.org/.

4. ACOG Committee Opinion No. 634. Hereditary cancer syndromes and risk assessment. Obstet Gynecol 2015: 125:1538-43.

Citation Format: Lindsay Dohany, Heidi Owen, Ashley Reeves, Christina Settler. Hereditary cancer risk assessment using a chatbot in women presenting to obstetrics and gynecology practices across the U.S. [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 P6-08-39.

The real inequalities

Background

The ‘greedy geezer’ and ‘poor elderly’ narratives both assume that the older population are homogeneous and that the experiences of older people are universal. This ignores the fact that there are significant health inequalities (i) amongst the older population and (ii) in terms of who gets to be ‘old’ (and for how long). Further, the focus on intergenerational inequality is a deliberate distraction from the far more significant health inequalities that exist in terms of gender, geography, ethnicity, socio-economic status etc across the whole population - regardless of age.

Methods

Health inequalities amongst the older population and inequalities in terms of who gets to be ‘old’ will be examined through health inequalities across the population by gender, geography, ethnicity, socio-economic status etc.

Results

Given, for example, that total intergenerational transfers incorporating private transfers are from the older to the younger, it is quite possible that if we reduce public intergenerational transfers (working age to older) then all we are doing is increasing inherited inequality.

Conclusions

Policy focused on ‘intergenerational equity’ and ‘intergenerational accounting’ will often exacerbate inequalities within generations, to the benefit of the wealthiest and the detriment of much of the population. Win-win solutions only emerge if there is a focus on addressing the many and more profound health inequalities that cross-cut generations.

Outcomes of retesting BRCA negative patients using multigene panels

The utility of multigene panels in retesting patients who previously tested negative for a pathogenic mutation by BRCA1/2 testing is not well established. Patients who previously tested negative for a pathogenic BRCA1/2 mutation by standard sequencing, and who were seen in cancer genetics center between November 1, 2012 and June 30, 2015 for additional testing utilizing multigene panels, were identified using our genetic testing registry. Data on demographics, personal and family history of cancer, results of panel testing and the impact on patient management was collected retrospectively. A total of 122 patients underwent retesting during the study period. Thirteen (11%) pathogenic mutations were identified in the following genes: CHEK2(4), PALB2(3), ATM(2), CDH1, APC, BARD1 and MRE11A. Eleven out of these thirteen mutations were deemed actionable based on published guidelines. Of these eleven, seven patients had an actual change in clinical management as a result of retesting. Furthermore, retesting also led to a change in clinical management in the two patients with mutations in genes (BARD1 and MRE11A) which do not have clear guidelines for management. There were no significant differences in demographics and personal and family history of cancer between patients who tested positive and those who tested negative on retesting. This study demonstrates the clinical utility of multigene panels in a group of high risk individuals who previously tested negative for a BRCA1/2 mutation. This retesting approach revealed a pathogenic mutation in 11% of cases. Retesting led to significant change in clinical management in a majority of patients with actionable mutations (7 out of 11), as well as in those with mutations in genes which do not have specific management guidelines.

Preoperative genetic testing impacts surgical decision making in BRCA mutation carriers with breast cancer: a retrospective cohort analysis

Background

The impact of timing of genetic testing on surgical decision making in women with breast cancer and BRCA mutation is not well known.

Methods

Women who were found to carry a deleterious BRCA mutation and had been diagnosed with breast cancer were identified from a database at Beaumont Health. Women who had received BRCA positive results at least a day prior to their index surgery were considered to be aware of their mutation status prior to surgery. Baseline characteristics and surgical choices were compared between women who were aware of their mutation status prior to surgery and those who were not. Fischer’s exact test was used for categorical variables and Mann–Whitney U-Test was used for continuous variables.

Results

A total of 220 patients were included in the final analysis, 208 (94.5%) with unilateral breast cancer and 12 (5.5%) with bilateral breast cancer. Out of the 208 patients with unilateral breast cancer, 106 (51.0%) patients were aware of their mutation status prior to index surgery while 102 (49%) were not. A significantly (p < 0.05) higher proportion of women underwent contralateral prophylactic mastectomy in the group that was aware of their mutation status prior to index surgery compared to the group that was not (76.4% vs 14.7%).

Conclusions

Our study demonstrates that knowledge of BRCA mutation status impacts surgical decision making in favor of bilateral mastectomy in patients who are aware of their results prior to index surgery. This finding supports the practice of preoperative genetic testing in patients with newly diagnosed breast cancer.

Gender violence, poverty and HIV infection risk among persons engaged in the sex industry: cross-national analysis of the political economy of sex markets in 30 European and Central Asian countries

Objectives

Persons engaged in the sex industry are at greater risk of HIV and other sexually transmitted infections than the general population. One major factor is exposure to higher levels of risky sexual activity. Expanding condom use is a critical prevention strategy, but this requires negotiation with those buying sex, which takes place in the context of cultural and economic constraints. Impoverished individuals who fear violence are more likely to forego condoms.

Methods

Here we tested the hypotheses that poverty and fear of violence are two structural drivers of HIV infection risk in the sex industry. Using data from the European Centre for Disease Prevention and Control and the World Bank for 30 countries, we evaluated poverty, measured using the average income per day per person in the bottom 40% of the income distribution, and gender violence, measured using homicide rates in women and the proportion of women exposed to violence in the last 12 months and/or since age 16 years.

Results

We found that HIV prevalence among those in the sex industry was higher in countries where there were greater female homicide rates (β = 0.86; P = 0.018) and there was some evidence that self‐reported exposure to violence was also associated with higher HIV prevalence (β = 1.37; P = 0.043). Conversely, HIV prevalence was lower in countries where average incomes among the poorest were greater (β = −1.05; P = 0.046).

Conclusions

Our results are consistent with the theory that reducing poverty and exposure to violence may help reduce HIV infection risk among persons engaged in the sex industry.

Fit-for-work or fit-for-unemployment? Does the reassessment of disability benefit claimants using a tougher work capability assessment help people into work?

BACKGROUND

Many governments have introduced tougher eligibility assessments for out-of-work disability benefits, to reduce rising benefit caseloads. The UK government initiated a programme in 2010 to reassess all existing disability benefit claimants using a new functional checklist. We investigated whether this policy led to more people out-of-work with long-standing health problems entering employment.

METHOD

We use longitudinal data from the Labour Force Survey linked to data indicating the proportion of the population experiencing a reassessment in each of 149 upper tier local authorities in England between 2010 and 2013. Regression models were used to investigate whether the proportion of the population undergoing reassessment in each area was independently associated with the chances that people out-of-work with a long-standing health problem entered employment and transitions between inactivity and unemployment. We analysed whether any effects differed between people whose main health problem was mental rather than physical.

RESULTS

There was no significant association between the reassessment process and the chances that people out-of-work with a long-standing illness entered employment. The process was significantly associated with an increase in the chances that people with mental illnesses moved from inactivity into unemployment (HR=1.22, 95% CI 1.03 to 1.45).

CONCLUSIONS

The reassessment policy appears to have shifted people with mental health problems from inactivity into unemployment, but there was no evidence that it had increased their chances of employment. There is an urgent need for services that can support the increasing number of people with mental health problems on unemployment benefits.

Abstract P2-09-06: Multi-gene panel testing for hereditary cancer risk

Background: Multi-gene panels are widely available for assessing hereditary cancer risk in high risk individuals. Due to the use of these panels, many genetic mutations other than BRCA 1 or 2 can be detected which can potentially affect management. This study presents the results of multi-gene panel testing performed at Beaumont Health System.

Methods:All patients who underwent multi-gene panel testing at Beaumont Health System between November 1, 2012 and January 15, 2015 were included in this study. This cohort consisted of patients who met criteria for genetic testing due to personal or family history. All patients received comprehensive pre and post-test genetic counseling. The panels ranged from 5 to 43 genes associated with risk for breast and other cancers.

Results: 653 multi-gene panel tests were performed. The majority of these consisted of either a 5 gene high risk breast panel (25%), an 18 gene moderate to high risk breast panel (21%), or a 9 gene high risk breast and gynecologic panel (17%). 184 variants of undetermined significance (VUS) were identified with a pooled VUS rate of 28%. Among the commonly used panels, there was a positive correlation between VUS rate and the number of genes included in the panel (r = 0.86, p = 0.01, Range 6% to 70%). A pathogenic mutation was identified in one or more genes in 65 (10%) panels for a total of 67 mutations. Of these, 17 mutations were in BRCA1 or BRCA2 gene. Fifty non-BRCA deleterious mutations were identified with the following frequencies: CHEK2(12), MUTYH(7 monoallelic, 1 biallelic), TP53(4), PTEN(4), ATM(4), MSH6(3), PALB2(3), MSH2(2), CDH1(2), APC(2), NF1(2), BARD1(2), MLH1(1) and PMS2(1). Of these non-BRCA mutations, 41(82%) had a significant impact on management.

Conclusions: Our study demonstrates that multi-gene panel testing identifies several genes that can impact management and would likely not have been discovered by pedigree analysis alone. However, this added detection is associated with a higher VUS rate, especially using larger panels. Further research is needed to better define the role of multi-gene panel testing in high risk patients, with a focus on choosing appropriate genes, understanding the magnitude of cancer risk and delineating impact on management.

Citation Format: Yadav S, Ladkany R, Fulbright J, Dreyfuss H, Reeves A, Campian S, Thomas V, Zakalik D. Multi-gene panel testing for hereditary cancer risk. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-06.

'First, do no harm': are disability assessments associated with adverse trends in mental health? A longitudinal ecological study

Background

In England between 2010 and 2013, just over one million recipients of the main out-of-work disability benefit had their eligibility reassessed using a new functional checklist—the Work Capability Assessment. Doctors and disability rights organisations have raised concerns that this has had an adverse effect on the mental health of claimants, but there are no population level studies exploring the health effects of this or similar policies.

Method

We used multivariable regression to investigate whether variation in the trend in reassessments in each of 149 local authorities in England was associated with differences in local trends in suicides, self-reported mental health problems and antidepressant prescribing rates, while adjusting for baseline conditions and trends in other factors known to influence mental ill-health.

Results

Each additional 10 000 people reassessed in each area was associated with an additional 6 suicides (95% CI 2 to 9), 2700 cases of reported mental health problems (95% CI 548 to 4840), and the prescribing of an additional 7020 antidepressant items (95% CI 3930 to 10100). The reassessment process was associated with the greatest increases in these adverse mental health outcomes in the most deprived areas of the country, widening health inequalities.

Conclusions

The programme of reassessing people on disability benefits using the Work Capability Assessment was independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing. This policy may have had serious adverse consequences for mental health in England, which could outweigh any benefits that arise from moving people off disability benefits.

Outcomes of retesting BRCA-negative patients using multigene panels

23

Background: New technologies for identifying hereditary predisposition to breast cancer have led to the discovery of novel genes associated with cancer risk. This has prompted re-evaluation of patients who previously tested negative for BRCA1/2 gene mutations, with a possibility of discovering new genes which may impact management. This study reports on the results of retesting patients who previously were negative for BRCA1/2. Methods: Patients who tested negative for BRCA1/2 mutations who had significant personal and family history were referred back to the Cancer Genetics Center between February 1, 2012 and May 30, 2105 for discussion of additional testing. A detailed personal and family history was reviewed, and patients were counseled about the genetics and clinical implications of panel testing for multiple breast cancer genes. Panel testing using next generation sequencing technologies was ordered. Patients were seen in follow up for discussion of results and management. Results: A total of 12 pathogenic mutations were identified during the study period. The genes and frequencies of these mutations were: CHEK2(3), PALB2(3), ATM(2), APC(1), BARD(1), CDH(1), MUTYH(1). There were 33 variants of undetermined significance(VUS) in 27 patients. 5 of these were seen in patients with a known pathogenic mutation; 3 others were later classified as benign. The frequencies of these VUSs were: ATM (9), PALB2(3), BARD1 (3), PTEN(3), PMS2(3), MSH6(2), CHEK2 (1), MYH(1), RAD51(1), BRIP1(2), NF1(1), BMPR1A(1). Of the 46 patients who had their initial BRCA testing and repeat panel testing between February 1, 2012 and May 30, 2015, 6 (13%) tested positive for a pathogenic mutation. Conclusions: This study demonstrates the feasibility and potential clinical benefit of retesting individuals who previously tested negative for BRCA1/2 mutation. This approach had a significant management impact on patients and their families, with a 13% detection rate of pathogenic mutations. The success of retesting is predicated upon an infrastructure of provider and patient education, pre and post genetic counseling and serves as a model for other centers.

Abstract 2760: Impact of race and age on choice of surgery in newly diagnosed breast cancer patients who tested negative for BRCA 1/2 mutation

Introduction:

The benefit of bilateral mastectomies in breast cancer patients who test negative for a deleterious BRCA mutation has not been proven. In spite of this, a significant number of women with unilateral breast cancer who test negative for BRCA mutation choose bilateral mastectomies. We aimed to evaluate the role of age and race in such decision making.

Methodology:

Records of 323 patients referred to Cancer Genetics between January 01,2012 and June 30,2014 for pre-operative genetic evaluation were analyzed. This cohort consisted of patients with newly diagnosed breast cancer who met genetic testing criteria. Patients were excluded if their surgical records were not available, they declined genetic testing, they underwent surgery prior to their test results being available or they were positive for BRCA mutation. A total of 148 patients met our inclusion criteria and were evaluated for final analysis. Statistical analysis was performed using SPSS21.

Results:

Of the 148 women with breast cancer who tested negative for a deleterious BRCA mutation, 116(78%) were Caucasian, 9(6%) were African-American, 5(3%) were Asian, 4(3%) were Arab, 3(2%) were Indian, 2(2%) were American-Indian and 1(1%) was Hispanic. The race or ethnicity could not be identified in 8(5%) patients.

A total of 47(32%) patients ultimately underwent bilateral mastectomies in this cohort. Of these, 40(27%) underwent bilateral mastectomies as their initial surgery while 7(5%) underwent bilateral mastectomies eventually after undergoing partial mastectomy or simple mastectomy initially.

There was no statistically significant difference between the mean ages of the group that underwent bilateral mastectomy (48.9 yrs) and the group that underwent partial or simple mastectomy (49.1 yrs).

All of the 8 patients with an unknown ethnicity underwent bilateral mastectomy. The rest of the mastectomies (39) were performed in Caucasian patients. None of the non-Caucasian patients underwent bilateral mastectomy. This difference was statistically significant (p&lt;0.001).

Conclusion:

Our study demonstrates that a significant proportion(32%) of BRCA negative women with breast cancer undergo bilateral mastectomies. Furthermore, Caucasian patients with BRCA negative breast cancer are more likely to choose bilateral mastectomies than non-Caucasians. However, this result has to be interpreted with caution as our sample size of non-Caucasians was small(24). Considering our catchment population, this small sample brings concerns that a significant proportion of non-Caucasian patients may not be undergoing genetic testing despite meeting criteria. We did not find a significant impact of age on choice of surgery in BRCA negative women with breast cancer. Further studies with larger sample size are needed to better understand the role of race and age in access to genetic testing and surgical decision making.

Citation Format: Siddhartha Yadav, Heidi Dreyfuss, Jennifer Fulbright, Ashley Reeves, Sarah Campian, Dana Zakalik. Impact of race and age on choice of surgery in newly diagnosed breast cancer patients who tested negative for BRCA 1/2 mutation. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2760. doi:10.1158/1538-7445.AM2015-2760

Comparison of Informed Consent Preferences for Multiplex Genetic Carrier Screening among a Diverse Population

Multiplex genetic carrier screening is increasingly being integrated into reproductive care. Obtaining informed consent becomes more challenging as the number of screened conditions increases. Implementing a model of generic informed consent may facilitate informed decision-making. Current Wayne State University students and staff were invited to complete a web-based survey by blast email solicitation. Participants were asked to determine which of two generic informed consent scenarios they preferred: a brief versus a detailed consent. They were asked to rank the importance of different informational components in making an informed decision and to provide demographic information. Comparisons between informational preferences, demographic variables and scenario preferences were made. Six hundred ninety three participants completed the survey. When evaluating these generic consents, the majority preferred the more detailed consent (74.5%), and agreed that it provided enough information to make an informed decision (89.5%). Those who thought it would be more important to know the severity of the conditions being screened (p = .002) and range of symptoms (p = .000) were more likely to prefer the more detailed consent. There were no significant associations between scenario preferences and demographic variables. A generic consent was perceived to provide sufficient information for informed decision making regarding multiplex carrier screening with most preferring a more detailed version of the consent. Individual attitudes rather than demographic variables influenced preferences regarding the amount of information that should be included in the generic consent. The findings have implications for how clinicians approach providing tailored informed consent.