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Mahamat‐Saleh Y, Rinaldi S, Kaaks R, Biessy C, Gonzalez‐Gil EM, Murphy N, Le Cornet C, Huerta JM, Sieri S, Tjønneland A, Mellemkjær L, Guevara M, Overvad K, Perez‐Cornago A, Tin Tin S, Padroni L, Simeon V, Masala G, May A, Monninkhof E, Christakoudi S, Heath AK, Tsilidis K, Agudo A, Schulze MB, Rothwell J, Cadeau C, Severi S, Weiderpass E, Gunter MJ, Dossus L. Metabolically defined body size and body shape phenotypes and risk of postmenopausal breast cancer in the European Prospective Investigation into Cancer and Nutrition. Cancer Med 2023; 12:12668-12682. [PMID: 37096432 PMCID: PMC10278526 DOI: 10.1002/cam4.5896] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Excess body fatness and hyperinsulinemia are both associated with an increased risk of postmenopausal breast cancer. However, whether women with high body fatness but normal insulin levels or those with normal body fatness and high levels of insulin are at elevated risk of breast cancer is not known. We investigated the associations of metabolically defined body size and shape phenotypes with the risk of postmenopausal breast cancer in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition. METHODS Concentrations of C-peptide-a marker for insulin secretion-were measured at inclusion prior to cancer diagnosis in serum from 610 incident postmenopausal breast cancer cases and 1130 matched controls. C-peptide concentrations among the control participants were used to define metabolically healthy (MH; in first tertile) and metabolically unhealthy (MU; >1st tertile) status. We created four metabolic health/body size phenotype categories by combining the metabolic health definitions with normal weight (NW; BMI < 25 kg/m2 , or WC < 80 cm, or WHR < 0.8) and overweight or obese (OW/OB; BMI ≥ 25 kg/m2 , or WC ≥ 80 cm, or WHR ≥ 0.8) status for each of the three anthropometric measures separately: (1) MHNW, (2) MHOW/OB, (3) MUNW, and (4) MUOW/OB. Conditional logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Women classified as MUOW/OB were at higher risk of postmenopausal breast cancer compared to MHNW women considering BMI (OR = 1.58, 95% CI = 1.14-2.19) and WC (OR = 1.51, 95% CI = 1.09-2.08) cut points and there was also a suggestive increased risk for the WHR (OR = 1.29, 95% CI = 0.94-1.77) definition. Conversely, women with the MHOW/OB and MUNW were not at statistically significant elevated risk of postmenopausal breast cancer risk compared to MHNW women. CONCLUSION These findings suggest that being overweight or obese and metabolically unhealthy raises risk of postmenopausal breast cancer while overweight or obese women with normal insulin levels are not at higher risk. Additional research should consider the combined utility of anthropometric measures with metabolic parameters in predicting breast cancer risk.
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Affiliation(s)
| | - S. Rinaldi
- International Agency for Research on CancerLyonFrance
| | - R. Kaaks
- Division of Cancer EpidemiologyGerman Cancer Research Center (DFKZ)HeidelbergGermany
| | - C. Biessy
- International Agency for Research on CancerLyonFrance
| | | | - N. Murphy
- International Agency for Research on CancerLyonFrance
| | - C. Le Cornet
- Division of Cancer EpidemiologyGerman Cancer Research Center (DFKZ)HeidelbergGermany
| | - J. M. Huerta
- Department of EpidemiologyMurcia Regional Health CouncilMurciaSpain
- CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain
| | - S. Sieri
- Epidemiology and Prevention UnitFondazione IRCCS Istituto Nazionale dei Tumori20133MilanItaly
| | - A. Tjønneland
- Danish Cancer Society Research CenterCopenhagenDenmark
- Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - L. Mellemkjær
- Danish Cancer Society Research CenterCopenhagenDenmark
| | - M. Guevara
- Navarra Public Health Institute31003PamplonaSpain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)28029MadridSpain
- Navarra Institute for Health Research (IdiSNA)31008PamplonaSpain
| | - K. Overvad
- Department of Public Health, Section for EpidemiologyAarhus UniversityAarhusDenmark
| | - A. Perez‐Cornago
- Cancer Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - S. Tin Tin
- Cancer Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - L. Padroni
- Department of Clinical and Biological SciencesUniversity of TurinTurinItaly
| | - V. Simeon
- Dipartimento di Salute Mentale e Fisica e Medicina PreventivaUniversità degli Studi della Campania 'Luigi Vanvitelli'80121NaplesItaly
| | - G. Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO)FlorenceItaly
| | - A. May
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - E. Monninkhof
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - S. Christakoudi
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Inflammation BiologySchool of Immunology and Microbial SciencesKing's College LondonLondonUK
| | - A. K. Heath
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - A. Agudo
- Unit of Nutrition and CancerCatalan Institute of Oncology – ICOL'Hospitalet de LlobregatSpain
- Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care ProgramBellvitge Biomedical Research Institute – IDIBELLL'Hospitalet de LlobregatSpain
| | - M. B. Schulze
- Department of Molecular EpidemiologyGerman Institute of Human Nutrition Potsdam‐RehbrueckeNuthetalGermany
- Institute of Nutritional ScienceUniversity of PotsdamNuthetalGermany
| | - J. Rothwell
- Paris‐Saclay UniversityUVSQ, Inserm, Gustave Roussy, “Exposome and Heredity” team, CESPVillejuifFrance
| | - C. Cadeau
- Paris‐Saclay UniversityUVSQ, Inserm, Gustave Roussy, “Exposome and Heredity” team, CESPVillejuifFrance
| | - S. Severi
- Paris‐Saclay UniversityUVSQ, Inserm, Gustave Roussy, “Exposome and Heredity” team, CESPVillejuifFrance
| | - E. Weiderpass
- International Agency for Research on CancerLyonFrance
| | - M. J. Gunter
- International Agency for Research on CancerLyonFrance
| | - L. Dossus
- International Agency for Research on CancerLyonFrance
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Colvin E, Ng S, Hepworth J, Hepworth J, Hartley T, Godfrey N, Tricker K, Rothwell J, Beaman G, Woodward ER. Hereditary renal cancer patient and public involvement group: A collaborative, consensus decision process to develop a communication tool for patient use. J Clin Transl Sci 2023; 7:e115. [PMID: 37250990 PMCID: PMC10225253 DOI: 10.1017/cts.2023.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/29/2023] Open
Abstract
Patient and public involvement (PPI) must be more frequently embedded within clinical research to ensure translational outcomes are patient-led and meet patient needs. Active partnerships with patients and public groups are an important opportunity to hear patient voices, understand patient needs, and inform future research avenues. A hereditary renal cancer (HRC) PPI group was developed with the efforts of patient participants (n = 9), pooled from recruits within the early detection for HRC pilot study, working in collaboration with researchers and healthcare professionals (n = 8). Patient participants had HRC conditions including Von Hippel-Lindau (n = 3) and Hereditary Leiomyomatosis and Renal Cell Carcinoma (n = 5), and public participants included two patient Trustees (n = 2) from VHL UK & Ireland Charity. Discussions among the enthusiastic participants guided the development of a novel patient information sheet for HRC patients. This communication tool was designed to aid patients when informing family members about their diagnoses and the wider implications for relatives, a gap identified by participants within group discussions. While this partnership was tailored for a specific HRC patient and public group, the process implemented can be employed for other hereditary cancer groups and could be transferable within other healthcare settings.
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Affiliation(s)
- Ellen Colvin
- Manchester Centre for Genomic Medicine, St. Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stephanie Ng
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | | | - Thomas Hartley
- Research & Innovation, Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Nicola Godfrey
- Research & Innovation, Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Karen Tricker
- Research & Innovation, Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jeanette Rothwell
- Research & Innovation, Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Glenda Beaman
- Manchester Centre for Genomic Medicine, St. Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Emma R. Woodward
- Manchester Centre for Genomic Medicine, St. Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Bancroft EK, Page EC, Brook MN, Thomas S, Taylor N, Pope J, McHugh J, Jones AB, Karlsson Q, Merson S, Ong KR, Hoffman J, Huber C, Maehle L, Grindedal EM, Stormorken A, Evans DG, Rothwell J, Lalloo F, Brady AF, Bartlett M, Snape K, Hanson H, James P, McKinley J, Mascarenhas L, Syngal S, Ukaegbu C, Side L, Thomas T, Barwell J, Teixeira MR, Izatt L, Suri M, Macrae FA, Poplawski N, Chen-Shtoyerman R, Ahmed M, Musgrave H, Nicolai N, Greenhalgh L, Brewer C, Pachter N, Spigelman AD, Azzabi A, Helfand BT, Halliday D, Buys S, Ramon Y Cajal T, Donaldson A, Cooney KA, Harris M, McGrath J, Davidson R, Taylor A, Cooke P, Myhill K, Hogben M, Aaronson NK, Ardern-Jones A, Bangma CH, Castro E, Dearnaley D, Dias A, Dudderidge T, Eccles DM, Green K, Eyfjord J, Falconer A, Foster CS, Gronberg H, Hamdy FC, Johannsson O, Khoo V, Lilja H, Lindeman GJ, Lubinski J, Axcrona K, Mikropoulos C, Mitra AV, Moynihan C, Ni Raghallaigh H, Rennert G, Collier R, Offman J, Kote-Jarai Z, Eeles RA. A prospective prostate cancer screening programme for men with pathogenic variants in mismatch repair genes (IMPACT): initial results from an international prospective study. Lancet Oncol 2021; 22:1618-1631. [PMID: 34678156 PMCID: PMC8576477 DOI: 10.1016/s1470-2045(21)00522-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lynch syndrome is a rare familial cancer syndrome caused by pathogenic variants in the mismatch repair genes MLH1, MSH2, MSH6, or PMS2, that cause predisposition to various cancers, predominantly colorectal and endometrial cancer. Data are emerging that pathogenic variants in mismatch repair genes increase the risk of early-onset aggressive prostate cancer. The IMPACT study is prospectively assessing prostate-specific antigen (PSA) screening in men with germline mismatch repair pathogenic variants. Here, we report the usefulness of PSA screening, prostate cancer incidence, and tumour characteristics after the first screening round in men with and without these germline pathogenic variants. METHODS The IMPACT study is an international, prospective study. Men aged 40-69 years without a previous prostate cancer diagnosis and with a known germline pathogenic variant in the MLH1, MSH2, or MSH6 gene, and age-matched male controls who tested negative for a familial pathogenic variant in these genes were recruited from 34 genetic and urology clinics in eight countries, and underwent a baseline PSA screening. Men who had a PSA level higher than 3·0 ng/mL were offered a transrectal, ultrasound-guided, prostate biopsy and a histopathological analysis was done. All participants are undergoing a minimum of 5 years' annual screening. The primary endpoint was to determine the incidence, stage, and pathology of screening-detected prostate cancer in carriers of pathogenic variants compared with non-carrier controls. We used Fisher's exact test to compare the number of cases, cancer incidence, and positive predictive values of the PSA cutoff and biopsy between carriers and non-carriers and the differences between disease types (ie, cancer vs no cancer, clinically significant cancer vs no cancer). We assessed screening outcomes and tumour characteristics by pathogenic variant status. Here we present results from the first round of PSA screening in the IMPACT study. This study is registered with ClinicalTrials.gov, NCT00261456, and is now closed to accrual. FINDINGS Between Sept 28, 2012, and March 1, 2020, 828 men were recruited (644 carriers of mismatch repair pathogenic variants [204 carriers of MLH1, 305 carriers of MSH2, and 135 carriers of MSH6] and 184 non-carrier controls [65 non-carriers of MLH1, 76 non-carriers of MSH2, and 43 non-carriers of MSH6]), and in order to boost the sample size for the non-carrier control groups, we randomly selected 134 non-carriers from the BRCA1 and BRCA2 cohort of the IMPACT study, who were included in all three non-carrier cohorts. Men were predominantly of European ancestry (899 [93%] of 953 with available data), with a mean age of 52·8 years (SD 8·3). Within the first screening round, 56 (6%) men had a PSA concentration of more than 3·0 ng/mL and 35 (4%) biopsies were done. The overall incidence of prostate cancer was 1·9% (18 of 962; 95% CI 1·1-2·9). The incidence among MSH2 carriers was 4·3% (13 of 305; 95% CI 2·3-7·2), MSH2 non-carrier controls was 0·5% (one of 210; 0·0-2·6), MSH6 carriers was 3·0% (four of 135; 0·8-7·4), and none were detected among the MLH1 carriers, MLH1 non-carrier controls, and MSH6 non-carrier controls. Prostate cancer incidence, using a PSA threshold of higher than 3·0 ng/mL, was higher in MSH2 carriers than in MSH2 non-carrier controls (4·3% vs 0·5%; p=0·011) and MSH6 carriers than MSH6 non-carrier controls (3·0% vs 0%; p=0·034). The overall positive predictive value of biopsy using a PSA threshold of 3·0 ng/mL was 51·4% (95% CI 34·0-68·6), and the overall positive predictive value of a PSA threshold of 3·0 ng/mL was 32·1% (20·3-46·0). INTERPRETATION After the first screening round, carriers of MSH2 and MSH6 pathogenic variants had a higher incidence of prostate cancer compared with age-matched non-carrier controls. These findings support the use of targeted PSA screening in these men to identify those with clinically significant prostate cancer. Further annual screening rounds will need to confirm these findings. FUNDING Cancer Research UK, The Ronald and Rita McAulay Foundation, the National Institute for Health Research support to Biomedical Research Centres (The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Oxford; Manchester and the Cambridge Clinical Research Centre), Mr and Mrs Jack Baker, the Cancer Council of Tasmania, Cancer Australia, Prostate Cancer Foundation of Australia, Cancer Council of Victoria, Cancer Council of South Australia, the Victorian Cancer Agency, Cancer Australia, Prostate Cancer Foundation of Australia, Asociación Española Contra el Cáncer (AECC), the Instituto de Salud Carlos III, Fondo Europeo de Desarrollo Regional (FEDER), the Institut Català de la Salut, Autonomous Government of Catalonia, Fundação para a Ciência e a Tecnologia, National Institutes of Health National Cancer Institute, Swedish Cancer Society, General Hospital in Malmö Foundation for Combating Cancer.
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Affiliation(s)
- Elizabeth K Bancroft
- Oncogenetics Team, Institute of Cancer Research, London, UK; Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | | | - Mark N Brook
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Sarah Thomas
- Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Natalie Taylor
- Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Jennifer Pope
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Jana McHugh
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | | | | | - Susan Merson
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Kai Ren Ong
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham, UK
| | - Jonathan Hoffman
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham, UK
| | - Camilla Huber
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham, UK
| | - Lovise Maehle
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | | | - Astrid Stormorken
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - D Gareth Evans
- Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jeanette Rothwell
- Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Fiona Lalloo
- Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Angela F Brady
- North West Thames Regional Genetics Service, London North West University Healthcare NHS Trust, Harrow, UK
| | - Marion Bartlett
- North West Thames Regional Genetics Service, London North West University Healthcare NHS Trust, Harrow, UK
| | | | | | - Paul James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Joanne McKinley
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lyon Mascarenhas
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sapna Syngal
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | - Chinedu Ukaegbu
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, USA
| | - Lucy Side
- University Hospital Southampton, Southampton, UK; Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Tessy Thomas
- University Hospital Southampton, Southampton, UK; Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Julian Barwell
- Department of Genetics, University of Leicester, Leicester, UK; University Hospitals Leicester, Leicester, UK
| | - Manuel R Teixeira
- Genetics Department and Research Center, Portuguese Oncology Institute (IPO Porto), Porto, Portugal; Biomedical Sciences Institute (ICBAS), Porto University, Porto, Portugal
| | - Louise Izatt
- Clinical Genetics Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mohnish Suri
- Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Finlay A Macrae
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Parkville Familial Cancer Centre, The Royal Melbourne Hospital, Parkville, VIC, Australia; Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Nicola Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Rakefet Chen-Shtoyerman
- The Genetic Institute, Kaplan Medical Center, Rehovot, Israel; Biology Department, Ariel University, Ariel, Israel
| | - Munaza Ahmed
- North East Thames Regional Genetics Service, Institute of Child Health, London, UK
| | - Hannah Musgrave
- Yorkshire Regional Genetics Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nicola Nicolai
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Lynn Greenhalgh
- Clinical Genetics Service, Liverpool Women's Hospital, Liverpool, UK
| | - Carole Brewer
- Peninsular Genetics, Derriford Hospital, Plymouth, UK; Royal Devon and Exeter Hospital, Exeter, UK
| | - Nicholas Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Subiaco, WA, Australia; Department of Paediatrics, University of Western Australia, Perth, WA, Australia
| | - Allan D Spigelman
- Hunter Family Cancer Service, Waratah, NSW, Australia; University of New South Wales, St Vincent's Clinical School, NSW, Australia; Cancer Genetics Clinic, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, NSW, Australia
| | - Ashraf Azzabi
- Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Brian T Helfand
- John and Carol Walter Center for Urological Health, Division of Urology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Dorothy Halliday
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Saundra Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | - Kathleen A Cooney
- Duke Cancer Institute and Duke University School of Medicine, Durham, NC, USA
| | - Marion Harris
- Monash Health, Clayton, VIC, Australia; Monash University, Clayton, VIC, Australia
| | - John McGrath
- Royal Devon and Exeter Hospital, Exeter, UK; University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Rosemarie Davidson
- West of Scotland Genetic Service, Queen Elizabeth University Hospital, Glasgow, UK
| | - Amy Taylor
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | | | - Kathryn Myhill
- Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew Hogben
- Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Audrey Ardern-Jones
- Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Chris H Bangma
- Department of Urology, Erasmus Cancer Institute, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Elena Castro
- Spanish National Cancer Research Center, Madrid, Spain
| | - David Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, Surrey, UK
| | - Alexander Dias
- Instituto Nacional de Cancer Jose de Alencar Gomes da Silva INCA, Rio de Janeiro, Brazil
| | | | - Diana M Eccles
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK
| | - Kate Green
- Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jorunn Eyfjord
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | | | | | - Freddie C Hamdy
- Churchill Hospital, Headington, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Oskar Johannsson
- Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
| | - Vincent Khoo
- Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK; St George's Hospital, Tooting, London, UK; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, Surrey, UK
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Laboratory Medicine, Department of Surgery, and Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Geoffrey J Lindeman
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Parkville Familial Cancer Centre, The Royal Melbourne Hospital, Parkville, VIC, Australia; Cancer Biology and Stem Cells Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Jan Lubinski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Karol Axcrona
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | | | - Anita V Mitra
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Clare Moynihan
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | | | - Gad Rennert
- CHS National Cancer Control Center, Carmel Medical Center, Haifa, Israel
| | - Rebecca Collier
- Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Judith Offman
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, Guy's Cancer Centre, Guy's Hospital, London, UK
| | | | - Rosalind A Eeles
- Oncogenetics Team, Institute of Cancer Research, London, UK; Cancer Genetics Unit & Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK.
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Schreglmann S, Wang D, Peach R, Li J, Zhang X, Latorre A, Rhodes E, Panella E, Boyden E, Barahona M, Santaniello S, Rothwell J, Bhatia K, Grossman N. FV 12. Non-invasive Suppression of Essential Tremor via Phase-Locked Disruption of its Temporal Coherence. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rocchi L, Di Santo A, Brown K, Ibanez Pereda J, Casula E, Rawji V, Di Lazzaro V, Rothwell J. P218 Disentangling EEG responses to TMS due to cortical and peripheral activations. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fong P, Spampinato D, Hannah R, Rocchi L, Santo AD, Shoura M, Bhatia K, Rothwell J. P87 SICI: effect of conditioning stimulus orientation. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bancroft EK, Saya S, Brown E, Thomas S, Taylor N, Rothwell J, Pope J, Chamberlain A, Page E, Benafif S, Hanson H, Dias A, Mikropoulos C, Izatt L, Side L, Walker L, Donaldson A, Cook JA, Barwell J, Wiles V, Limb L, Eccles DM, Leach MO, Shanley S, Gilbert FJ, Gallagher D, Rajashanker B, Whitehouse RW, Koh DM, Sohaib SA, Evans DG, Eeles RA, Walker LG. Psychosocial effects of whole-body MRI screening in adult high-risk pathogenic TP53 mutation carriers: a case-controlled study (SIGNIFY). J Med Genet 2020; 57:226-236. [PMID: 31719169 PMCID: PMC7146942 DOI: 10.1136/jmedgenet-2019-106407] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/18/2019] [Accepted: 09/21/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Germline TP53 gene pathogenic variants (pv) cause a very high lifetime risk of developing cancer, almost 100% for women and 75% for men. In the UK, annual MRI breast screening is recommended for female TP53 pv carriers. The SIGNIFY study (Magnetic Resonance Imaging screening in Li Fraumeni syndrome: An exploratory whole body MRI) study reported outcomes of whole-body MRI (WB-MRI) in a cohort of 44 TP53 pv carriers and 44 matched population controls. The results supported the use of a baseline WB-MRI screen in all adult TP53 pv carriers. Here we report the acceptability of WB-MRI screening and effects on psychosocial functioning and health-related quality of life in the short and medium terms. METHODS Psychosocial and other assessments were carried out at study enrolment, immediately before MRI, before and after MRI results, and at 12, 26 and 52 weeks' follow-up. RESULTS WB-MRI was found to be acceptable with high levels of satisfaction and low levels of psychological morbidity throughout. Although their mean levels of cancer worry were not high, carriers had significantly more cancer worry at most time-points than controls. They also reported significantly more clinically significant intrusive and avoidant thoughts about cancer than controls at all time-points. There were no clinically significant adverse psychosocial outcomes in either carriers with a history of cancer or in those requiring further investigations. CONCLUSION WB-MRI screening can be implemented in TP53 pv carriers without adverse psychosocial outcomes in the short and medium terms. A previous cancer diagnosis may predict a better psychosocial outcome. Some carriers seriously underestimate their risk of cancer. Carriers of pv should have access to a clinician to help them develop adaptive strategies to cope with cancer-related concerns and respond to clinically significant depression and/or anxiety.
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Affiliation(s)
- Elizabeth K Bancroft
- Oncogenetics Team, The Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Sibel Saya
- Oncogenetics Team, The Institute of Cancer Research, London, UK
- Centre for Cancer Research & Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Brown
- Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Thomas
- Oncogenetics Team, The Royal Marsden NHS Foundation Trust, London, UK
| | - Natalie Taylor
- Oncogenetics Team, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jeanette Rothwell
- Clinical Genetics, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jennifer Pope
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | | | - Elizabeth Page
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Sarah Benafif
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | - Helen Hanson
- South West Thames Regional Genetics Service, St Georges NHS Foundation Trust, London, UK
| | - Alexander Dias
- Oncogenetics Team, The Institute of Cancer Research, London, UK
| | | | - Louise Izatt
- Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lucy Side
- Clinical Genetics, Wessex Clinical Genetics Service, Southampton, UK
| | - Lisa Walker
- Clinical Genetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alan Donaldson
- Clinical Genetics, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jackie A Cook
- Department of Clinical Genetics, Sheffield Children's Hospital, Sheffield, UK
| | - Julian Barwell
- Clinical Genetics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Vicki Wiles
- Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lauren Limb
- North West Thames Regional Genetics Service (Kennedy-Galton Centre), London North West University Healthcare NHS Trust, Harrow, UK
| | - Diana M Eccles
- Cancer Sciences, University of Southampton Faculty of Medicine, Southampton, UK
| | - Martin O Leach
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
- Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Susan Shanley
- Formerly at the Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - David Gallagher
- Cancer Genetics Service, Mater Hospital School, Dublin, Ireland
| | | | | | - Dow-Mu Koh
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
- Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - S Aslam Sohaib
- Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Gareth Evans
- Clinical Genetics, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rosalind A Eeles
- Oncogenetics Team, The Royal Marsden NHS Foundation Trust, London, UK
- Oncogenetics Team, The Institute of Cancer Research, London, UK
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Page EC, Bancroft EK, Brook MN, Assel M, Hassan Al Battat M, Thomas S, Taylor N, Chamberlain A, Pope J, Raghallaigh HN, Evans DG, Rothwell J, Maehle L, Grindedal EM, James P, Mascarenhas L, McKinley J, Side L, Thomas T, van Asperen C, Vasen H, Kiemeney LA, Ringelberg J, Jensen TD, Osther PJS, Helfand BT, Genova E, Oldenburg RA, Cybulski C, Wokolorczyk D, Ong KR, Huber C, Lam J, Taylor L, Salinas M, Feliubadaló L, Oosterwijk JC, van Zelst-Stams W, Cook J, Rosario DJ, Domchek S, Powers J, Buys S, O'Toole K, Ausems MGEM, Schmutzler RK, Rhiem K, Izatt L, Tripathi V, Teixeira MR, Cardoso M, Foulkes WD, Aprikian A, van Randeraad H, Davidson R, Longmuir M, Ruijs MWG, Helderman van den Enden ATJM, Adank M, Williams R, Andrews L, Murphy DG, Halliday D, Walker L, Liljegren A, Carlsson S, Azzabi A, Jobson I, Morton C, Shackleton K, Snape K, Hanson H, Harris M, Tischkowitz M, Taylor A, Kirk J, Susman R, Chen-Shtoyerman R, Spigelman A, Pachter N, Ahmed M, Ramon Y Cajal T, Zgajnar J, Brewer C, Gadea N, Brady AF, van Os T, Gallagher D, Johannsson O, Donaldson A, Barwell J, Nicolai N, Friedman E, Obeid E, Greenhalgh L, Murthy V, Copakova L, Saya S, McGrath J, Cooke P, Rønlund K, Richardson K, Henderson A, Teo SH, Arun B, Kast K, Dias A, Aaronson NK, Ardern-Jones A, Bangma CH, Castro E, Dearnaley D, Eccles DM, Tricker K, Eyfjord J, Falconer A, Foster C, Gronberg H, Hamdy FC, Stefansdottir V, Khoo V, Lindeman GJ, Lubinski J, Axcrona K, Mikropoulos C, Mitra A, Moynihan C, Rennert G, Suri M, Wilson P, Dudderidge T, Offman J, Kote-Jarai Z, Vickers A, Lilja H, Eeles RA. Interim Results from the IMPACT Study: Evidence for Prostate-specific Antigen Screening in BRCA2 Mutation Carriers. Eur Urol 2019; 76:831-842. [PMID: 31537406 PMCID: PMC6880781 DOI: 10.1016/j.eururo.2019.08.019] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/12/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Mutations in BRCA2 cause a higher risk of early-onset aggressive prostate cancer (PrCa). The IMPACT study is evaluating targeted PrCa screening using prostate-specific-antigen (PSA) in men with germline BRCA1/2 mutations. OBJECTIVE To report the utility of PSA screening, PrCa incidence, positive predictive value of PSA, biopsy, and tumour characteristics after 3 yr of screening, by BRCA status. DESIGN, SETTING, AND PARTICIPANTS Men aged 40-69 yr with a germline pathogenic BRCA1/2 mutation and male controls testing negative for a familial BRCA1/2 mutation were recruited. Participants underwent PSA screening for 3 yr, and if PSA > 3.0 ng/ml, men were offered prostate biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PSA levels, PrCa incidence, and tumour characteristics were evaluated. Statistical analyses included Poisson regression offset by person-year follow-up, chi-square tests for proportion t tests for means, and Kruskal-Wallis for medians. RESULTS AND LIMITATIONS A total of 3027 patients (2932 unique individuals) were recruited (919 BRCA1 carriers, 709 BRCA1 noncarriers, 902 BRCA2 carriers, and 497 BRCA2 noncarriers). After 3 yr of screening, 527 men had PSA > 3.0 ng/ml, 357 biopsies were performed, and 112 PrCa cases were diagnosed (31 BRCA1 carriers, 19 BRCA1 noncarriers, 47 BRCA2 carriers, and 15 BRCA2 noncarriers). Higher compliance with biopsy was observed in BRCA2 carriers compared with noncarriers (73% vs 60%). Cancer incidence rate per 1000 person years was higher in BRCA2 carriers than in noncarriers (19.4 vs 12.0; p = 0.03); BRCA2 carriers were diagnosed at a younger age (61 vs 64 yr; p = 0.04) and were more likely to have clinically significant disease than BRCA2 noncarriers (77% vs 40%; p = 0.01). No differences in age or tumour characteristics were detected between BRCA1 carriers and BRCA1 noncarriers. The 4 kallikrein marker model discriminated better (area under the curve [AUC] = 0.73) for clinically significant cancer at biopsy than PSA alone (AUC = 0.65). CONCLUSIONS After 3 yr of screening, compared with noncarriers, BRCA2 mutation carriers were associated with a higher incidence of PrCa, younger age of diagnosis, and clinically significant tumours. Therefore, systematic PSA screening is indicated for men with a BRCA2 mutation. Further follow-up is required to assess the role of screening in BRCA1 mutation carriers. PATIENT SUMMARY We demonstrate that after 3 yr of prostate-specific antigen (PSA) testing, we detect more serious prostate cancers in men with BRCA2 mutations than in those without these mutations. We recommend that male BRCA2 carriers are offered systematic PSA screening.
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Affiliation(s)
| | - Elizabeth K Bancroft
- Oncogenetics Team, Institute of Cancer Research, London, UK; Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Mark N Brook
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, NY, USA
| | | | - Sarah Thomas
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Natalie Taylor
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | | | - Jennifer Pope
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | | | - D Gareth Evans
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jeanette Rothwell
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Lovise Maehle
- Department of medical genetics, Oslo University Hospital, 0424 Oslo, Norway
| | | | - Paul James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia; Genetic Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Lyon Mascarenhas
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Joanne McKinley
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lucy Side
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Tessy Thomas
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | | | - Hans Vasen
- The Foundation for the Detection of Hereditary Cancer, Leiden, The Netherlands
| | | | - Janneke Ringelberg
- The Foundation for the Detection of Hereditary Cancer, Leiden, The Netherlands
| | | | | | - Brian T Helfand
- John and Carol Walter Center for Urological Health, Division of Urology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Elena Genova
- John and Carol Walter Center for Urological Health, Division of Urology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Rogier A Oldenburg
- Department of clinical genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Cezary Cybulski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Dominika Wokolorczyk
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Kai-Ren Ong
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham, UK
| | - Camilla Huber
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham, UK
| | - Jimmy Lam
- Department of Urology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Louise Taylor
- Department of Urology, Repatriation General Hospital, Daw Park, SA, Australia
| | - Monica Salinas
- Hereditary Cancer Program, ICO-IDIBELL (Bellvitge Biomedical Research Institute, Catalan Institute of Oncology), CIBERONC, Barcelona, Spain
| | - Lidia Feliubadaló
- Hereditary Cancer Program, ICO-IDIBELL (Bellvitge Biomedical Research Institute, Catalan Institute of Oncology), CIBERONC, Barcelona, Spain
| | - Jan C Oosterwijk
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Jackie Cook
- Sheffield Clinical Genetics Service, Sheffield Children's Hospital, Sheffield, UK
| | | | - Susan Domchek
- Basser Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacquelyn Powers
- Basser Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Saundra Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Karen O'Toole
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Margreet G E M Ausems
- Division of Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Centre, Utrecht, The Netherlands
| | - Rita K Schmutzler
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Louise Izatt
- Clinical Genetics Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vishakha Tripathi
- Clinical Genetics Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Manuel R Teixeira
- Genetics Department and Research Center, Portuguese Oncology Institute (IPO Porto), Porto, Portugal; Biomedical Sciences Institute (ICBAS), Porto University, Porto, Portugal
| | - Marta Cardoso
- Genetics Department and Research Center, Portuguese Oncology Institute (IPO Porto), Porto, Portugal
| | - William D Foulkes
- Cancer Research Program, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Armen Aprikian
- Cancer Research Program, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Rosemarie Davidson
- West of Scotland Genetic Service, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mark Longmuir
- West of Scotland Genetic Service, Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | - Muriel Adank
- VU University Medical Center, Amsterdam, The Netherlands
| | - Rachel Williams
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lesley Andrews
- Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Declan G Murphy
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dorothy Halliday
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Lisa Walker
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Annelie Liljegren
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Stefan Carlsson
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Ashraf Azzabi
- Northern Genetics Service, Newcastle upon Tyne Hospitals, UK
| | - Irene Jobson
- Northern Genetics Service, Newcastle upon Tyne Hospitals, UK
| | - Catherine Morton
- Familial Cancer Centre, The Royal Melbourne Hospital, Grattan St, Parkville, VIC, Australia
| | - Kylie Shackleton
- Familial Cancer Centre, The Royal Melbourne Hospital, Grattan St, Parkville, VIC, Australia
| | | | | | - Marion Harris
- Familial Cancer Centre, Monash Health, Clayton, VIC, Australia
| | - Marc Tischkowitz
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Trust, Cambridge, UK; Academic Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Level 6 Addenbrooke's Treatment Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Amy Taylor
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Judy Kirk
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, Sydney, NSW, Australia
| | - Rachel Susman
- Genetic Health Queensland, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
| | | | - Allan Spigelman
- Hunter Family Cancer Service, Waratah, NSW, Australia; University of New South Wales, St Vincent's Clinical School, NSW, Australia; Cancer Genetics Clinic, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, NSW, Australia
| | - Nicholas Pachter
- Genetic Services of WA, King Edward Memorial Hospital, Subiaco, WA, Australia; Department of Paediatrics, University of Western Australia, Perth, WA, Australia
| | - Munaza Ahmed
- NE Thames Regional Genetics Service, Institute of Child Health, London, UK
| | | | | | - Carole Brewer
- Peninsular Genetics, Derriford Hospital, Plymouth, UK; Royal Devon and Exeter Hospital, Exeter, UK
| | - Neus Gadea
- Hospital Vall d'Hebron, Barcelona, Spain
| | - Angela F Brady
- North West Thames Regional Genetics Service, Kennedy-Galton Centre, London North West University Healthcare NHS Trust, Harrow, UK
| | - Theo van Os
- Academic Medical Center, Amsterdam, The Netherlands
| | | | - Oskar Johannsson
- Landspitali-the National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Julian Barwell
- University of Leicester, Leicester, UK; University Hospitals Leicester, Leicester, UK
| | | | | | - Elias Obeid
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Lynn Greenhalgh
- Clinical Genetics Service, Liverpool Women's Hospital, Liverpool, UK
| | | | | | - Sibel Saya
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - John McGrath
- Royal Devon and Exeter Hospital, Exeter, UK; University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | | | - Karina Rønlund
- Department of Clinical Genetics, Vejle Hospital, Vejle, Denmark
| | - Kate Richardson
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Alex Henderson
- Northern Genetics Service, Newcastle upon Tyne Hospitals, UK; West Cumberland Infirmary, Whitehaven, UK
| | - Soo H Teo
- Cancer Research Initiatives Foundation, Subang Jaya Medical Centre, Selangor, Darul Ehsan, Malaysia
| | - Banu Arun
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Karin Kast
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alexander Dias
- Oncogenetics Team, Institute of Cancer Research, London, UK; Instituto Nacional de Cancer Jose de Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | | | - Audrey Ardern-Jones
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Chris H Bangma
- Department of urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Elena Castro
- Spanish National Cancer Research Center, Madrid, Spain
| | - David Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, UK
| | - Diana M Eccles
- The University of Southampton Medical School, Southampton, UK; Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Karen Tricker
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jorunn Eyfjord
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | | | | | - Freddie C Hamdy
- Churchill Hospital, Headington, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Vincent Khoo
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK; St George's Hospital, Tooting, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, UK; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Geoffrey J Lindeman
- Familial Cancer Centre, The Royal Melbourne Hospital, Grattan St, Parkville, VIC, Australia; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Cancer Biology and Stem Cells Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Jan Lubinski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Karol Axcrona
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | | | - Anita Mitra
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Clare Moynihan
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Gadi Rennert
- CHS National Cancer Control Center, Carmel Medical Center, Haifa, Israel
| | | | | | | | - Judith Offman
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, Guy's Cancer Centre, Guy's Hospital, London, UK
| | | | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Hans Lilja
- Department of Translational Medicine, Lund University, Malmö, Sweden; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Rosalind A Eeles
- Oncogenetics Team, Institute of Cancer Research, London, UK; Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK.
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Tee SR, Devane LA, Evoy D, Rothwell J, Geraghty J, Prichard RS, McDermott EW. Meta-analysis of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy-proven node-positive breast cancer. Br J Surg 2019; 105:1541-1552. [PMID: 30311642 DOI: 10.1002/bjs.10986] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/18/2018] [Accepted: 07/26/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy for breast cancer has the potential to achieve a pathological complete response in up to 40 per cent of patients, converting disease that was initially node-positive to node-negative. This has raised the question of whether sentinel lymph node biopsy could be an alternative to axillary lymph node dissection in these patients. The aim was to undertake a systematic review and meta-analysis of the accuracy and reliability of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy-proven node-positive breast cancer. METHODS A literature search was conducted using PubMed, Ovid MEDLINE, Embase and Web of Science databases up to 30 April 2017. Inclusion criteria for studies were pathological confirmation of initial node-positive disease, and sentinel lymph node biopsy performed after neoadjuvant chemotherapy followed by axillary lymph node dissection. RESULTS A total of 13 studies met the inclusion criteria and were included in the analysis (1921 patients in total). The pooled estimate of identification rate was 90 (95 per cent c.i. 87 to 93) per cent and the false-negative rate was 14 (11 to 17) per cent. In subgroup analysis, the false-negative rate with use of dual mapping was 11 (6 to 15) per cent, compared with 19 (11 to 27) per cent with single mapping. The false-negative rate was 20 (13 to 27) per cent when one node was removed, 12 (5 to 19) per cent with two nodes removed and 4 (0 to 9) per cent with removal of three or more nodes. CONCLUSION Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with biopsy-proven node-positive breast cancer is accurate and reliable, but requires careful patient selection and optimal surgical techniques.
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Affiliation(s)
- S R Tee
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - L A Devane
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D Evoy
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J Rothwell
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J Geraghty
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - R S Prichard
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - E W McDermott
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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O'Connell L, Walsh S, Evoy D, O'Doherty A, Quinn C, Rothwell J, Geraghty J, McDermott EW, Prichard R. The approach to an isolated close anterior margin in breast conserving surgery. Ann R Coll Surg Engl 2019; 101:268-272. [PMID: 30855173 DOI: 10.1308/rcsann.2019.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Although close radial margins after breast-conserving surgery routinely undergo re-excision, appropriate management of patients with close anterior margins remains a topic of controversy. An increasing body of literature suggests that re-excision of close anterior margins yields low rates of residual malignancy and may only be necessary in selected patients. The aim of this study was to examine the management of close anterior margins after breast conserving surgery in a single institution and to analyse the rate of residual disease in re-excised anterior margins. METHODS All patients having breast conserving surgery at St Vincent's University Hospital from January 2008 to December 2012 were reviewed retrospectively. Data collected included patient demographics, tumour characteristics, margin positivity, re-excision rates and definitive histology of the re-excision specimens. A close margin was defined as les than 2 mm. RESULTS A total of 930 patients were included with an average age of 65 years (range 29-94 years). Of these, 121 (13%) had a close anterior margin. Further re-excison of the anterior margin was carried out in 37 patients (30.6%) and a further 16 (13.2%) proceeded to mastectomy. Residual disease was found in 18.5% (7/36) of those who underwent re-excision and 7/16 (43.75%) of those who underwent mastectomy. Overall, 11.57% (14/121) of patients with close anterior margins were subsequently found to have residual disease. CONCLUSION The low yield of residual disease in re-excised anterior margins specimens supports the concept that routine re-excision of close anterior margins is not necessary. Further research is required to definitively assess its influence on the risk of local recurrence.
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Affiliation(s)
- L O'Connell
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
| | - S Walsh
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
| | - D Evoy
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
| | - A O'Doherty
- Department of Radiology, St Vincent's University Hospital , Dublin , Ireland
| | - C Quinn
- Department of Pathology, St Vincent's University Hospital , Dublin , Ireland
| | - J Rothwell
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
| | - J Geraghty
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
| | - E W McDermott
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
| | - R Prichard
- Department of Breast, Endocrine and General Surgery, St Vincent's University Hospital , Dublin , Ireland
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Orlov N, O'daly O, Tracy D, Rothwell J, Shergill S. Neurophysiological and behavioural effects of tDCS upon memory and learning in schizophrenia. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Mikropoulos C, Hutten Selkirk CG, Saya S, Bancroft E, Vertosick E, Dadaev T, Brendler C, Page E, Dias A, Evans DG, Rothwell J, Maehle L, Axcrona K, Richardson K, Eccles D, Jensen T, Osther PJ, van Asperen CJ, Vasen H, Kiemeney LA, Ringelberg J, Cybulski C, Wokolorczyk D, Hart R, Glover W, Lam J, Taylor L, Salinas M, Feliubadaló L, Oldenburg R, Cremers R, Verhaegh G, van Zelst-Stams WA, Oosterwijk JC, Cook J, Rosario DJ, Buys SS, Conner T, Domchek S, Powers J, Ausems MGEM, Teixeira MR, Maia S, Izatt L, Schmutzler R, Rhiem K, Foulkes WD, Boshari T, Davidson R, Ruijs M, Helderman-van den Enden ATJM, Andrews L, Walker L, Snape K, Henderson A, Jobson I, Lindeman GJ, Liljegren A, Harris M, Adank MA, Kirk J, Taylor A, Susman R, Chen-Shtoyerman R, Pachter N, Spigelman A, Side L, Zgajnar J, Mora J, Brewer C, Gadea N, Brady AF, Gallagher D, van Os T, Donaldson A, Stefansdottir V, Barwell J, James PA, Murphy D, Friedman E, Nicolai N, Greenhalgh L, Obeid E, Murthy V, Copakova L, McGrath J, Teo SH, Strom S, Kast K, Leongamornlert DA, Chamberlain A, Pope J, Newlin AC, Aaronson N, Ardern-Jones A, Bangma C, Castro E, Dearnaley D, Eyfjord J, Falconer A, Foster CS, Gronberg H, Hamdy FC, Johannsson O, Khoo V, Lubinski J, Grindedal EM, McKinley J, Shackleton K, Mitra AV, Moynihan C, Rennert G, Suri M, Tricker K, Moss S, Kote-Jarai Z, Vickers A, Lilja H, Helfand BT, Eeles RA. Prostate-specific antigen velocity in a prospective prostate cancer screening study of men with genetic predisposition. Br J Cancer 2018; 118:e17. [PMID: 29509747 PMCID: PMC5877440 DOI: 10.1038/bjc.2018.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This corrects the article DOI: 10.1038/bjc.2017.429.
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13
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Mikropoulos C, Selkirk CGH, Saya S, Bancroft E, Vertosick E, Dadaev T, Brendler C, Page E, Dias A, Evans DG, Rothwell J, Maehle L, Axcrona K, Richardson K, Eccles D, Jensen T, Osther PJ, van Asperen CJ, Vasen H, Kiemeney LA, Ringelberg J, Cybulski C, Wokolorczyk D, Hart R, Glover W, Lam J, Taylor L, Salinas M, Feliubadaló L, Oldenburg R, Cremers R, Verhaegh G, van Zelst-Stams WA, Oosterwijk JC, Cook J, Rosario DJ, Buys SS, Conner T, Domchek S, Powers J, Ausems MGEM, Teixeira MR, Maia S, Izatt L, Schmutzler R, Rhiem K, Foulkes WD, Boshari T, Davidson R, Ruijs M, Helderman-van den Enden ATJM, Andrews L, Walker L, Snape K, Henderson A, Jobson I, Lindeman GJ, Liljegren A, Harris M, Adank MA, Kirk J, Taylor A, Susman R, Chen-Shtoyerman R, Pachter N, Spigelman A, Side L, Zgajnar J, Mora J, Brewer C, Gadea N, Brady AF, Gallagher D, van Os T, Donaldson A, Stefansdottir V, Barwell J, James PA, Murphy D, Friedman E, Nicolai N, Greenhalgh L, Obeid E, Murthy V, Copakova L, McGrath J, Teo SH, Strom S, Kast K, Leongamornlert DA, Chamberlain A, Pope J, Newlin AC, Aaronson N, Ardern-Jones A, Bangma C, Castro E, Dearnaley D, Eyfjord J, Falconer A, Foster CS, Gronberg H, Hamdy FC, Johannsson O, Khoo V, Lubinski J, Grindedal EM, McKinley J, Shackleton K, Mitra AV, Moynihan C, Rennert G, Suri M, Tricker K, Moss S, Kote-Jarai Z, Vickers A, Lilja H, Helfand BT, Eeles RA. Prostate-specific antigen velocity in a prospective prostate cancer screening study of men with genetic predisposition. Br J Cancer 2018; 118:266-276. [PMID: 29301143 PMCID: PMC5785754 DOI: 10.1038/bjc.2017.429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Prostate-specific antigen (PSA) and PSA-velocity (PSAV) have been used to identify men at risk of prostate cancer (PrCa). The IMPACT study is evaluating PSA screening in men with a known genetic predisposition to PrCa due to BRCA1/2 mutations. This analysis evaluates the utility of PSA and PSAV for identifying PrCa and high-grade disease in this cohort. METHODS PSAV was calculated using logistic regression to determine if PSA or PSAV predicted the result of prostate biopsy (PB) in men with elevated PSA values. Cox regression was used to determine whether PSA or PSAV predicted PSA elevation in men with low PSAs. Interaction terms were included in the models to determine whether BRCA status influenced the predictiveness of PSA or PSAV. RESULTS 1634 participants had ⩾3 PSA readings of whom 174 underwent PB and 45 PrCas diagnosed. In men with PSA >3.0 ng ml-l, PSAV was not significantly associated with presence of cancer or high-grade disease. PSAV did not add to PSA for predicting time to an elevated PSA. When comparing BRCA1/2 carriers to non-carriers, we found a significant interaction between BRCA status and last PSA before biopsy (P=0.031) and BRCA2 status and PSAV (P=0.024). However, PSAV was not predictive of biopsy outcome in BRCA2 carriers. CONCLUSIONS PSA is more strongly predictive of PrCa in BRCA carriers than non-carriers. We did not find evidence that PSAV aids decision-making for BRCA carriers over absolute PSA value alone.
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Affiliation(s)
| | - Christina G Hutten Selkirk
- The John and Carol Walter Center for Urological Health, Department of Surgery, North Shore University Health System, Evanston, IL 60201, USA
- Center for Medical Genetics, Department of Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Sibel Saya
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Elizabeth Bancroft
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, Fulham Rd, London SW3 6JJ, UK
| | - Emily Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Tokhir Dadaev
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Charles Brendler
- The John and Carol Walter Center for Urological Health, Department of Surgery, North Shore University Health System, Evanston, IL 60201, USA
| | - Elizabeth Page
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Alexander Dias
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, Fulham Rd, London SW3 6JJ, UK
| | - D Gareth Evans
- Genomic Medicine, Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, University of Manchester, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Jeanette Rothwell
- Genomic Medicine, Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, University of Manchester, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Lovise Maehle
- Department of Medical Genetics, Oslo University Hospital, Oslo 0372, Norway
| | - Karol Axcrona
- Akershus University Hospital, Lørenskog 1478, Norway
| | - Kate Richardson
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, East Melbourne, VIC 3000, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC 3010, Australia
| | - Diana Eccles
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton SO16 5YA, UK
- Cancer Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Thomas Jensen
- Department of Clinical Genetics, Vejle Hospital, Vejle 7100, Denmark
| | - Palle J Osther
- Department of Clinical Genetics, Vejle Hospital, Vejle 7100, Denmark
| | - Christi J van Asperen
- Leiden University Medical Center, Department of Clinical Genetics, Leiden, ZA 2333, The Netherlands
| | - Hans Vasen
- Netherlands Foundation for the Detection of Hereditary Tumors, Leiden, ZA 2333, The Netherlands
| | | | - Janneke Ringelberg
- Netherlands Foundation for the Detection of Hereditary Tumors, Leiden, ZA 2333, The Netherlands
| | - Cezary Cybulski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin 70-204, Poland
| | - Dominika Wokolorczyk
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin 70-204, Poland
| | - Rachel Hart
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham B15 2TG, UK
| | - Wayne Glover
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham B15 2TG, UK
| | - Jimmy Lam
- Department of Urology, Repatriation General Hospital, Daw Park, SA 5041, Australia
| | - Louise Taylor
- Department of Urology, Repatriation General Hospital, Daw Park, SA 5041, Australia
| | - Monica Salinas
- Hereditary Cancer Program, Catalan Institute of Oncology (ICO-IDIBELL, CIBERONC), L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Lidia Feliubadaló
- Hereditary Cancer Program, Catalan Institute of Oncology (ICO-IDIBELL, CIBERONC), L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Rogier Oldenburg
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam 3015 CE, The Netherlands
| | - Ruben Cremers
- Radboud University Medical Center, Nijmegen, GA 6525, The Netherlands
| | - Gerald Verhaegh
- Radboud University Medical Center, Nijmegen, GA 6525, The Netherlands
| | - Wendy A van Zelst-Stams
- Netherlands Foundation for the Detection of Hereditary Tumors, Leiden, ZA 2333, The Netherlands
| | - Jan C Oosterwijk
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, The Netherlands
| | - Jackie Cook
- Sheffield Clinical Genetics Service, Sheffield Children's Hospital, Sheffield S10 2TH, UK
| | | | - Saundra S Buys
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84103, USA
| | - Tom Conner
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84103, USA
| | - Susan Domchek
- Basser Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jacquelyn Powers
- Basser Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Margreet GEM Ausems
- Department of Genetics, University Medical Centre Utrecht, Utrecht, CX, The Netherlands
| | - Manuel R Teixeira
- Genetics Department and Research Center, Portuguese Oncology Institute, Porto 4200-072, Portugal
- Biomedical Sciences Institute (ICBAS), Porto University, Porto 4200-072, Portugal
| | - Sofia Maia
- Genetics Department and Research Center, Portuguese Oncology Institute, Porto 4200-072, Portugal
| | - Louise Izatt
- South East Thames Genetics Service, Guy’s Hospital, London SE1 9RT, UK
| | - Rita Schmutzler
- Center of Familial Breast and Ovarian Cancer, University Hospital of Cologne, Cologne 50937, Germany
| | - Kerstin Rhiem
- Center of Familial Breast and Ovarian Cancer, University Hospital of Cologne, Cologne 50937, Germany
| | - William D Foulkes
- McGill Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal, QC H3A 0G4, Canada
| | - Talia Boshari
- McGill Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal, QC H3A 0G4, Canada
| | - Rosemarie Davidson
- Duncan Guthrie Institute of Medical Genetics, Yorkhill NHS Trust, Glasgow G38SJ, UK
| | - Marielle Ruijs
- The Netherlands Cancer Institute, Amsterdam 1066 CX, The Netherlands
| | | | - Lesley Andrews
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Lisa Walker
- Churchill Hospital, Headington, Oxford OX3 7LE, UK
| | - Katie Snape
- St George’s Hospital, Tooting, London SW17 0QT, UK
| | - Alex Henderson
- Northern Genetics Service, Newcastle upon Tyne Hospitals, Newcastle NE1 3BZ, UK
| | - Irene Jobson
- Northern Genetics Service, Newcastle upon Tyne Hospitals, Newcastle NE1 3BZ, UK
| | - Geoffrey J Lindeman
- Parkville Familial Cancer Centre, The Royal Melbourne Hospital, Grattan St, Parkville, VIC 3050, Australia
- Stem Cells and Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3050, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Annelie Liljegren
- Karolinska University Hospital and Karolinska Institutet, Solna 171 77, Sweden
| | - Marion Harris
- Familial Cancer Centre, Monash Health, Clayton, VIC 3168, Australia
| | - Muriel A Adank
- VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Judy Kirk
- Familial Cancer Service, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia
- Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, Sydney, NSW 2155, Australia
| | - Amy Taylor
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Rachel Susman
- Genetic Health Queensland, Royal Brisbane & Women's Hospital, Herston, QLD 4029, Australia
| | | | - Nicholas Pachter
- Genetic Services of WA, King Edward Memorial Hospital, Subiaco, WA 6008, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA 6009, Australia
| | - Allan Spigelman
- Hunter Family Cancer Service, Waratah, NSW 2298, Australia
- University of New South Wales, St Vincent’s Clinical School, NSW 2052, Australia
- The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Lucy Side
- NE Thames Regional Genetics Service, Great Ormond St Hospital & UCL Institute of Women’s Health, London WC1N 3JH, UK
| | | | | | - Carole Brewer
- Peninsular Genetics, Derriford Hospital, Plymouth PL6 8DH, UK
- Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK
| | - Neus Gadea
- High Risk and Cancer Prevention Clinic, Vall d'Hebron University Hospital, Barcelona 08035, Spain
| | - Angela F Brady
- North West Thames Regional Genetics Service, London North West Healthcare NHS Trust, London HA1 3UJ, UK
| | | | - Theo van Os
- Academic Medical Center, Amsterdam 1105 AZ, The Netherlands
| | | | | | - Julian Barwell
- University of Leicester, Leicester LE1 7RH, UK
- University Hospitals Leicester, Leicester LE1 5WW, UK
| | - Paul A James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, East Melbourne, VIC 3000, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC 3010, Australia
- Genetic Medicine, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Declan Murphy
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC 3010, Australia
| | - Eitan Friedman
- Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | | | - Lynn Greenhalgh
- Cheshire and Mersey Clinical Genetics Service, Liverpool Women’s Hospital, Liverpool L8 7SS, UK
| | - Elias Obeid
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Vedang Murthy
- Tata Memorial Centre, Mumbai, Maharashtra 400012, India
| | - Lucia Copakova
- National Cancer Institute, Bratislava 83310, Slovak Republic
| | - John McGrath
- Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK
| | - Soo-Hwang Teo
- Cancer Research Initiatives Foundation, Subang Jaya Medical Centre, Subang Jaya, Selangor 47500, Darul Ehsan, Malaysia
| | - Sara Strom
- The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Karin Kast
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01069, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden 01307, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | | | - Anthony Chamberlain
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Jenny Pope
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Anna C Newlin
- Center for Medical Genetics, Department of Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Neil Aaronson
- The Netherlands Cancer Institute, Amsterdam 1066 CX, The Netherlands
| | | | - Chris Bangma
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam 3015 CE, The Netherlands
| | - Elena Castro
- Prostate Cancer Unit, Spanish National Cancer Research Centre, Madrid 28029, Spain
| | - David Dearnaley
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, Fulham Rd, London SW3 6JJ, UK
| | - Jorunn Eyfjord
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik 101, Iceland
| | - Alison Falconer
- Imperial College Healthcare NHS Trust, London, London W2 1NY, UK
| | | | | | - Freddie C Hamdy
- Churchill Hospital, Headington, Oxford OX3 7LE, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX1 2JD, UK
| | - Oskar Johannsson
- Landspitali—the National University Hospital of Iceland, Reykjavik 101, Iceland
| | - Vincent Khoo
- Royal Marsden NHS Foundation Trust, Fulham Rd, London SW3 6JJ, UK
| | - Jan Lubinski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin 70-204, Poland
| | | | - Joanne McKinley
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, East Melbourne, VIC 3000, Australia
| | - Kylie Shackleton
- Parkville Familial Cancer Centre, The Royal Melbourne Hospital, Grattan St, Parkville, VIC 3050, Australia
| | - Anita V Mitra
- University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - Clare Moynihan
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Gad Rennert
- CHS National Cancer Control Center, Carmel Medical Center, Haifa 3436212, Israel
| | - Mohnish Suri
- Nottingham City Hospital, Nottingham NG5 1PB, UK
| | - Karen Tricker
- Genomic Medicine, Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, University of Manchester, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - The IMPACT study collaborators91
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
- The John and Carol Walter Center for Urological Health, Department of Surgery, North Shore University Health System, Evanston, IL 60201, USA
- Center for Medical Genetics, Department of Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA
- Royal Marsden NHS Foundation Trust, Fulham Rd, London SW3 6JJ, UK
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Genomic Medicine, Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, University of Manchester, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
- Department of Medical Genetics, Oslo University Hospital, Oslo 0372, Norway
- Akershus University Hospital, Lørenskog 1478, Norway
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, East Melbourne, VIC 3000, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC 3010, Australia
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton SO16 5YA, UK
- Cancer Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Department of Clinical Genetics, Vejle Hospital, Vejle 7100, Denmark
- Leiden University Medical Center, Department of Clinical Genetics, Leiden, ZA 2333, The Netherlands
- Netherlands Foundation for the Detection of Hereditary Tumors, Leiden, ZA 2333, The Netherlands
- Radboud University Medical Center, Nijmegen, GA 6525, The Netherlands
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin 70-204, Poland
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham B15 2TG, UK
- Department of Urology, Repatriation General Hospital, Daw Park, SA 5041, Australia
- Hereditary Cancer Program, Catalan Institute of Oncology (ICO-IDIBELL, CIBERONC), L’Hospitalet de Llobregat, Barcelona 08908, Spain
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam 3015 CE, The Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, The Netherlands
- Sheffield Clinical Genetics Service, Sheffield Children's Hospital, Sheffield S10 2TH, UK
- Royal Hallamshire Hospital, Sheffield S10 2JF, UK
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT 84103, USA
- Basser Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Genetics, University Medical Centre Utrecht, Utrecht, CX, The Netherlands
- Genetics Department and Research Center, Portuguese Oncology Institute, Porto 4200-072, Portugal
- Biomedical Sciences Institute (ICBAS), Porto University, Porto 4200-072, Portugal
- South East Thames Genetics Service, Guy’s Hospital, London SE1 9RT, UK
- Center of Familial Breast and Ovarian Cancer, University Hospital of Cologne, Cologne 50937, Germany
- McGill Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal, QC H3A 0G4, Canada
- Duncan Guthrie Institute of Medical Genetics, Yorkhill NHS Trust, Glasgow G38SJ, UK
- The Netherlands Cancer Institute, Amsterdam 1066 CX, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, HX 6229, The Netherlands
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, NSW 2031, Australia
- Churchill Hospital, Headington, Oxford OX3 7LE, UK
- St George’s Hospital, Tooting, London SW17 0QT, UK
- Northern Genetics Service, Newcastle upon Tyne Hospitals, Newcastle NE1 3BZ, UK
- Parkville Familial Cancer Centre, The Royal Melbourne Hospital, Grattan St, Parkville, VIC 3050, Australia
- Stem Cells and Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3050, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
- Karolinska University Hospital and Karolinska Institutet, Solna 171 77, Sweden
- Familial Cancer Centre, Monash Health, Clayton, VIC 3168, Australia
- VU University Medical Center, Amsterdam 1081 HV, The Netherlands
- Familial Cancer Service, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia
- Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, Sydney, NSW 2155, Australia
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Genetic Health Queensland, Royal Brisbane & Women's Hospital, Herston, QLD 4029, Australia
- The Genetic Institute, Kaplan Medical Center, Rehovot 76100, Israel
- Genetic Services of WA, King Edward Memorial Hospital, Subiaco, WA 6008, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA 6009, Australia
- Hunter Family Cancer Service, Waratah, NSW 2298, Australia
- University of New South Wales, St Vincent’s Clinical School, NSW 2052, Australia
- The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, NSW 2010, Australia
- NE Thames Regional Genetics Service, Great Ormond St Hospital & UCL Institute of Women’s Health, London WC1N 3JH, UK
- Institute of Oncology, Ljubljana 1000, Slovenia
- Hospital de Sant Pau, Barcelona 08041, Spain
- Peninsular Genetics, Derriford Hospital, Plymouth PL6 8DH, UK
- Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK
- High Risk and Cancer Prevention Clinic, Vall d'Hebron University Hospital, Barcelona 08035, Spain
- North West Thames Regional Genetics Service, London North West Healthcare NHS Trust, London HA1 3UJ, UK
- St James’ Hospital, Dublin 8, Ireland
- Academic Medical Center, Amsterdam 1105 AZ, The Netherlands
- St Michael’s Hospital, Bristol BS2 8EG, UK
- Landspitali—the National University Hospital of Iceland, Reykjavik 101, Iceland
- University of Leicester, Leicester LE1 7RH, UK
- University Hospitals Leicester, Leicester LE1 5WW, UK
- Genetic Medicine, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
- Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Istituto Nazionale dei Tumori, Milano 20133, Italy
- Cheshire and Mersey Clinical Genetics Service, Liverpool Women’s Hospital, Liverpool L8 7SS, UK
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA
- Tata Memorial Centre, Mumbai, Maharashtra 400012, India
- National Cancer Institute, Bratislava 83310, Slovak Republic
- Cancer Research Initiatives Foundation, Subang Jaya Medical Centre, Subang Jaya, Selangor 47500, Darul Ehsan, Malaysia
- The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01069, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden 01307, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
- Prostate Cancer Unit, Spanish National Cancer Research Centre, Madrid 28029, Spain
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik 101, Iceland
- Imperial College Healthcare NHS Trust, London, London W2 1NY, UK
- HCA Healthcare Laboratories, London WC1E 6JA, UK
- University Hospital, Umea 907 37, Sweden
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX1 2JD, UK
- University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
- CHS National Cancer Control Center, Carmel Medical Center, Haifa 3436212, Israel
- Nottingham City Hospital, Nottingham NG5 1PB, UK
- The IMPACT Study Collaborators List see Appendix 1
- Centre for Cancer Prevention, Queen Mary University of London, London EC1M 6BQ
- Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Translational Medicine, Lund University, Malmö 205 02, Sweden
| | - Sue Moss
- Centre for Cancer Prevention, Queen Mary University of London, London EC1M 6BQ
| | - Zsofia Kote-Jarai
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Hans Lilja
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX1 2JD, UK
- Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Brian T Helfand
- The John and Carol Walter Center for Urological Health, Department of Surgery, North Shore University Health System, Evanston, IL 60201, USA
| | - Rosalind A Eeles
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, Fulham Rd, London SW3 6JJ, UK
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14
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Antal A, Alekseichuk I, Bikson M, Brockmöller J, Brunoni AR, Chen R, Cohen LG, Dowthwaite G, Ellrich J, Flöel A, Fregni F, George MS, Hamilton R, Haueisen J, Herrmann CS, Hummel FC, Lefaucheur JP, Liebetanz D, Loo CK, McCaig CD, Miniussi C, Miranda PC, Moliadze V, Nitsche MA, Nowak R, Padberg F, Pascual-Leone A, Poppendieck W, Priori A, Rossi S, Rossini PM, Rothwell J, Rueger MA, Ruffini G, Schellhorn K, Siebner HR, Ugawa Y, Wexler A, Ziemann U, Hallett M, Paulus W. Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines. Clin Neurophysiol 2017; 128:1774-1809. [PMID: 28709880 PMCID: PMC5985830 DOI: 10.1016/j.clinph.2017.06.001] [Citation(s) in RCA: 627] [Impact Index Per Article: 89.6] [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: 02/16/2017] [Revised: 05/29/2017] [Accepted: 06/06/2017] [Indexed: 12/11/2022]
Abstract
Low intensity transcranial electrical stimulation (TES) in humans, encompassing transcranial direct current (tDCS), transcutaneous spinal Direct Current Stimulation (tsDCS), transcranial alternating current (tACS), and transcranial random noise (tRNS) stimulation or their combinations, appears to be safe. No serious adverse events (SAEs) have been reported so far in over 18,000 sessions administered to healthy subjects, neurological and psychiatric patients, as summarized here. Moderate adverse events (AEs), as defined by the necessity to intervene, are rare, and include skin burns with tDCS due to suboptimal electrode-skin contact. Very rarely mania or hypomania was induced in patients with depression (11 documented cases), yet a causal relationship is difficult to prove because of the low incidence rate and limited numbers of subjects in controlled trials. Mild AEs (MAEs) include headache and fatigue following stimulation as well as prickling and burning sensations occurring during tDCS at peak-to-baseline intensities of 1-2mA and during tACS at higher peak-to-peak intensities above 2mA. The prevalence of published AEs is different in studies specifically assessing AEs vs. those not assessing them, being higher in the former. AEs are frequently reported by individuals receiving placebo stimulation. The profile of AEs in terms of frequency, magnitude and type is comparable in healthy and clinical populations, and this is also the case for more vulnerable populations, such as children, elderly persons, or pregnant women. Combined interventions (e.g., co-application of drugs, electrophysiological measurements, neuroimaging) were not associated with further safety issues. Safety is established for low-intensity 'conventional' TES defined as <4mA, up to 60min duration per day. Animal studies and modeling evidence indicate that brain injury could occur at predicted current densities in the brain of 6.3-13A/m2 that are over an order of magnitude above those produced by tDCS in humans. Using AC stimulation fewer AEs were reported compared to DC. In specific paradigms with amplitudes of up to 10mA, frequencies in the kHz range appear to be safe. In this paper we provide structured interviews and recommend their use in future controlled studies, in particular when trying to extend the parameters applied. We also discuss recent regulatory issues, reporting practices and ethical issues. These recommendations achieved consensus in a meeting, which took place in Göttingen, Germany, on September 6-7, 2016 and were refined thereafter by email correspondence.
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Affiliation(s)
- A Antal
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany.
| | - I Alekseichuk
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - M Bikson
- Department of Biomedical Engineering, The City College of New York, New York, USA
| | - J Brockmöller
- Department of Clinical Pharmacology, University Medical Center Goettingen, Germany
| | - A R Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27) and Interdisciplinary Center for Applied Neuromodulation University Hospital, University of São Paulo, São Paulo, Brazil
| | - R Chen
- Division of Neurology, Department of Medicine, University of Toronto and Krembil Research Institute, Toronto, Ontario, Canada
| | - L G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke NIH, Bethesda, USA
| | | | - J Ellrich
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Institute of Physiology and Pathophysiology, University of Erlangen-Nürnberg, Erlangen, Germany; EBS Technologies GmbH, Europarc Dreilinden, Germany
| | - A Flöel
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurologie, Greifswald, Germany
| | - F Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - M S George
- Brain Stimulation Division, Medical University of South Carolina, and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - R Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - J Haueisen
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, Germany
| | - C S Herrmann
- Experimental Psychology Lab, Department of Psychology, European Medical School, Carl von Ossietzky Universität, Oldenburg, Germany
| | - F C Hummel
- Defitech Chair of Clinical Neuroengineering, Centre of Neuroprosthetics (CNP) and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland
| | - J P Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, and EA 4391, Nerve Excitability and Therapeutic Team (ENT), Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - D Liebetanz
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - C K Loo
- School of Psychiatry & Black Dog Institute, University of New South Wales, Sydney, Australia
| | - C D McCaig
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - C Miniussi
- Center for Mind/Brain Sciences CIMeC, University of Trento, Rovereto, Italy; Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - P C Miranda
- Institute of Biophysics and Biomedical Engineering, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - V Moliadze
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein (UKSH), Campus Kiel, Christian-Albrechts-University, Kiel, Germany
| | - M A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, University Hospital Bergmannsheil, Bochum, Germany
| | - R Nowak
- Neuroelectrics, Barcelona, Spain
| | - F Padberg
- Department of Psychiatry and Psychotherapy, Munich Center for Brain Stimulation, Ludwig-Maximilian University Munich, Germany
| | - A Pascual-Leone
- Division of Cognitive Neurology, Harvard Medical Center and Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center, Boston, USA
| | - W Poppendieck
- Department of Information Technology, Mannheim University of Applied Sciences, Mannheim, Germany
| | - A Priori
- Center for Neurotechnology and Experimental Brain Therapeutich, Department of Health Sciences, University of Milan Italy; Deparment of Clinical Neurology, University Hospital Asst Santi Paolo E Carlo, Milan, Italy
| | - S Rossi
- Department of Medicine, Surgery and Neuroscience, Human Physiology Section and Neurology and Clinical Neurophysiology Section, Brain Investigation & Neuromodulation Lab, University of Siena, Italy
| | - P M Rossini
- Area of Neuroscience, Institute of Neurology, University Clinic A. Gemelli, Catholic University, Rome, Italy
| | | | - M A Rueger
- Department of Neurology, University Hospital of Cologne, Germany
| | | | | | - H R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Y Ugawa
- Department of Neurology, Fukushima Medical University, Fukushima, Japan; Fukushima Global Medical Science Center, Advanced Clinical Research Center, Fukushima Medical University, Japan
| | - A Wexler
- Department of Science, Technology & Society, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - U Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - M Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - W Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
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15
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Saya S, Killick E, Thomas S, Taylor N, Bancroft EK, Rothwell J, Benafif S, Dias A, Mikropoulos C, Pope J, Chamberlain A, Gunapala R, Izatt L, Side L, Walker L, Tomkins S, Cook J, Barwell J, Wiles V, Limb L, Eccles D, Leach MO, Shanley S, Gilbert FJ, Hanson H, Gallagher D, Rajashanker B, Whitehouse RW, Koh DM, Sohaib SA, Evans DG, Eeles RA. Baseline results from the UK SIGNIFY study: a whole-body MRI screening study in TP53 mutation carriers and matched controls. Fam Cancer 2017; 16:433-440. [PMID: 28091804 PMCID: PMC5487773 DOI: 10.1007/s10689-017-9965-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the United Kingdom, current screening guidelines for TP53 germline mutation carriers solely recommends annual breast MRI, despite the wide spectrum of malignancies typically seen in this group. This study sought to investigate the role of one-off non-contrast whole-body MRI (WB MRI) in the screening of asymptomatic TP53 mutation carriers. 44 TP53 mutation carriers and 44 population controls were recruited. Scans were read by radiologists blinded to participant carrier status. The incidence of malignancies diagnosed in TP53 mutation carriers against general population controls was calculated. The incidences of non-malignant relevant disease and irrelevant disease were measured, as well as the number of investigations required to determine relevance of findings. In TP53 mutation carriers, 6 of 44 (13.6, 95% CI 5.2-27.4%) participants were diagnosed with cancer during the study, all of which would be considered life threatening if untreated. Two were found to have two primary cancers. Two participants with cancer had abnormalities on the MRI which were initially thought to be benign (a pericardial cyst and a uterine fibroid) but transpired to be sarcomas. No controls were diagnosed with cancer. Fifteen carriers (34.1, 95% CI 20.5-49.9%) and seven controls (15.9, 95% CI 6.7-30.1%) underwent further investigations following the WB MRI for abnormalities that transpired to be benign (p = 0.049). The cancer detection rate in this group justifies a minimum baseline non-contrast WB MRI in germline TP53 mutation carriers. This should be adopted into national guidelines for management of adult TP53 mutation carriers in addition to the current practice of contrast enhanced breast MRI imaging.
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Affiliation(s)
- Sibel Saya
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
| | - Emma Killick
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | | | - Jeanette Rothwell
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Sarah Benafif
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
| | - Alexander Dias
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
| | - Christos Mikropoulos
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
- Cancer Unit, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Jenny Pope
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
| | - Anthony Chamberlain
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
| | | | - Louise Izatt
- Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Lucy Side
- Great Ormond Street Hospital & UCL Institute for Women's Health, London, UK
| | | | - Susan Tomkins
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jackie Cook
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | | | | | - Diana Eccles
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Martin O Leach
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Susan Shanley
- Royal Marsden NHS Foundation Trust, London, UK
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | - Bala Rajashanker
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | - Dow-Mu Koh
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - D Gareth Evans
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Rosalind A Eeles
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK.
- Royal Marsden NHS Foundation Trust, London, UK.
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16
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Baban C, Mc Kiernan J, Devane L, Rothwell J, Evoy D, Geraghty J, O’Doherty A, Quinn C, D’Arcy C, McDermott E, Prichard R. The incidence and consequences of escape from hormonal manipulation in elderly breast cancer patients. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.01.089] [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: 10/19/2022] Open
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17
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Rothwell J. Understanding and improving mechanisms of non-invasive brain stimulation. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Samusyte G, Bostock H, Rothwell J, Koltzenburg M. P157 Reliability of threshold tracking technique for short interval intracortical inhibition. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2016.10.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Muthalib M, Cabibel V, Rothwell J, Teo W, Perrey S. Effects of HD-tDCS and crossed-facilitation on interhemispheric interactions. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Maruyama A, Ono K, Sato D, Yamashiro Y, Nuruki A, Nakamura Y, Touge T, Rothwell J. Could Pinch force MVC be improved by training when coupled with pairs at 2.0ms of threshold TMS pulses? Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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Antelmi E, Di Stasio F, Rocchi L, Erro R, Liguori R, Ganos C, Brugger F, Teo J, Berardelli A, Rothwell J, Bhatia KP. Corrigendum to "Impaired eye blink classical conditioning distinguishes dystonic patients with and without tremor" [Park. Relat. Disord. 31 (2016) 23-27]. Parkinsonism Relat Disord 2016; 35:102. [PMID: 27989567 DOI: 10.1016/j.parkreldis.2016.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- E Antelmi
- Department of Biomedical and Neuromotor Sciences, University of Bologna and IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK.
| | - F Di Stasio
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - L Rocchi
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - R Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - R Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna and IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - C Ganos
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - F Brugger
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - J Teo
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - A Berardelli
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - J Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - K P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
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22
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McCartan DP, Prichard RS, MacDermott RJ, Rothwell J, Geraghty J, Evoy D, Quinn CM, Skehan SJ, O'Doherty A, McDermott EW. Role of bone scan in addition to CT in patients with breast cancer selected for systemic staging. Br J Surg 2016; 103:839-44. [DOI: 10.1002/bjs.10124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/04/2015] [Accepted: 01/05/2016] [Indexed: 01/05/2023]
Abstract
Abstract
Background
The majority of women with breast cancer present with localized disease. The optimal strategy for identifying patients with metastatic disease at diagnosis remains unclear. The aim of this study was to evaluate the additional diagnostic yield from isotope bone scanning when added to CT staging of the thorax, abdomen and pelvis (CT-TAP) in patients with newly diagnosed breast cancer.
Methods
All patients diagnosed with breast cancer who underwent staging CT-TAP and bone scan between 2011 and 2013 were identified from a prospective database of a tertiary referral breast cancer centre that provides a symptomatic and population-based screening breast service. Criteria for staging included: biopsy-proven axillary nodal metastases; planned neoadjuvant chemotherapy or mastectomy; locally advanced or inflammatory breast cancer and symptoms suggestive of metastases.
Results
A total of 631 patients underwent staging by CT-TAP and bone scan. Of these, 69 patients (10·9 per cent) had distant metastasis at presentation, with disease confined to a single organ in 49 patients (71 per cent) and 20 (29 per cent) having metastatic deposits in multiple organs. Bone metastasis was the most common site; 39 of 49 patients had bone metastasis alone and 12 had a single isolated metastatic deposit. All but two of these were to the axial skeleton. No preoperative histological factors identified a cohort of patients at risk of metastatic disease. Omission of the bone scan in systemic staging would have resulted in a false-negative rate of 0·8 per cent.
Conclusion
For patients diagnosed with breast cancer, CT-TAP is a satisfactory stand-alone investigation for systemic staging.
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Affiliation(s)
- D P McCartan
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - R S Prichard
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - R J MacDermott
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - J Rothwell
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - J Geraghty
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - D Evoy
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - C M Quinn
- Department of Pathology, St Vincent's University Hospital, Dublin, Ireland
| | - S J Skehan
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - A O'Doherty
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - E W McDermott
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
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23
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Triccas LT, Burridge J, Hughes A, Verheyden G, Desikan M, Rothwell J. A double-blinded randomised controlled trial exploring the effect of anodal transcranial direct current stimulation and uni-lateral robot therapy for the impaired upper limb in sub-acute and chronic stroke. NeuroRehabilitation 2015; 37:181-91. [DOI: 10.3233/nre-151251] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - J.H. Burridge
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - A. Hughes
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - G. Verheyden
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - M. Desikan
- Sobell Department of Motor Neuroscience, Institute of Neurology, University College of London, London, UK
| | - J. Rothwell
- Sobell Department of Motor Neuroscience, Institute of Neurology, University College of London, London, UK
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24
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Boland M, Prichard R, Daskalova I, Lowery A, Evoy D, Geraghty J, Rothwell J, Quinn C, O'Doherty A, McDermott E. Axillary nodal burden in primary breast cancer patients with positive pre-operative ultrasound guided fine needle aspiration cytology: Management in the era of ACOSOG Z011. Eur J Surg Oncol 2015; 41:559-65. [DOI: 10.1016/j.ejso.2015.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/22/2014] [Accepted: 01/10/2015] [Indexed: 01/17/2023] Open
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25
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Meshkat B, Prichard RS, Al-Hilli Z, Bass GA, Quinn C, O'Doherty A, Rothwell J, Geraghty J, Evoy D, McDermott EW. A comparison of clinical-pathological characteristics between symptomatic and interval breast cancer. Breast 2015; 24:278-82. [PMID: 25771080 DOI: 10.1016/j.breast.2015.02.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 09/22/2014] [Revised: 02/09/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND An association between interval breast cancers (cancer detected after a normal mammogram and before the next scheduled mammogram) and tumour aggressiveness has been postulated which may reflect their relatively poor overall prognosis. The aim of this study was to evaluate known prognostic features of screen detected breast cancers compared to interval breast cancers. METHODS Patients diagnosed with breast cancer between January 2010 and 2013 at a single unit of the National Breast Screening Program (NBSP) in Ireland and those between the ages of 50 and 65 diagnosed at a symptomatic breast clinic were included in the study. Patients who had not had a screening mammogram within the proceeding two years or had a previous history of breast cancer were excluded. Data were retrospectively collected on patient demographics, tumour type, grade, hormone receptor status and stage of disease at presentation. RESULTS There were 915 patients included in the study, with 92% (n = 844) diagnosed through the NBSP. Ductal carcinoma in-situ accounted for 19% (n = 160) of screen-detected breast cancers but only 2.8% of interval cancers (p < 0.05). The most common type of invasive cancer was invasive ductal carcinoma. Tumour grade was significantly higher in interval breast cancers (p < 0.05). Interval cancers were identified at a significantly higher stage (Stage 1 versus 2; p < 0.001) than screen-detected cancers. Interval breast cancers were less likely to be ER positive (76% versus 81%; p < 0.05) and significantly more likely to over-express HER2 (20% vs 10%, p < 0.05) than screen-detected cancers. CONCLUSION This study highlights the fact that interval cancers appear to have a number of adverse prognostic markers for overall breast cancer survival when compared to women with screen-detected breast cancers. Interval cancers were more likely to be invasive, of a higher grade and stage and with a greater predominance of HER2 and triple negative molecular subtypes. Therefore this heterogeneous group of tumours may be biologically more aggressive and account disproportionately to overall breast cancer mortality.
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Affiliation(s)
- B Meshkat
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland.
| | - R S Prichard
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - Z Al-Hilli
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - G A Bass
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - C Quinn
- Department of Histopathology, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - A O'Doherty
- Department of Radiology, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - J Rothwell
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - J Geraghty
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - D Evoy
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - E W McDermott
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
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26
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Ansari N, Shojaei M, Rostami R, Daneshfar A, Rothwell J. The Effect Of rTMS On Visual Short Term And Spatial Recognition Memory Of Female Elite Volleyball Players Of Iran. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Muthalib M, Re R, Besson P, Perrey S, Rothwell J, Contini D, Spinelli L, Torricelli A. Transcranial direct current stimulation induced modulation of cortical haemodynamics: A comparison between time-domain and continuous-wave functional near-infrared spectroscopy. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Chieffo R, Ciocca M, Leocani L, Miranda P, Rothwell J. 113. Short-term effect of different tdcs intensities on motor cortex excitability. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Green J, Biehal N, Roberts C, Dixon J, Kay C, Parry E, Rothwell J, Roby A, Kapadia D, Scott S, Sinclair I. Authors' reply. Br J Psychiatry 2014; 205:498-9. [PMID: 25452605 DOI: 10.1192/bjp.205.6.498b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jonathan Green
- Jonathan Green, Professor of Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre. ; N. Biehal, Department of Social Policy and Social Work, University of York, York; C. Roberts, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, Social Policy Research Unit (SPRU), University of York, York; C. Kay, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; E. Parry, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, A. Roby, D. Kapadia, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; S. Scott, Institute of Psychiatry, King's College London, London; I. Sinclair, Social Policy Research Unit (SPRU), University of York, York, UK
| | - N Biehal
- Jonathan Green, Professor of Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre. ; N. Biehal, Department of Social Policy and Social Work, University of York, York; C. Roberts, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, Social Policy Research Unit (SPRU), University of York, York; C. Kay, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; E. Parry, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, A. Roby, D. Kapadia, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; S. Scott, Institute of Psychiatry, King's College London, London; I. Sinclair, Social Policy Research Unit (SPRU), University of York, York, UK
| | - C Roberts
- Jonathan Green, Professor of Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre. ; N. Biehal, Department of Social Policy and Social Work, University of York, York; C. Roberts, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, Social Policy Research Unit (SPRU), University of York, York; C. Kay, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; E. Parry, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, A. Roby, D. Kapadia, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; S. Scott, Institute of Psychiatry, King's College London, London; I. Sinclair, Social Policy Research Unit (SPRU), University of York, York, UK
| | - J Dixon
- Jonathan Green, Professor of Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre. ; N. Biehal, Department of Social Policy and Social Work, University of York, York; C. Roberts, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, Social Policy Research Unit (SPRU), University of York, York; C. Kay, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; E. Parry, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, A. Roby, D. Kapadia, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; S. Scott, Institute of Psychiatry, King's College London, London; I. Sinclair, Social Policy Research Unit (SPRU), University of York, York, UK
| | - C Kay
- Jonathan Green, Professor of Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre. ; N. Biehal, Department of Social Policy and Social Work, University of York, York; C. Roberts, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, Social Policy Research Unit (SPRU), University of York, York; C. Kay, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; E. Parry, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, A. Roby, D. Kapadia, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; S. Scott, Institute of Psychiatry, King's College London, London; I. Sinclair, Social Policy Research Unit (SPRU), University of York, York, UK
| | - E Parry
- Jonathan Green, Professor of Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre. ; N. Biehal, Department of Social Policy and Social Work, University of York, York; C. Roberts, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, Social Policy Research Unit (SPRU), University of York, York; C. Kay, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; E. Parry, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, A. Roby, D. Kapadia, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; S. Scott, Institute of Psychiatry, King's College London, London; I. Sinclair, Social Policy Research Unit (SPRU), University of York, York, UK
| | - J Rothwell
- Jonathan Green, Professor of Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre. ; N. Biehal, Department of Social Policy and Social Work, University of York, York; C. Roberts, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, Social Policy Research Unit (SPRU), University of York, York; C. Kay, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; E. Parry, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, A. Roby, D. Kapadia, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; S. Scott, Institute of Psychiatry, King's College London, London; I. Sinclair, Social Policy Research Unit (SPRU), University of York, York, UK
| | - A Roby
- Jonathan Green, Professor of Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre. ; N. Biehal, Department of Social Policy and Social Work, University of York, York; C. Roberts, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, Social Policy Research Unit (SPRU), University of York, York; C. Kay, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; E. Parry, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, A. Roby, D. Kapadia, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; S. Scott, Institute of Psychiatry, King's College London, London; I. Sinclair, Social Policy Research Unit (SPRU), University of York, York, UK
| | - D Kapadia
- Jonathan Green, Professor of Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre. ; N. Biehal, Department of Social Policy and Social Work, University of York, York; C. Roberts, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, Social Policy Research Unit (SPRU), University of York, York; C. Kay, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; E. Parry, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, A. Roby, D. Kapadia, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; S. Scott, Institute of Psychiatry, King's College London, London; I. Sinclair, Social Policy Research Unit (SPRU), University of York, York, UK
| | - S Scott
- Jonathan Green, Professor of Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre. ; N. Biehal, Department of Social Policy and Social Work, University of York, York; C. Roberts, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, Social Policy Research Unit (SPRU), University of York, York; C. Kay, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; E. Parry, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, A. Roby, D. Kapadia, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; S. Scott, Institute of Psychiatry, King's College London, London; I. Sinclair, Social Policy Research Unit (SPRU), University of York, York, UK
| | - I Sinclair
- Jonathan Green, Professor of Child and Adolescent Psychiatry, University of Manchester and Manchester Academic Health Sciences Centre. ; N. Biehal, Department of Social Policy and Social Work, University of York, York; C. Roberts, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, Social Policy Research Unit (SPRU), University of York, York; C. Kay, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; E. Parry, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, A. Roby, D. Kapadia, Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester; S. Scott, Institute of Psychiatry, King's College London, London; I. Sinclair, Social Policy Research Unit (SPRU), University of York, York, UK
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Bancroft EK, Page EC, Castro E, Lilja H, Vickers A, Sjoberg D, Assel M, Foster CS, Mitchell G, Drew K, Mæhle L, Axcrona K, Evans DG, Bulman B, Eccles D, McBride D, van Asperen C, Vasen H, Kiemeney LA, Ringelberg J, Cybulski C, Wokolorczyk D, Selkirk C, Hulick PJ, Bojesen A, Skytte AB, Lam J, Taylor L, Oldenburg R, Cremers R, Verhaegh G, van Zelst-Stams WA, Oosterwijk JC, Blanco I, Salinas M, Cook J, Rosario DJ, Buys S, Conner T, Ausems MG, Ong KR, Hoffman J, Domchek S, Powers J, Teixeira MR, Maia S, Foulkes WD, Taherian N, Ruijs M, Helderman-van den Enden AT, Izatt L, Davidson R, Adank MA, Walker L, Schmutzler R, Tucker K, Kirk J, Hodgson S, Harris M, Douglas F, Lindeman GJ, Zgajnar J, Tischkowitz M, Clowes VE, Susman R, Ramón y Cajal T, Patcher N, Gadea N, Spigelman A, van Os T, Liljegren A, Side L, Brewer C, Brady AF, Donaldson A, Stefansdottir V, Friedman E, Chen-Shtoyerman R, Amor DJ, Copakova L, Barwell J, Giri VN, Murthy V, Nicolai N, Teo SH, Greenhalgh L, Strom S, Henderson A, McGrath J, Gallagher D, Aaronson N, Ardern-Jones A, Bangma C, Dearnaley D, Costello P, Eyfjord J, Rothwell J, Falconer A, Gronberg H, Hamdy FC, Johannsson O, Khoo V, Kote-Jarai Z, Lubinski J, Axcrona U, Melia J, McKinley J, Mitra AV, Moynihan C, Rennert G, Suri M, Wilson P, Killick E, Moss S, Eeles RA. Targeted prostate cancer screening in BRCA1 and BRCA2 mutation carriers: results from the initial screening round of the IMPACT study. Eur Urol 2014; 66:489-99. [PMID: 24484606 PMCID: PMC4105321 DOI: 10.1016/j.eururo.2014.01.003] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 01/02/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND Men with germline breast cancer 1, early onset (BRCA1) or breast cancer 2, early onset (BRCA2) gene mutations have a higher risk of developing prostate cancer (PCa) than noncarriers. IMPACT (Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in BRCA1/2 mutation carriers and controls) is an international consortium of 62 centres in 20 countries evaluating the use of targeted PCa screening in men with BRCA1/2 mutations. OBJECTIVE To report the first year's screening results for all men at enrollment in the study. DESIGN, SETTING AND PARTICIPANTS We recruited men aged 40-69 yr with germline BRCA1/2 mutations and a control group of men who have tested negative for a pathogenic BRCA1 or BRCA2 mutation known to be present in their families. All men underwent prostate-specific antigen (PSA) testing at enrollment, and those men with PSA >3 ng/ml were offered prostate biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PSA levels, PCa incidence, and tumour characteristics were evaluated. The Fisher exact test was used to compare the number of PCa cases among groups and the differences among disease types. RESULTS AND LIMITATIONS We recruited 2481 men (791 BRCA1 carriers, 531 BRCA1 controls; 731 BRCA2 carriers, 428 BRCA2 controls). A total of 199 men (8%) presented with PSA >3.0 ng/ml, 162 biopsies were performed, and 59 PCas were diagnosed (18 BRCA1 carriers, 10 BRCA1 controls; 24 BRCA2 carriers, 7 BRCA2 controls); 66% of the tumours were classified as intermediate- or high-risk disease. The positive predictive value (PPV) for biopsy using a PSA threshold of 3.0 ng/ml in BRCA2 mutation carriers was 48%-double the PPV reported in population screening studies. A significant difference in detecting intermediate- or high-risk disease was observed in BRCA2 carriers. Ninety-five percent of the men were white, thus the results cannot be generalised to all ethnic groups. CONCLUSIONS The IMPACT screening network will be useful for targeted PCa screening studies in men with germline genetic risk variants as they are discovered. These preliminary results support the use of targeted PSA screening based on BRCA genotype and show that this screening yields a high proportion of aggressive disease. PATIENT SUMMARY In this report, we demonstrate that germline genetic markers can be used to identify men at higher risk of prostate cancer. Targeting screening at these men resulted in the identification of tumours that were more likely to require treatment.
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Affiliation(s)
- Elizabeth K Bancroft
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK; Oncogenetics Team, Institute of Cancer Research, London, UK
| | | | - Elena Castro
- Oncogenetics Team, Institute of Cancer Research, London, UK; Spanish National Cancer Research Centre, Madrid, Spain
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Institute of Biomedical Technology, University of Tampere, Tampere, Finland; Department of Laboratory Medicine, Lund University, Malmö, Sweden
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daniel Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Gillian Mitchell
- Familial Cancer Centre, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Drew
- Familial Cancer Centre, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | | | | | - D Gareth Evans
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Barbara Bulman
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Diana Eccles
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Donna McBride
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | | | - Hans Vasen
- Foundation for the Detection of Hereditary Tumours, Leiden, The Netherlands
| | | | - Janneke Ringelberg
- Foundation for the Detection of Hereditary Tumours, Leiden, The Netherlands
| | - Cezary Cybulski
- International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
| | - Dominika Wokolorczyk
- International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
| | - Christina Selkirk
- Center for Medical Genetics, NorthShore University HealthSystem, Evanston, IL, USA
| | - Peter J Hulick
- Center for Medical Genetics, NorthShore University HealthSystem, Evanston, IL, USA; Priztker School of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | - Jimmy Lam
- Department of Urology, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Louise Taylor
- Department of Urology, Repatriation General Hospital, Daw Park, South Australia, Australia
| | | | - Ruben Cremers
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gerald Verhaegh
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Jan C Oosterwijk
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ignacio Blanco
- Hereditary Cancer Program, Catalonian Institute of Oncology, L'Hospitalet, Barcelona, Spain
| | - Monica Salinas
- Hereditary Cancer Program, Catalonian Institute of Oncology, L'Hospitalet, Barcelona, Spain
| | - Jackie Cook
- Sheffield Clinical Genetics Service, Sheffield Children's Hospital, Sheffield, UK
| | | | - Saundra Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Tom Conner
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Margreet G Ausems
- Department of Medical Genetics, University Medical Centre Utrecht, The Netherlands
| | - Kai-ren Ong
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham, UK
| | - Jonathan Hoffman
- Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham, UK
| | - Susan Domchek
- Basser Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacquelyn Powers
- Basser Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Manuel R Teixeira
- Genetics Department and Research Center, Portuguese Oncology Institute, Porto, Portugal; Biomedical Sciences Institute (ICBAS), Porto University, Porto, Portugal
| | - Sofia Maia
- Genetics Department and Research Center, Portuguese Oncology Institute, Porto, Portugal
| | - William D Foulkes
- McGill Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Nassim Taherian
- McGill Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Marielle Ruijs
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Louise Izatt
- South East Thames Genetics Service, London, UK, Guy's Hospital, London, UK
| | - Rosemarie Davidson
- Duncan Guthrie Institute of Medical Genetics, Yorkhill NHS Trust, Glasgow, UK
| | - Muriel A Adank
- VU University Medical Center, Amsterdam, The Netherlands
| | | | - Rita Schmutzler
- Center of Familial Breast and Ovarian Cancer, University Hospital of Cologne, Cologne, Germany
| | - Kathy Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Judy Kirk
- Familial Cancer Service, Westmead Hospital, Westmead, Sydney, New South Wales, Australia; Sydney Medical School (University of Sydney) at Westmead Millennium Institute, Sydney, NSW, Australia
| | | | - Marion Harris
- Familial Cancer Centre, Monash Health, Clayton, Victoria, Australia
| | - Fiona Douglas
- Northern Genetics Service, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Geoffrey J Lindeman
- Familial Cancer Centre, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Stem Cells and Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Marc Tischkowitz
- Addenbrooke's Hospital, Cambridge, UK; The University of Cambridge, Cambridge, UK
| | - Virginia E Clowes
- Addenbrooke's Hospital, Cambridge, UK; The University of Cambridge, Cambridge, UK
| | - Rachel Susman
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | | | - Nicholas Patcher
- Genetic Services of WA, King Edward Memorial Hospital, Subiaco, WA, Australia; Department of Paediatrics, University of Western Australia, Perth, WA, Australia
| | - Neus Gadea
- Hospital Vall d'Hebron, Barcelona, Spain
| | - Allan Spigelman
- Hunter Family Cancer Service, Waratah, New South Wales, Australia; University of New South Wales, St. Vincent's Clinical School, Darlinghurst, New South Wales, Australia; Hereditary Cancer Clinic, The Kinghorn Cancer Centre, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Theo van Os
- Academic Medical Center, Amsterdam, The Netherlands
| | - Annelie Liljegren
- Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Lucy Side
- NE Thames Regional Genetics Service, Institute of Child Health, London, UK
| | - Carole Brewer
- Peninsular Genetics, Derriford Hospital, Plymouth, UK; Royal Devon and Exeter Hospital, Exeter, UK
| | - Angela F Brady
- North West Thames Regional Genetics Service, Kennedy-Galton Centre, North West London Hospitals NHS Trust, Harrow, UK
| | | | | | | | | | - David J Amor
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | | | - Julian Barwell
- University of Leicester, Leicester, UK; University Hospitals Leicester, Leicester, UK
| | - Veda N Giri
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | | | - Soo-Hwang Teo
- Cancer Research Initiatives Foundation, Subang Jaya Medical Centre, Selangor, Darul Ehsan, Malaysia
| | - Lynn Greenhalgh
- Clinical Genetics, Royal Liverpool Children's Hospital, Liverpool, UK
| | - Sara Strom
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Alex Henderson
- Northern Genetics Service, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | | | | | - Neil Aaronson
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Audrey Ardern-Jones
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Chris Bangma
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - David Dearnaley
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK; Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Philandra Costello
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Jorunn Eyfjord
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Jeanette Rothwell
- Genetic Medicine, Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | | | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Churchill Hospital, Headington, Oxford, UK
| | - Oskar Johannsson
- Landspitali-the National University Hospital of Iceland, Reykjavik, Iceland
| | - Vincent Khoo
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | | | - Jan Lubinski
- International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
| | | | - Jane Melia
- The University of Cambridge, Cambridge, UK
| | - Joanne McKinley
- Familial Cancer Centre, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Anita V Mitra
- Oncogenetics Team, Institute of Cancer Research, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - Clare Moynihan
- Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Gad Rennert
- CHS National Cancer Control Center, Carmel Medical Center, Haifa, Israel
| | | | | | - Emma Killick
- Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK; Oncogenetics Team, Institute of Cancer Research, London, UK
| | - Sue Moss
- Queen Mary University of London, London, UK
| | - Rosalind A Eeles
- Oncogenetics Team, Institute of Cancer Research, London, UK; Cancer Genetics Unit and Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK.
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Hammerbeck U, Hoad D, Yousif N, Quattrocchi G, Diedrichsen J, Greenwood R, Rothwell J. P357: Motor learning differences due to training with an emphasis on fast movement or movement accuracy for reaching movements after stroke. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50471-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gazarian K, Davare M, Davis E, Haggard P, Rothwell J, Ward N. P1072: Effector-specific motor resonance is modulated by the type of observed action. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)51101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chieffo R, Ciocca M, Leocani L, Miranda P, Rothwell J. P270: Short-term effect of different tDCS intensities on motor cortex excitability. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Strigaro G, Ruge D, Chen JC, Marshall L, Desikan M, Rothwell J, Cantello R. P41: Visuomotor functional connectivity: a TMS study. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50204-0] [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: 10/25/2022]
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Popa T, Milani P, Richard A, Brochard V, Tranchant C, Rothwell J, Vidailhet M, Meunier S, Roze E. P926: On the neurophysiology of myoclonus-dystonia and why it stands apart from other primary dystonia. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50962-5] [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: 10/25/2022]
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Ciocca M, Priori A, Rothwell J. P261: Transcutaneous direct current stimulation on cervical spinal cord: effects on H-reflex and spinal reflexes. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50382-3] [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: 10/25/2022]
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Kuppuswamy A, Clark E, Turner I, Rothwell J, Ward N. P349: Fatigue after stroke is related to motor cortex “restfulness” and not to physical or cognitive functional ability. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50463-4] [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: 10/25/2022]
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Rawji V, Ciocca M, Zacharia A, Rothwell J. P266: Investigating the effect of current flow on cortical excitability using bipolar tDCS. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50387-2] [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: 10/25/2022]
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Murase N, Cengiz B, Rothwell J. P1074: The role of somatosensory input in paired associative stimulation. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)51103-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ciocca M, Cappon D, Priori A, Rothwell J. P262: High-definition transcranial direct current stimulation (HD-tDCS): a TMS study to investigate focal motor cortex (M1) excitability. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50383-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Strigaro G, Hamada M, Cantello R, Rothwell J. P675: Interneuron networks involved in human associative plasticity. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50767-5] [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: 10/25/2022]
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Rothwell J. Non-invasive brain stimulation and rehabilitation. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.1551] [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: 10/25/2022]
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Green JM, Biehal N, Roberts C, Dixon J, Kay C, Parry E, Rothwell J, Roby A, Kapadia D, Scott S, Sinclair I. Multidimensional Treatment Foster Care for Adolescents in English care: randomised trial and observational cohort evaluation. Br J Psychiatry 2014; 204:214-21. [PMID: 24357575 DOI: 10.1192/bjp.bp.113.131466] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Children in care often have poor outcomes. There is a lack of evaluative research into intervention options. AIMS To examine the efficacy of Multidimensional Treatment Foster Care for Adolescents (MTFC-A) compared with usual care for young people at risk in foster care in England. METHOD A two-arm single (assessor) blinded randomised controlled trial (RCT) embedded within an observational quasi-experimental case-control study involving 219 young people aged 11-16 years (trial registration: ISRCTN 68038570). The primary outcome was the Child Global Assessment Scale (CGAS). Secondary outcomes were ratings of educational attendance, achievement and rate of offending. RESULTS The MTFC-A group showed a non-significant improvement in CGAS outcome in both the randomised cohort (n = 34, adjusted mean difference 1.3, 95% CI -7.1 to 9.7, P = 0.75) and in the trimmed observational cohort (n = 185, adjusted mean difference 0.95, 95% CI -2.38 to 4.29, P = 0.57). No significant effects were seen in secondary outcomes. There was a possible differential effect of the intervention according to antisocial behaviour. CONCLUSIONS There was no evidence that the use of MTFC-A resulted in better outcomes than usual care. The intervention may be more beneficial for young people with antisocial behaviour but less beneficial than usual treatment for those without.
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Affiliation(s)
- J M Green
- J. M. Green, BA, MA, MBBS, DCH, FRCPsych, Institute of Brain Behaviour and Mental Health, The University of Manchester, Manchester; N. Biehal, BA, MA, PhD, Department of Social Policy and Social Work, University of York, York; C. Roberts, BSc, MSc, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; J. Dixon, BA, MA, Social Policy Research Unit (SPRU), University of York, York; C. Kay, BSc, PhD, Institute of Brain Behaviour and Mental Health, The University of Manchester, Manchester; E. Parry, BA, MSc, Mood Disorders Centre, University of Exeter, Exeter; J. Rothwell, BSc, PhD, A. Roby, BSc, MSc, ClinPsyD, D. Kapadia, BSc, MSc, Institute of Brain Behaviour and Mental Health, The University of Manchester, Manchester; S. Scott, MB BChir, FRCP, FRCPsych, Institute of Psychiatry, King's College London, London; I. Sinclair, BA, PhD, Social Policy Research Unit (SPRU), University of York, York, UK
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O'Reilly EA, Aucharaz N, Kelly G, Al Azawi D, Prichard RS, Evoy D, Rothwell J, Geraghty J, O'Doherty A, Skehan S, Quinn C, McDermott E. Abstract P1-01-01: The value of isosulphan blue dye in addition to isotope scanning in the identification of the sentinel lymph node in breast cancer patients with a positive lymphoscintigraphy: A randomised controlled trial (ISRCTN 98849733). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-01-01] [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
Introduction
The advent of multimodal and targeted breast cancer treatment has seen a radical shift from aggressive surgical intervention to a more minimalist approach, both within the breast and axilla. Primary among these changes is the utilisation of the sentinel lymph node biopsy (SLNB) to detect disease within the axilla and a move away from an obligatory axillary clearance when the sentinel node is positive. This depends on the accurate identification of the SLN and initial studies describe a higher identification rate and a lower false negative rate with a dual tracer identification technique. This encompasses a combination of a blue / green dye and radio-labelled isotope. The use of blue dye has been, of itself, associated with significant morbidity and therefore many clinicians may opt for single tracer identification.
Aims
The aim of the current study was to determine whether the addition of blue dye to radio-isotope increased the positive SLN detection rate, where the SLN was identified pre-operatively on a lymphoscintigram.
Methods
A prospective randomised controlled trial comparing the combined techniques of isosulphan blue dye and isotope scanning versus isotope scanning alone was performed at a single tertiary referral centre. Ethical approval was obtained prior to commencing the study from the hospital ethics committee. Enrolment commenced in March 2010 and ceased in September 2012. The study design was a randomised open label controlled parallel group trial. The primary outcome measure was the effect of the omission of the blue dye on the identification of SLN if the lymphoscintigram was positive (1 -3 nodes identified).
Results
A total of 673 patients were included in the final analysis with 344 patients receiving the combination (blue dye and radio-isotope) and 329 patients who received radio-isotope scanning alone. The groups were evenly matched both demographically and pathologically. The mean age was 48 years (48.3 versus 47.7 years; P = 0.47), the mean tumour size was 23.1mm (23.2mm versus 23.0mm; p = 0.89) and there was no statistically significant difference in the grade of the tumours between the two groups (p = 0.58). Overall, there was no difference in the number of nodes retrieved between the two groups (563 versus 523; p = 0.30). Similarly, there was no difference in the number of positive lymph nodes that were identified between the two groups (107 versus 98; 23.8% versus 22%; p = 0.65).
Conclusions
The addition of isosulphan blue dye does not aid in the identification of the SLN in patients who have a positive lymphoscintigram when radioisotope colloid is used.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-01.
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Affiliation(s)
- EA O'Reilly
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - N Aucharaz
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - G Kelly
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - D Al Azawi
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - RS Prichard
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - D Evoy
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - J Rothwell
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - J Geraghty
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - A O'Doherty
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - S Skehan
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - C Quinn
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
| | - E McDermott
- St Vincent's Healthcare Group, Elm Park, Dublin, Ireland; University College Dublin, Dublin, Ireland; St. Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland; St Vincent's Healthcare Grouup, Elm Park, Dublin 4, Ireland
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Boland MR, Prichard RS, Daskalova I, Lowery AJ, Maguire A, Evoy D, Geraghty J, Rothwell J, Quinn CM, O'Doherty A, McDermott EW. Abstract P2-18-05: Axillary nodal burden in patients with a positive pre-operative ultrasound guided fine needle aspiration cytology. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p2-18-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Recent years have seen a dramatic shift to more conservative management of the axilla and the presence of a positive sentinel lymph node biopsy does not now automatically mandate an axillary clearance. This is based largely on data from the American College of Surgeons Oncology Group (ACOSOG) Z11 study, which failed to demonstrate a difference in local recurrence or overall survival when an axillary clearance was omitted in a highly selective group of patients with a positive sentinel lymph node. However, the presence of a positive pre-operative ultrasound guided axillary FNAC(Fine Needle Aspiration Cytology) may be representative of a higher burden of axillary disease.
Aim
Therefore, the aims of this study were firstly to quantify the actual nodal burden in breast cancer patients with a positive pre-operative ultrasound guided axillary FNAC and secondly to identify the number of patients who may have been spared an axillary clearance based on Z11 eligibility criteria.
Methods
A retrospective review of a prospectively maintained database within a tertiary breast cancer referral centre was performed. All patients with a positive pre-operative axillary FNAC were identified within a five year period (2007 – 2011). Demographic, tumour and biological characteristics and final nodal status were analysed. Eligibility for randomisation according to the Z11 criteria was assessed based on the final pathology and the number of patients who could have been spared an axillary clearance was identified.
Results
A total of 360 patients were identified with a positive axillary ultrasound guided FNAC. Sixty-three patients had no axillary surgery and three patients had recurrent disease, leaving a total of 294 for analysis. The mean age was 56 years (range 22 – 87). The mean size of the tumour was 31.3mm (range 4mm – 132mm) and the majority were an invasive grade 3 (57%) ductal carcinoma (84%). Luminal A (63%) was the commonest sub-type. The mean number of nodes removed at axillary clearance was 24 (range 7 – 58) while the mean number of positive nodes excised was 6 (range 0 – 47). Of these, the mean number of level I positive nodes was 4, level II was 1 and level III nodes was <1.
Overall a total of 78 patients had less than three positive nodes identified in the axilla and potentially may have been eligible for the Z11 study. However, when patients who had a mastectomy, neo-adjuvant chemotherapy were excluded and the presence of extra-capsular nodal involvement was accounted for only 19 (6.4%) patients may have been spared an axillary clearance.
Conclusions
The presence of nodal positivity on a pre-operative FNAC is associated with a higher burden of axillary disease. Only a minority of these patients would be able to avoid an axillary clearance in the setting of the recent Z11 study. Performing an axillary ultrasound and FNAC of suspicious nodes allows patients to avoid an unnecessary sentinel lymph node biopsy and proceed directly to an axillary clearance.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-18-05.
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Affiliation(s)
- MR Boland
- St Vincent's Healthcare Group, Dublin, Ireland
| | - RS Prichard
- St Vincent's Healthcare Group, Dublin, Ireland
| | - I Daskalova
- St Vincent's Healthcare Group, Dublin, Ireland
| | - AJ Lowery
- St Vincent's Healthcare Group, Dublin, Ireland
| | - A Maguire
- St Vincent's Healthcare Group, Dublin, Ireland
| | - D Evoy
- St Vincent's Healthcare Group, Dublin, Ireland
| | - J Geraghty
- St Vincent's Healthcare Group, Dublin, Ireland
| | - J Rothwell
- St Vincent's Healthcare Group, Dublin, Ireland
| | - CM Quinn
- St Vincent's Healthcare Group, Dublin, Ireland
| | - A O'Doherty
- St Vincent's Healthcare Group, Dublin, Ireland
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Rosenkranz K, Seibel J, Kacar A, Rothwell J. P 164. Short-term immobilisation of the hand changes excitability and plasticity of the human motor cortex. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khedr E, El Gamal NF, El-Fetoh NA, Khalifa H, Karim A, Rothwell J. P 234. Transcranial direct current stimulation and Alzheimer’s disease. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hasan A, Galea J, Casula E, Falkai P, Bestmann S, Rothwell J. P 43. Functional connectivity between the dorsolateral prefrontal cortex and the ipsilateral primary motor cortex. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.121] [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: 10/26/2022]
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Rothwell J. IS 16. Variability of the response to brain stimulation plasticity protocols: A concealed problem. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.035] [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: 10/26/2022]
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