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DiSilvestro JB, Haddad J, Robison K, Beffa L, Laprise J, Scalia-Wilbur J, Raker C, Clark MA, Lokich E, Hofstatter E, Dalela D, Brown A, Bradford L, Toland M, Stuckey A. Ovarian Cancer Risk-Reduction and Screening in BRCA1/2 Mutation Carriers. J Womens Health (Larchmt) 2024; 33:624-628. [PMID: 38488054 DOI: 10.1089/jwh.2023.0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Objective: To determine the utilization of risk-reducing strategies and screening protocols for ovarian cancer in female BRCA1/2 carriers. Methods: This study was a sub-analysis of female participants from a larger multicenter, cross-sectional survey of BRCA1/2 mutation carriers unaffected by cancer. The questionnaire was administered electronically via email at four institutions located in the northeast United States. Data were analyzed with Fisher's exact test. Results: The survey was completed by 104 female BRCA mutation carriers. BRCA subtypes included 54.3% BRCA2, 41.0% BRCA1, and 2.9% both. The age at which patients underwent genetic testing varied 21.2% were 18-24 years, 25.0% were 25-34 years, 29.8% were 35-44 years, and 24.0% were 45 years or older. Nearly, all respondents (97.1%) reported that a provider had discussed risk-reducing surgeries. Of the 79 females who underwent genetic testing before 45 years of age, 53.2% reported that a health care provider recommended taking combined oral contraceptive pills (COCs) to reduce their risk of ovarian cancer, and, of these women, 88.1% chose to use them. COCs were offered at higher rates among women who were younger at the age of genetic testing (18-24: 86%, 25-34: 62%, 35-44: 23%; p < 0.0001). Approximately half (55.8%) of the respondents reported having been offered increased screening for possible early detection of ovarian cancer, of which 81.0% chose to undergo screening. The majority utilized a combination of transvaginal ultrasound and serum CA125 measurements. There were no differences observed in screening utilization based on BRCA mutation type. Conclusion: In our cohort of female BRCA mutation carriers, risk-reducing surgery was offered to almost all women, whereas only half were offered risk-reducing medication and/or increased screening. Further investigation is needed to identify barriers to the utilization of risk-reducing strategies among this high-risk population.
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Affiliation(s)
- Jessica B DiSilvestro
- Department of Obstetrics-Gynecology, Program in Women's Oncology, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Jessica Haddad
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Katina Robison
- Department of Obstetrics-Gynecology, Program in Women's Oncology, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Lindsey Beffa
- Department of Obstetrics-Gynecology, Program in Women's Oncology, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Jessica Laprise
- Department of Obstetrics-Gynecology, Program in Women's Oncology, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Jennifer Scalia-Wilbur
- Department of Obstetrics-Gynecology, Program in Women's Oncology, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Christina Raker
- Department of Obstetrics-Gynecology, Program in Women's Oncology, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Melissa A Clark
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- The School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Elizabeth Lokich
- Department of Obstetrics-Gynecology, Program in Women's Oncology, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Erin Hofstatter
- Cancer Genetics and Prevention Program, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Disha Dalela
- Cancer Genetics and Prevention Program, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Amy Brown
- Department of Medical Oncology, Hartford Healthcare Cancer Institute, Hartford, Connecticut, USA
| | - Leslie Bradford
- Division of Gynecologic Oncology, Maine Medical Partners, Scarborough, Maine, USA
| | - Maris Toland
- Division of Gynecologic Oncology, Maine Medical Partners, Scarborough, Maine, USA
| | - Ashley Stuckey
- Department of Obstetrics-Gynecology, Program in Women's Oncology, Women and Infants Hospital, Providence, Rhode Island, USA
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Gebhart P, Singer CF, Gschwantler-Kaulich D. CA125 Levels in BRCA mutation carriers - a retrospective single center cohort study. BMC Cancer 2023; 23:610. [PMID: 37393265 DOI: 10.1186/s12885-023-11116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Ovarian cancer screening in BRCA1/2 mutation carriers utilizes assessment of carbohydrate antigen 125 (CA125) and transvaginal ultrasound (TVU), despite low sensitivity and specificity. We evaluated the association between CA125 levels, BRCA1/2 mutation status and menopausal status to provide more information on clinical conditions that may influence CA125 levels. METHODS We retrospectively analyzed repeated measurements of CA125 levels and clinical data of 466 women at high risk for ovarian cancer. CA125 levels were compared between women with and without deleterious mutations in BRCA1/2. Pearson's correlation was used to determine the association between age and CA125 serum level. Differences in CA125 levels were assessed with the Mann-Whitney U test. The effect of BRCA1/2 mutation status and menopausal status on the change in CA125 levels was determined by Two-factor analysis of variance (ANOVA). RESULTS The CA125 serum levels of premenopausal women (median, 13.8 kU/mL; range, 9.4 - 19.5 kU/mL) were significantly higher than in postmenopausal women (median, 10.4 kU/mL; range, 7.7 - 14.0 kU/mL; p < .001). There was no significant difference in the CA125 levels of BRCA mutation carriers and non-mutation carriers across all age groups (p = .612). When investigating the combined effect of BRCA1/2 mutation and menopausal status, variance analysis revealed a significant interaction between BRCA1/2 mutation status and menopausal status on CA125 levels (p < .001). There was a significant difference between the CA125 levels of premenopausal and postmenopausal women, with a large effect in BRCA mutation carriers (p < .001, d = 1.05), whereas in non-mutation carriers there was only a small effect (p < .001, d = 0.32). CONCLUSION Our findings suggest that hereditary mutations in BRCA1/2 affect the decline of CA125 levels with increasing age. To prove a definite effect of this mutation on the CA125 level, prospective trials need to be conducted to define new cut-off levels of CA 125 in mutation carriers and optimize ovarian cancer screening.
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Affiliation(s)
- P Gebhart
- Department of Obstetrics and Gynaecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- Department of Obstetrics and Gynecology, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - C F Singer
- Department of Obstetrics and Gynaecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Obstetrics and Gynecology, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - D Gschwantler-Kaulich
- Department of Obstetrics and Gynaecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Obstetrics and Gynecology, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Schrijver LH, Antoniou AC, Olsson H, Mooij TM, Roos-Blom MJ, Azarang L, Adlard J, Ahmed M, Barrowdale D, Davidson R, Donaldson A, Eeles R, Evans DG, Frost D, Henderson A, Izatt L, Ong KR, Bonadona V, Coupier I, Faivre L, Fricker JP, Gesta P, van Engelen K, Jager A, Menko FH, Mourits MJE, Singer CF, Tan YY, Foretova L, Navratilova M, Schmutzler RK, Ellberg C, Gerdes AM, Caldes T, Simard J, Olah E, Jakubowska A, Rantala J, Osorio A, Hopper JL, Phillips KA, Milne RL, Beth Terry M, Noguès C, Engel C, Kast K, Goldgar DE, van Leeuwen FE, Easton DF, Andrieu N, Rookus MA. Oral contraceptive use and ovarian cancer risk for BRCA1/2 mutation carriers: an international cohort study. Am J Obstet Gynecol 2021; 225:51.e1-51.e17. [PMID: 33493488 PMCID: PMC8278569 DOI: 10.1016/j.ajog.2021.01.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/30/2020] [Accepted: 01/19/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Ovarian cancer risk in BRCA1 and BRCA2 mutation carriers has been shown to decrease with longer duration of oral contraceptive use. Although the effects of using oral contraceptives in the general population are well established (approximately 50% risk reduction in ovarian cancer), the estimated risk reduction in mutation carriers is much less precise because of potential bias and small sample sizes. In addition, only a few studies on oral contraceptive use have examined the associations of duration of use, time since last use, starting age, and calendar year of start with risk of ovarian cancer. OBJECTIVE This study aimed to investigate in more detail the associations of various characteristics of oral contraceptive use and risk of ovarian cancer, to provide healthcare providers and carriers with better risk estimates. STUDY DESIGN In this international retrospective study, ovarian cancer risk associations were assessed using oral contraceptives data on 3989 BRCA1 and 2445 BRCA2 mutation carriers. Age-dependent-weighted Cox regression analyses were stratified by study and birth cohort and included breast cancer diagnosis as a covariate. To minimize survival bias, analyses were left truncated at 5 years before baseline questionnaire. Separate analyses were conducted for each aspect of oral contraceptive use and in a multivariate analysis, including all these aspects. In addition, the analysis of duration of oral contraceptive use was stratified by recency of use. RESULTS Oral contraceptives were less often used by mutation carriers who were diagnosed with ovarian cancer (ever use: 58.6% for BRCA1 and 53.5% BRCA2) than by unaffected carriers (ever use: 88.9% for BRCA1 and 80.7% for BRCA2). The median duration of use was 7 years for both BRCA1 and BRCA2 carriers who developed ovarian cancer and 9 and 8 years for unaffected BRCA1 and BRCA2 carriers with ovarian cancer, respectively. For BRCA1 mutation carriers, univariate analyses have shown that both a longer duration of oral contraceptive use and more recent oral contraceptive use were associated with a reduction in the risk of ovarian cancer. However, in multivariate analyses, including duration of use, age at first use, and time since last use, duration of oral contraceptive use proved to be the prominent protective factor (compared with <5 years: 5-9 years [hazard ratio, 0.67; 95% confidence interval, 0.40-1.12]; >10 years [hazard ratio, 0.37; 95% confidence interval, 0.19-0.73]; Ptrend=.008). The inverse association between duration of use and ovarian cancer risk persisted for more than 15 years (duration of ≥10 years; BRCA1 <15 years since last use [hazard ratio, 0.24; 95% confidence interval, 0.14-0.43]; BRCA1 >15 years since last use [hazard ratio, 0.56; 95% confidence interval, 0.18-0.59]). Univariate results for BRCA2 mutation carriers were similar but were inconclusive because of limited sample size. CONCLUSION For BRCA1 mutation carriers, longer duration of oral contraceptive use is associated with a greater reduction in ovarian cancer risk, and the protection is long term.
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Affiliation(s)
- Lieske H Schrijver
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Håkan Olsson
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Thea M Mooij
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marie-José Roos-Blom
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Leyla Azarang
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Julian Adlard
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Munaza Ahmed
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Daniel Barrowdale
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Rosemarie Davidson
- Department of Clinical Genetics, South Glasgow University Hospitals, Glasgow, United Kingdom
| | - Alan Donaldson
- Department of Clinical Genetics, St. Michael's Hospital, Bristol, United Kingdom
| | - Ros Eeles
- Oncogenetics Team, The Institute of Cancer Research, London, United Kingdom
| | - D Gareth Evans
- Division of Evolution and Genomic Sciences, Department of Genomic Medicine, Manchester Academic Health Sciences Centre, Manchester University, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Debra Frost
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Alex Henderson
- Centre for Life, Institute of Genetic Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Louise Izatt
- Clinical Genetics, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kai-Ren Ong
- West Midlands Regional Genetics Service, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Valérie Bonadona
- Université Claude Bernard Lyon 1, Villeurbanne, France; Centre National de la Recherche Scientifique, Unités Mixtes de Recherche, Lyon, France; Centre Léon Bérard, Unité de Prévention et Epidémiologie Génétique, Lyon, France
| | - Isabelle Coupier
- Centre Hospitalier Universitaire de Montpellier, Hôpital Arnaud de Villeneuve, Montpellier, France; Service de Génétique médicale et Oncogénétique, Montpellier, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche en Cancérologie de Marseille Val d'Aurel, Montpellier, France
| | - Laurence Faivre
- Genomic and Immunotherapy Medical Institute, Hôpital d'Enfants, Centre Hospitalier Universitaire de Dijon, Dijon, France; Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc, Dijon, France
| | | | - Paul Gesta
- Service d'Oncogénétique Régional Poitou-Charentes, Centre Hospitalier Georges Renon, Niort, France
| | - Klaartje van Engelen
- Department of Clinical Genetics, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Family Cancer Clinic, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Fred H Menko
- Family Cancer Clinic, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marian J E Mourits
- Department of Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Yen Y Tan
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Lenka Foretova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Marie Navratilova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Rita K Schmutzler
- Medical Faculty, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Carolina Ellberg
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Trinidad Caldes
- Molecular Oncology Laboratory, Hospital Clinico San Carlos, Instituto de Investigación Hospital Clínico San Carlos, Centro de Investigación Biomédica en Red de Cáncer, Martin Lagos, Madrid, Spain
| | - Jacques Simard
- Genomics Center, Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Québec City, Québec, Canada
| | - Edith Olah
- Department of Molecular Genetics, National Institute of Oncology, Budapest, Hungary
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland; Independent Laboratory of Molecular Biology and Genetic Diagnostics, Pomeranian Medical University, Szczecin, Poland
| | - Johanna Rantala
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Ana Osorio
- Human Genetics Group, Centro Nacional De Investigaciones Oncologicas, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly-Anne Phillips
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Catherine Noguès
- Département d'Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli-Calmettes, Marseille, France; Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Développement, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Aix-Marseille University, Marseille, France
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Germany
| | - Karin Kast
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - David E Goldgar
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Nadine Andrieu
- Institut National de la Santé et de la Recherche Médicale, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, Paris, France; Paris Sciences et Lettres University, Paris, France
| | - Matti A Rookus
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
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Bramanti SM, Trumello C, Lombardi L, Cavallo A, Stuppia L, Antonucci I, Babore A. Uncertainty following an inconclusive result from the BRCA1/2 genetic test: A review about psychological outcomes. World J Psychiatry 2021; 11:189-200. [PMID: 34046315 PMCID: PMC8134867 DOI: 10.5498/wjp.v11.i5.189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/28/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An inconclusive result from BRCA1/2 genetic testing indicates that a genetic variant of uncertain significance is detected. This case constitutes the majority of genetic test results, but studies specifically addressing the psychological adjustment of people with inconclusive results are scarce.
AIM To examine psychological outcomes of receiving an uninformative BRCA1/2 test result.
METHODS PubMed, PsychInfo, and Cochrane Central Register of Controlled Trials were screened for studies focusing on distress, anxiety, and depression levels in individuals with inconclusive genetic test results. This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method.
RESULTS Studies on psychological outcomes of inconclusive BRCA1/2 focused on general and specific distress, anxiety, and depression. Overall, they produced mixed results. These inconsistent findings are probably due to the uncertainty caused by this type of result, that may also influence the decisions of individuals about surveillance and prophylactic options, reducing their compliance. In addition, this review highlights specific risk and protective factors that affect psychological adjustment in individuals with an inconclusive genetic testing result.
CONCLUSION Individuals with inconclusive genetic test results need specific educational programs and support to better understand the meaning of their results in order to be able to make decisions about surveillance and prophylactic options.
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Affiliation(s)
- Sonia Monique Bramanti
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, University “G. d’Annunzio”, Chieti 66100, Italy
| | - Carmen Trumello
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, University “G. d’Annunzio”, Chieti 66100, Italy
| | - Lucia Lombardi
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, University “G. d’Annunzio”, Chieti 66100, Italy
| | - Alessandra Cavallo
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, University “G. d’Annunzio”, Chieti 66100, Italy
| | - Liborio Stuppia
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, University “G. d’Annunzio”, Chieti 66100, Italy
| | - Ivana Antonucci
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, University “G. d’Annunzio”, Chieti 66100, Italy
| | - Alessandra Babore
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, University “G. d’Annunzio”, Chieti 66100, Italy
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Haque R, Skates SJ, Armstrong MA, Lentz SE, Anderson M, Jiang W, Alvarado MM, Chillemi G, Shaw SF, Kushi LH, Powell CB. Feasibility, patient compliance and acceptability of ovarian cancer surveillance using two serum biomarkers and Risk of Ovarian Cancer Algorithm compared to standard ultrasound and CA 125 among women with BRCA mutations. Gynecol Oncol 2020; 157:521-528. [DOI: 10.1016/j.ygyno.2020.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/22/2020] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
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Conley CC, Agnese DM, Vadaparampil ST, Andersen BL. Factors associated with intentions for breast cancer risk management: Does risk group matter? Psychooncology 2019; 28:1119-1126. [PMID: 30889627 DOI: 10.1002/pon.5066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE National guidelines provide breast cancer (BC) risk management recommendations based on estimated lifetime risk. Despite this specificity, it is unclear if women's risk management intentions are or are not guideline concordant. To address this knowledge gap, women at varying risk levels reported intentions for risk-reducing behaviors. Factors associated with intentions, informed by the Health Beliefs Model, were also studied. METHODS Women with elevated BC risk (N = 103) were studied and categorized by risk level: moderate (15%-20%), high (greater than or equal to 20%), or very high (BRCA1/2 positive). Participants self-reported BC susceptibility, self-efficacy, and benefits, barriers, and intentions for risk-reducing mastectomy (RRM), risk-reducing salpingo-oophorectomy (RRSO), chemoprevention, improving diet or physical activity, and reducing alcohol use. RESULTS Groups significantly differed in RRSO intentions (P < .01); BRCA1/2 positive women had greater intentions for RRSO. Groups did not differ in intentions for RRM, chemoprevention, or lifestyle changes (Ps > .28). In hierarchical linear regression models examining Health Belief Model (HBM) factors, perceived susceptibility was associated with intentions for RRM (β = .169, P = .08). Perceived benefits was associated with intentions for RRM (β = .237, P = .02) and chemoprevention (β = .388, P < .01). Self-efficacy was associated with intentions for physical activity (β = .286, P < .01). CONCLUSIONS Consistent with guidelines, BRCA1/2 positive women reported greater intentions for RRSO, and risk groups did not differ in intentions for lifestyle changes. Notably, women's intentions for RRM and chemoprevention were guideline discordant; groups did not differ in intentions for these behaviors. Accounting for the effects of risk group, modifiable health beliefs were also associated with risk management intentions; these may represent targets for decision support interventions.
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Affiliation(s)
- Claire C Conley
- Department of Psychology, The Ohio State University, Columbus, Ohio.,Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Doreen M Agnese
- Department of Surgical Oncology, The Ohio State University, Columbus, Ohio
| | - Susan T Vadaparampil
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center, Tampa, Florida
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Dossa F, Cusimano MC, Sutradhar R, Metcalfe K, Little T, Lerner-Ellis J, Eisen A, Meschino WS, Baxter NN. Real-world health services utilisation and outcomes after BRCA1 and BRCA2 testing in Ontario, Canada: the What Comes Next Cohort Study protocol. BMJ Open 2018; 8:e025317. [PMID: 30181190 PMCID: PMC6129086 DOI: 10.1136/bmjopen-2018-025317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Women who have pathogenic mutations in the BRCA1 and BRCA2 genes are at greatly increased risks for breast and ovarian cancers. Although risk-reduction strategies can be undertaken by these women, knowledge regarding the uptake of these strategies is limited. Additionally, the healthcare behaviours of women who receive inconclusive test results are not known. This study protocol describes the creation of a retrospective cohort of women who have undergone genetic testing for BRCA1 and BRCA2, linking genetic test results with administrative data to quantify the uptake of risk-reduction strategies and to assess long-term cancer and non-cancer outcomes after genetic testing. METHODS AND ANALYSIS Approximately two-thirds of BRCA1 and BRCA2 testing in Ontario, Canada is performed at North York General Hospital (NYGH) and Mount Sinai Hospital (MSH), Toronto. We will use registries at these sites to assemble a cohort of approximately 17 000 adult women who underwent BRCA1 and BRCA2 testing from January 2007 to April 2016. Trained chart abstractors will obtain detailed information for all women tested over this period, including demographics, personal and family cancer histories and genetic test results. We will link these data to provincial administrative databases, enabling assessment of healthcare utilisation and long-term outcomes after testing. Study outcomes will include the uptake of breast cancer screening and prophylactic breast and ovarian surgery, cancer incidence and mortality and incidence of non-cancer health outcomes, including cardiovascular, osteoporotic and neurodegenerative disease. ETHICS AND DISSEMINATION This study has been approved by the Research Ethics Boards at NYGH (no 16-0035), MSH (no 13-0124) and Sunnybrook Health Sciences Centre (no 275-2016). We plan to disseminate research findings through peer-reviewed publications and presentations at national and international meetings.
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Affiliation(s)
- Fahima Dossa
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Maria C Cusimano
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Kelly Metcalfe
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Tari Little
- Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jordan Lerner-Ellis
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Andrea Eisen
- Sunnybrook Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Wendy S Meschino
- Department of Molecular Genetics, North York General Hospital, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Inadequate Rates of BRCA Testing with its Negative Consequences for Women with Epithelial Ovarian Cancer and their Families: an Overview of the Literature. Clin Oncol (R Coll Radiol) 2018; 30:472-483. [DOI: 10.1016/j.clon.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/18/2018] [Indexed: 12/19/2022]
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Schrijver LH, Olsson H, Phillips KA, Terry MB, Goldgar DE, Kast K, Engel C, Mooij TM, Adlard J, Barrowdale D, Davidson R, Eeles R, Ellis S, Evans DG, Frost D, Izatt L, Porteous ME, Side LE, Walker L, Berthet P, Bonadona V, Leroux D, Mouret-Fourme E, Venat-Bouvet L, Buys SS, Southey MC, John EM, Chung WK, Daly MB, Bane A, van Asperen CJ, Gómez Garcia EB, Mourits MJE, van Os TAM, Roos-Blom MJ, Friedlander ML, McLachlan SA, Singer CF, Tan YY, Foretova L, Navratilova M, Gerdes AM, Caldes T, Simard J, Olah E, Jakubowska A, Arver B, Osorio A, Noguès C, Andrieu N, Easton DF, van Leeuwen FE, Hopper JL, Milne RL, Antoniou AC, Rookus MA. Oral Contraceptive Use and Breast Cancer Risk: Retrospective and Prospective Analyses From a BRCA1 and BRCA2 Mutation Carrier Cohort Study. JNCI Cancer Spectr 2018; 2:pky023. [PMID: 31360853 PMCID: PMC6649757 DOI: 10.1093/jncics/pky023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/16/2018] [Accepted: 04/24/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND For BRCA1 and BRCA2 mutation carriers, the association between oral contraceptive preparation (OCP) use and breast cancer (BC) risk is still unclear. METHODS Breast camcer risk associations were estimated from OCP data on 6030 BRCA1 and 3809 BRCA2 mutation carriers using age-dependent Cox regression, stratified by study and birth cohort. Prospective, left-truncated retrospective and full-cohort retrospective analyses were performed. RESULTS For BRCA1 mutation carriers, OCP use was not associated with BC risk in prospective analyses (hazard ratio [HR] = 1.08, 95% confidence interval [CI] = 0.75 to 1.56), but in the left-truncated and full-cohort retrospective analyses, risks were increased by 26% (95% CI = 6% to 51%) and 39% (95% CI = 23% to 58%), respectively. For BRCA2 mutation carriers, OCP use was associated with BC risk in prospective analyses (HR = 1.75, 95% CI = 1.03 to 2.97), but retrospective analyses were inconsistent (left-truncated: HR = 1.06, 95% CI = 0.85 to 1.33; full cohort: HR = 1.52, 95% CI = 1.28 to 1.81). There was evidence of increasing risk with duration of use, especially before the first full-term pregnancy (BRCA1: both retrospective analyses, P < .001 and P = .001, respectively; BRCA2: full retrospective analysis, P = .002). CONCLUSIONS Prospective analyses did not show that past use of OCP is associated with an increased BC risk for BRCA1 mutation carriers in young middle-aged women (40-50 years). For BRCA2 mutation carriers, a causal association is also not likely at those ages. Findings between retrospective and prospective analyses were inconsistent and could be due to survival bias or a true association for younger women who were underrepresented in the prospective cohort. Given the uncertain safety of long-term OCP use for BRCA1/2 mutation carriers, indications other than contraception should be avoided and nonhormonal contraceptive methods should be discussed.
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Affiliation(s)
- Lieske H Schrijver
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Håkan Olsson
- Department of Oncology, Lund University Hospital
| | - Kelly-Anne Phillips
- Lund University, Lund, Sweden; Sir Peter MacCallum Department of Oncology
- Division of Cancer Medicine
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - David E Goldgar
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Karin Kast
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Christoph Engel
- Oncology and Pathology, Department of Clinical Sciences Lund
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Germany
| | - Thea M Mooij
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Julian Adlard
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, UK
| | - Daniel Barrowdale
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Rosemarie Davidson
- Department of Clinical Genetics, South Glasgow University Hospitals, Glasgow, UK
| | - Ros Eeles
- Oncogenetics Team, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Steve Ellis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - D Gareth Evans
- Genomic Medicine, Manchester Academic Health Sciences Centre, Institute of Human Development, Manchester University, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Debra Frost
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Louise Izatt
- Clinical Genetics, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Mary E Porteous
- South East of Scotland Regional Genetics Service, Western General Hospital, Edinburgh, UK
| | - Lucy E Side
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Lisa Walker
- Oxford Regional Genetics Service, Churchill Hospital, Oxford, UK
| | | | | | - Dominique Leroux
- CHU de Grenoble, Hôpital Couple-Enfant, Département de Génétique, Grenoble, France
| | | | | | - Saundra S Buys
- Department of Medicine, Huntsman Cancer Institute, Salt Lake City, UT
| | - Melissa C Southey
- Genetic Epidemiology Laboratory, Department of Pathology
- Precision Medicine, School of Clinical Science at Monash Health, Monash University, Victoria, Australia
| | - Esther M John
- Department of Epidemiology, Cancer Prevention Institute of California, Fremont, CA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - Wendy K Chung
- Department of Pediatrics and Medicine, Columbia University, New York, NY
| | - Mary B Daly
- Division of Population Science, Fox Chase Cancer Center, Philadelphia, PA
| | - Anita Bane
- Department of Pathology and Molecular Medicine, Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology-Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Encarna B Gómez Garcia
- Department of Clinical Genetics and GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marian J E Mourits
- Department of Gynaecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Theo A M van Os
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands
| | - Marie-José Roos-Blom
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michael L Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Parkville, Victoria, Australia
- Division of Cancer Medicine
- Department of Medical Oncology, St Vincent's Hospital, Fitzroy, Australia
| | - Christian F Singer
- Department of OB/GYN and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Yen Y Tan
- Department of OB/GYN and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Lenka Foretova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic, Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology
| | - Marie Navratilova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic, Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology
- Medical Faculty, University of Cologne and University Hospital Cologne, Germany
| | | | - Trinidad Caldes
- Molecular Oncology Laboratory, Hospital Clinico San Carlos, IdISSC, CIBERONC, Martin Lagos s/n, Madrid, Spain
| | - Jacques Simard
- Genomics Center, Centre Hospitalier Universitaire de Québec Research Center and Laval University, Quebec City, Quebec, Canada
| | - Edith Olah
- Department of Molecular Genetics, National Institute of Oncology, Budapest, Hungary
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Brita Arver
- Department of Oncology-Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ana Osorio
- Human Genetics Group, Spanish National Cancer Centre, Madrid, Spain
| | - Catherine Noguès
- Oncogénétique Clinique, Institut Paoli-Calmettes and Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - Nadine Andrieu
- INSERM U900, Paris, France
- Institut Curie, Paris, France
- Ecole des Mines de Paris, ParisTech, Fontainebleau, France
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Victoria, Australia
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
| | - Matti A Rookus
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - EMBRACE, GENEPSO, BCFR, HEBON, kConFab, and IBCCS
- Lund University, Lund, Sweden; Sir Peter MacCallum Department of Oncology
- Research Department, Peter MacCallum Cancer Centre, Victoria, Australia
- Department of Epidemiology
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK
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Huesch MD, Schetter S, Segel J, Chetlen A. Evaluation of the "Angelina Jolie Effect" on Screening Mammography Utilization in an Academic Center. J Am Coll Radiol 2018; 14:1020-1026. [PMID: 28601611 DOI: 10.1016/j.jacr.2017.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/28/2017] [Accepted: 03/10/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to understand the impact on screening mammography at our institution, comparing weekly utilization in the 2 years before and the 2 years after Ms Angelina Jolie disclosed in the New York Times on May 13, 2013, that she had had a prophylactic double mastectomy. METHODS All 48,110 consecutive screening mammograms conducted at our institution between May 16, 2011, and May 16, 2015, were selected from our electronic medical record system. We used interrupted time series statistical models and graphical methods on utilization data to understand utilization changes before and after Ms Jolie's news. RESULTS The graphed trend of weekly screening mammogram utilization failed to show changes around the time of interest. Analytical models and statistical tests also failed to show a step change increase or acceleration of utilization around May 2013. However, graphical and time series analyses showed a flattening of utilization in the middle of 2014. CONCLUSIONS In our well-powered analysis in a large regional breast imaging center, we found no support for the hypothesis that this celebrity news drove increased screening.
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Affiliation(s)
- Marco D Huesch
- Department of Radiology, Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Susann Schetter
- Department of Radiology, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Joel Segel
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania
| | - Alison Chetlen
- Department of Radiology, Milton S. Hershey Medical Center, Hershey, Pennsylvania
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11
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Gschwantler-Kaulich D, Weingartshofer S, Rappaport-Fürhauser C, Zeilinger R, Pils D, Muhr D, Braicu EI, Kastner MT, Tan YY, Semmler L, Sehouli J, Singer CF. Diagnostic markers for the detection of ovarian cancer in BRCA1 mutation carriers. PLoS One 2017; 12:e0189641. [PMID: 29244844 PMCID: PMC5731824 DOI: 10.1371/journal.pone.0189641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022] Open
Abstract
Background Screening for ovarian cancer (OC) in women at high risk consists of a combination of carbohydrate antigen 125 (CA125) and transvaginal ultrasound, despite their low sensitivity and specificity. This could be improved by the combination of several biomarkers, which has been shown in average risk patients but has not been investigated until now in female BRCA mutation carriers. Methods Using a multiplex, bead-based, immunoassay system, we analyzed the concentrations of leptin, prolactin, osteopontin, insulin-like growth factor II, macrophage inhibitory factor, CA125 and human epididymis antigen 4 in 26 healthy wild type women, 26 healthy BRCA1 mutation carriers, 28 wildtype OC patients and 26 OC patients with BRCA1 mutation. Results Using the ROC analysis, we found a high overall sensitivity of 94.3% in differentiating healthy controls from OC patients with comparable results in the wildtype subgroup (sensitivity 92.8%, AUC = 0.988; p = 5.2e-14) as well as in BRCA1 mutation carriers (sensitivity 95.2%, AUC = 0.978; p = 1.7e-15) at an overall specificity of 92.3%. The used algorithm also allowed to identify healthy BRCA1 mutation carriers when compared to healthy wildtype women (sensitivity 88.4%, specificity 80.7%, AUC = 0.895; p = 6e-08), while this was less pronounced in patients with OC (sensitivity 66.7%, specificity 67.8%, AUC = 0.724; p = 0.00065). Conclusion We have developed an algorithm, which can differentiate between healthy women and OC patients and have for the first time shown, that such an algorithm can also be used in BRCA mutation carriers. To clarify a suggested benefit to the existing early detection program, large prospective trials with mainly early stage OC cases are warranted.
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Affiliation(s)
- Daphne Gschwantler-Kaulich
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
- * E-mail:
| | - Sigrid Weingartshofer
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
| | | | - Robert Zeilinger
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
| | - Dietmar Pils
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniela Muhr
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
| | - Elena I. Braicu
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer, Charité - Campus Virchow-Klinikum, University Medicine of Berlin, Berlin, Germany
| | - Marie-Therese Kastner
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
| | - Yen Y. Tan
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
- QIMR Berghofer Medical Research Institute, Herston QLD, Australia
| | - Lorenz Semmler
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer, Charité - Campus Virchow-Klinikum, University Medicine of Berlin, Berlin, Germany
| | - Christian F. Singer
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University Vienna, Vienna, Austria
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12
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Drescher CW, Beatty JD, Resta R, Andersen MR, Watabayashi K, Thorpe J, Hawley S, Purkey H, Chubak J, Hanson N, Buist DS, Urban N. The effect of referral for genetic counseling on genetic testing and surgical prevention in women at high risk for ovarian cancer: Results from a randomized controlled trial. Cancer 2016; 122:3509-3518. [PMID: 27447168 PMCID: PMC5253334 DOI: 10.1002/cncr.30190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Guidelines recommend genetic counseling and testing for women who have a pedigree suggestive of an inherited susceptibility for ovarian cancer. The authors evaluated the effect of referral to genetic counseling on genetic testing and prophylactic oophorectomy in a randomized controlled trial. METHODS Data from an electronic mammography reporting system identified 12,919 women with a pedigree that included breast cancer, of whom 625 were identified who had a high risk for inherited susceptibility to ovarian cancer using a risk-assessment questionnaire. Of these, 458 women provided informed consent and were randomized 1:1 to intervention consisting of a genetic counseling referral (n = 228) or standard clinical care (n = 230). RESULTS Participants were predominantly aged 45 to 65 years, and 30% and 20% reported a personal history of breast cancer or a family history of ovarian cancer, respectively. Eighty-five percent of women in the intervention group participated in a genetic counseling session. Genetic testing was reported by 74 (33%) and 20 (9%) women in the intervention and control arms (P < .005), respectively. Five women in the intervention arm and 2 in the control arm were identified as germline mutation carriers. Ten women in the intervention arm and 3 in the control arm underwent prophylactic bilateral salpingo-oophorectomy (P < .05). CONCLUSIONS Routine referral of women at high risk for ovarian cancer to genetic counseling promotes genetic testing and prophylactic surgery. The findings from the current randomized controlled trial demonstrate the value of implementing strategies that target women at high risk for ovarian cancer to ensure they are offered access to recommended care. CA Cancer J Clin 2016. © 2016 American Cancer Society, Inc. Cancer 2016;122:3509-3518. © 2016 American Cancer Society.
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Affiliation(s)
- Charles W. Drescher
- Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - J. David Beatty
- Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Swedish Cancer Institute, Swedish Medical Center, Seattle, WA
| | - Robert Resta
- Swedish Cancer Institute, Swedish Medical Center, Seattle, WA
- Hereditary Cancer Clinic, Swedish Medical Center, Seattle, WA
| | - M Robyn Andersen
- Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kate Watabayashi
- Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jason Thorpe
- Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sarah Hawley
- Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Hannah Purkey
- Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jessica Chubak
- Group Health Research Institute, Seattle, WA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Nancy Hanson
- Swedish Cancer Institute, Swedish Medical Center, Seattle, WA
- Hereditary Cancer Clinic, Swedish Medical Center, Seattle, WA
| | - Diana S.M. Buist
- Group Health Research Institute, Seattle, WA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA
| | - Nicole Urban
- Translational Outcomes Research, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA
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13
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Kelly KM, Ellington L, Schoenberg N, Jackson T, Dickinson S, Porter K, Leventhal H, Andrykowski M. Genetic counseling content: How does it impact health behavior? J Behav Med 2015; 38:766-76. [PMID: 25533642 PMCID: PMC4478279 DOI: 10.1007/s10865-014-9613-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 12/08/2014] [Indexed: 01/11/2023]
Abstract
Women with hereditary breast-ovarian cancer face decisions about screening (transvaginal ultrasound, CA125, mammography, breast exams) and proactive (before cancer) or reactive (after cancer) surgery (oophorectomy, mastectomy). The content of genetic counseling and its relation to these key health behaviors is largely unexamined. Ashkenazi Jewish women (n = 78) were surveyed through the process of genetic testing and had audiorecorded counseling sessions available for Linguistic Inquiry and Word Count analysis. Proportions for participant and counselor cognitive and affective content during sessions were used as primary predictor variables in linear mixed models for change in intentions for screening and treatment and in self-reported screening. Cognitive and affective content were important predictors of behavior. Counselor cognitive content was associated with ovarian screening. An interaction effect also emerged for CA-125, such that counselor cognitive content plus participant cognitive content or counselor affective content were associated with more screening. Teasing out the factors in risk communication that impact decision-making are critical, and affect from a risk communicator can spur action, such as cancer screening.
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Affiliation(s)
- Kimberly M Kelly
- Mary Babb Randolph Cancer Center and School of Pharmacy, Health Science Center, West Virginia University, PO Box 9510, Morgantown, WV, 26506, USA.
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Thomas Jackson
- Department of Statistics, Indiana University, Bloomington, IN, USA
| | | | - Kyle Porter
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Howard Leventhal
- Institute for Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Michael Andrykowski
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
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14
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Abstract
As the testing criteria for BRCA expand, we are identifying a greater number of young women at significant risk for breast and ovarian cancer. Fortunately, there is strong evidence to support risk reduction from mastectomy and oophorectomy. However, these surgeries come with significant psychological and physical health consequences. For breast cancer, screening with mammogram and magnetic resonance imaging may be a reasonable approach for a woman who does not desire surgery. However, there is no evidence to suggest any efficacy in screening for ovarian cancer, and women electing to not undergo surgery must have a detailed discussion with their physician regarding the risks and benefits of different management strategies. As more women are electing to undergo surgical risk reduction, providers must also be able to counsel and care for these women who will face unique health challenges after surgical menopause at a young age. A review of the current evidence behind management of the BRCA woman follows, with a focus on areas of controversy and current research.
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15
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Chai X, Friebel TM, Singer CF, Evans DG, Lynch HT, Isaacs C, Garber JE, Neuhausen SL, Matloff E, Eeles R, Tung N, Weitzel JN, Couch FJ, Hulick PJ, Ganz PA, Daly MB, Olopade OI, Tomlinson G, Blum JL, Domchek SM, Chen J, Rebecck TR. Use of risk-reducing surgeries in a prospective cohort of 1,499 BRCA1 and BRCA2 mutation carriers. Breast Cancer Res Treat 2014; 148:397-406. [PMID: 25311111 PMCID: PMC4224991 DOI: 10.1007/s10549-014-3134-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 01/08/2023]
Abstract
Inherited mutations in BRCA1 or BRCA2 (BRCA1/2) confer very high risk of breast and ovarian cancers. Genetic testing and counseling can reduce risk and death from these cancers if appropriate preventive strategies are applied, including risk-reducing salpingo-oophorectomy (RRSO) or risk-reducing mastectomy (RRM). However, some women who might benefit from these interventions do not take full advantage of them. We evaluated RRSO and RRM use in a prospective cohort of 1,499 women with inherited BRCA1/2 mutations from 20 centers who enrolled in the study without prior cancer or RRSO or RRM and were followed forward for the occurrence of these events. We estimated the age-specific usage of RRSO/RRM in this cohort using Kaplan-Meier analyses. Use of RRSO was 45% for BRCA1 and 34% for BRCA2 by age 40, and 86% for BRCA1 and 71% for BRCA2 by age 50. RRM usage was estimated to be 46% by age 70 in both BRCA1 and BRCA2 carriers. BRCA1 mutation carriers underwent RRSO more frequently than BRCA2 mutation carriers overall, but the uptake of RRSO in BRCA2 was similar after mutation testing and in women born since 1960. RRM uptake was similar for both BRCA1 and BRCA2. Childbearing influenced the use of RRSO and RRM in both BRCA1 and BRCA2. Uptake of RRSO is high, but some women are still diagnosed with ovarian cancer before undergoing RRSO. This suggests that research is needed to understand the optimal timing of RRSO to maximize risk reduction and limit potential adverse consequences of RRSO.
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Affiliation(s)
- Xinglei Chai
- Center for Clinical Epidemiology and Biostatistics
| | - Tara M. Friebel
- Center for Clinical Epidemiology and Biostatistics
- Basser Center for BRCA and Abramson Cancer Center
| | | | - D. Gareth Evans
- Department of Genomic Medicine, University of Manchester, MAHSC, St. Mary’s Hospital, Manchester, UK
| | | | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | | | - Susan L. Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA
| | | | - Rosalind Eeles
- The Institute of Cancer Research & Royal Marsden NHS Foundation Trust, London & Sutton
| | - Nadine Tung
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - Peter J. Hulick
- NorthShore University HealthSystem, Evanston, IL and The university of Chicago, Chicago, IL
| | - Patricia A. Ganz
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles, CA
| | | | | | - Gail Tomlinson
- University of Texas, Southwestern Medical Center, Dallas, TX
| | | | - Susan M. Domchek
- Basser Center for BRCA and Abramson Cancer Center
- Department of Medicine, The University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jinbo Chen
- Center for Clinical Epidemiology and Biostatistics
| | - Timothy R. Rebecck
- Center for Clinical Epidemiology and Biostatistics
- Basser Center for BRCA and Abramson Cancer Center
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16
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Enhancement of ovarian tumor detection with αvβ3 integrin-targeted ultrasound molecular imaging agent in laying hens: a preclinical model of spontaneous ovarian cancer. Int J Gynecol Cancer 2014; 24:19-28. [PMID: 24304684 DOI: 10.1097/igc.0000000000000040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Because of the lack of an effective early detection test, ovarian cancer (OVCA) in most cases is detected at late stages and remains a fatal gynecological malignancy. Molecular imaging provides information on the changes associated with the development of a disease at molecular levels. Because angiogenesis is an early event in tumor development, increased expression of αvβ3 integrins by ovarian tumor-associated angiogenic microvessels provides a target for noninvasive ultrasound imaging to detect early-stage OVCA. The goal of this study was to examine the feasibility of αvβ3 integrin-targeted molecular imaging agent in enhancing the detection of spontaneous ovarian tumor in laying hens, a preclinical model of OVCA. METHODS The study was conducted in 2 phases, including a cross-sectional exploratory followed by a prospective monitoring of hens for 45 weeks with targeted ultrasound imaging. Changes in ultrasound signal intensity were determined before and after the injection of αvβ3 integrin-targeted imaging agent in hens with spontaneous OVCA. All images were digitally stored. After scanning, ovarian tissues from all hens were collected and processed for histopathologic and immunohistochemical studies. RESULTS Ultrasound signal intensity was significantly (P < 0.001) higher in hens with early-stage OVCA than in normal hens and increased further in late-stage OVCA. Compared with that in normal cases, ultrasound signal intensities increased approximately 19-fold in early stage and 26-fold in late-stage OVCA. Differences in signal enhancement were not observed among different histologic subtypes of OVCA. Higher signal intensities from targeted imaging of ovarian tumors were associated with increased number of αvβ3 integrin-expressing ovarian microvessels. Prospective monitoring of hens with αvβ3 integrin-targeted imaging agent detected OVCA at early stage. CONCLUSIONS These results suggest that αvβ3 integrin-targeted imaging agent enhanced the visualization of ovarian tumor-associated angiogenic microvessels in hens with early-stage OVCA and may form a foundation for clinical studies.
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Use of Exogenous Hormones and Risks of Breast and Ovarian Cancers in BRCA1/2 Mutation Carriers; Methodological and Clinical Considerations. CURRENT BREAST CANCER REPORTS 2014. [DOI: 10.1007/s12609-014-0145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Garcia C, Lyon L, Littell RD, Powell CB. Comparison of risk management strategies between women testing positive for a BRCA variant of unknown significance and women with known BRCA deleterious mutations. Genet Med 2014; 16:896-902. [PMID: 24854227 DOI: 10.1038/gim.2014.48] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/09/2014] [Indexed: 01/02/2023] Open
Abstract
PURPOSE The aim of this article is to describe cancer risk-reducing behaviors of women with BRCA variants of unknown significance. METHODS A retrospective chart review from 1995 to 2012 identified women with BRCA mutations in a northern California community system. Exclusion criteria included loss of membership/death within 1 year of testing, prior ovarian cancer, or bilateral salpingo-oophorectomy. Primary outcomes were rate of risk-reducing mastectomy and risk-reducing salpingo-oophorectomy. RESULTS The mean age of the 69 variant of unknown significance carriers was 50 vs. 47 years for the 305 women with a deleterious mutation. Women with a variant of unknown significance were followed for a median of 69 months. Among women with a variant of unknown significance, 30% underwent risk-reducing salpingo-oophorectomy and 11% underwent risk-reducing mastectomy, as compared with 74 and 44%, respectively, for women with a deleterious mutation. Women with a deleterious mutation were more likely to undergo surveillance in the first year after testing. The odds ratios are as follows: 2.1 for mammogram, 6.0 for magnetic resonance imaging, 7.7 for Ca-125, and 5.0 for transvaginal ultrasound. Fifty-six percent of women with a variant of unknown significance were reclassified after a median of 39 months, longer than the median time to risk-reducing salpingo-oophorectomy (18.6 months) or risk-reducing mastectomy (20.1 months). CONCLUSION Uptake of risk-reducing strategies among women with a variant of unknown significance is lower than among women with a deleterious mutation. Given the prognostic uncertainty and high rate of reclassification for women with a variant of unknown significance, individualizing counseling and directing efforts toward surveillance, chemoprevention, or salpingectomy are recommended.
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Affiliation(s)
- Christine Garcia
- Department of Gynecologic Oncology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Liisa Lyon
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Ramey D Littell
- Department of Gynecologic Oncology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - C Bethan Powell
- Department of Gynecologic Oncology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
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Garcia C, Wendt J, Lyon L, Jones J, Littell RD, Armstrong MA, Raine-Bennett T, Powell CB. Risk management options elected by women after testing positive for a BRCA mutation. Gynecol Oncol 2013; 132:428-33. [PMID: 24355485 DOI: 10.1016/j.ygyno.2013.12.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/28/2013] [Accepted: 12/09/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the uptake of risk-reducing options for the management of ovarian and breast cancer risk in BRCA mutation carriers in a large community based integrated health system in Northern California. METHODS A retrospective cohort of deleterious BRCA mutation carriers (1995-2012) was evaluated for consistency with NCCN guidelines for risk reducing salpingo-oophorectomy (RRSO) by age of 35-40, risk reducing mastectomy (RRM), as well as surveillance practices, including pelvic ultrasound, CA 125, mammogram, and breast MRI. Secondary outcomes included the use of chemoprevention and hormone replacement. RESULTS Of the 305 eligible women, 170 were BRCA1 positive, and 135 were BRCA2 positive. Seventy four percent underwent RRSO with only 17% under age 40, while 44% underwent RRM. The median time from the test to both RRSO and RRM was 6 months. In the first year after BRCA diagnosis, 45% underwent a pelvic ultrasound, dropping to 2.3% by year 5. In year 1, 47% had a CA 125, dropping to 2% by year 5. The number of women undergoing annual MRI and mammogram fell similarly over time. Sixteen percent of BRCA carriers used oral contraceptives (OCPs) and only one patient used tamoxifen for chemoprevention. CONCLUSION Uptake of RRSO in BRCA carriers in a population based health system is high, however the majority of women do not have RRSO by the NCCN recommended age. Compliance with surveillance is low and rapidly declines even 1 year out from testing. Attention needs to be focused on the earlier identification of BRCA mutation carriers with consolidated and standardized care to improve risk reduction.
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Affiliation(s)
- Christine Garcia
- Kaiser Permanente Medical Group, Gynecologic Oncology Division, USA
| | - Jacqueline Wendt
- Kaiser Permanente Medical Group, Gynecologic Oncology Division, USA
| | - Liisa Lyon
- Kaiser Permanente Medical Group, Division of Research, USA
| | - Jennifer Jones
- Kaiser Permanente Medical Group, Genetics Department, USA
| | - Ramey D Littell
- Kaiser Permanente Medical Group, Gynecologic Oncology Division, USA
| | | | | | - C Bethan Powell
- Kaiser Permanente Medical Group, Gynecologic Oncology Division, USA.
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Rethinking elective bilateral oophorectomy at the time of hysterectomy for benign disease. Maturitas 2013; 76:109-10. [PMID: 23849176 DOI: 10.1016/j.maturitas.2013.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 06/10/2013] [Indexed: 11/23/2022]
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Risk reduction surgery in non-BRCA carriers–is less more? Nat Rev Clin Oncol 2013. [DOI: 10.1038/nrclinonc.2012.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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