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Katz SJ, Ward KC, Hamilton AS, Abrahamse P, Hawley ST, Kurian AW. Association of Germline Genetic Test Type and Results With Patient Cancer Worry After Diagnosis of Breast Cancer. JCO Precis Oncol 2018; 2018:PO.18.00225. [PMID: 30656245 PMCID: PMC6333469 DOI: 10.1200/po.18.00225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There are concerns that multigene panel testing compared with BRCA1/ 2-only testing after diagnosis of breast cancer may lead to unnecessary patient worry about cancer because of more ambiguous results. METHODS Patients with breast cancer diagnosed from 2013 to 2015 and accrued from SEER registries in Georgia and Los Angeles were surveyed (n = 5,080; response rate, 70%), and responses were merged with SEER data and germline genetic testing and results. We examined patient reports of cancer worry by test type and results in 1,063 women who linked to a genetic test and reported undergoing testing. RESULTS More than half of the sample (n = 640; 60.2%) received BRCA1/2-only testing versus 423 patients (39.8%) who had a multigene panel. A minority of tested patients reported substantial cancer worry after treatment: 11.1% (n = 130) reported higher impact of cancer worry, and 15.1% (n = 162) reported a high frequency of cancer worry (worrying often or almost always) in the past month. Impact of cancer worry did not substantively differ by test type, test result outcomes, or clinical or treatment factors. The odds ratio for higher impact of cancer worry was 0.81 (95% CI, 0.51 to 1.28) for multigene versus BRCA1/2-only testing. In a separate model, the odds ratios were 1.21 (95% CI, 0.54 to 2.68) and 0.90 (95% CI, 0.50 to 1.62) for pathogenic variant and variant of uncertain significance, respectively, versus a negative test (the reference group). CONCLUSION Compared with BRCA1/2 testing alone, multigene panel testing was not associated with increased cancer worry after diagnosis of breast cancer.
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Affiliation(s)
- Steven J. Katz
- Steven J. Katz, Paul Abrahamse, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; and Allison W. Kurian, Stanford University, Stanford, CA
| | - Kevin C. Ward
- Steven J. Katz, Paul Abrahamse, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; and Allison W. Kurian, Stanford University, Stanford, CA
| | - Ann S. Hamilton
- Steven J. Katz, Paul Abrahamse, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; and Allison W. Kurian, Stanford University, Stanford, CA
| | - Paul Abrahamse
- Steven J. Katz, Paul Abrahamse, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; and Allison W. Kurian, Stanford University, Stanford, CA
| | - Sarah T. Hawley
- Steven J. Katz, Paul Abrahamse, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; and Allison W. Kurian, Stanford University, Stanford, CA
| | - Allison W. Kurian
- Steven J. Katz, Paul Abrahamse, and Sarah T. Hawley, University of Michigan; Sarah T. Hawley, Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Ann S. Hamilton, University of Southern California, Los Angeles; and Allison W. Kurian, Stanford University, Stanford, CA
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Frey MK, Kopparam RV, Ni Zhou Z, Fields JC, Buskwofie A, Carlson AD, Caputo T, Holcomb K, Chapman-Davis E. Prevalence of nonfounder BRCA1/2 mutations in Ashkenazi Jewish patients presenting for genetic testing at a hereditary breast and ovarian cancer center. Cancer 2018; 125:690-697. [PMID: 30480775 DOI: 10.1002/cncr.31856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Genetic assessment in Ashkenazi Jewish (AJ) patients often is limited to BRCA1/2 founder mutation testing. With access to time-efficient and cost-efficient multigene panel testing, some advocate expanding genetic testing in this population. However, to the best of the authors' knowledge, rates of nonfounder BRCA1/2 mutations and mutations in cancer-associated genes other than BRCA1/2 among AJ are not known. In the current study, the authors sought to assess the prevalence of mutations other than BRCA1/2 founder mutations among AJ patients undergoing genetic assessment. METHODS The authors reviewed the medical records for all AJ patients who underwent genetic assessment at a single institution between June 2013 and December 2016. Mutations were categorized as 1) BRCA1/2 AJ founder mutations (BRCA1 185delAG, BRCA1 5382insC, or BRCA2 6174delT); 2) nonfounder BRCA1/2 mutations; or 3) mutations in non-BRCA1/2 cancer-associated genes. RESULTS A total of 732 AJ patients underwent genetic assessment. Of these, 371 patients (51%) had a personal history of breast or ovarian cancer, 540 patients (73.8%) had a family history of breast cancer, and 132 patients (18%) had a family history of ovarian cancer. In the study population, 101 patients (13.8%) were found to have a pathogenic mutation, 78 patients (10.7%) had a BRCA1/2 founder mutation, 3 patients (0.4%) had a nonfounder BRCA1/2 mutation, and 20 patients (2.7%) had a mutation in a non-BRCA1/2 cancer-associated gene. Non-BRCA1/2 cancer-associated genes harboring mutations included RAD51D, TP53, mutS homolog 6 (MSH6), checkpoint kinase 2 (CHEK2), adenomatous polyposis coli (APC), and Fanconi anemia group C protein (FANCC). CONCLUSIONS Among AJ patients found to have a pathogenic mutation on genetic assessment, approximately 22.8% had a mutation that would be missed with BRCA1/2 AJ founder mutation testing. Comprehensive multigene panel sequencing can provide clinically relevant genetic information for AJ patients and should be considered for genetic assessment in this population.
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Affiliation(s)
- Melissa K Frey
- Division of Gynecologic Oncology, Weill Cornell Medicine, New York, New York
| | - Rohini V Kopparam
- Division of Gynecologic Oncology, Weill Cornell Medicine, New York, New York
| | - Zhen Ni Zhou
- Division of Gynecologic Oncology, Weill Cornell Medicine, New York, New York
| | - Jessica C Fields
- Division of Gynecologic Oncology, Weill Cornell Medicine, New York, New York
| | - Ama Buskwofie
- Division of Gynecologic Oncology, Weill Cornell Medicine, New York, New York
| | - Ann D Carlson
- Genetic Risk Assessment Program, Weill Cornell Medicine, New York, New York
| | - Thomas Caputo
- Division of Gynecologic Oncology, Weill Cornell Medicine, New York, New York
| | - Kevin Holcomb
- Division of Gynecologic Oncology, Weill Cornell Medicine, New York, New York
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