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Gaba F, Blyuss O, Tan A, Munblit D, Oxley S, Khan K, Legood R, Manchanda R. Breast Cancer Risk and Breast-Cancer-Specific Mortality following Risk-Reducing Salpingo-Oophorectomy in BRCA Carriers: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15051625. [PMID: 36900415 PMCID: PMC10001253 DOI: 10.3390/cancers15051625] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/20/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Risk-reducing salpingo-oophorectomy (RRSO) is the gold standard method of ovarian cancer risk reduction, but the data are conflicting regarding the impact on breast cancer (BC) outcomes. This study aimed to quantify BC risk/mortality in BRCA1/BRCA2 carriers after RRSO. METHODS We conducted a systematic review (CRD42018077613) of BRCA1/BRCA2 carriers undergoing RRSO, with the outcomes including primary BC (PBC), contralateral BC (CBC) and BC-specific mortality (BCSM) using a fixed-effects meta-analysis, with subgroup analyses stratified by mutation and menopause status. RESULTS RRSO was not associated with a significant reduction in the PBC risk (RR = 0.84, 95%CI: 0.59-1.21) or CBC risk (RR = 0.95, 95%CI: 0.65-1.39) in BRCA1 and BRCA2 carriers combined but was associated with reduced BC-specific mortality in BC-affected BRCA1 and BRCA2 carriers combined (RR = 0.26, 95%CI: 0.18-0.39). Subgroup analyses showed that RRSO was not associated with a reduction in the PBC risk (RR = 0.89, 95%CI: 0.68-1.17) or CBC risk (RR = 0.85, 95%CI: 0.59-1.24) in BRCA1 carriers nor a reduction in the CBC risk in BRCA2 carriers (RR = 0.35, 95%CI: 0.07-1.74) but was associated with a reduction in the PBC risk in BRCA2 carriers (RR = 0.63, 95%CI: 0.41-0.97) and BCSM in BC-affected BRCA1 carriers (RR = 0.46, 95%CI: 0.30-0.70). The mean NNT = 20.6 RRSOs to prevent one PBC death in BRCA2 carriers, while 5.6 and 14.2 RRSOs may prevent one BC death in BC-affected BRCA1 and BRCA2 carriers combined and BRCA1 carriers, respectively. CONCLUSIONS RRSO was not associated with PBC or CBC risk reduction in BRCA1 and BRCA2 carriers combined but was associated with improved BC survival in BC-affected BRCA1 and BRCA2 carriers combined and BRCA1 carriers and a reduced PBC risk in BRCA2 carriers.
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Affiliation(s)
- Faiza Gaba
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
- Department of Gynaecological Oncology, Barts Health NHS Trust, London E1 1FR, UK
| | - Oleg Blyuss
- Wolfson Institute of Population Health, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), 29 Shmitovskiy Proezd, 123337 Moscow, Russia
| | - Alex Tan
- Wolfson Institute of Population Health, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), 29 Shmitovskiy Proezd, 123337 Moscow, Russia
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK
- Solov’ev Research and Clinical Center for Neuropsychiatry, 43 Ulitsa Donskaya, 115419 Moscow, Russia
| | - Samuel Oxley
- Department of Gynaecological Oncology, Barts Health NHS Trust, London E1 1FR, UK
- Wolfson Institute of Population Health, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Khalid Khan
- Department of Preventive Medicine and Public Health, Universidad de Granada, 18071 Granada, Spain
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Ranjit Manchanda
- Department of Gynaecological Oncology, Barts Health NHS Trust, London E1 1FR, UK
- Wolfson Institute of Population Health, Barts CRUK Cancer Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
- MRC Clinical Trials Unit, University College London, 90 High Holborn, London WC1V 6LJ, UK
- Department of Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
- Correspondence:
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2
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Gomes P, Matos PM, Silva ER, Silva J, Silva E, Sales CMD. Distress facing increased genetic risk of cancer: The role of social support and emotional suppression. PATIENT EDUCATION AND COUNSELING 2022; 105:2436-2442. [PMID: 35339327 DOI: 10.1016/j.pec.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Healthy individuals from hereditary cancer families undergoing genetic testing for cancer susceptibility (GTC) report more distress when they perceive their social support as low and suppress their emotions. This study aimed to explore how suppressing emotions and perceiving others as unsupportive are related with cancer-risk distress. METHODS We performed a regression-based mediation analysis to assess if expressive suppression mediates or is mediated by perceived social support in the relation with cancer-risk distress. Participants were 125 healthy adults aged over 18 (M = 36.07, SD = 12.86), mostly female (72,4%), who undergone GTC to assess the presence of hereditary breast and ovarian cancer or Lynch syndromes. RESULTS Controlling for age and gender, we found a moderate size indirect effect of social support on cancer-risk distress through expressive suppression (β = -0.095) and a direct effect of expressive suppression on cancer-risk distress. CONCLUSIONS When healthy individuals from hereditary cancer families perceive their social network as less responsive, they tend to not express their emotions, which relates to increased distress facing GTC. PRACTICE IMPLICATIONS Practitioners may assess cancer-risk related distress before the GTC and offer distressed individuals interventions focused on changing emotion regulation strategies in a safe group context.
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Affiliation(s)
- Pedro Gomes
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal; Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal.
| | - Paula Mena Matos
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal.
| | - Eunice R Silva
- Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; Psychology Service, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal.
| | - João Silva
- Cancer Genetics Group, Research Centre of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal; Medical Genetics Service, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal.
| | - Eliana Silva
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal.
| | - Célia M D Sales
- Centre for Psychology at University of Porto (CPUP), Faculty of Psychology and Education Sciences at University of Porto (FPCEUP), 4200-135 Porto, Portugal.
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Makhnoon S, Tran G, Levin B, Mattie KD, Dreyer B, Volk RJ, Grana G, Arun BK, Peterson SK. Uptake of cancer risk management strategies among women who undergo cascade genetic testing for breast cancer susceptibility genes. Cancer 2021; 127:3605-3613. [PMID: 34157779 DOI: 10.1002/cncr.33668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Uptake of cancer risk management based on inherited predispositions, which encompasses bilateral mastectomy (BLM), bilateral salpingo-oophorectomy (BSO), and intensified screening, is the primary motivation for cascade testing for hereditary breast and ovarian cancer (HBOC). However, long-term outcome data for cascade testers are lacking. METHODS Medical records were abstracted for all unaffected women with pathogenic variants in HBOC genes from 2 cancer hospitals (2013-2019) with at least 1 year of follow-up to compare the uptake of surgery and screening between cascade and noncascade testers. RESULTS Cascade testers (79.8%) were younger than noncascade testers (mean age, 37.6 vs 43.5 years; P = .002). Among women aged ≥40 years, 43% underwent BLM, and 71.6% underwent BSO, with no significant difference in uptake between cascade and noncascade testers. The mean time to BSO among cascade testers was shorter among women aged ≥40 years versus those aged <40 years (11.8 vs 31.9 months; P = .04); no such difference was observed among noncascade testers. Mammography and breast magnetic resonance imaging rates were low in the recorded 6 years for both groups after genetic counseling. CONCLUSIONS Management uptake among cascade testers is high with rates comparable to those for unaffected BRCA-positive women. A large proportion of women act on cascade test results, and this represents a novel report of utilization of cancer management strategies.
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Affiliation(s)
- Sukh Makhnoon
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace Tran
- Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brooke Levin
- William G. Rohrer Cancer Genetics Program, Division of Hematology and Medical Oncology, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey
| | - Kristin D Mattie
- William G. Rohrer Cancer Genetics Program, Division of Hematology and Medical Oncology, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey
| | | | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Generosa Grana
- William G. Rohrer Cancer Genetics Program, Division of Hematology and Medical Oncology, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey
| | - Banu K Arun
- Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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4
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Buick C, Murphy KJ, Howell D, Metcalfe K. Understanding the role of oncogenic human papillomavirus (HPV) status on adherence behaviors among women with abnormal cervical cytology. BMC WOMENS HEALTH 2021; 21:29. [PMID: 33461543 PMCID: PMC7812645 DOI: 10.1186/s12905-020-01168-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND With the introduction of oncogenic Human Papillomavirus (HPV) testing into cervical screening there is a renewed focus on primary prevention among high-risk groups. To date, little is known about the effectiveness of this program, and the extent to which individual-level factors, such as psychosocial health and agency, may play a role. In particular, it is unclear if knowledge of one's oncogenic HPV status impacts on adherence behaviors amongst women with screening abnormalities. The purpose of this study was to identify if clinical, demographic or psychosocial factors predict non-adherence with recommended colposcopy follow-up. METHODS This prospective pilot study included 145 women referred to a large Toronto colposcopy clinic between December, 2013 and September, 2014. Demographic, clinical and psychosocial characteristics were collected at three points in time: (1) at initial colposcopy consultation; (2) 4-6 weeks following initial consultation, and; (3) at time of follow-up appointment (within 12 months of initial consultation). RESULTS Overall, 13% (n = 145) of the women were classified as non-adherent. Older women (OR = 0.73, p < 0.01) and those with higher-grade lesions (OR = 0.10, p < 0.01) were less likely to be non-adherent, whereas current smokers (OR = 22.46, p < 0.01) were more likely to be non-adherent. While not statistically significant, variation in rates of non-adherence amongst the various HPV status groups (untested; 15.3%, HPV positive; 5.3%, HPV negative; 6.7%) warrants further study. CONCLUSION Findings of this study indicate that younger women, those with higher-grade lesions and current smokers were more likely to be non-adherent to recommended colposcopy follow-up. While HPV status did not reach statistical significance, the direction of this finding suggests that testing for HPV may have a positive reinforcing role on adherence to follow-up. The direction of this finding warrants further study, and potentially a practical clinical goal as HPV testing for women becomes standard of care.
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Affiliation(s)
- Catriona Buick
- Faculty of Health, York University, Health, Nursing and Environmental Studies Building, Room: 301A, 4700 Keele St, Toronto, ON, M3J 1P3, Canada.
| | - K Joan Murphy
- Faculty of Health, York University, Health, Nursing and Environmental Studies Building, Room: 301A, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - Doris Howell
- Faculty of Health, York University, Health, Nursing and Environmental Studies Building, Room: 301A, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - Kelly Metcalfe
- Faculty of Health, York University, Health, Nursing and Environmental Studies Building, Room: 301A, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
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5
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Kassem N, Stout LA, Hunter C, Schneider B, Radovich M. Precision Prevention: The Current State and Future of Genomically Guided Cancer Prevention. JCO Precis Oncol 2020; 4:96-108. [PMID: 35050732 DOI: 10.1200/po.19.00278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The identification of cancer-predisposing germline variants has potentially substantial clinical impact for patients and their families. Although management guidelines have been proposed for some genes, guidelines for other genes are lacking. This review focuses on the current surveillance and management guidelines for the most common hereditary cancer syndromes and discusses some of the most pivotal studies supporting the available guidelines. We also highlight the gaps in the identification of germline carriers, the cascade testing of at-risk relatives, and the challenges impeding the proper follow-up and optimal management of pathogenic germline carriers. The anticipated surge in the number of identified germline carriers, deficient management guidelines, poor cascade testing uptake, and long-term follow-up necessitate the development of multidisciplinary clinics as an obligatory step toward the improvement of cancer prevention.
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Affiliation(s)
- Nawal Kassem
- Indiana University School of Medicine, Indianapolis, IN.,Indiana University Health Precision Genomics, Indianapolis, IN
| | - Leigh Anne Stout
- Indiana University School of Medicine, Indianapolis, IN.,Indiana University Health Precision Genomics, Indianapolis, IN
| | - Cynthia Hunter
- Indiana University School of Medicine, Indianapolis, IN.,Indiana University Health Precision Genomics, Indianapolis, IN
| | - Bryan Schneider
- Indiana University School of Medicine, Indianapolis, IN.,Indiana University Health Precision Genomics, Indianapolis, IN
| | - Milan Radovich
- Indiana University School of Medicine, Indianapolis, IN.,Indiana University Health Precision Genomics, Indianapolis, IN
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6
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Gaba F, Blyuss O, Chandrasekaran D, Osman M, Goyal S, Gan C, Izatt L, Tripathi V, Esteban I, McNicol L, Ragupathy K, Crawford R, Evans DG, Legood R, Menon U, Manchanda R. Attitudes towards risk-reducing early salpingectomy with delayed oophorectomy for ovarian cancer prevention: a cohort study. BJOG 2020; 128:714-726. [PMID: 32803845 DOI: 10.1111/1471-0528.16424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) acceptability and effect of surgical prevention on menopausal sequelae/satisfaction/regret in women at increased ovarian cancer (OC) risk. DESIGN Multicentre, cohort, questionnaire study (IRSCTN:12310993). SETTING United Kingdom (UK). POPULATION UK women without OC ≥18 years, at increased OC risk, with/without previous RRSO, ascertained through specialist familial cancer/genetic clinics and BRCA support groups. METHODS Participants completed a 39-item questionnaire. Baseline characteristics were described using descriptive statistics. Logistic/linear regression models analysed the impact of variables on RRESDO acceptability and health outcomes. MAIN OUTCOMES RRESDO acceptability, menopausal sequelae, satisfaction/regret. RESULTS In all, 346 of 683 participants underwent risk-reducing salpingo-oophorectomy (RRSO). Of premenopausal women who had not undergone RRSO, 69.1% (181/262) found it acceptable to participate in a research study offering RRESDO. Premenopausal women concerned about sexual dysfunction were more likely to find RRESDO acceptable (odds ratio [OR] = 2.9, 95% CI 1.2-7.7, P = 0.025). Women experiencing sexual dysfunction after premenopausal RRSO were more likely to find RRESDO acceptable in retrospect (OR = 5.3, 95% CI 1.2-27.5, P < 0.031). In all, 88.8% (143/161) premenopausal and 95.2% (80/84) postmenopausal women who underwent RRSO, respectively, were satisfied with their decision, whereas 9.4% (15/160) premenopausal and 1.2% (1/81) postmenopausal women who underwent RRSO regretted their decision. HRT uptake in premenopausal individuals without breast cancer (BC) was 74.1% (80/108). HRT use did not significantly affect satisfaction/regret levels but did reduce symptoms of vaginal dryness (OR = 0.4, 95% CI 0.2-0.9, P = 0.025). CONCLUSION Data show high RRESDO acceptability, particularly in women concerned about sexual dysfunction. Although RRSO satisfaction remains high, regret rates are much higher for premenopausal women than for postmenopausal women. HRT use following premenopausal RRSO does not increase satisfaction but does reduce vaginal dryness. TWEETABLE ABSTRACT RRESDO has high acceptability among premenopausal women at increased ovarian cancer risk, particularly those concerned about sexual dysfunction.
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Affiliation(s)
- F Gaba
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - O Blyuss
- School of Physics, Astronomy and Mathematics, University of Hertfordshire, Hatfield, UK.,Department of Paediatrics and Paediatric Infectious Diseases, Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Applied Mathematics, Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - D Chandrasekaran
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - M Osman
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK
| | - S Goyal
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK
| | - C Gan
- Department of Gynaecological Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Izatt
- Department of Clinical Genetics, Guy's Hospital, London, UK
| | - V Tripathi
- Department of Clinical Genetics, Guy's Hospital, London, UK
| | - I Esteban
- Ninewells Hospital, NHS Tayside, Dundee, UK
| | - L McNicol
- Ninewells Hospital, NHS Tayside, Dundee, UK
| | | | - R Crawford
- Department of Gynaecological Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D G Evans
- Manchester Centre for Genomic Medicine, MAHSC, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
| | - R Legood
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - R Manchanda
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,MRC Clinical Trials Unit, University College London, London, UK
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7
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Stolier AJ, Corsetti RL. Newly Diagnosed Breast Cancer Patients Choose Bilateral Mastectomy over Breast-Conserving Surgery When Testing Positive for a BRCA1/2 Mutation. Am Surg 2020. [DOI: 10.1177/000313480507101209] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In women diagnosed with breast cancer and testing positive for a BRCA1/2 mutation, decisions as to whether to undergo prophylactic risk-reduction surgery may differ from those women who test positive in a presymptomatic phase. Eighty-four women were identified who had undergone genetic testing at the time of breast cancer diagnosis. The study group consisted of 46 of these women who had initially undergone breast-conserving surgery. Eight patients (17.4%) tested positive for a mutation. Seven of the eight underwent bilateral prophylactic mastectomy prior to receiving radiation therapy. The only patient not undergoing bilateral mastectomy was awaiting liver transplant. Women who are candidates for breast-conserving surgery and who test positive for a breast cancer gene mutation choose mastectomy over surveillance.
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Affiliation(s)
- Alan J. Stolier
- Department of Surgery, Tulane University Health Sciences Center and the Tulane Cancer Center, New Orleans, Louisiana
| | - Ralph L. Corsetti
- Department of Surgery, Tulane University Health Sciences Center and the Tulane Cancer Center, New Orleans, Louisiana
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8
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Gaba F, Manchanda R. Systematic review of acceptability, cardiovascular, neurological, bone health and HRT outcomes following risk reducing surgery in BRCA carriers. Best Pract Res Clin Obstet Gynaecol 2020; 65:46-65. [DOI: 10.1016/j.bpobgyn.2020.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 02/08/2023]
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9
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May T, Evans JP. Addressing perceived economic obstacles to genetic testing as a way to mitigate disparities in family health history for adoptees. HEALTH ECONOMICS, POLICY, AND LAW 2020; 15:277-287. [PMID: 30567613 DOI: 10.1017/s1744133118000488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this paper, we ask whether or not we can afford to realize the potential benefits of genetic testing as a screening tool for adoptees. Our method is to provide reasonable cost and savings estimates. We argue that the prospect of cost neutrality should be sufficient to explore the targeted screening for a population who will otherwise suffer an avoidable health disparity in access to inherited disease information. Our goal here is to establish that the investment needed to attain these benefits is not beyond our means.
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Affiliation(s)
- Thomas May
- Floyd and Judy Rogers Endowed Professor, Elson S. Floyd College of Medicine, Washington State University, Vancouver, WA, USA
- Ethics and Genomics Program, HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
- Institute for Health and Aging, University of California San Francisco, San Francisco, CA, USA
| | - James P Evans
- Bryson Distinguished Professor of Genetics & Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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10
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McBride CM, Guan Y, Hay JL. Regarding the Yin and Yang of Precision Cancer- Screening and Treatment: Are We Creating a Neglected Majority? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4168. [PMID: 31671746 PMCID: PMC6862105 DOI: 10.3390/ijerph16214168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 12/31/2022]
Abstract
In this commentary, we submit that the current emphasis of precision cancer screening and treatment (PCST) has been to provide and interpret the implications of "positive" screening results for those deemed to be at greatest risk for cancer or most likely to benefit from targeted treatments. This is an important, but proportionately small target group, regardless of the cancer context. Overlooked by this focus is the larger majority of those screened who receive "negative" results. We contend that for optimal dissemination of PCST, the complement of positive and negative results be viewed as an inseparable yin-yang duality with the needs of those who receive negative screening results viewed as important as those deemed to be at highest risk or derive targeted treatment benefit. We describe three areas where communication of negative PCST results warrant particular attention and research consideration: population-based family history screening, germline testing for hereditary cancer syndromes, and tumor testing for targeted cancer treatment decision-making. Without thoughtful consideration of the potential for negative results to have psychological and behavioral influences, there is a potential to create a "neglected majority". This majority may be inclined to misinterpret results, disseminate inaccurate information to family, dismiss the credibility of results, or become disillusioned with existing medical treatments.
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Affiliation(s)
- Colleen M McBride
- Behavioral Science and Health Education Department, Rollins School of Public Health Emory University, Atlanta, GA 30322, USA.
| | - Yue Guan
- Behavioral Science and Health Education Department, Rollins School of Public Health Emory University, Atlanta, GA 30322, USA.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City, NY 10022, USA.
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11
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Uterine and Tubal Lavage for Earlier Cancer Detection Using an Innovative Catheter: A Feasibility and Safety Study. Int J Gynecol Cancer 2019; 28:1692-1698. [PMID: 30376484 PMCID: PMC6254778 DOI: 10.1097/igc.0000000000001361] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Poor survival of high-grade serous pelvic cancer is caused by a lack of effective screening measures. The detection of exfoliated cells from high-grade serous pelvic cancer, or precursor lesions, is a promising concept for earlier diagnosis. However, collecting those cells in the most efficient way while fulfilling all requirements for a screening approach is a challenge. We introduce a new catheter for uterine and tubal lavage (UtL) and the clinical evaluation of its performance. METHODS/MATERIALS In study I, the clinical feasibility of the UtL using the new catheter was examined in 93 patients admitted for gynecologic surgery under general anesthesia. In study II, the safety of the UtL procedure was assessed. The pain during and after the UtL performed under local anesthesia was rated on a visual analog scale by 22 healthy women. RESULTS In study I, the UtL was carried out successfully in 92 (98.9%) of 93 cases by 16 different gynecologists. It was rated as easy to perform in 84.8% of patients but as rather difficult in cancer patients (odds ratio, 5.559; 95% confidence interval, 1.434-21.546; P = 0.007). For benign conditions, dilatation before UtL was associated with menopause status (odds ratio, 4.929; 95% confidence interval, 1.439-16.884; P = 0.016). In study II, the pain during UtL was rated with a median visual analog scale score of 1.6. During a period of 4 weeks after UtL, none of the participants had to use medication or developed symptoms requiring medical attention. The UtL took 6.5 minutes on average. The amount of extracted DNA was above the lower limit for a sensitive, deep-sequencing mutation analysis in all cases. CONCLUSIONS Our studies demonstrate that the UtL, using the new catheter, is a safe, reliable, and well-tolerated procedure, which does not require elaborate training. Therefore, UtL fulfils all prerequisites to be used in a potential screening setting.
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12
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Courtney E, Chin XW, Yuen J, Li ST, Chen Y, Allen JC, Tan V, Lim GH, Ngeow J. Risk management adherence following genetic testing for hereditary cancer syndromes: a Singaporean experience. Fam Cancer 2019; 17:621-626. [PMID: 29368260 DOI: 10.1007/s10689-018-0071-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Assessing adherence behavior among mutation carriers to cancer risk management guidelines is important for both service improvement and cost-effectiveness analyses, but such real-world data is often lacking. The present study aims to report adherence rates among mutation carriers in a recently established cancer genetics program in Singapore. We conducted a medical chart review of mutation carriers who had attended for genetic counseling and gathered data regarding risk management behavior, including cancer surveillance and/or risk-reducing surgery, and cancers subsequently detected. Of the 52 subjects included in the study, the majority were affected prior to genetic testing (78.8%) and had family history suggestive of a germline mutation (88.5%). The overall adherence rate was 96.2%, including 37 (74.0%) fully-adherent and 13 (26.0%) partially-adherent subjects, with five cancers subsequently detected. Among the 28 BRCA1/2 mutation carriers, adherence to breast cancer risk management was also high (89.3%), although uptake of risk-reducing bilateral salpingo-oophorectomy was not as common (60%). Whilst overall adherence in this cohort was high, BRCA1/2 mutation carriers may require targeted interventions to improve ovarian cancer risk management uptake. Additionally, further education among health professionals and the wider community regarding cancer genetics is needed to ensure the early identification of mutation carriers.
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Affiliation(s)
- Eliza Courtney
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Xin Wei Chin
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Jeanette Yuen
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Shao-Tzu Li
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Yanni Chen
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - John Carson Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Veronique Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Geok Hoon Lim
- KK Breast Centre, KK Women's and Children's Hospital, Singapore, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore. .,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
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Seiffert DJ, McCarthy Veach P, LeRoy B, Guan W, Zierhut H. Beyond medical actionability: Public perceptions of important actions in response to hypothetical genetic testing results. J Genet Couns 2019; 28:355-366. [PMID: 30710467 DOI: 10.1002/jgc4.1048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/18/2018] [Accepted: 10/02/2018] [Indexed: 01/09/2023]
Abstract
Rationales for returning results from whole genome sequencing (WGS) and genetic testing have historically focused on medical utility. Understanding the wide array of actions individuals might take following genetic testing results could have important implications for clinical care. We aimed to survey the public regarding their perceptions of the importance of a wide variety of different actions one might take upon receiving hypothetical results from a WGS test where the results indicate a high risk of developing a genetic condition. We assessed whether demographic characteristics, type of condition, and perceived severity of the condition differentially affected importance ratings of actions they would take. In a survey administered at the 2015 Minnesota State Fair, 909 participants imagined that they had a blood test that looked at their genes and indicated that they were at high risk of developing one of three randomized conditions (Alzheimer's disease, macular degeneration, or colon cancer). Participants rated the importance of 35 actions. Principal component analysis, used to categorize actions, yielded eight categories: (1) medical management and communication; (2) partner support; (3) support and life fulfillment; (4) diet and exercise; (5) distal planning; (6) religion/spiritual support; (7) reproductive actions; and (8) proximal planning. Participants rated a wide range of actions as important, with medical management and communication, and partner support receiving the highest mean ratings. Linear regression yielded significant associations between importance ratings and demographics variables (age and gender), genetic condition, and perceived severity of the condition for different action categories. Genetic counselors and other healthcare professionals should consider a variety of possible patient actions beyond medical actionability when discussing genetic testing results.
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Affiliation(s)
| | - Patricia McCarthy Veach
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota
| | - Bonnie LeRoy
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota
| | - Weihua Guan
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota
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Trends in use of bilateral prophylactic mastectomy vs high-risk surveillance in unaffected carriers of inherited breast cancer syndromes in the Inherited Cancer Registry (ICARE). Breast Cancer Res Treat 2018; 174:39-45. [PMID: 30474778 DOI: 10.1007/s10549-018-5057-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/16/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Awareness of inherited breast cancer has increased bilateral prophylactic mastectomy (BPM) among unaffected genetic mutation carriers, yet many still choose surveillance. We aimed to identify differences among women electing BPM vs high-risk surveillance. METHODS Participants from an IRB-approved database recruited from 11/2000 to 01/2017 with a deleterious/pathogenic, variant suspected deleterious, or likely pathogenic mutation in ≥ 1 of 11 genes with increased risk for breast cancer (per 2017 NCCN guidelines) were identified. Participants with breast cancer and males were excluded. Sociodemographic and clinical data were collected. The BPM and high-risk surveillance groups were compared using Wilcoxon, Fisher's Exact, and Pearson's Chi-Square analyses. RESULTS A total of 304 unaffected genetic mutation carriers were identified; 22 men were excluded. 113/282 (40%) underwent BPM. There was no significant difference in age, race, marital status, high school graduates, family history of breast cancer, breast biopsies, chemoprevention use, or understanding implications of genetic mutation carriage. BPM participants were more likely to have a prior pregnancy (p = 0.0005), college education (p = 0.04), income > $50,000/year (p = 0.01), first-degree relative with breast cancer (p = 0.04), higher total number of relatives with breast cancer (p = 0.01), and rate of risk-reducing salpingo-oophorectomy (p = < 0.0001). The high-risk surveillance group was more likely to have a history of ovarian cancer (p = 0.009) and cancer worry (p = < 0.0001). CONCLUSIONS BPM is a common but not universal choice among unaffected genetic carriers of inherited breast cancer syndromes. Parity, education, income, ovarian cancer history, first-degree relatives with breast cancer, and cancer worry play significant roles in these decisions.
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15
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Honold F, Camus M. Prophylactic mastectomy versus surveillance for the prevention of breast cancer in women's BRCA carriers. Medwave 2018; 18:e7161. [PMID: 30052622 DOI: 10.5867/medwave.2018.04.7160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/23/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Women who have mutations in BRCA genes have a high risk of developing breast cancer. Therefore, multiple preventive strategies have been proposed, within which is prophylactic mastectomy. Considering physical and psychological effects of surgery, the controversy is established as to whether the preventive effect exceeds that of active vigilance. METHODS To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified 13 systematic reviews including 50 studies overall. We concluded prophylactic mastectomy is associated with frequent adverse effects, but probably reduces the incidence of breast cancer and decreases mortality, in addition to being associated with high levels of satisfaction.
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Affiliation(s)
- Francisca Honold
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Mauricio Camus
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Cirugía Oncológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Av. Diagonal Paraguay 476, piso 1, Santiago, Chile
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Abstract
Women carrying germline mutations in BRCA1 or BRCA2 have significantly increased lifetime risks of breast and tubo-ovarian cancer. To manage the breast cancer risk women may elect to have breast screening by MRI/mammogram from age 30, to take risk-reducing medication, or to have a prophylactic bilateral mastectomy. To manage the tubo-ovarian cancer risk, the only effective strategy is to have a bilateral salpingo-oophorectomy, recommended by age 40 (BRCA1) or 'around' age 40 (BRCA2). Early studies suggested that uptake of these cancer risk-reducing strategies was low. More recent studies have revealed higher rates of uptake, however it is unclear whether uptake is genuinely improving or whether the higher uptake rates reflect changes in the populations studied. In this study we surveyed 193 BRCA1/2 mutation carriers in the state of Tasmania to determine the uptake of cancer risk-reducing strategies and what factors might influence women's decisions in relation to both gynaecological and breast surgery. We observed that uptake of risk management strategies varied depending on the strength of the recommendation in the national guidelines. Uptake rates were > 90% for strategies which are strongly recommended, such as breast screening by MRI/mammogram and bilateral salpingo-oophorectomy, and were unaffected by demographic factors such as socio-economic disadvantage and educational achievement. Uptake rates were much lower for strategies which are presented in the guidelines as options for consideration and where patient choice and shared decision making are encouraged, such as prophylactic mastectomy (29%) and chemoprevention (1%) and in the case of prophylactic mastectomy, were influenced by both socio-economic advantage and educational achievement.
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Padamsee TJ, Wills CE, Yee LD, Paskett ED. Decision making for breast cancer prevention among women at elevated risk. Breast Cancer Res 2017; 19:34. [PMID: 28340626 PMCID: PMC5366153 DOI: 10.1186/s13058-017-0826-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Several medical management approaches have been shown to be effective in preventing breast cancer and detecting it early among women at elevated risk: 1) prophylactic mastectomy; 2) prophylactic oophorectomy; 3) chemoprevention; and 4) enhanced screening routines. To varying extents, however, these approaches are substantially underused relative to clinical practice recommendations. This article reviews the existing research on the uptake of these prevention approaches, the characteristics of women who are likely to use various methods, and the decision-making processes that underlie the differing choices of women. It also highlights important areas for future research, detailing the types of studies that are particularly needed in four key areas: documenting women's perspectives on their own perceptions of risk and prevention decisions; explicit comparisons of available prevention pathways and their likely health effects; the psychological, interpersonal, and social processes of prevention decision making; and the dynamics of subgroup variation. Ultimately, this research could support the development of interventions that more fully empower women to make informed and values-consistent decisions, and to move towards favorable health outcomes.
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Affiliation(s)
- Tasleem J. Padamsee
- Division of Health Services Management & Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH 43220 USA
| | - Celia E. Wills
- College of Nursing, The Ohio State University, Columbus, OH USA
| | - Lisa D. Yee
- College of Medicine, The Ohio State University, Columbus, OH USA
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Ruberg JL, Helm CW, Felleman BI, Helm JE, Studts JL. Is attendance at an ovarian cancer screening clinic a worry-reducing event? Findings from pre- to post-screening. Gynecol Oncol 2016; 144:363-368. [PMID: 27986270 DOI: 10.1016/j.ygyno.2016.11.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Many studies have examined the relationship between worry and cancer screening. Due to methodological inconsistencies, results of these studies have varied and few conclusions can be made when generalizing across studies. The purpose of the current study was to better understand the worry-cancer screening relationship using a prospective research design. METHOD 180 women enrolled in an annual ovarian cancer (OC) screening clinic completed surveys at three time points-pre-screening, day of screening, and post-screening-using three measures of cancer-specific worry. RESULTS OC worry was highest in the weeks prior to screening and mere presentation at a screening clinic was associated with a significant worry decline. Observed elevations in worry following abnormal screening were not universal and varied by the instrument used to measure worry. CONCLUSIONS In contrast to our hypotheses, it appears that mere presentation at a cancer screening clinic may be a worry-reducing event. Receipt of abnormal results was not necessarily associated with increased worry.
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Affiliation(s)
- Joshua L Ruberg
- University of Louisville, Louisville, KY 40292, United States; James Graham Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, United States; VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, United States; Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| | - C William Helm
- University of Louisville, Louisville, KY 40292, United States; James Graham Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, United States
| | - Benjamin I Felleman
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, United States
| | - Jane E Helm
- University of Louisville, Louisville, KY 40292, United States; James Graham Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, United States
| | - Jamie L Studts
- University of Louisville, Louisville, KY 40292, United States; University of Kentucky College of Medicine, Lexington, KY 40536-0086, United States; James Graham Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, United States; Lucille P. Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, United States
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19
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Turner AR, Lane BR, Rogers D, Lipkus I, Weaver K, Danhauer SC, Zhang Z, Hsu FC, Noyes SL, Adams T, Toriello H, Monroe T, McKanna T, Young T, Rodarmer R, Kahnoski RJ, Tourojman M, Kader AK, Zheng SL, Baer W, Xu J. Randomized trial finds that prostate cancer genetic risk score feedback targets prostate-specific antigen screening among at-risk men. Cancer 2016; 122:3564-3575. [PMID: 27433786 PMCID: PMC5247411 DOI: 10.1002/cncr.30162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/16/2016] [Accepted: 04/21/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Prostate-specific antigen (PSA) screening may reduce death due to prostate cancer but leads to the overdiagnosis of many cases of indolent cancer. Targeted use of PSA screening may reduce overdiagnosis. Multimarker genomic testing shows promise for risk assessment and could be used to target PSA screening. METHODS To test whether counseling based on the family history (FH) and counseling based on a genetic risk score (GRS) plus FH would differentially affect subsequent PSA screening at 3 months (primary outcome), a randomized trial of FH versus GRS plus FH was conducted with 700 whites aged 40 to 49 years without prior PSA screening. Secondary outcomes included anxiety, recall, physician discussion at 3 months, and PSA screening at 3 years. Pictographs versus numeric presentations of genetic risk were also evaluated. RESULTS At 3 months, no significant differences were observed in the rates of PSA screening between the FH arm (2.1%) and the GRS-FH arm (4.5% with GRS-FH vs. 2.1% with FH: χ2 = 3.13, P = .077); however, PSA screening rates at 3 months significantly increased with given risk in the GRS-FH arm (P = .013). Similar results were observed for discussions with physicians at 3 months and PSA screening at 3 years. Average anxiety levels decreased after the individual cancer risk was provided (P = .0007), with no differences between groups. Visual presentation by pictographs did not significantly alter comprehension or anxiety. CONCLUSIONS This is likely the first randomized trial of multimarker genomic testing to report genomic targeting of cancer screening. This study found little evidence of concern about excess anxiety or overuse/underuse of PSA screening when multimarker genetic risks were provided to patients. Cancer 2016;122:3564-3575. © 2016 American Cancer Society.
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Affiliation(s)
- Aubrey R. Turner
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Brian R. Lane
- Spectrum Health Hospital System, Grand Rapids, MI, 49546
- Michigan State University College of Human Medicine, Grand Rapids, MI 49546
| | - Dan Rogers
- Van Andel Research Institute, Grand Rapids, MI
| | | | - Kathryn Weaver
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Suzanne C. Danhauer
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Zheng Zhang
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | | | - Tamara Adams
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Helga Toriello
- Spectrum Health Hospital System, Grand Rapids, MI, 49546
| | - Thomas Monroe
- Spectrum Health Hospital System, Grand Rapids, MI, 49546
| | - Trudy McKanna
- Spectrum Health Hospital System, Grand Rapids, MI, 49546
| | - Tracey Young
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Ryan Rodarmer
- Spectrum Health Hospital System, Grand Rapids, MI, 49546
| | | | | | - A. Karim Kader
- Department of Surgery, University of California San Diego, San Diego, CA
| | - S. Lilly Zheng
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - William Baer
- Grand Valley Medical Specialists, Grand Rapids, MI
| | - Jianfeng Xu
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
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Melvin CL, Jefferson MS, Rice LJ, Cartmell KB, Halbert CH. Predictors of Participation in Mammography Screening among Non-Hispanic Black, Non-Hispanic White, and Hispanic Women. Front Public Health 2016; 4:188. [PMID: 27656640 PMCID: PMC5012250 DOI: 10.3389/fpubh.2016.00188] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/23/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Many factors influence women's decisions to participate in guideline-recommended screening mammography. We evaluated the influence of women's socioeconomic characteristics, health-care access, and cultural and psychological health-care preferences on timely mammography screening participation. MATERIALS AND METHODS A random digit dial survey of United States non-Hispanic Black, non-Hispanic White, and Hispanic women aged 40-75, from January to August 2009, determined self-reported time of most recent mammogram. Screening rates were assessed based on receipt of a screening mammogram within the prior 12 months, the interval recommended at the time by the American Cancer Society. RESULTS Thirty-nine percent of women reported not having a mammogram within the last 12 months. The odds of not having had a screening mammography were higher for non-Hispanic White women than for non-Hispanic Black (OR = 2.16, 95% CI = 0.26, 0.82, p = 0.009) or Hispanic (OR = 4.17, 95% CI = 0.12, 0.48, p = 0.01) women. Lack of health insurance (OR = 3.22, 95% CI = 1.54, 6.73, p = 0.002) and lack of usual source of medical care (OR = 3.37, 95% CI = 1.43, 7.94, p = 0.01) were associated with not being screened as were lower self-efficacy to obtain screening (OR = 2.43, 95% CI = 1.26, 4.73, p = 0.01) and greater levels of religiosity and spirituality (OR = 1.42, 95% CI = 1.00, 2.00, p = 0.05). Neither perceived risk nor present temporal orientation was significant. DISCUSSION Odds of not having a mammogram increased if women were uninsured, without medical care, non-Hispanic White, older in age, not confident in their ability to obtain screening, or held passive or external religious/spiritual values. Results are encouraging given racial disparities in health-care participation and suggest that efforts to increase screening among minority women may be working.
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Affiliation(s)
- Cathy L. Melvin
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Melanie S. Jefferson
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - LaShanta J. Rice
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Chanita Hughes Halbert
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, SC, USA
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Halbert CH, Gattoni-Celli S, Savage S, Prasad SM, Kittles R, Briggs V, Delmoor E, Rice LJ, Jefferson M, Johnson JC. Ever and Annual Use of Prostate Cancer Screening in African American Men. Am J Mens Health 2016; 11:99-107. [PMID: 26240090 DOI: 10.1177/1557988315596225] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Since prostate cancer continues to disproportionately affect African American men in terms of incidence, morbidity, and mortality, prostate-specific antigen (PSA) screening plays an important role in early detection, especially when men engage in informed decision making to accept or decline this test. The authors evaluated utilization of PSA testing among African American men based on factors that are important components of making informed decisions. Utilization of PSA testing was evaluated based on whether men had ever had PSA testing and PSA testing during the past year in a community-based sample of African American men ages 50 to 75 ( n = 132). Overall, 64% of men ( n = 85) reported that they had ever had a PSA test; the mean ( SD) age for first use of PSA testing was 47.7 ( SD = 7.4). The likelihood of ever having a PSA test increased significantly with physician communication (odds ratio [OR] = 14.2; 95% confidence interval [CI] = 4.20, 48.10; p = .0001) and with having an annual household income that was greater than $20,000 (OR = 9.80; 95% CI = 3.15, 30.51; p = .0001). The odds of ever having a PSA test were also decreased with each unit increase in future temporal orientation (OR = 0.66; 95% CI = 0.47, 0.93; p = .02). Of the men who had ever had PSA testing, 57% were screened during the past year. Only health insurance status had a significant independent association with having annual PSA testing (OR = 5.10; 95% CI = 1.67, 15.60; p = .004). Different factors were associated significantly with ever having PSA testing and annual testing among African American men. African American men may not be making an informed decision about prostate cancer screening.
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Affiliation(s)
- Chanita Hughes Halbert
- 1 Medical University of South Carolina, Charleston, SC, USA.,2 Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Sebastiano Gattoni-Celli
- 1 Medical University of South Carolina, Charleston, SC, USA.,2 Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Stephen Savage
- 1 Medical University of South Carolina, Charleston, SC, USA.,2 Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Sandip M Prasad
- 1 Medical University of South Carolina, Charleston, SC, USA.,2 Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | | | - Vanessa Briggs
- 4 Health Promotion Council of Southeastern Pennsylvania, Philadelphia, PA, USA
| | - Ernestine Delmoor
- 5 Philadelphia Chapter, National Black Leadership Initiative on Cancer, Philadelphia, PA, USA
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Senior V, Smith JA, Michie S, Marteau TM. Making Sense of Risk: An Interpretative Phenomenological Analysis of Vulnerability to Heart Disease. J Health Psychol 2016; 7:157-68. [DOI: 10.1177/1359105302007002455] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study investigates perceptions of familial hypercholesterolaemia (FH) and its genetic basis in patients diagnosed with, and receiving treatment for, FH. Semi-structured interviews were conducted with seven patients. Transcripts were analysed using interpretative phenomenological analysis (IPA). Participants reported engaging in an active process of seeking causes for their FH. FH was invariably attributed to genes. In some cases diet and stress were also considered as causes of FH. Causal attributions appear to be both a determinant and a result of behavioural strategies to reduce risk. On the whole, FH was perceived as unproblematic, a perception that appeared to reflect downward social comparison processes. Nonetheless, participants reported acting in ways consonant with the perception of an increased risk of heart attack, in particular, being vigilant to symptoms of a possible heart attack.
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Miller SM, Roussi P, Daly MB, Buzaglo JS, Sherman K, Godwin AK, Balshem A, Atchison ME. Enhanced Counseling for Women Undergoing BRCA1/2 Testing: Impact on Subsequent Decision Making About Risk Reduction Behaviors. HEALTH EDUCATION & BEHAVIOR 2016; 32:654-67. [PMID: 16148211 DOI: 10.1177/1090198105278758] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The authors evaluated the impact of an enhanced counseling intervention, designed to promote well-informed decision making for follow-up risk reduction options for ovarian cancer, among high-risk women undergoing BRCA1/2 testing ( N = 77). Following standard genetic counseling, participants received either an enhanced counseling session—designed to help participants anticipate their reactions to possible test outcomes and plan for postresult consequences—or a general health information control session. One week after disclosure of test results, women in the enhanced counseling group experienced a greater reduction in avoidant ideation, suggesting more complete processing of risk feedback. At the 6-monthfollow-up, intervention respondents reported seeking out more information about prophylactic oophorectomy and were more likely to have actually undergone preventive surgery. The results indicate that the use of enhanced counseling can play an important role in decision making about risk reduction behaviors following BRCA1/2 testing.
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Affiliation(s)
- Suzanne M Miller
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, PA 19111, USA.
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Michie S, Lester K, Pinto J, Marteau TM. Communicating Risk Information in Genetic Counseling: An Observational Study. HEALTH EDUCATION & BEHAVIOR 2016; 32:589-98. [PMID: 16148206 DOI: 10.1177/1090198105278562] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study investigates risk communication within genetic counselling. Transcripts of 115 U.K. genetic consultations were reliably coded into form of risk expression used, whether the patient responded with understanding and agreement or showed signs of misunderstanding or disagreement, or did not respond at all, and whether clinicians assessed patient comprehension. Of the 492 risk expressions used, 53% were words and 47% were numbers (32% probabilities and 15% percentages). There was no association between form of risk expression and response. Clinicians assessed comprehension on only 25% of occasions, less often following the use of words than numbers, and on only 9% of occasions when there was no response to their risk communication. Because patients did not respond to 43% of risk communications, there is a concern that patients may make decisions without understanding the risks involved.
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Affiliation(s)
- Susan Michie
- Centre for Outcomes Research and Effectiveness, Department of Psychology, University College London, London.
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Buchanan AH, Voils CI, Schildkraut JM, Fine C, Horick NK, Marcom PK, Wiggins K, Skinner CS. Adherence to Recommended Risk Management among Unaffected Women with a BRCA Mutation. J Genet Couns 2016; 26:79-92. [PMID: 27265406 DOI: 10.1007/s10897-016-9981-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 05/24/2016] [Indexed: 01/01/2023]
Abstract
Identifying unaffected women with a BRCA mutation can have a significant individual and population health impact on morbidity and mortality if these women adhere to guidelines for managing cancer risk. But, little is known about whether such women are adherent to current guidelines. We conducted telephone surveys of 97 unaffected BRCA mutation carriers who had genetic counseling at least one year prior to the survey to assess adherence to current guidelines, factors associated with adherence, and common reasons for performing and not performing recommended risk management. More than half of participants reported being adherent with current risk management recommendations for breast cancer (69 %, n = 67), ovarian cancer (82 %, n = 74) and both cancers (66 %, n = 64). Older age (OR = 10.53, p = 0.001), white race (OR = 8.93, p = 0.019), higher breast cancer genetics knowledge (OR = 1.67, p = 0.030), higher cancer-specific distress (OR = 1.07, p = 0.002) and higher physical functioning (OR = 1.09, p = 0.009) were significantly associated with adherence to recommended risk management for both cancers. Responses to open-ended questions about reasons for performing and not performing risk management behaviors indicated that participants recognized the clinical utility of these behaviors. Younger individuals and those with lower physical functioning may require targeted interventions to improve adherence, perhaps in the setting of long-term follow-up at a multi-disciplinary hereditary cancer clinic.
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Affiliation(s)
- Adam H Buchanan
- Geisinger Health System, Genomic Medicine Institute, M.C. 26-20, 100 N. Academy Ave, Danville, PA, 17822, USA.
| | - Corrine I Voils
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Catherine Fine
- Department of Genetics, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Nora K Horick
- Massachusetts General Hospital Biostatistics Center, Boston, MA, USA
| | - P Kelly Marcom
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Kristi Wiggins
- Division of Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Celette Sugg Skinner
- Department of Clinical Sciences and Harold C Simmons Cancer Center, University of Texas - Southwestern, Dallas, TX, USA
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26
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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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Albada A, van Dulmen S, Dijkstra H, Wieffer I, Witkamp A, Ausems MGEM. Counselees' Expressed Level of Understanding of the Risk Estimate and Surveillance Recommendation are Not Associated with Breast Cancer Surveillance Adherence. J Genet Couns 2015; 25:279-89. [PMID: 26321750 PMCID: PMC4799246 DOI: 10.1007/s10897-015-9869-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 07/23/2015] [Indexed: 11/16/2022]
Abstract
We studied counselees’ expressed understanding of the risk estimate and surveillance recommendation in the final consultation for breast cancer genetic counseling in relation with their risk perception, worry and cancer surveillance adherence 1 year post-counseling. Consecutive counselees were included from 2008 to 2010. Counselees with an indication for diagnostic DNA-testing for themselves or a breast cancer affected relative were requested to complete online questionnaires before and after counseling and one year after counseling (N = 152–124). Self-reported surveillance was compared to surveillance recommendations. Consultations were videotaped. Counselees’ reactions to the risks and recommendations were coded. Statements about the risk perception and surveillance intentions of breast cancer unaffected counselees were transcribed. Associations with outcomes were explored. Almost all breast cancer unaffected counselees (>90 %) reacted to their risk estimate with an utterance indicating understanding and this reaction was not significantly associated with their post-visit risk perception alignment. Over one-third (38.6 %) overestimated their risk post-counseling. Few counselees (5.8 %) expressed surveillance intentions. One year after counseling, about three-quarters (74.0 %) of the breast cancer unaffected counselees had adhered to the surveillance recommendation. Almost one-quarter (23.3 %) had performed more mammograms/MRI scans than recommended, which was associated with prior mammography uptake (n = 47; X2 = 5.2; p = .02). Counselees’ post-counseling overestimation of their risk, high levels of worry and high surveillance uptake were not reflected in their reactions to the counselor’s information during the final visit.
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Affiliation(s)
- Akke Albada
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
| | - Henrietta Dijkstra
- NIVEL (Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Ivette Wieffer
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Arjen Witkamp
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Margreet G E M Ausems
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
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Witt J, Elwyn G, Wood F, Rogers MT, Menon U, Brain K. Adapting the coping in deliberation (CODE) framework: a multi-method approach in the context of familial ovarian cancer risk management. PATIENT EDUCATION AND COUNSELING 2014; 97:200-210. [PMID: 25064250 DOI: 10.1016/j.pec.2014.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 06/28/2014] [Accepted: 07/03/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To test whether the coping in deliberation (CODE) framework can be adapted to a specific preference-sensitive medical decision: risk-reducing bilateral salpingo-oophorectomy (RRSO) in women at increased risk of ovarian cancer. METHODS We performed a systematic literature search to identify issues important to women during deliberations about RRSO. Three focus groups with patients (most were pre-menopausal and untested for genetic mutations) and 11 interviews with health professionals were conducted to determine which issues mattered in the UK context. Data were used to adapt the generic CODE framework. RESULTS The literature search yielded 49 relevant studies, which highlighted various issues and coping options important during deliberations, including mutation status, risks of surgery, family obligations, physician recommendation, peer support and reliable information sources. Consultations with UK stakeholders confirmed most of these factors as pertinent influences on deliberations. Questions in the generic framework were adapted to reflect the issues and coping options identified. CONCLUSIONS The generic CODE framework was readily adapted to a specific preference-sensitive medical decision, showing that deliberations and coping are linked during deliberations about RRSO. PRACTICE IMPLICATIONS Adapted versions of the CODE framework may be used to develop tailored decision support methods and materials in order to improve patient-centred care.
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Affiliation(s)
- Jana Witt
- Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
| | - Glyn Elwyn
- Dartmouth Center for Healthcare Delivery Science, Hanover, NH, USA; Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
| | - Fiona Wood
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | | | - Usha Menon
- Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Kate Brain
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
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29
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Kwong A, Chu ATW, Wu CTS, Tse DMS. Attitudes and compliance of clinical management after genetic testing for hereditary breast and ovarian cancer among high-risk Southern Chinese females with breast cancer history. Fam Cancer 2014; 13:423-30. [PMID: 24623488 DOI: 10.1007/s10689-014-9706-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Western studies have shown that the uptake rates of surveillance and prophylaxis may vary among BRCA mutation carriers between ethnicities. The present study is the first to investigate the behavioural impact and subjective attitudes in Southern Chinese high-risk families who had undergone BRCA1 and BRCA2 genetic testing up to 2.5 years post-testing. Individuals who had such genetic testing and have consented to participate in the prospective database of Hong Kong Hereditary Breast Cancer Family Registry were recruited and surveyed by a face-to-face or telephone interview. Sociodemographic information, genetic test results, pre- and post-testing surveillance, medical regimes, and attitudes towards the choice of clinical management were obtained by interviews and retrieval of medical records using this prospective database. 69 females with breast cancer history were recruited into the study. Twenty-nine female carriers (15 BRCA1 mutated gene-carriers and 14 BRCA2 mutated gene-carriers) and 40 non-carriers of a BRCA 1/2 mutations were interviewed. The uptake rate of high risk breast screening i.e. clinical breast examination, mammography, and breast MRI is significantly higher among female carriers (48.3 %) after knowing genetic testing results than before (p < 0.01). A strong significant relationship between any increase or decrease of ovarian ultrasound screening (OS) and genetic status is found (p < .001), with more females did OS and with a higher frequency after knowing genetic testing results among both carriers (22.7 % → 86.4 %) and non-carriers (37.5 % → 50.0 %). Among carriers, very few opted for prophylactic surgeries. The present cohort might see prophylaxis as last resort and would use traditional Chinese medicine in cancer risk management.
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Affiliation(s)
- Ava Kwong
- Division of Breast Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China,
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30
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Brewer NT, Defrank JT, Chiu WK, Ibrahim JG, Walko CM, Rubin P, Olajide OA, Moore SG, Raab RE, Carrizosa DR, Corso SW, Schwartz G, Peppercorn JM, McLeod HL, Carey LA, Irvin WJ. Patients' understanding of how genotype variation affects benefits of tamoxifen therapy for breast cancer. Public Health Genomics 2014; 17:43-7. [PMID: 24457521 DOI: 10.1159/000356565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/10/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND CYP2D6 is a critical enzyme in the metabolism of tamoxifen and potentially a key determinant in breast cancer outcomes. Our study examined patients' beliefs about how the CYP2D6 genotype would affect their prognoses. METHODS Women enrolled in a pharmacogenomic clinical trial and on tamoxifen for prevention or treatment of breast cancer underwent CYP2D6 genotyping (EM = extensive, IM = intermediate, PM = poor metabolizing alleles). The informed consent said that the purpose of the trial was to examine effects of dose adjustment based on genotype, but that clinical benefits were uncertain. Our embedded sub-study surveyed 320 patients prior to receiving their genotypes. We experimentally manipulated 6 vignettes to describe hypothetical tamoxifen treatment (no or yes) and hypothetical genotype (EM, IM or PM). For each vignette, women gave their perceived recurrence risk (RR; 0-100%). RESULTS Women believed that genotype would not affect their RR if they did not take tamoxifen (p = 0.06). However, women believed that if prescribed tamoxifen, genotype would affect their RR (22% if EM, 30% if IM and 40% if PM, p < 0.001). CONCLUSION Women believed that extensive tamoxifen metabolizers had better prognoses, despite study materials stating uncertainty about any benefit. The rapidly changing nature of genomic science calls for caution when communicating clinical utility.
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Affiliation(s)
- N T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, N.C., USA
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31
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Schneider KI, Schmidtke J. Patient compliance based on genetic medicine: a literature review. J Community Genet 2013; 5:31-48. [PMID: 23934761 DOI: 10.1007/s12687-013-0160-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 07/02/2013] [Indexed: 12/19/2022] Open
Abstract
For this literature review, medical literature data bases were searched for studies on patient compliance after genetic risk assessment. The review focused on conditions where secondary or tertiary preventive options exist, namely cancer syndromes (BRCA-related cancer, HNPCC/colon cancer), hemochromatosis, thrombophilia, smoking cessation, and obesity. As a counterpart, patient compliance was assessed regarding medication adherence and medical advice in some of the most epidemiologically important conditions (including high blood pressure, metabolic syndrome, and coronary heart disease) after receiving medical advice based on nongenetic risk information or a combination of genetic and nongenetic risk information. In the majority of studies based on genetic risk assessments, patients were confronted with predictive rather than diagnostic genetic profiles. Most of the studies started from a knowledge base around 10 years ago when DNA testing was at an early stage, limited in scope and specificity, and costly. The major result is that overall compliance of patients after receiving a high-risk estimate from genetic testing for a given condition is high. However, significant behavior change does not take place just because the analyte is "genetic." Many more factors play a role in the complex process of behavioral tuning. Without adequate counseling and guidance, patients may interpret risk estimates of predictive genetic testing with an increase in fear and anxiety.
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Affiliation(s)
- Kai Insa Schneider
- Institute of Human Genetics, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
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Laitman Y, Vaisman Y, Feldman D, Helpman L, Gitly M, Paluch Shimon S, Berger R, Cohen L, Narod SA, Friedman E. Rates of risk-reducing surgery in IsraeliBRCA1andBRCA2mutation carriers. Clin Genet 2013; 85:68-71. [DOI: 10.1111/cge.12149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 03/15/2013] [Accepted: 03/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - L Helpman
- Department of Gynecooncology; Sheba Medical Center; Tel-Hashomer Israel
- Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | | | - S Paluch Shimon
- The Institute of Oncology; Sheba Medical Center; Tel-Hashomer Israel
- Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - R Berger
- Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
- The Institute of Oncology; Sheba Medical Center; Tel-Hashomer Israel
| | - L Cohen
- The BRACHA non-profit organization, Israel
| | - SA Narod
- Women's College Research Institute; Toronto Ontario Canada
| | - E Friedman
- Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
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33
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Kim D, Kang E, Hwang E, Sun Y, Hwang Y, Yom CK, Kim K, No JH, Kim YB, Kim SW. Factors affecting the decision to undergo risk-reducing salpingo-oophorectomy among women with BRCA gene mutation. Fam Cancer 2013; 12:621-8. [DOI: 10.1007/s10689-013-9625-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zagouri F, Chrysikos DT, Sergentanis TN, Giannakopoulou G, Zografos CG, Papadimitriou CA, Zografos GC. Prophylactic Mastectomy: An Appraisal. Am Surg 2013. [DOI: 10.1177/000313481307900233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The main indication of prophylactic mastectomy pertains to BRCA1 or BRCA2 mutation carriers. Prophylactic mastectomy includes the simple method and the subcutaneous method. Both methods can be followed by breast plastic reconstruction either at the same time or later. This review examines key issues regarding prophylactic mastectomy: the selection of patients, its effectiveness, its limitations, convergence/divergence in existing guidelines, and future perspectives.
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Affiliation(s)
- Flora Zagouri
- From the Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Dimosthenis T. Chrysikos
- From the Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Theodoros N. Sergentanis
- From the Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Georgia Giannakopoulou
- From the Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Constantine G. Zografos
- From the Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Christos A. Papadimitriou
- From the Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, Athens, Greece
| | - George C. Zografos
- From the Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, Athens, Greece
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Prophylactic Salpingectomy and Delayed Oophorectomy as an Alternative for BRCA Mutation Carriers. Obstet Gynecol 2013; 121:14-24. [DOI: 10.1097/aog.0b013e3182783c2f] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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DeFrank JT, Carey LA, Brewer NT. Understanding how breast cancer patients use risk information from genomic tests. J Behav Med 2012; 36:567-73. [PMID: 22878783 DOI: 10.1007/s10865-012-9449-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 06/08/2012] [Indexed: 10/28/2022]
Abstract
We sought to examine how patients' treatment decisions incorporate potentially conflicting information from standard clinical indicators (e.g., tumor size) and genomic tests for breast cancer recurrence risk. Participants were 77 early stage breast cancer survivors who previously received genomic testing. They read six hypothetical vignettes that varied recurrence risk indicated by standard tests (low or high risk) coupled with the genomic test (low, intermediate or high risk). For each vignette, women reported their perceived recurrence risk and treatment preferences. Test results indicating high recurrence risk increased perception of risk and preference for chemotherapy (p < .001 for all). Perceived risk explained (i.e., mediated) the effect of test results on chemotherapy preferences. When test results conflicted, women gave more weight to genomic over standard test results. Hypothetical genomic test results had the intended effect of influencing women's perceptions of recurrence risk and interest in chemotherapy.
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Affiliation(s)
- Jessica T DeFrank
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall, CB 7440, Chapel Hill, NC, 27599-7440, USA,
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Adherence to breast and ovarian cancer screening recommendations for female relatives from the Ontario site of the Breast Cancer Family Registry. Eur J Cancer Prev 2012; 20:492-500. [PMID: 21691207 DOI: 10.1097/cej.0b013e3283476217] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study compares adherence to breast and ovarian cancer screening recommendations among a population cohort of women at familial risk of breast and/or ovarian cancer. This cross-sectional study included 1039 first-degree female relatives without breast cancer identified from the Ontario site of the Breast Cancer Family Registry. We compared breast and ovarian cancer screening behaviors, using a telephone-administered questionnaire among three groups of women defined by their familial risk (high, moderate, and low) of breast and/or ovarian cancer. Associations between screening behaviors and familial risk were assessed using multinomial regression models adjusted by familial clustering. Women, 40-49 years of age, at moderate or high familial risk were significantly more likely to have had a screening mammogram within the past 12 months [odds ratio (OR): 2.80; 95% confidence interval (CI): 1.40-5.58], and women of less than 50 years of age were more likely to have a clinical breast examination (OR: 1.84; 95% CI: 1.02-3.31) compared with women at low familial risk. Compared with women at low or moderate familial risk, women at high familial risk were significantly more likely to have ever had a genetic test for the BRCA 1/2 genes (OR: 2.67; 95% CI: 1.76-4.05). Although the overall level of adherence among high-risk women is suboptimal in the community, women at a higher familial risk are adhering more often to cancer screening recommendations than women at a lower familial risk.
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Deans R, Creighton SM, Liao LM, Conway GS. Timing of gonadectomy in adult women with complete androgen insensitivity syndrome (CAIS): patient preferences and clinical evidence. Clin Endocrinol (Oxf) 2012; 76:894-8. [PMID: 22211628 DOI: 10.1111/j.1365-2265.2012.04330.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Adult women with complete androgen insensitivity syndrome (CAIS) are increasingly likely to defer or decline gonadectomy despite counselling about malignancy risk. The objectives of this study were to review the evidence on the risk of gonadal malignancy in adult women with CAIS and to explore women's reasons for deferring gonadectomy. STUDY DESIGN A case series and literature review. PATIENTS Sixteen women with CAIS over the age of 18 years who have elected to defer gonadectomy. RESULTS Sixty-two relevant papers were identified. Of these, 14 confirmed that tumours had been reported in 98 adults. Taking into account the limitations of combining historic case series, this review estimates a risk of gonadal malignancy of 14% (range 0% and 22%) in adults with CAIS. The most common reasons women offered for deferring gonadectomy included inconvenience of surgery, concern about surgical risk and reluctance to take hormone replacement therapy. CONCLUSIONS Perceived benefits for retaining gonads in women with CAIS are prompting more women to keep their gonads in situ. An accurate estimate for adult malignancy risk is unavailable, and the risks currently quoted may be falsely reassuring.
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Affiliation(s)
- Rebecca Deans
- University of New South Wales and Royal Hospital for Women, Sydney Australia, NSW, Australia
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Follow-up of carriers of BRCA1 and BRCA2 variants of unknown significance: variant reclassification and surgical decisions. Genet Med 2012; 13:998-1005. [PMID: 21811163 DOI: 10.1097/gim.0b013e318226fc15] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE : Approximately 5-10% of patients who undergo genetic testing of BRCA1 and BRCA2 receive a variant of unknown significance (VUS) result. The ambiguous nature of a VUS may increase difficulty in patient understanding and decision making regarding risk reduction and surveillance options, including cancer risk-reducing surgeries. VUS reclassification to benign or deleterious may occur in time; however, clinical decisions may need to be made expeditiously, and some patients may pursue irreversible treatments before VUS reclassification. METHODS : We reviewed the surgical decisions of 107 women postdisclosure of a BRCA VUS result counseled at our institute between 1998 and 2009. CONCLUSION : Among women receiving a BRCA VUS result at our center, 11 of 107 (10.3%) pursued cancer risk-reducing mastectomy and 22 of 107 (20.6%) pursued cancer risk-reducing bilateral salpingo-oophorectomy. Reclassification of VUS occurred up to 9 years after testing, and 5 of 22 (22.7%) women followed up for 8 or more years continue to have a VUS result. We discuss considerations for providers of genetic services to discuss with patients who receive a VUS result.
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40
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Schwartz MD, Isaacs C, Graves KD, Poggi E, Peshkin BN, Gell C, Finch C, Kelly S, Taylor KL, Perley L. Long-term outcomes of BRCA1/BRCA2 testing: risk reduction and surveillance. Cancer 2012; 118:510-7. [PMID: 21717445 PMCID: PMC3286617 DOI: 10.1002/cncr.26294] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 04/25/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND For BRCA1/BRCA2 gene testing to benefit public health, mutation carriers must initiate appropriate risk management strategies. There has been little research examining the long-term use and prospective predictors of the full range of risk management behaviors among women who have undergone BRCA1/2 testing. We evaluated long-term uptake and predictors of risk-reducing mastectomy (RRM), risk-reducing bilateral salpingo-oophorectomy (RRBSO), chemoprevention, and cancer screening among women at a mean of 5.3 years after testing. METHODS The study participants comprised 465 women who underwent BRCA1/2 testing. Prior to genetic counseling, we measured family/personal cancer history, sociodemographics, perceived risk, cancer-specific distress, and general distress. We contacted patients at a mean of 5.3 years after testing to measure use of RRM, RRBSO, chemoprevention, and breast and ovarian cancer screening. RESULTS Among participants with intact breasts and/or ovaries at the time of testing, BRCA1/2 carriers were significantly more likely to obtain RRM (37%) and RRBSO (65%) compared with women who received uninformative (RRM, 6.8%; RRBSO, 13.3%) or negative (RRM, 0%; RRBSO, 1.9%) results. Among carriers, precounseling anxiety was associated with subsequent uptake of RRM. RRO was predicted by age. Carriers were also more likely have used breast cancer chemoprevention and have undergone magnetic resonance imaging screening. CONCLUSION This prospective evaluation of the uptake and predictors of long-term management outcomes provides a clearer picture of decision making in this population. At a mean of 5.3 years after testing, more than 80% of carriers had obtained RRM, RRBSO, or both, suggesting that BRCA1/2 testing is likely to have a favorable effect on breast and ovarian cancer outcomes.
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Affiliation(s)
- Marc D Schwartz
- Department of Oncology, Cancer Control Program, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA.
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Metcalfe KA, Mian N, Enmore M, Poll A, Llacuachaqui M, Nanda S, Sun P, Hughes KS, Narod SA. Long-term follow-up of Jewish women with a BRCA1 and BRCA2 mutation who underwent population genetic screening. Breast Cancer Res Treat 2012; 133:735-40. [PMID: 22240989 DOI: 10.1007/s10549-011-1941-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 12/22/2011] [Indexed: 12/15/2022]
Abstract
There are two mutations in BRCA1 and one in BRCA2, which are present in up to 2.5% of Jewish women. Population genetic testing for Jewish women has been proposed; however, it is unclear how this would impact the uptake of cancer prevention options and psychosocial functioning in women with a positive result. Two thousand and eighty unselected Jewish women were tested for the Jewish BRCA mutations, and 1.1% were positive. Cancer-related distress was measured before testing, and at 1 and 2 years post-testing. Information on uptake of cancer risk reduction options was collected at 2 years. Breast and ovarian cancer risks were estimated using BRCAPRO. Within 2 years of receiving a positive result, 11.1% of women had prophylactic mastectomy, and 89.5% had a prophylactic oophorectomy. The mean breast cancer risk was estimated to be 37.2% at time of testing, compared to 20.9% at 2 years post-testing. The mean ovarian cancer risk was estimated to be 24.5% at time of testing, compared to 7.5% at 2 years following testing. Distress decreased between 1 and 2 years for women with prophylactic mastectomy and oophorectomy (P = 0.02), and for women with prophylactic oophorectomy only (P = 0.04) but not for those with neither surgery. The majority of Jewish women with a BRCA mutation identified through a population screening elected prophylactic oophorectomy, but a few had a prophylactic mastectomy. Uptake of either surgery resulted in decreased distress. Provision of population BRCA testing resulted in reduced risks of breast and ovarian cancers in women with a mutation.
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Affiliation(s)
- Kelly A Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Park S, Cochrane BB, Koh SB, Chung C. Comparison of Breast Cancer Risk Estimations, Risk Perception, and Screening Behaviors in Obese Rural Korean Women. Oncol Nurs Forum 2011; 38:E394-401. [DOI: 10.1188/11.onf.e394-e401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Halbert CH, Stopfer JE, McDonald J, Weathers B, Collier A, Troxel AB, Domchek S. Long-term reactions to genetic testing for BRCA1 and BRCA2 mutations: does time heal women's concerns? J Clin Oncol 2011; 29:4302-6. [PMID: 21990416 DOI: 10.1200/jco.2010.33.1561] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Short-term reactions to BRCA1 and BRCA2 (BRCA1/2) genetic test results have been described in several reports, but the long-terms effects of testing have not been examined extensively. METHODS We conducted an observational study to characterize the long-term impact of genetic testing for BRCA1/2 mutations in 167 women who had received genetic test results at least 4 years ago. We also evaluated the relationship between genetic testing-specific reactions and breast and ovarian cancer screening to determine the behavioral significance of adverse reactions. RESULTS Seventy-four percent of women were not experiencing any distress regarding their test result, 41% were not experiencing any uncertainty, and 51% had a score for positive experiences that was suggestive of low levels of adverse reactions in terms of family support and communication. Mutation carriers (odds ratio, 3.96; 95% CI, 1.44 to 10.89; P = .01) were most likely to experience distress. Only less time since disclosure was related significantly to experiencing uncertainty (odds ratio, 0.62; 95% CI, 0.44 to 0.88; P = .008). In terms of cancer screening, 81% of women had a mammogram during the year before study enrollment, 25% had magnetic resonance imaging (MRI), 20% had a transvaginal ultrasound, and 20% had a CA-125. Experiencing distress was associated significantly with having a CA-125 (χ(2) = 3.89, P = .05), and uncertainty was associated with having an MRI (χ(2) = 8.90, P = .003). CONCLUSION Our findings show that women are not likely to experience genetic testing concerns several years after receiving BRCA1/2 test results; distress and uncertainty are not likely to have adverse effects on screening among women at risk for hereditary disease.
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Abstract
BACKGROUND The use of direct-to-consumer genomewide profiling to assess disease risk is controversial, and little is known about the effect of this technology on consumers. We examined the psychological, behavioral, and clinical effects of risk scanning with the Navigenics Health Compass, a commercially available test of uncertain clinical validity and utility. METHODS We recruited subjects from health and technology companies who elected to purchase the Health Compass at a discounted rate. Subjects reported any changes in symptoms of anxiety, intake of dietary fat, and exercise behavior at a mean (±SD) of 5.6±2.4 months after testing, as compared with baseline, along with any test-related distress and the use of health-screening tests. RESULTS From a cohort of 3639 enrolled subjects, 2037 completed follow-up. Primary analyses showed no significant differences between baseline and follow-up in anxiety symptoms (P=0.80), dietary fat intake (P=0.89), or exercise behavior (P=0.61). Secondary analyses revealed that test-related distress was positively correlated with the average estimated lifetime risk among all the assessed conditions (β=0.117, P<0.001). However, 90.3% of subjects who completed follow-up had scores indicating no test-related distress. There was no significant increase in the rate of use of screening tests associated with genomewide profiling, most of which are not considered appropriate for screening asymptomatic persons in any case. CONCLUSIONS In a selected sample of subjects who completed follow-up after undergoing consumer genomewide testing, such testing did not result in any measurable short-term changes in psychological health, diet or exercise behavior, or use of screening tests. Potential effects of this type of genetic testing on the population at large are not known. (Funded by the National Institutes of Health and Scripps Health.).
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Affiliation(s)
- Cinnamon S Bloss
- Scripps Genomic Medicine, Scripps Translational Science Institute, and Scripps Health, La Jolla, CA 92037, USA
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Time to prophylactic surgery in BRCA1/2 carriers depends on psychological and other characteristics. Genet Med 2010; 12:801-7. [DOI: 10.1097/gim.0b013e3181f48d1c] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Teller P, Kramer RK. Management of the asymptomatic BRCA mutation carrier. APPLICATION OF CLINICAL GENETICS 2010; 3:121-31. [PMID: 23776357 PMCID: PMC3681169 DOI: 10.2147/tacg.s8882] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Current management of an asymptomatic BRCA mutation carrier includes early initiation and intensive cancer screening in combination with risk reduction strategies. The primary objectives of these interventions are earlier detection and cancer prevention to increase quality of life and prolonged survival. Existing recommendations are often based on the consensus of experts as there are few, supportive, randomized control trials. Management strategies for unaffected patients with BRCA mutations are continually redefined and customized as more evidence-based knowledge is acquired with regard to current intervention efficacy, mutation-related histology, and new treatment modalities. This review provides an outline of current, supported management principles, and interventions in the care of the asymptomatic BRCA mutation carrier. Topics covered include surveillance modalities and risk reduction achieved through behavioral modification, chemoprevention, and prophylactic surgery.
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Affiliation(s)
- Paige Teller
- Surgical Oncology, Medical University of South Carolina, Charleston, SC, USA
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Female BRCA mutation carriers with a preference for prophylactic mastectomy are more likely to participate an educational-support group and to proceed with the preferred intervention within 2 years. Fam Cancer 2010; 9:213-20. [PMID: 19967456 DOI: 10.1007/s10689-009-9311-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Women with a BRCA mutation face a complex choice between breast cancer surveillance and prophylactic mastectomy. We determined risk management preferences shortly after genetic test disclosure and mastectomy status after a median observation period of 2 years. The effect of an educational-support group on the realisation of risk management preference was explored. We included 163 newly disclosed BRCA mutation carriers with no history of cancer, whose breast cancer risk management preferences were recorded. All carriers were offered the opportunity to participate an educational-support group. Mastectomy status was checked after a median observation period of 2 years. Of the total sample, 27% had an initial preference for mastectomy and 48% attended an educational-support group. After a median observation period of 2 years, 30% of the total sample had undergone prophylactic mastectomy. Of the women with a preference for surveillance, 90% of educational-support group attendees and 88% of the other mutation carriers, were still under surveillance. The number of women with a preference for mastectomy who actually had a mastectomy performed, was significantly higher in the group that attended an educational-support group as compared to those who did not, 89% and 63% respectively (OR 4.8, P = 0.04). Strong predictors for prophylactic mastectomy within 2 years were younger age and prior preference for mastectomy (R (2) = 0.57). Nearly all BRCA mutation carriers proceed with their initial choice for surveillance or prophylactic mastectomy. The study provides presumptive evidence that educational-support group participants decide to undergo prophylactic mastectomy earlier than non-attendees.
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Kwon JS, Gutierrez-Barrera AM, Young D, Sun CC, Daniels MS, Lu KH, Arun B. Expanding the criteria for BRCA mutation testing in breast cancer survivors. J Clin Oncol 2010; 28:4214-20. [PMID: 20733129 DOI: 10.1200/jco.2010.28.0719] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Every year approximately 25% of women diagnosed with breast cancer are younger than 50 years of age, and almost 10% of them have a BRCA mutation. Not all potential carriers are identified by existing criteria for BRCA testing. We estimated the costs and benefits of different BRCA testing criteria for women with breast cancer younger than 50 years. METHODS We developed a Markov Monte Carlo simulation to compare six criteria for BRCA mutation testing: (1) no testing (reference); (2) medullary breast cancer in patients younger than 50 years; (3) any breast cancer in patients younger than 40 years; (4) triple negative (TN) breast cancer in patients younger than 40 years; (5) TN breast cancer in patients younger than 50 years; (6) any breast cancer in patients younger than 50 years. Net health benefits were life expectancy and quality-adjusted life expectancy, and primary outcome was the incremental cost-effectiveness ratio (ICER). The model estimated the number of new breast and ovarian cancer cases. RESULTS BRCA mutation testing for all women with breast cancer who were younger than 50 years could prevent the highest number of breast and ovarian cancer cases, but with unfavorable ICERs. Testing women with TN breast cancers who were younger than 50 years was cost-effective with an ICER of $8,027 per year of life gained ($9,084 per quality-adjusted life-year), and could reduce subsequent breast and ovarian cancer risks by 23% and 41%, respectively, compared with the reference strategy. CONCLUSION Testing women with TN breast cancers who were younger than 50 years for BRCA mutations is a cost-effective strategy and should be adopted into current guidelines for genetic testing.
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Affiliation(s)
- Janice S Kwon
- Division of Gynecologic Oncology, University of British Columbia and British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
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Hicken B, Tucker D. Impact of genetic risk feedback: Perceived risk and motivation for health protective behaviours. PSYCHOL HEALTH MED 2010. [DOI: 10.1080/13548500120101531] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Bringing the Social into Genetics: The Psychosocial Genetics Risk Assessment and Management Framework (PG-RAM). CURRENT PSYCHOLOGY 2010. [DOI: 10.1007/s12144-010-9085-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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