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Dijkstra T, van den Heuvel LM, van Tintelen JP, van der Werf C, van Langen IM, Christiaans I. Predicting personal cardiovascular disease risk based on family health history: Development of expert-based family criteria for the general population. Eur J Hum Genet 2023; 31:1381-1386. [PMID: 36973393 PMCID: PMC10689818 DOI: 10.1038/s41431-023-01334-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
In inherited and familial cardiovascular diseases (CVDs), relatives without current symptoms can still be at risk for early and preventable cardiovascular events. One way to help people evaluate their potential risk of CVD is through a risk-assessment tool based on family health history. However, family criteria including inherited CVD risk to be used by laypersons are non-existent. In this project, we employed a qualitative study design to develop expert-based family criteria for use in individual risk assessment. In the first phase of the project, we identified potential family criteria through an online focus group with physicians with expertise in monogenic and/or multifactorial CVDs. The family criteria from phase one were then used as input for a three-round Delphi procedure carried out in a larger group of expert physicians to reach consensus on appropriate criteria. This led to consensus on five family criteria that focus on cardiovascular events at young age (i.e., sudden death, any CVD, implantable cardioverter-defibrillator, aortic aneurysm) and/or an inherited CVD in one or more close relatives. We then applied these family criteria to a high-risk cohort from a clinical genetics department and demonstrated that they have substantial diagnostic accuracy. After further evaluation in a general population cohort, we decided to only use the family criteria for first-degree relatives. We plan to incorporate these family criteria into a digital tool for easy risk assessment by the public and, based on expert advice, will develop supporting information for general practitioners to act upon potential risks identified by the tool. Results from an expert focus group, a Delphi method in a larger group of experts, and evaluation in two cohorts were used to develop family criteria for assessing cardiovascular disease risk based on family health history for a digital risk-prediction tool for use by the general population. CVD Cardiovascular disease, ICD Implantable cardioverter defibrillator, TAA Thoracic aortic aneurysm, AAA Abdominal aortic aneurysm.
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Affiliation(s)
- Tetske Dijkstra
- Department of Clinical Genetics, University Medical Center Groningen / University of Groningen, Groningen, the Netherlands
| | - Lieke M van den Heuvel
- Department of Clinical Genetics, University Medical Center Groningen / University of Groningen, Groningen, the Netherlands
- Department of Clinical Genetics, Academic Medical Center / University of Amsterdam, Amsterdam, the Netherlands
- Department of Biomedical Genetics, University Medical Center Utrecht / University Utrecht, Utrecht, the Netherlands
| | - J Peter van Tintelen
- Department of Biomedical Genetics, University Medical Center Utrecht / University Utrecht, Utrecht, the Netherlands
| | - Christian van der Werf
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Irene M van Langen
- Department of Clinical Genetics, University Medical Center Groningen / University of Groningen, Groningen, the Netherlands
| | - Imke Christiaans
- Department of Clinical Genetics, University Medical Center Groningen / University of Groningen, Groningen, the Netherlands.
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Adedokun B, Ademola A, Makumbi T, Odedina S, Agwai I, Ndom P, Gakwaya A, Ogundiran T, Ojengbede O, Huo D, Olopade OI. Unawareness of breast cancer family history among African women. Pan Afr Med J 2023; 45:188. [PMID: 38020349 PMCID: PMC10656588 DOI: 10.11604/pamj.2023.45.188.21616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 12/01/2023] Open
Abstract
Introduction comprehensive cancer risk assessment services are lacking in most sub-Saharan African countries and the use of accurate family history (FH) information could serve as a cheap strategy for risk evaluation. The aim of this study is to determine the proportion of women unaware of family history of cancer among female relatives and associated socio-demographic characteristics. Methods using case-control data on breast cancer among 4294 women in Nigeria, Uganda and Cameroon, we investigated the proportion of women unaware of family history of cancer among their female relatives. The association between participants' response to their awareness of female relatives' cancer history and socio-demographic characteristics was analysed according to case-control status, family side and distance of relation. Results: the proportion of women unaware if any relative had cancer was 33%, and was significantly higher among controls (43.2%) compared to 23.9% among cases (p<0.001) (Adjusted Odds Ratio (OR) = 2.51, 95% CI = 2.14 - 2.95). Age, education and marital status remained significantly associated with being unaware of FH among controls on multiple regression. Conclusion about a third of women interviewed did not know about cancer history in at least one of their female relatives. Efforts aimed at improving cancer awareness in sub-Saharan Africa (SSA) are needed. Our findings could be useful for future studies of cancer risk assessment in SSA.
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Affiliation(s)
- Babatunde Adedokun
- Center for Clinical Cancer Genetics and Global Health, University of Chicago, Chicago, United States of America
| | | | | | - Stella Odedina
- Center for Population and Reproductive Health, University of Ibadan, Ibadan, Nigeria
| | - Imaria Agwai
- Center for Population and Reproductive Health, University of Ibadan, Ibadan, Nigeria
| | - Paul Ndom
- Hôpital Général Yaoundé, Yaoundé, Cameroon
| | - Antony Gakwaya
- School of Medicine, St. Augustine International University, Kampala, Uganda
| | | | - Oladosu Ojengbede
- Center for Population and Reproductive Health, University of Ibadan, Ibadan, Nigeria
| | - Dezheng Huo
- Center for Clinical Cancer Genetics and Global Health, University of Chicago, Chicago, United States of America
| | - Olufunmilayo I. Olopade
- Center for Clinical Cancer Genetics and Global Health, University of Chicago, Chicago, United States of America
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Haga SB, Orlando LA. Expanding Family Health History to Include Family Medication History. J Pers Med 2023; 13:jpm13030410. [PMID: 36983592 PMCID: PMC10053261 DOI: 10.3390/jpm13030410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
The collection of family health history (FHH) is an essential component of clinical practice and an important piece of data for patient risk assessment. However, family history data have generally been limited to diseases and have not included medication history. Family history was a key component of early pharmacogenetic research, confirming the role of genes in drug response. With the substantial number of known pharmacogenes, many affecting response to commonly prescribed medications, and the availability of clinical pharmacogenetic (PGx) tests and guidelines for interpretation, the collection of family medication history can inform testing decisions. This paper explores the roots of family-based pharmacogenetic studies to confirm the role of genes in these complex phenotypes and the benefits and challenges of collecting family medication history as part of family health history intake.
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Dillon J, Ademuyiwa FO, Barrett M, Moss HA, Wignall E, Menendez C, Hughes KS, Plichta JK. Disparities in Genetic Testing for Heritable Solid-Tumor Malignancies. Surg Oncol Clin N Am 2021; 31:109-126. [PMID: 34776060 DOI: 10.1016/j.soc.2021.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Genetic testing offers providers a potentially life saving tool for identifying and intervening in high-risk individuals. However, disparities in receipt of genetic testing have been consistently demonstrated and undoubtedly have significant implications for the populations not receiving the standard of care. If correctly used, there is the potential for genetic testing to play a role in decreasing health disparities among individuals of different races and ethnicities. However, if genetic testing continues to revolutionize cancer care while being disproportionately distributed, it also has the potential to widen the existing mortality gap between various racial and ethnic populations.
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Affiliation(s)
- Jacquelyn Dillon
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Foluso O Ademuyiwa
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Megan Barrett
- Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Haley A Moss
- Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA. https://twitter.com/haleyarden1
| | | | - Carolyn Menendez
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Clinical Cancer Genetics, Duke Cancer Institute, Durham, NC, USA. https://twitter.com/@CSMenendez
| | - Kevin S Hughes
- Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Dwyer AA, Hesse-Biber S, Shea H, Zeng Z, Yi S. Coping response and family communication of cancer risk in men harboring a BRCA mutation: A mixed methods study. Psychooncology 2021; 31:486-495. [PMID: 34582073 DOI: 10.1002/pon.5831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Providing genetic counseling and genetic testing to at-risk blood relatives (cascade screening) is important for improving BRCA cancer outcomes. Intra-familial communication of risk is critical for cascade screening efforts yet relatively little is known about men's role in communicating BRCA risk. We sought to examine men's coping response to their BRCA status and intra-familial communication of risk to inform the development of tailored interventions that could promote cascade screening. METHODS We employed a sequential mixed-methods design. First, we measured coping response (quantitative) using the Multidimensional Impact of Cancer Risk Assessment (MICRA). MICRA scores were compared between BRCA+ men, BRCA- men and BRCA+ women. Subsequently, we used template analysis to analyze qualitative interviews exploring coping and intra-familial communication of risk. The Theory of Planned Behavior (TPB) served as a guiding framework for identifying intervention targets. RESULTS BRCA+ men (n = 36) had significantly higher levels of distress (p < 0.001), uncertainty (p < 0.001) and negative experiences (p < 0.05) compared to BRCA- male counterparts (n = 23). BRCA+ men had significantly lower distress (p < 0.001) and uncertainty (p < 0.001) than BRCA+ women (n = 406). Qualitative analysis of in-depth interviews with BRCA+ men (n = 35) identified promoters and barriers to active coping response and intra-familial communication of risk. Mapping results onto the TPB identified targets for tailoring person-centered approaches for men addressing beliefs/attitude, subjective norms, and perceived behavioral control. CONCLUSIONS Men and women appear to have different coping responses to learning their BRCA status. Developing tailored (sex-based), theory informed interventions may help promote intra-familial communication of BRCA risk and support cascade screening.
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Affiliation(s)
- Andrew A Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA.,Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Hannah Shea
- Department of Sociology, Boston College, Chestnut Hill, Massachusetts, USA
| | - Ziwei Zeng
- Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts, USA
| | - Shiya Yi
- Department of Measurement, Evaluation, Statistics and Assessment, Boston College, Chestnut Hill, Massachusetts, USA
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Reichl F, Muhr D, Rebhan K, Kramer G, Shariat SF, Singer CF, Tan YY. Cancer Spectrum, Family History of Cancer and Overall Survival in Men with Germline BRCA1 or BRCA2 Mutations. J Pers Med 2021; 11:jpm11090917. [PMID: 34575694 PMCID: PMC8466243 DOI: 10.3390/jpm11090917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/06/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Men with germline BRCA1/2 mutations are not well studied compared to their female counterparts. This study evaluates the cancer characteristics, family history of cancer, and outcomes of male BRCA1/2 mutation carriers. METHODS: All men with germline BRCA1/2 mutations who attended genetic assessment between October 1995 and October 2019 at the Medical University of Vienna were identified. Clinicohistopathological features, family history of cancer, and outcomes were assessed by mutation status. RESULTS: Of the 323 men included, 45 (13.9%) had a primary cancer diagnosis, many of whom were BRCA2 carriers (75.5%). Breast cancer (BC) was the most common cancer (57.8%) followed by prostate cancer (15.6%). Invasive ductal carcinoma and hormone receptor positive tumors were the most common. Among 26 BC-affected patients, 42% did not have any relatives with cancer. Parent of origin was only known in half of the 26 men, with 42% of them inherited through the maternal lineage versus 8% through the paternal. BRCA2 carriers and those with a family history of BC had worse overall survival (20 y vs. 23 y BRCA1 carriers; P = 0.007; 19 y vs. 21 y for those without family history of BC; P = 0.036). CONCLUSION: Male BRCA2 carriers were most likely to develop cancer and had worse prognosis. In our dataset, BC was the most common cancer, likely due to referral bias. Not all mutation carriers present with BC or have a family history of cancer to warrant genetic testing.
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Affiliation(s)
- Florian Reichl
- Department of Obstetrics, Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.R.); (D.M.); (C.F.S.)
| | - Daniela Muhr
- Department of Obstetrics, Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.R.); (D.M.); (C.F.S.)
| | - Katharina Rebhan
- Department of Urology, Medical University of Vienna, Waeringer Guertel 18-20, 1090 Vienna, Austria; (K.R.); (G.K.); (S.F.S.)
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Waeringer Guertel 18-20, 1090 Vienna, Austria; (K.R.); (G.K.); (S.F.S.)
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, Waeringer Guertel 18-20, 1090 Vienna, Austria; (K.R.); (G.K.); (S.F.S.)
- Institute for Urology and Reproductive Health, Sechenov University, 119991 Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Urology, Second Faculty of Medicine, Charles University, 15006 Prague, Czech Republic
| | - Christian F. Singer
- Department of Obstetrics, Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.R.); (D.M.); (C.F.S.)
| | - Yen Y. Tan
- Department of Obstetrics, Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (F.R.); (D.M.); (C.F.S.)
- Correspondence:
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Aslam S, Shabana, Ahmed M. Implications of ACMG guidelines to identify high-risk acute lymphoblastic leukemia patients with hereditary cancer susceptibility syndromes (HCSS) in a highly consanguineous population. BMC Pediatr 2021; 21:282. [PMID: 34134655 PMCID: PMC8207605 DOI: 10.1186/s12887-021-02749-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/25/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Hereditary cancer susceptibility syndrome (HCSS) contributes to the cancer predisposition at an early age, therefore, identification of HCSS has found to be crucial for surveillance, managing therapeutic interventions and refer the patients and their families for genetic counselling. The study aimed to identify ALL patients who meet the American College of Medical Genetics (ACMG) criteria and refer them for the genetic testing for HCSS as hereditary leukemia and hematologic malignancy syndrome, and to elucidate the significance of high consanguinity with the prevalence of inherited leukemia in Pakistani population. METHODS A total of 300 acute lymphoblastic leukemia patients were recruited from the Children's Hospital, Lahore, Pakistan from December 2018 to September 2019. A structured self-reporting questionnaire based on family and medical history of the disease was utilized for the data collection. RESULTS In our cohort, 60.40% of ALL patients were identified to meet ACMG criteria. Among them, a large number of patients (40.65%) solely fulfil the criteria due to the presence of parental consanguinity. However, parental consanguinity showed protective impact on the onset at early age of disease [OD = 0.44 (0.25-0.77), p-value = 0.00] while, a family history of cancer increased the risk of cardiotoxicity [OD = 2.46 (1.15-5.24), p-value = 0.02]. Parental consanguinity shows no significant impact on the family history of cancer and the number of relatives with cancer. CONCLUSIONS More than 50% of the ALL patients were considered the strong candidates' for genetic testing of HCSS in the Pakistani population, and parental consanguinity was the leading criteria fulfilled by the individuals when assessed through ACMG guidelines. Our study suggests revisiting ACMG guidelines, especially for the criterion of parental consanguinity, and formulating the score based criteria based on; genetic research, the toxicology profile, physical features, personal and family history of cancer for the identification of patients for the genetic testing.
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Affiliation(s)
- Sara Aslam
- Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, 54590, Pakistan.
| | - Shabana
- Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, 54590, Pakistan.
| | - Mehboob Ahmed
- Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, 54590, Pakistan
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How do non-geneticist physicians deal with genetic tests? A qualitative analysis. Eur J Hum Genet 2021; 30:320-331. [PMID: 33907318 PMCID: PMC8904857 DOI: 10.1038/s41431-021-00884-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/01/2022] Open
Abstract
Genetic testing is accepted to be a common practice in many medical specialties. These genetic tests raise issues such as respect for basic rights, how to handle results and uncertainty and how to balance concerns for medical confidentiality with the rights of third parties. Physicians need help to deal with the rapid development of genomic medicine as most of them have received no specific training on the medical, ethical, and social issues involved. Analyzing how these professionals integrate genetic testing into the patient-provider relationship is essential to paving the way for a better use of genomics by all. We conducted a qualitative study comprising a series of focus groups with 21 neurologists and endocrinologists about their genetic testing practices in the western part of France. The interviews were transcribed and analyzed for major themes. We identified an automated care management procedure of genetic testing that affects patient autonomy. The simple fact of having a written consent cannot justify a genetic test given the stakes associated with the results. We also suggest orienting practices toward a systemic approach using a multidisciplinary team or network to provide resources for dealing with uncertainties in interpreting results or situations that require additional technical or clinical skills and, if necessary, to allow for joint consultations with both a geneticist and a non-geneticist medical specialist.
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Ang L, Chan CPY, Yau WP, Seow WJ. Association between family history of lung cancer and lung cancer risk: a systematic review and meta-analysis. Lung Cancer 2020; 148:129-137. [PMID: 32892102 DOI: 10.1016/j.lungcan.2020.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Familial risk of lung cancer has been widely studied but the effects of sociodemographic factors and geographical regions are largely unknown. METHODS PubMed and Embase were systematically searched until 1st October 2019. A total of 84 articles were identified and (19 cohort and 66 case control studies) included in this systematic review and meta-analysis. Pooled summary estimates and 95% confidence intervals were estimated, and the analysis was stratified by sociodemographic factors and geographical regions. RESULTS Geographical regions, sex, age of proband, smoking status, type of first-degree relatives, number of affected relatives, and early onset of lung cancer in affected relatives were significant determinants of familial risk of lung cancer. Higher risk of familial lung cancer was found among Asians as compared to non-Asians, younger individuals (age≤50) as compared with older individuals (age>50), individuals with ≥2 affected relatives as compared with individuals with one affected relative, ever-smokers as compared with never-smokers, Asian females as compared with Western females, and never-smokers in Asia as compared with never-smokers in the West. CONCLUSIONS Familial risk of lung cancer is influenced by both genetic and environmental factors. Future studies should control for environmental factors such as air pollution and environmental tobacco smoke which are prevalent in Asia.
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Affiliation(s)
- Lina Ang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Cheryl Pui Yi Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Wai-Ping Yau
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Wei Jie Seow
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
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Parent of Origin Effects on Family Communication of Risk in BRCA+ Women: A Qualitative Investigation of Human Factors in Cascade Screening. Cancers (Basel) 2020; 12:cancers12082316. [PMID: 32824510 PMCID: PMC7464326 DOI: 10.3390/cancers12082316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/08/2020] [Accepted: 08/13/2020] [Indexed: 12/22/2022] Open
Abstract
Pathogenic germline variants in Breast Cancer 1/2 (BRCA) genes confer increased cancer risk. Understanding BRCA status/risk can enable family cascade screening and improve cancer outcomes. However, more than half of the families do not communicate family cancer history/BRCA status, and cancer outcomes differ according to parent of origin (i.e., maternally vs. paternally inherited pathogenic variant). We aimed to explore communication patterns around family cancer history/BRCA risk according to parent of origin. We analyzed qualitative interviews (n = 97) using template analysis and employed the Theory of Planned Behavior (TPB) to identify interventions to improve communication. Interviews revealed sub-codes of ‘male stoicism and ‘paternal guilt’ that impede family communication (template code: gender scripting). Conversely, ‘fatherly protection’ and ‘female camaraderie’ promote communication of risk. The template code ‘dysfunctional family communication’ was contextualized by several sub-codes (‘harmful negligence’, ‘intra-family ignorance’ and ‘active withdrawal of support’) emerging from interview data. Sub-codes ‘medical misconceptions’ and ‘medical minimizing’ deepened our understanding of the template code ‘medical biases’. Importantly, sub-codes of ‘informed physicians’ and ‘trust in healthcare’ mitigated bias. Mapping findings to the TPB identified variables to tailor interventions aimed at enhancing family communication of risk and promoting cascade screening. In conclusion, these data provide empirical evidence of the human factors impeding communication of family BRCA risk. Tailored, theory-informed interventions merit consideration for overcoming blocked communication and improving cascade screening uptake.
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Mankaney G, Macaron C, Burke CA. Refining Risk Factors for Gastric Cancer in Patients With Lynch Syndrome to Optimize Surveillance Esophagogastroduodenoscopy. Clin Gastroenterol Hepatol 2020; 18:780-782. [PMID: 31606458 DOI: 10.1016/j.cgh.2019.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Gautam Mankaney
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Carole Macaron
- Section of Gastroenterology, Department of Veterans Affairs, Louis Stokes Cleveland Medical Center, Cleveland, Ohio
| | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio; Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, Ohio
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12
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Wood ME, Rehman HT, Bedrosian I. Importance of family history and indications for genetic testing. Breast J 2019; 26:100-104. [PMID: 31865627 DOI: 10.1111/tbj.13722] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 01/22/2023]
Abstract
Family history is an important cancer risk assessment tool, and it is easy to use. The family history is integral in identifying an individual's risk for primary cancer and assists in the assessment of risk for a second primary cancer. For oncology providers, the critical family history is defined as including first- and second-degree family history, maternal and paternal history, type of primary cancer, and age at diagnosis and ethnicity. Family history should be taken at diagnosis and updated periodically. Despite the importance of family history to patient care, there are significant barriers to taking a family history. We review the impact of collecting complete family history data with respect to calculation of cancer risk, recommendations for screening, and prevention strategies and referral for genetic testing.
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Affiliation(s)
- Marie E Wood
- Hematology/Oncology Division, University of Vermont College of Medicine, Burlington, Vermont
| | - Hibba Tul Rehman
- Hematology/Oncology Division, University of Vermont College of Medicine, Burlington, Vermont
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Røe OD, Markaki M, Tsamardinos I, Lagani V, Nguyen OTD, Pedersen JH, Saghir Z, Ashraf HG. 'Reduced' HUNT model outperforms NLST and NELSON study criteria in predicting lung cancer in the Danish screening trial. BMJ Open Respir Res 2019; 6:e000512. [PMID: 31803478 PMCID: PMC6890385 DOI: 10.1136/bmjresp-2019-000512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 12/21/2022] Open
Abstract
Hypothesis We hypothesise that the validated HUNT Lung Cancer Risk Model would perform better than the NLST (USA) and the NELSON (Dutch‐Belgian) criteria in the Danish Lung Cancer Screening Trial (DLCST). Methods The DLCST measured only five out of the seven variables included in validated HUNT Lung Cancer Model. Therefore a ‘Reduced’ model was retrained in the Norwegian HUNT2-cohort using the same statistical methodology as in the original HUNT model but based only on age, pack years, smoking intensity, quit time and body mass index (BMI), adjusted for sex. The model was applied on the DLCST-cohort and contrasted against the NLST and NELSON criteria. Results Among the 4051 smokers in the DLCST with 10 years follow-up, median age was 57.6, BMI 24.75, pack years 33.8, cigarettes per day 20 and most were current smokers. For the same number of individuals selected for screening, the performance of the ‘Reduced’ HUNT was increased in all metrics compared with both the NLST and the NELSON criteria. In addition, to achieve the same sensitivity, one would need to screen fewer people by the ‘Reduced’ HUNT model versus using either the NLST or the NELSON criteria (709 vs 918, p=1.02e-11 and 1317 vs 1668, p=2.2e-16, respectively). Conclusions The ‘Reduced’ HUNT model is superior in predicting lung cancer to both the NLST and NELSON criteria in a cost-effective way. This study supports the use of the HUNT Lung Cancer Model for selection based on risk ranking rather than age, pack year and quit time cut-off values. When we know how to rank personal risk, it will be up to the medical community and lawmakers to decide which risk threshold will be set for screening.
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Affiliation(s)
- Oluf Dimitri Røe
- Department of Clinical and Molecular Medicine, Norges teknisk-naturvitenskapelige universitet, Trondheim, Norway.,Cancer Clinic, Sykehuset Levanger, Levanger, Norway
| | - Maria Markaki
- Department of Computer Science, University of Crete - Voutes Campus, Heraklion, Greece
| | - Ioannis Tsamardinos
- Department of Computer Science, University of Crete - Voutes Campus, Heraklion, Greece.,Institute of Applied Mathematics, Foundation for Research and Technology - Hellas (FORTH), Heraklion, Greece
| | - Vincenzo Lagani
- Science and Technology Park of Crete, GNOSIS Data Analysis PC, Heraklion, Greece.,Institute of Chemical Biology, Ilia State University, Tbilisi, Georgia
| | - Olav Toai Duc Nguyen
- Department of Clinical and Molecular Medicine, Norges teknisk-naturvitenskapelige universitet, Trondheim, Norway.,Cancer Clinic, Sykehuset Levanger, Levanger, Norway
| | - Jesper Holst Pedersen
- Department of Thoracic Surgery RT, Rigshospitalet, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - Zaigham Saghir
- Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Haseem Gary Ashraf
- Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark.,Department of Radiology, Akershus University Hospital, Lørenskog, Norway
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14
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Hesse-Biber S, Dwyer AA, Yi S. Parent of origin differences in psychosocial burden and approach to BRCA risk management. Breast J 2019; 26:734-738. [PMID: 31659791 DOI: 10.1111/tbj.13633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/26/2019] [Accepted: 09/06/2019] [Indexed: 01/18/2023]
Abstract
We conducted a mixed-method study to examine coping response in BRCA+ women based on parent of origin (maternally vs paternally inherited BRCA mutation). Quantitative findings (n = 408) revealed paternally inherited cases had genetic testing later and were more likely to have a cancer diagnosis. Having a maternally inherited mutation was the strongest predictor of proactive risk management response. Qualitative interviews (n = 56) identified proactive responses among maternally inherited cases compared to reactive responses in paternally inherited cases. Findings underscore the importance of unbiased pedigree analysis to determine cancer risk. Women with paternally inherited BRCA mutations may benefit from additional psychosocial support.
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Affiliation(s)
| | - Andrew A Dwyer
- Connell School of Nursing and Munn Center for Nursing Research, Boston College, Massachusetts General Hospital, Boston, MA, USA
| | - Shiya Yi
- Department of Measurement, Evaluation, Statistics and Assessment, Boston College, Chestnut Hill, MA, USA
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15
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Bucheit L, Johansen Taber K, Ready K. Validation of a digital identification tool for individuals at risk for hereditary cancer syndromes. Hered Cancer Clin Pract 2019; 17:2. [PMID: 30651894 PMCID: PMC6330430 DOI: 10.1186/s13053-018-0099-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/15/2018] [Indexed: 01/05/2023] Open
Abstract
Background The number of individuals meeting criteria for genetic counseling and testing for hereditary cancer syndromes (HCS) is far less than the number that actually receive it. To facilitate identification of patients at risk for HCS, Counsyl developed a digital identification tool (digital ID tool) to match personal and family cancer history to National Comprehensive Cancer Network (NCCN) BRCA-related Hereditary Breast and Ovarian Cancer (HBOC), Lynch syndrome, and polyposis testing criteria in one-to-one, automated fashion. The purpose of this study was to validate the ability of the digital ID tool to accurately identify histories that do and do not meet NCCN testing criteria. Methods Third-party recorded three-generation pedigrees were retrospectively reviewed by a certified genetic counselor (CGC) to determine if independent events included in pedigree histories met NCCN guidelines, and were then sorted into groups: high risk events (meets criteria) and low risk events (does not meet criteria). Events were entered into the digital ID tool to determine the extent of its concordance with events sorted by CGC review. Statistical tests of accuracy were calculated at a 95% confidence interval (CI). Results One hundred ninety-seven pedigrees were reviewed consecutively representing 765 independent events for analysis across groups. 382/382 (100%) high risk events identified by the digital ID tool and 381/383 (99.47%) low risk events identified by the digital ID tool were concordant with CGC sorting. The digital ID tool had a sensitivity of 100% (99.04–100% CI) and specificity of 99.48% (98.13–99.94% CI). The overall accuracy of the digital ID tool was estimated to be 99.74% (99.06–99.97% CI), reflecting the rate at which the digital ID tool reached the same conclusion as that of CGC review of pedigree events for the recommendation of genetic testing for individuals at risk for HCS. Conclusions The digital ID tool accurately matches NCCN criteria in one-to-one fashion to identify at-risk individuals for HCS and may be useful in clinical practice, specifically for BRCA-related HBOC and Lynch Syndrome. Electronic supplementary material The online version of this article (10.1186/s13053-018-0099-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leslie Bucheit
- Counsyl, 180 Kimball Way, South San Francisco, CA 98040 USA
| | | | - Kaylene Ready
- Counsyl, 180 Kimball Way, South San Francisco, CA 98040 USA
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16
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LaDuca H, McFarland R, Gutierrez S, Yussuf A, Ho N, Pepper J, Reineke P, Cain T, Blanco K, Horton C, Dolinsky JS. Quality of Clinician-Reported Cancer History When Ordering Genetic Testing. JCO Clin Cancer Inform 2018; 2:1-11. [DOI: 10.1200/cci.18.00014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose Clinical history data reported on test requisition forms (TRFs) for hereditary cancer multigene panel testing (MGPT) are routinely used by genetic testing laboratories. More recently, publications have incorporated TRF-based clinical data into studies exploring yield of testing by phenotype and estimating cancer risks for mutation carriers. We aimed to assess the quality of TRF data for patients undergoing MGPT. Patients and Methods Ten percent of patients who underwent hereditary cancer MGPT between January and June 2015 at a clinical laboratory were randomly selected. TRF-reported cancer diagnoses were evaluated for completeness and accuracy for probands and relatives using clinical documents such as pedigrees and chart notes as the comparison standard in cases where these documents were submitted after the time of test order. Results TRF-reported cancer sites and ages at diagnosis were complete for > 90.0% of proband cancer diagnoses overall, and the completion rate was even higher (> 96.0%) for breast, ovarian, colorectal, and uterine cancers. When reported, these data were accurate on TRFs for > 99.5% of proband cancer sites and > 97.5% of proband ages at diagnosis. Cancer site and age at diagnosis data were also complete on the TRF for the majority of cancers among first- and second-degree relatives. Completeness decreased as relation to the proband became more distant, whereas accuracy remained high across all degrees of relation. Conclusion Data collected as part of cancer genetic risk assessment is completely and accurately reported on TRFs for the majority of probands and their close relatives and is comparable to information directly obtained from clinic notes, particularly for breast and other cancers commonly associated with hereditary cancer syndromes.
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Affiliation(s)
- Holly LaDuca
- Holly LaDuca, Stephanie Gutierrez, Amal Yussuf, Nadia Ho, Jonathan Pepper, Patrick Reineke, Kirsten Blanco, Carolyn Horton, Jill S. Dolinsky, Ambry Genetics, Aliso Viejo; Rachel McFarland, University of California Irvine, Irvine, CA; and Taylor Cain, Sarah Lawrence College, Bronxville, NY
| | - Rachel McFarland
- Holly LaDuca, Stephanie Gutierrez, Amal Yussuf, Nadia Ho, Jonathan Pepper, Patrick Reineke, Kirsten Blanco, Carolyn Horton, Jill S. Dolinsky, Ambry Genetics, Aliso Viejo; Rachel McFarland, University of California Irvine, Irvine, CA; and Taylor Cain, Sarah Lawrence College, Bronxville, NY
| | - Stephanie Gutierrez
- Holly LaDuca, Stephanie Gutierrez, Amal Yussuf, Nadia Ho, Jonathan Pepper, Patrick Reineke, Kirsten Blanco, Carolyn Horton, Jill S. Dolinsky, Ambry Genetics, Aliso Viejo; Rachel McFarland, University of California Irvine, Irvine, CA; and Taylor Cain, Sarah Lawrence College, Bronxville, NY
| | - Amal Yussuf
- Holly LaDuca, Stephanie Gutierrez, Amal Yussuf, Nadia Ho, Jonathan Pepper, Patrick Reineke, Kirsten Blanco, Carolyn Horton, Jill S. Dolinsky, Ambry Genetics, Aliso Viejo; Rachel McFarland, University of California Irvine, Irvine, CA; and Taylor Cain, Sarah Lawrence College, Bronxville, NY
| | - Nadia Ho
- Holly LaDuca, Stephanie Gutierrez, Amal Yussuf, Nadia Ho, Jonathan Pepper, Patrick Reineke, Kirsten Blanco, Carolyn Horton, Jill S. Dolinsky, Ambry Genetics, Aliso Viejo; Rachel McFarland, University of California Irvine, Irvine, CA; and Taylor Cain, Sarah Lawrence College, Bronxville, NY
| | - Jonathan Pepper
- Holly LaDuca, Stephanie Gutierrez, Amal Yussuf, Nadia Ho, Jonathan Pepper, Patrick Reineke, Kirsten Blanco, Carolyn Horton, Jill S. Dolinsky, Ambry Genetics, Aliso Viejo; Rachel McFarland, University of California Irvine, Irvine, CA; and Taylor Cain, Sarah Lawrence College, Bronxville, NY
| | - Patrick Reineke
- Holly LaDuca, Stephanie Gutierrez, Amal Yussuf, Nadia Ho, Jonathan Pepper, Patrick Reineke, Kirsten Blanco, Carolyn Horton, Jill S. Dolinsky, Ambry Genetics, Aliso Viejo; Rachel McFarland, University of California Irvine, Irvine, CA; and Taylor Cain, Sarah Lawrence College, Bronxville, NY
| | - Taylor Cain
- Holly LaDuca, Stephanie Gutierrez, Amal Yussuf, Nadia Ho, Jonathan Pepper, Patrick Reineke, Kirsten Blanco, Carolyn Horton, Jill S. Dolinsky, Ambry Genetics, Aliso Viejo; Rachel McFarland, University of California Irvine, Irvine, CA; and Taylor Cain, Sarah Lawrence College, Bronxville, NY
| | - Kirsten Blanco
- Holly LaDuca, Stephanie Gutierrez, Amal Yussuf, Nadia Ho, Jonathan Pepper, Patrick Reineke, Kirsten Blanco, Carolyn Horton, Jill S. Dolinsky, Ambry Genetics, Aliso Viejo; Rachel McFarland, University of California Irvine, Irvine, CA; and Taylor Cain, Sarah Lawrence College, Bronxville, NY
| | - Carolyn Horton
- Holly LaDuca, Stephanie Gutierrez, Amal Yussuf, Nadia Ho, Jonathan Pepper, Patrick Reineke, Kirsten Blanco, Carolyn Horton, Jill S. Dolinsky, Ambry Genetics, Aliso Viejo; Rachel McFarland, University of California Irvine, Irvine, CA; and Taylor Cain, Sarah Lawrence College, Bronxville, NY
| | - Jill S. Dolinsky
- Holly LaDuca, Stephanie Gutierrez, Amal Yussuf, Nadia Ho, Jonathan Pepper, Patrick Reineke, Kirsten Blanco, Carolyn Horton, Jill S. Dolinsky, Ambry Genetics, Aliso Viejo; Rachel McFarland, University of California Irvine, Irvine, CA; and Taylor Cain, Sarah Lawrence College, Bronxville, NY
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17
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Abusamaan MS, Quillin JM, Owodunni O, Emidio O, Kang IG, Yu B, Ma B, Bailey L, Razzak R, Smith TJ, Bodurtha JN. The Role of Palliative Medicine in Assessing Hereditary Cancer Risk. Am J Hosp Palliat Care 2018; 35:1490-1497. [PMID: 29843526 PMCID: PMC6385866 DOI: 10.1177/1049909118778865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND: Hereditary cancer assessment and communication about family history risks can be critical for surviving relatives. Palliative care (PC) is often the last set of providers before death. METHODS: We replicated a prior study of the prevalence of hereditary cancer risk among patients with cancer receiving PC consultations, assessed the history in the electronic medical record (EMR), and explored patients' attitudes toward discussions about family history. This study was conducted at an academic urban hospital between June 2016 and March 2017. RESULTS: The average age of the 75 adult patients with cancer was 60 years, 49 (55%) male and 49 (65%) white. A total of 19 (25%) patients had no clear documentation of family history in the EMR, sometimes because no family history was included in the admission template or an automatically imported template lacked content. In all, 24 (32%) patients had high-risk pedigrees that merited referral to genetic services. And, 48 (64%) patients thought that PC was an appropriate venue to discuss the implications of family history. The mean comfort level in addressing these questions was high. CONCLUSIONS: At an academic center, 25% of patients had no family history documented in the EMR. And, 32% of pedigrees warranted referral to genetic services, which was rarely documented. There is substantial room for quality improvement for oncologists and PC specialists-often the last set of providers-to address family cancer risk before death and to increase use and ease of documenting family history in the EMR. Addressing cancer family history could enhance prevention, especially among high-risk families.
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Affiliation(s)
| | | | | | | | | | - Brandon Yu
- Johns Hopkins University, Baltimore MD, USA
| | | | | | - Rab Razzak
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Thomas J. Smith
- Johns Hopkins University School of Medicine, Baltimore MD, USA
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18
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Douma KFL, Bleeker FE, Medendorp NM, Croes EAJ, Smets EMA. Information exchange between patients with Lynch syndrome and their genetic and non-genetic health professionals: whose responsibility? J Community Genet 2018; 10:237-247. [PMID: 30209752 PMCID: PMC6435774 DOI: 10.1007/s12687-018-0381-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/23/2018] [Indexed: 01/24/2023] Open
Abstract
Individuals at high risk for Lynch syndrome (LS) should be offered genetic counselling, since preventive options are available. However, uptake of genetic services and follow-up care are currently suboptimal, possibly caused by inadequate exchange of information. Therefore, this qualitative study aims to gain insight in the process of information exchange between patients diagnosed with LS and their non-genetic (i.e., general practitioner, gastroenterologist, gynaecologist) and genetic (i.e., clinical geneticist or genetic counsellor) health professionals concerning referral for genetic counselling and follow-up care. Participants comprised 13 patients diagnosed with LS (8 index patients and 5 of their affected relatives) and 24 health professionals (6 general practitioners, 8 gastroenterologists, 6 gynaecologists and 4 genetic health professionals). Analysis of the interview transcripts was performed in parallel and again after the interviews, following guidelines for qualitative research and using MAXQDA software. The main finding is that patients may ‘get lost’ between health professionals who lack a clear overview of their own and each other’s role and responsibilities in the referral and follow-up care for patients with possible LS. Education of non-genetic health professionals and optimisation of communication between health professionals might help to enable more timely diagnosis of LS and allow patients to address their doubts and questions to the most appropriate healthcare professional.
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Affiliation(s)
- Kirsten F L Douma
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam Public Health Research Institute, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Fonnet E Bleeker
- Department of Clinical Genetics, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.,Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Niki M Medendorp
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam Public Health Research Institute, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Emmelyn A J Croes
- Department Communication and Information Sciences, Tilburg University School of Humanities, Tilburg, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam Public Health Research Institute, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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19
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Christensen KD, Phillips KA, Green RC, Dukhovny D. Cost Analyses of Genomic Sequencing: Lessons Learned from the MedSeq Project. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1054-1061. [PMID: 30224109 PMCID: PMC6444358 DOI: 10.1016/j.jval.2018.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/11/2018] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To summarize lessons learned while analyzing the costs of integrating whole genome sequencing into the care of cardiology and primary care patients in the MedSeq Project by conducting the first randomized controlled trial of whole genome sequencing in general and specialty medicine. METHODS Case study that describes key methodological and data challenges that were encountered or are likely to emerge in future work, describes the pros and cons of approaches considered by the study team, and summarizes the solutions that were implemented. RESULTS Major methodological challenges included defining whole genome sequencing, structuring an appropriate comparator, measuring downstream costs, and examining clinical outcomes. Discussions about solutions addressed conceptual and practical issues that arose because of definitions and analyses around the cost of genomic sequencing in trial-based studies. CONCLUSIONS The MedSeq Project provides an instructive example of how to conduct a cost analysis of whole genome sequencing that feasibly incorporates best practices while being sensitive to the varied applications and diversity of results it may produce. Findings provide guidance for researchers to consider when conducting or analyzing economic analyses of whole genome sequencing and other next-generation sequencing tests, particularly regarding costs.
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Affiliation(s)
- Kurt D Christensen
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Kathryn A Phillips
- Department of Clinical Pharmacy, Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California San Francisco, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Robert C Green
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Partners HealthCare Personalized Medicine, Boston, MA, USA
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
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20
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White MC, Soman A, Weinberg CR, Rodriguez JL, Sabatino SA, Peipins LA, DeRoo L, Nichols HB, Hodgson ME, Sandler DP. Factors associated with breast MRI use among women with a family history of breast cancer. Breast J 2018; 24:764-771. [PMID: 29781100 DOI: 10.1111/tbj.13063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/04/2017] [Accepted: 10/04/2017] [Indexed: 11/29/2022]
Abstract
Although annual breast magnetic resonance imaging (MRI) is recommended for women at high risk for breast cancer as an adjunct to screening mammography, breast MRI use remains low. We examined factors associated with breast MRI use in a cohort of women with a family history of breast cancer but no personal cancer history. Study participants came from the Sister Study cohort, a nationwide, prospective study of women with at least 1 sister who had been diagnosed with breast cancer but who themselves had not ever had breast cancer (n = 17 894). Participants were surveyed on breast cancer beliefs, cancer worry, breast MRI use, provider communication, and genetic counseling and testing. Logistic regression was used to assess factors associated with having a breast MRI overall and for those at high risk. Breast MRI was reported by 16.1% and was more common among younger women and those with higher incomes. After adjustment for demographics, ever use of breast MRI was associated with actual and perceived risk. Odds ratios (OR) were 12.29 (95% CI, 8.85-17.06), 2.48 (95% CI, 2.27-2.71), and 2.50 (95% CI, 2.09-2.99) for positive BRCA1/2 test, lifetime breast cancer risk ≥ 20%, and being told by a health care provider of higher risk, respectively. Women who believed they had much higher risk than others or had higher level of worry were twice as likely to have had breast MRI; OR = 2.23 (95% CI, 1.82-2.75) and OR = 1.76 (95% CI, 1.52-2.04). Patterns were similar among women at high risk. Breast cancer risk, provider communication, and personal beliefs were determinants of breast MRI use. To support shared decisions about the use of breast MRI, women could benefit from improved understanding of the chances of getting breast cancer and increased quality of provider communications.
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Affiliation(s)
- Mary C White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Ashwini Soman
- Information Systems, Northrop Grumman Corporation, Atlanta, GA, USA
| | - Clarice R Weinberg
- Biostatistics Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Lucy A Peipins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Epidemiology and Applied Research Branch, Atlanta, GA, USA
| | - Lisa DeRoo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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21
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Welch BM, Wiley K, Pflieger L, Achiangia R, Baker K, Hughes-Halbert C, Morrison H, Schiffman J, Doerr M. Review and Comparison of Electronic Patient-Facing Family Health History Tools. J Genet Couns 2018; 27:381-391. [PMID: 29512060 PMCID: PMC5861014 DOI: 10.1007/s10897-018-0235-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/05/2018] [Indexed: 01/23/2023]
Abstract
Family health history (FHx) is one of the most important pieces of information available to help genetic counselors and other clinicians identify risk and prevent disease. Unfortunately, the collection of FHx from patients is often too time consuming to be done during a clinical visit. Fortunately, there are many electronic FHx tools designed to help patients gather and organize their own FHx information prior to a clinic visit. We conducted a review and analysis of electronic FHx tools to better understand what tools are available, to compare and contrast to each other, to highlight features of various tools, and to provide a foundation for future evaluation and comparisons across FHx tools. Through our analysis, we included and abstracted 17 patient-facing electronic FHx tools and explored these tools around four axes: organization information, family history collection and display, clinical data collected, and clinical workflow integration. We found a large number of differences among FHx tools, with no two the same. This paper provides a useful review for health care providers, researchers, and patient advocates interested in understanding the differences among the available patient-facing electronic FHx tools.
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Affiliation(s)
- Brandon M Welch
- Biomedical Informatics Center, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
- ItRunsInMyFamily.com, Inc., Charleston, SC, USA.
| | - Kevin Wiley
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Lance Pflieger
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Rosaline Achiangia
- Biomedical Informatics Center, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Karen Baker
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Chanita Hughes-Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Joshua Schiffman
- ItRunsInMyFamily.com, Inc., Charleston, SC, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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22
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Vos JR, Oosterwijk JC, Rookus MA, van der Hout AH, Mourits MJ, de Bock GH. The BRCA1/2 Parent-of-Origin Effect on Breast Cancer Risk—Response. Cancer Epidemiol Biomarkers Prev 2017; 26:285. [DOI: 10.1158/1055-9965.epi-16-0947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Janet R. Vos
- 1Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan C. Oosterwijk
- 2Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Matti A. Rookus
- 3Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annemarie H. van der Hout
- 2Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marian J. Mourits
- 4Department of Gynecological Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Geertruida H. de Bock
- 1Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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23
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Uncertainty quantification in breast cancer risk prediction models using self-reported family health history. J Clin Transl Sci 2017; 1:53-59. [PMID: 28670484 PMCID: PMC5483939 DOI: 10.1017/cts.2016.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/11/2016] [Indexed: 12/24/2022] Open
Abstract
Introduction. Family health history (FHx) is an important factor in breast and ovarian cancer risk assessment. As such, multiple risk prediction models rely strongly on FHx data when identifying a patient’s risk. These models were developed using verified information and when translated into a clinical setting assume that a patient’s FHx is accurate and complete. However, FHx information collected in a typical clinical setting is known to be imprecise and it is not well understood how this uncertainty may affect predictions in clinical settings. Methods. Using Monte Carlo simulations and existing measurements of uncertainty of self-reported FHx, we show how uncertainty in FHx information can alter risk classification when used in typical clinical settings. Results. We found that various models ranged from 52% to 64% for correct tier-level classification of pedigrees under a set of contrived uncertain conditions, but that significant misclassification are not negligible. Conclusions. Our work implies that (i) uncertainty quantification needs to be considered when transferring tools from a controlled research environment to a more uncertain environment (i.e, a health clinic) and (ii) better FHx collection methods are needed to reduce uncertainty in breast cancer risk prediction in clinical settings.
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24
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Douma KFL, Smets EMA, Allain DC. Non-genetic health professionals' attitude towards, knowledge of and skills in discussing and ordering genetic testing for hereditary cancer. Fam Cancer 2016; 15:341-50. [PMID: 26590592 PMCID: PMC4803807 DOI: 10.1007/s10689-015-9852-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Non-genetic health professionals (NGHPs) have insufficient knowledge of cancer genetics, express educational needs and are unprepared to counsel their patients regarding their genetic test results. So far, it is unclear how NGHPs perceive their own communication skills. This study was undertaken to gain insight in their perceptions, attitudes and knowledge. Two publically accessible databases were used to invite NGHPs providing cancer genetic services to complete a questionnaire. The survey assessed: sociodemographic attributes, experience in ordering hereditary cancer genetic testing, attitude, knowledge, perception of communication skills (e.g. information giving, decision-making) and educational needs. Of all respondents (N = 49, response rate 11 %), most have a positive view of their own information giving (mean = 53.91, range 13–65) and decision making skills (64–77 % depending on topic). NGHPs feel responsible for enabling disease and treatment related behavior (89–91 %). However, 20–30 % reported difficulties managing patients’ emotions and did not see management of long-term emotions as their responsibility. Correct answers on knowledge questions ranged between 41 and 96 %. Higher knowledge was associated with more confidence in NGHPs’ own communication skills (rs = .33, p = 0.03). Although NGHPs have a positive view of their communication skills, they perceive more difficulties managing emotions. The association between less confidence in communication skills and lower knowledge level suggests awareness of knowledge gaps affects confidence. NGHPs might benefit from education about managing client emotions. Further research using observation of actual counselling consultations is needed to investigate the skills of this specific group of providers.
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Affiliation(s)
- Kirsten F L Douma
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Dawn C Allain
- Division of Human Genetics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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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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Streff H, Profato J, Ye Y, Nebgen D, Peterson SK, Singletary C, Arun BK, Litton JK. Cancer Incidence in First- and Second-Degree Relatives of BRCA1 and BRCA2 Mutation Carriers. Oncologist 2016; 21:869-74. [PMID: 27306910 DOI: 10.1634/theoncologist.2015-0354] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/08/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mutations in the BRCA1 and BRCA2 genes are associated with increased risk of breast, ovarian, and several other cancers. The purpose of the present study was to evaluate the incidence of cancer in first- and second-degree relatives of BRCA mutation carriers compared with the general population. MATERIALS AND METHODS A total of 1,086 pedigrees of BRCA mutation carriers was obtained from a prospectively maintained, internal review board-approved study of persons referred for clinical genetic counseling at the University of Texas MD Anderson Cancer Center. We identified 9,032 first- and second-degree relatives from 784 pedigrees that had demonstrated a clear indication of parental origin of mutation. Standardized incidence ratios (SIRs) were used to compare the observed incidence of 20 primary cancer sites to the expected incidence of each cancer based on the calculated risk estimates according to each subject's age, sex, and ethnicity. RESULTS BRCA1 families had increased SIRs for breast and ovarian cancer (p < .001) and decreased SIRs for kidney, lung, prostate, and thyroid cancer and non-Hodgkin's lymphoma (p < .001). BRCA2 families had increased SIRs for breast, ovarian, and pancreatic cancer (p < .001) and decreased SIRs for kidney, lung, thyroid, and uterine cancer and non-Hodgkin's lymphoma (p < .0025). Analysis of only first-degree relatives (n = 4,099) identified no decreased SIRs and agreed with the increased SIRs observed in the overall study population. CONCLUSION We have confirmed previous reports of an association between breast, ovarian, and pancreatic cancers with BRCA mutations. Additional research to quantify the relative risks of these cancers for BRCA mutation carriers can help tailor recommendations for risk reduction and enhance genetic counseling. IMPLICATIONS FOR PRACTICE BRCA gene mutations have been well described to carry an increased risk of both breast and ovarian cancer. However, the implications and risks of other cancers continues to be investigated. Evaluating the risks for other cancers further is key in identifying and managing risk reduction strategies.
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Affiliation(s)
- Haley Streff
- Genetic Counseling Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas, USA
| | - Jessica Profato
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yuanqing Ye
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Denise Nebgen
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Claire Singletary
- Department of Pediatrics, The University of Texas Medical School at Houston, Houston, Texas, USA Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Banu K Arun
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Agnese DM, Pollock RE. Breast Cancer Genetic Counseling: A Surgeon's Perspective. Front Surg 2016; 3:4. [PMID: 26858951 PMCID: PMC4729881 DOI: 10.3389/fsurg.2016.00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/14/2016] [Indexed: 01/14/2023] Open
Abstract
As surgeons who care for patients with breast cancer, the possibility of a cancer diagnosis being related to a hereditary predisposition is always a consideration. Not only are we as surgeons always trying to identify these patients and families but also we are often asked about a potential hereditary component by the patients and their family members. It is therefore critical that we accurately assess patients to determine who may benefit from genetic testing. Importantly, the potential benefit for identifying a hereditary breast cancer extends beyond the patient to other family members and the risk may not be only for the development of breast cancers, but for other cancers as well. This review was written from the perspective of a surgeon with additional training in cancer genetics in an effort to provide a unique perspective on the issue and feel that a review of some of the more practical considerations is important.
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Affiliation(s)
- Doreen M Agnese
- Division of Surgical Oncology, Department of Surgery, The Ohio State University , Columbus, OH , USA
| | - Raphael E Pollock
- Division of Surgical Oncology, Department of Surgery, The Ohio State University , Columbus, OH , USA
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Molavi Vardanjani H, Baneshi MR, Haghdoost A. Cancer Visibility among Iranian Familial Networks: To What Extent Can We Rely on Family History Reports? PLoS One 2015; 10:e0136038. [PMID: 26308087 PMCID: PMC4550411 DOI: 10.1371/journal.pone.0136038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 07/30/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Patients' unawareness of their cancer diagnosis (PUAW) and their tendency for non-disclosure (TTND) to relatives leads to a lack of cancer visibility among familial networks. Lack of familial cancer visibility could affect the accuracy of family cancer history (FCH) reports. In this study, we investigated familial cancer visibility and its potential determinants. PATIENTS AND METHODS A sample of patients with a confirmed cancer diagnosis was interviewed. Participants were asked about their number of relatives, number of their relatives who are aware about the cancer diagnosis, and the number of relatives from whom they intended to conceal their diagnosis. PUAW was also assessed. Point estimates and 95% confidence intervals were calculated using the bootstrap technique. Multivariate analyses were conducted using mixed Poisson and logistic regression analyses. RESULTS A total of 415 participants with a mean age of 53±15 years and a male to female ratio of 0.53 were enrolled in this study. The rates of PUAW, TTND, and familial cancer visibility in the total sample were 0.20 (95% confidence interval (CI): 0.16, 0.24), 0.16 (95% CI: 0.12, 0.19), and 0.86 (95% CI: 0.83, 0.89), respectively. PUAW (adjusted rate ratio (RR) = 1.32, 95% CI: 1.27, 1.38), TTND (RR = 0.92, 95% CI: 0.91, 0.93), and the patients' gender (RR = 0.92, 95% CI: 0.82, 0.95) were the most important determinants of familial cancer visibility. CONCLUSION Familial cancer visibility may be a point of concern among the Iranian population. Self-reported cancer histories and FCHs may have low sensitivities (not exceeding 80% and 86%, respectively) in this population. However, these estimates may vary across different societies, because of societal and cultural contexts.
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Affiliation(s)
- Hossein Molavi Vardanjani
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Baneshi
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - AliAkbar Haghdoost
- Regional Knowledge Hub, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Wang C, Sen A, Plegue M, Ruffin MT, O'Neill SM, Rubinstein WS, Acheson LS. Impact of family history assessment on communication with family members and health care providers: A report from the Family Healthware™ Impact Trial (FHITr). Prev Med 2015; 77:28-34. [PMID: 25901453 PMCID: PMC4508012 DOI: 10.1016/j.ypmed.2015.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 04/06/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study examines the impact of Family Healthware™ on communication behaviors; specifically, communication with family members and health care providers about family health history. METHODS A total of 3786 participants were enrolled in the Family Healthware™ Impact Trial (FHITr) in the United States from 2005-7. The trial employed a two-arm cluster-randomized design, with primary care practices serving as the unit of randomization. Using generalized estimating equations (GEE), analyses focused on communication behaviors at 6month follow-up, adjusting for age, site and practice clustering. RESULTS A significant interaction was observed between study arm and baseline communication status for the family communication outcomes (p's<.01), indicating that intervention had effects of different magnitude between those already communicating at baseline and those who were not. Among participants who were not communicating at baseline, intervention participants had higher odds of communicating with family members about family history risk (OR=1.24, p=0.042) and actively collecting family history information at follow-up (OR=2.67, p=0.026). Family Healthware™ did not have a significant effect on family communication among those already communicating at baseline, or on provider communication, regardless of baseline communication status. Greater communication was observed among those at increased familial risk for a greater number of diseases. CONCLUSION Family Healthware™ prompted more communication about family history with family members, among those who were not previously communicating. Efforts are needed to identify approaches to encourage greater sharing of family history information, particularly with health care providers.
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Affiliation(s)
- Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, USA.
| | - Ananda Sen
- Department of Biostatistics, University of Michigan, Ann Arbor, USA; Department of Family Medicine, University of Michigan, Ann Arbor, USA
| | - Melissa Plegue
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, USA; Department of Family Medicine, University of Michigan, Ann Arbor, USA
| | - Mack T Ruffin
- Department of Family Medicine, University of Michigan, Ann Arbor, USA
| | - Suzanne M O'Neill
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Wendy S Rubinstein
- National Center for Biotechnology Information, National Institutes of Health, Bethesda, USA
| | - Louise S Acheson
- Departments of Family Medicine & Community Health and Reproductive Biology, Case Western Reserve University and Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Cleveland, USA
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Syurina EV, Gerritsen AMJM, Hens K, Feron FJM. “What about FH of my child?” parents’ opinion on family history collection in preventive primary pediatric care. Per Med 2015; 12:327-337. [DOI: 10.2217/pme.15.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: Family history (FH) in Preventive Primary Pediatric Care is to identify children at risk for complex diseases and provide personal preventive strategies. This study was to assess parents’ opinion on FH collection. Methods: Semi-structured interviews were conducted. Among issues addressed were: former experiences with FH, knowledge about FH, family definition and sharing information about FH. Results: The importance of FH for participants depended on their knowledge, perceived family health status and former experiences. After insight into FH, parents shift to believing it to be important, but certain barriers exist in reporting FH. Conclusion: Parents suggest that the importance of FH should be more emphasized and more trusting relationship with Preventive Primary Pediatric Care should be invested in.
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Affiliation(s)
- Elena V Syurina
- Department of Social Medicine, School for Public Health & Primary Care (CAPHRI), Faculty of Health, Medicine & Life Sciences, Maastricht University, The Netherlands
| | - Anne-Marie JM Gerritsen
- Department of Social Medicine, School for Public Health & Primary Care (CAPHRI), Faculty of Health, Medicine & Life Sciences, Maastricht University, The Netherlands
| | - Kristien Hens
- Centre for Society & the Life Sciences (CSG), Nijmegen, The Netherlands
| | - Frans JM Feron
- Department of Social Medicine, School for Public Health & Primary Care (CAPHRI), Faculty of Health, Medicine & Life Sciences, Maastricht University, The Netherlands
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Mammographic density and breast cancer risk by family history in women of white and Asian ancestry. Cancer Causes Control 2015; 26:621-6. [PMID: 25761408 DOI: 10.1007/s10552-015-0551-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Mammographic density, i.e., the radiographic appearance of the breast, is a strong predictor of breast cancer risk. To determine whether the association of breast density with breast cancer is modified by a first-degree family history of breast cancer (FHBC) in women of white and Asian ancestry, we analyzed data from four case-control studies conducted in the USA and Japan. METHODS The study population included 1,699 breast cancer cases and 2,422 controls, of whom 45% reported white (N = 1,849) and 40% Asian (N = 1,633) ancestry. To standardize mammographic density assessment, a single observer re-read all mammograms using one type of interactive thresholding software. Logistic regression was applied to estimate odds ratios (OR) while adjusting for confounders. RESULTS Overall, 496 (12%) of participants reported a FHBC, which was significantly associated with breast cancer risk in the adjusted model (OR 1.51; 95% CI 1.23-1.84). There was a statistically significant interaction on a multiplicative scale between FHBC and continuous percent density (per 10 % density: p = 0.03). The OR per 10% increase in percent density was higher among women with a FHBC (OR 1.30; 95% CI 1.13-1.49) than among those without a FHBC (OR 1.14; 1.09-1.20). This pattern was apparent in whites and Asians. The respective ORs were 1.45 (95% CI 1.17-1.80) versus 1.22 (95% CI 1.14-1.32) in whites, whereas the values in Asians were only 1.24 (95% CI 0.97-1.58) versus 1.09 (95% CI 1.00-1.19). CONCLUSIONS These findings support the hypothesis that women with a FHBC appear to have a higher risk of breast cancer associated with percent mammographic density than women without a FHBC.
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Tehranifar P, Wu HC, Shriver T, Cloud AJ, Terry MB. Validation of family cancer history data in high-risk families: the influence of cancer site, ethnicity, kinship degree, and multiple family reporters. Am J Epidemiol 2015; 181:204-12. [PMID: 25568166 DOI: 10.1093/aje/kwu258] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Information on family cancer history (FCH) is often collected for first-degree relatives, but more extensive FCH information is critical for greater accuracy in risk assessment. Using self-reported diagnosis of cancer as the gold standard, we examined differences in the sensitivity and specificity of relative-reported FCH by cancer site, race/ethnicity, language preference, and kinship degree (1,524 individuals from 557 families; average number of relatives per family = 2.7). We evaluated the impact of FCH data collected in 2007-2013 from multiple relatives by comparing mean values and proportions for the number of relatives with any cancer, breast cancer, or ovarian cancer as reported by a single relative and by multiple relatives in the same family. The sensitivity of FCH was lower in Hispanics, Spanish-speaking persons, and third-degree relatives (e.g., for all cancers, sensitivities were 80.7%, 87.4%, and 91.0% for third-, second-, and first-degree relatives, respectively). FCH reported by multiple relatives included a higher number of relatives with cancer than the number reported by a single relative (e.g., mean increase of 1.2 relatives with any cancer), with more relatives diagnosed with any cancer, breast cancer, and ovarian cancer in 52%, 36% and 12% of families, respectively. Collection of FCH data from multiple relatives may provide a more comprehensive picture of FCH and may potentially improve risk assessment and preventive care.
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Schlichting JA, Mengeling MA, Makki NM, Malhotra A, Halfdanarson TR, Klutts JS, Levy BT, Kaboli PJ, Charlton ME. Increasing colorectal cancer screening in an overdue population: participation and cost impacts of adding telephone calls to a FIT mailing program. J Community Health 2014; 39:239-47. [PMID: 24499966 DOI: 10.1007/s10900-014-9830-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Many people who live in rural areas face distance barriers to colonoscopy. Our previous study demonstrated the utility of mailing fecal immunochemical tests (FIT) to average risk patients overdue for colorectal cancer (CRC screening). The aims of this study were to determine if introductory and reminder telephone calls would increase the proportion of returned FITs as well as to compare costs. Average risk patients overdue for CRC screening received a high intensity intervention (HII), which included an introductory telephone call to see if they were interested in taking a FIT prior to mailing the test out and reminder phone calls if the FIT was not returned. This HII group was compared to our previous low intensity intervention (LII) where a FIT was mailed to a similar group of veterans with no telephone contact. While a higher proportion of eligible respondents returned FITs in the LII (92 vs. 45 %), there was a much higher proportion of FITs returned out of those mailed in the HII (85 vs. 14 %). The fewer wasted FITs in the HII led to it having lower cost per FIT returned ($27.43 vs. $44.86). Given that either intervention is a feasible approach for patients overdue for CRC screening, health care providers should consider offering FITs using a home-based mailing program along with other evidence-based CRC screening options to average risk patients. Factors such as location, patient population, FIT cost and reimbursement, and personnel costs need to be considered when deciding the most effective way to implement FIT screening.
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Affiliation(s)
- Jennifer A Schlichting
- VA Office of Rural Health, Rural Health Resource Center - Central Region, Iowa City VA Healthcare System, 601 Hwy 6 West, Iowa City, IA, 52246, USA
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Sie AS, Prins JB, Spruijt L, Kets CM, Hoogerbrugge N. Can we test for hereditary cancer at 18 years when we start surveillance at 25? Patient reported outcomes. Fam Cancer 2014; 12:675-82. [PMID: 23604858 DOI: 10.1007/s10689-013-9644-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
DNA-testing for BRCA1/2 or Lynch syndrome is possible from the age of 18 years, although surveillance usually starts at 25. Some patients regret their decision of testing before age 25. This retrospective study evaluates whether the testing age should be above 25 years to prevent adverse effects such as regret or decisional conflict, by determining the percentage and characteristics of patients reporting these problems. 111 of 219 patients (51%) tested for BRCA1/2 mutations or Lynch syndrome between 18 and 25 years from July 1996 to February 2011, returned self-report surveys. Primary measures were regret, decisional conflict and family influence. Secondary measures included quality of life (QoL), coping style, impact of genetic testing, and risk perception. Median age was 27 [21-40] years, with 86% female. 73% was tested for BRCA1/2, 27% for Lynch syndrome. Only 3% reported regret, however 39% had moderate (32%) to severe (7%) decisional conflict. Regression analysis revealed that decisional conflict was associated with more monitoring/neutral coping style (p < 0.03) or paternal/no family mutation (p < 0.02); there were no differences in QoL, impact or risk perception. 42% were mutation carriers, showing equal decisional conflict to non-carriers. 68% would recommend testing <25 years; 77% desired surveillance <25 years if a mutation carrier. Almost no patient tested for hereditary cancer between 18 and 25 years regretted this decision. A third reported retrospective decisional conflict, especially those actively seeking information when faced with a threat and/or those with a paternal or unknown inheritance. These patients may benefit from decisional support and personalized information.
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Affiliation(s)
- Aisha S Sie
- Department of Human Genetics, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Pritzlaff M, Yorczyk A, Robinson LS, Pirzadeh-Miller S, Lin T, Euhus D, Ross TS. An internal performance assessment of CancerGene Connect: an electronic tool to streamline, measure and improve the genetic counseling process. J Genet Couns 2014; 23:1034-44. [PMID: 24916850 DOI: 10.1007/s10897-014-9732-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/14/2014] [Indexed: 11/24/2022]
Abstract
CancerGene Connect (CGC) is a web-based program that combines the collection of family and medical history, cancer risk assessment, psychosocial assessment, report templates, a result tracking system, and a patient follow up system. The performance of CGC was assessed in several ways: pre-appointment completion data analyzed for demographic and health variables; a time study to assess overall time per case and to compare the data entry by the genetic counselor compared to the patient, and a measured quality assessment of the program via observation and interview of patients. Prior to their appointment, 52.3% of 2,414 patients completed the online patient questionnaire section of CGC. There were significant differences in completion rates among racial and ethnic groups. County hospital patients were less likely to complete the questionnaire than insured patients (p < 0.0001); and likewise uninsured patients and patients with Medicare/Medicaid were less likely to complete the questionnaire than private patients (p < 0.0001). The average genetic counseling time per case was 82 min, with no significant differences whether the counselor or the patient completed CGC. CGC reduces genetic counselor time by approximately 14-46% compared to average time per case using traditional risk assessment and documentation methods previously reported. All surveyed users felt the questionnaire was easy to understand. CGC is an effective tool that streamlines workflow, and provides a standardized data collection tool that can be used to evaluate and improve the genetic counseling process.
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Affiliation(s)
- Mary Pritzlaff
- Department of Cancer Genetics, University of Texas Southwestern Medical Center's Simmons Comprehensive Cancer Center, Dallas and Moncrief Cancer Institute, Dallas, TX, USA
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Weinberg CR, Shi M, DeRoo LA, Taylor JA, Sandler DP, Umbach DM. Asymmetry in family history implicates nonstandard genetic mechanisms: application to the genetics of breast cancer. PLoS Genet 2014; 10:e1004174. [PMID: 24651610 PMCID: PMC3961172 DOI: 10.1371/journal.pgen.1004174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 12/25/2013] [Indexed: 11/19/2022] Open
Abstract
Genome-wide association studies typically target inherited autosomal variants, but less studied genetic mechanisms can play a role in complex disease. Sex-linked variants aside, three genetic phenomena can induce differential risk in maternal versus paternal lineages of affected individuals: 1. maternal effects, reflecting the maternal genome's influence on prenatal development; 2. mitochondrial variants, which are inherited maternally; 3. autosomal genes, whose effects depend on parent of origin. We algebraically show that small asymmetries in family histories of affected individuals may reflect much larger genetic risks acting via those mechanisms. We apply these ideas to a study of sisters of women with breast cancer. Among 5,091 distinct families of women reporting that exactly one grandmother had breast cancer, risk was skewed toward maternal grandmothers (p<0.0001), especially if the granddaughter was diagnosed between age 45 and 54. Maternal genetic effects, mitochondrial variants, or variant genes with parent-of-origin effects may influence risk of perimenopausal breast cancer.
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Affiliation(s)
- Clarice R. Weinberg
- Biostatistics Branch, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, United States of America
- * E-mail:
| | - Min Shi
- Biostatistics Branch, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, United States of America
| | - Lisa A. DeRoo
- Epidemiology Branch, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, United States of America
| | - Jack A. Taylor
- Epidemiology Branch, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, United States of America
| | - Dale P. Sandler
- Epidemiology Branch, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, United States of America
| | - David M. Umbach
- Biostatistics Branch, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, United States of America
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Lu KH, Wood ME, Daniels M, Burke C, Ford J, Kauff ND, Kohlmann W, Lindor NM, Mulvey TM, Robinson L, Rubinstein WS, Stoffel EM, Snyder C, Syngal S, Merrill JK, Wollins DS, Hughes KS. American Society of Clinical Oncology Expert Statement: collection and use of a cancer family history for oncology providers. J Clin Oncol 2014; 32:833-40. [PMID: 24493721 PMCID: PMC3940540 DOI: 10.1200/jco.2013.50.9257] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Karen H. Lu
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Marie E. Wood
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Molly Daniels
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Cathy Burke
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - James Ford
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Noah D. Kauff
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Wendy Kohlmann
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Noralane M. Lindor
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Therese M. Mulvey
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Linda Robinson
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Wendy S. Rubinstein
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Elena M. Stoffel
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Carrie Snyder
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Sapna Syngal
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Janette K. Merrill
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Dana Swartzberg Wollins
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
| | - Kevin S. Hughes
- Karen H. Lu, Molly Daniels, and Cathy Burke, MD Anderson Cancer Center, Houston; Linda Robinson, Simmons Comprehensive Cancer Center, Dallas, TX; Marie E. Wood, University of Vermont, Burlington, VT; James Ford, Stanford University Medical Center, Stanford, CA; Noah D. Kauff, Memorial Sloan-Kettering Cancer Center, New York, NY; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; Therese M. Mulvey, Southcoast Centers for Cancer Care, Fall River; Sapna Syngal, Dana-Farber Cancer Institute, Brigham and Women's Hospital; Kevin S. Hughes, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Boston, MA; Wendy Rubinstein, National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD; Elena M. Stoffel, University of Michigan, Ann Arbor, MI; Carrie Snyder, Creighton University, Omaha, NE; and Janette K. Merrill and Dana Swartzberg Wollins, American Society of Clinical Oncology, Alexandria, VA
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Feng R, Patel H, Howard G. Quantifying Maternal and Paternal Disease History Using Log-Rank Score with an Application to a National Cohort Study. INTERNATIONAL JOURNAL OF STATISTICS IN MEDICAL RESEARCH 2014. [PMID: 26213591 PMCID: PMC4512761 DOI: 10.6000/1929-6029.2014.03.01.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Both maternal and paternal disease history can be important predictors of the risk of common conditions such as heart disease or cancer because of shared environmental and genetic risk factors. Sometimes maternal and paternal history can have remarkably different effects on offspring's status. The results are often affected by how the maternal and paternal disease histories are quantified. We proposed using the log-rank score (LRS) to investigate the separate effect of maternal and paternal history on diseases, which takes parental disease status and the age of their disease onset into account. Through simulation studies, we compared the performance of the maternal and paternal LRS with simple binary indicators under two different mechanisms of unbalanced parental effects. We applied the LRS to a national cohort study to further segregate family risks for heart diseases. We demonstrated using the LRS rather than binary indicators can improve the prediction of disease risks and better discriminate the paternal and maternal histories. In the real study, we found that the risk for stroke is closely related with maternal history but not with paternal history and that maternal and paternal disease history have similar impact on the onset of myocardial infarction.
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Affiliation(s)
- Rui Feng
- Department of Biostatistics and Epidemiology, University of Pennsylvania, USA
| | - Hersh Patel
- Department of Biology, University of Pennsylvania, USA
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, USA
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Aiyar L, Shuman C, Hayeems R, Dupuis A, Pu S, Wodak S, Chitayat D, Velsher L, Davies J. Risk estimates for complex disorders: comparing personal genome testing and family history. Genet Med 2013; 16:231-7. [DOI: 10.1038/gim.2013.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 06/24/2013] [Indexed: 11/09/2022] Open
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Vig HS, McCarthy AM, Liao K, Demeter MB, Fredericks T, Armstrong K. Age at diagnosis may trump family history in driving BRCA testing in a population of breast cancer patients. Cancer Epidemiol Biomarkers Prev 2013; 22:1778-85. [PMID: 23917453 DOI: 10.1158/1055-9965.epi-13-0426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Standard BRCA genetic testing criteria include young age of diagnosis, family history, and Jewish ancestry. The purpose of this study was to assess the effect of these criteria on BRCA test utilization in breast cancer patients. METHODS Breast cancer patients aged 18 to 64 years living in Pennsylvania in 2007 completed a survey on family history of breast and ovarian cancer and BRCA testing (N = 2,213). Multivariate logistic regression was used to estimate odds of BRCA testing by patient characteristics, and predicted probabilities of testing were calculated for several clinical scenarios. RESULTS Young age at diagnosis (<50 years) was strongly associated with BRCA testing, with women diagnosed before age 50 years having nearly five times the odds of receiving BRCA testing compared to women diagnosed at age 50 or older (OR = 4.81; 95% CI, 3.85-6.00; P < 0.001). Despite a similar BRCA mutation prevalence estimate (8-10%), a young Jewish patient <50 years with no family history had markedly higher predicted probability of testing (63%) compared with an older, non-Jewish breast cancer patient with more than one first-degree relative (43%). CONCLUSION Age at diagnosis, Jewish ancestry, and both maternal and paternal family history are strongly predictive of BRCA testing. However, among women diagnosed at age 50 or older, family history may be an underused criterion that may benefit from targeted intervention. IMPACT Robust methods specific to ascertaining detailed family history, such as through electronic medical records, are needed to accurately identify patients for BRCA testing.
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Affiliation(s)
- Hetal S Vig
- Authors' Affiliations: Cancer Institute of New Jersey, New Brunswick, New Jersey; and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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