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Steadman JA, Hoskin TL, Klassen C, Boughey JC, Degnim AC, Piltin MA, Mrdutt MM, Johnson JE, Hieken TJ. Assessment of the effect of the American Society of Breast Surgery guidelines on contralateral prophylactic mastectomy rates for unilateral breast cancer. Surgery 2024; 175:677-686. [PMID: 37863697 DOI: 10.1016/j.surg.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/31/2023] [Accepted: 09/05/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND In July 2016, the American Society of Breast Surgeons published guidelines discouraging contralateral prophylactic mastectomy for average-risk women with unilateral breast cancer. We incorporated these into practice with structured patient counseling and aimed to assess the effect of this initiative on contralateral prophylactic mastectomy rates. METHODS We evaluated female patients with unilateral breast cancer undergoing mastectomy at our institution from January 2011 to November 2022. Variables associated with contralateral prophylactic mastectomy and trends over time were analyzed using the Wilcoxon rank sum test or χ2 analysis as appropriate. RESULTS Among 3,208 patients, (median age 54 years) 1,366 (43%) had a unilateral mastectomy, and 1,842 (57%) also had a concomitant contralateral prophylactic mastectomy. Across all patients, contralateral prophylactic mastectomy rates significantly decreased post-implementation from 2017 to 2019 (55%) vs 2015 to 2016 (62%) (P = .01) but increased from 2020 to 2022 (61%). Immediate breast reconstruction rate was 70% overall (81% with contralateral prophylactic mastectomy and 56% without contralateral prophylactic mastectomy, P < .001). Younger age, White race, mutation status, and earlier stage were also associated with contralateral prophylactic mastectomy. Genetic testing increased from 27% pre-guideline to 74% 2020 to 2022, as did the proportion of patients with a pathogenic variant (4% pre-guideline vs 11% from 2020-2022, P < .001), of whom 91% had a contralateral prophylactic mastectomy. Among tested patients without a pathogenic variant and patients not tested, contralateral prophylactic mastectomy rates declined from 78% to 67% and 48% to 38% pre -and post-guidelines, respectively, P < .001. CONCLUSION Implementation of specific patient counseling was effective in decreasing contralateral prophylactic mastectomy rates. While recognizing that patient choice plays a significant role in the decision for contralateral prophylactic mastectomy, further educational efforts are warranted to affect contralateral prophylactic mastectomy rates, particularly in the setting of negative genetic testing.
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Affiliation(s)
- Jessica A Steadman
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Tanya L Hoskin
- Division of Biostatistics and Clinical Trials, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Amy C Degnim
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mara A Piltin
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mary M Mrdutt
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Jeffrey E Johnson
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Tina J Hieken
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN.
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Keskin Karakoyun H, Yüksel ŞK, Amanoglu I, Naserikhojasteh L, Yeşilyurt A, Yakıcıer C, Timuçin E, Akyerli CB. Evaluation of AlphaFold structure-based protein stability prediction on missense variations in cancer. Front Genet 2023; 14:1052383. [PMID: 36896237 PMCID: PMC9988940 DOI: 10.3389/fgene.2023.1052383] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/08/2023] [Indexed: 02/23/2023] Open
Abstract
Identifying pathogenic missense variants in hereditary cancer is critical to the efforts of patient surveillance and risk-reduction strategies. For this purpose, many different gene panels consisting of different number and/or set of genes are available and we are particularly interested in a panel of 26 genes with a varying degree of hereditary cancer risk consisting of ABRAXAS1, ATM, BARD1, BLM, BRCA1, BRCA2, BRIP1, CDH1, CHEK2, EPCAM, MEN1, MLH1, MRE11, MSH2, MSH6, MUTYH, NBN, PALB2, PMS2, PTEN, RAD50, RAD51C, RAD51D, STK11, TP53, and XRCC2. In this study, we have compiled a collection of the missense variations reported in any of these 26 genes. More than a thousand missense variants were collected from ClinVar and the targeted screen of a breast cancer cohort of 355 patients which contributed to this set with 160 novel missense variations. We analyzed the impact of the missense variations on protein stability by five different predictors including both sequence- (SAAF2EC and MUpro) and structure-based (Maestro, mCSM, CUPSAT) predictors. For the structure-based tools, we have utilized the AlphaFold (AF2) protein structures which comprise the first structural analysis of this hereditary cancer proteins. Our results agreed with the recent benchmarks that computed the power of stability predictors in discriminating the pathogenic variants. Overall, we reported a low-to-medium-level performance for the stability predictors in discriminating pathogenic variants, except MUpro which had an AUROC of 0.534 (95% CI [0.499-0.570]). The AUROC values ranged between 0.614-0.719 for the total set and 0.596-0.682 for the set with high AF2 confidence regions. Furthermore, our findings revealed that the confidence score for a given variant in the AF2 structure could alone predict pathogenicity more robustly than any of the tested stability predictors with an AUROC of 0.852. Altogether, this study represents the first structural analysis of the 26 hereditary cancer genes underscoring 1) the thermodynamic stability predicted from AF2 structures as a moderate and 2) the confidence score of AF2 as a strong descriptor for variant pathogenicity.
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Affiliation(s)
- Hilal Keskin Karakoyun
- Department of Biochemistry and Molecular Biology, Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Şirin K Yüksel
- Department of Biochemistry and Molecular Biology, Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Ilayda Amanoglu
- Department of Biostatistics and Bioinformatics, Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Lara Naserikhojasteh
- Department of Biostatistics and Bioinformatics, Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Ahmet Yeşilyurt
- Acibadem Labgen Genetic Diagnosis Centre, Acibadem Health Group, Istanbul, Türkiye
| | - Cengiz Yakıcıer
- Acibadem Pathology Laboratories, Acibadem Health Group, Istanbul, Türkiye
| | - Emel Timuçin
- Department of Biostatistics and Medical Informatics, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Cemaliye B Akyerli
- Department of Medical Biology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
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McDonald JT, Ricks-Santi LJ. Hereditary variants of unknown significance in African American women with breast cancer. PLoS One 2022; 17:e0273835. [PMID: 36315513 PMCID: PMC9621418 DOI: 10.1371/journal.pone.0273835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022] Open
Abstract
Expanded implementation of genetic sequencing has precipitously increased the discovery of germline and somatic variants. The direct benefit of identifying variants in actionable genes may lead to risk reduction strategies such as increased surveillance, prophylactic surgery, as well as lifestyle modifications to reduce morbidity and mortality. However, patients with African ancestry are more likely to receive inconclusive genetic testing results due to an increased number of variants of unknown significance decreasing the utility and impact on disease management and prevention. This study examines whole exome sequencing results from germline DNA samples in African American women with a family history of cancer including 37 cases that were diagnosed with breast cancer and 51 family members. Self-identified ancestry was validated and compared to the 1000 genomes population. The analysis of sequencing results was limited to 85 genes from three clinically available common genetic screening platforms. This target region had a total of 993 variants of which 6 (<1%) were pathogenic or likely pathogenic, 736 (74.1%) were benign, and 170 (17.1%) were classified as a variant of unknown significance. There was an average of 3.4±1.8 variants with an unknown significance per individual and 85 of 88 individuals (96.6%) harbored at least one of these in the targeted genes. Pathogenic or likely pathogenic variants were only found in 6 individuals for the BRCA1 (p.R1726fs, rs80357867), BRCA2 (p.K589fs, rs397507606 & p.L2805fs, rs397507402), RAD50 (p.E995fs, rs587780154), ATM (p.V2424G, rs28904921), or MUTYH (p.G396D, rs36053993) genes. Strategies to functionally validate the remaining variants of unknown significance, especially in understudied and hereditary cancer populations, are greatly needed to increase the clinical utility and utilization of clinical genetic screening platforms to reduce cancer incidence and mortality.
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Affiliation(s)
- J. Tyson McDonald
- Department of Radiation Medicine, Georgetown University School of Medicine, Washington, DC, United States of America
| | - Luisel J. Ricks-Santi
- Cancer Research Center, Hampton University, Hampton, VA, United States of America
- Department of Pharmacotherapy and Translational Research, College of Medicine, University of Florida, Gainesville, FL, United States of America
- * E-mail:
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4
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Paixão D, Torrezan GT, Santiago KM, Formiga MN, Ahuno ST, Dias-Neto E, Tojal da Silva I, Foulkes WD, Polak P, Carraro DM. Characterization of genetic predisposition to molecular subtypes of breast cancer in Brazilian patients. Front Oncol 2022; 12:976959. [PMID: 36119527 PMCID: PMC9472814 DOI: 10.3389/fonc.2022.976959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction BRCA1 and BRCA2 germline pathogenic variants (GPVs) account for most of the 5-10% of breast cancer (BC) that is attributable to inherited genetic variants. BRCA1 GPVs are associated with the triple negative subtype, whereas BRCA2 GPVs are likely to result in higher grade, estrogen-receptor positive BCs. The contribution of other genes of high and moderate risk for BC has not been well defined and risk estimates to specific BC subtypes is lacking, especially for an admixed population like Brazilian. Objective The aim of this study is to evaluate the value of a multigene panel in detecting germline mutations in cancer-predisposing genes for Brazilian BC patients and its relation with molecular subtypes and the predominant molecular ancestry. Patients and methods A total of 321 unrelated BC patients who fulfilled NCCN criteria for BRCA1/2 testing between 2016-2018 were investigated with a 94-genes panel. Molecular subtypes were retrieved from medical records and ancestry-specific variants were obtained from off-target reads obtained from the sequencing data. Results We detected 83 GPVs in 81 patients (positivity rate of 25.2%). Among GPVs, 47% (39/83) were identified in high-risk BC genes (BRCA1/2, PALB2 and TP53) and 18% (15/83) in moderate-penetrance genes (ATM, CHEK2 and RAD51C). The remainder of the GPVs (35% - 29/83), were identified in lower-risk genes. As for the molecular subtypes, triple negative BC had a mutation frequency of 31.6% (25/79), with predominance in BRCA1 (12.6%; 10/79). Among the luminal subtypes, except Luminal B HER2-positive, 18.7% (29/155) had GPV with BRCA1/2 genes contributing 7.1% (11/155) and non-BRCA1/2 genes, 12.9% (20/155). For Luminal B HER2-positive subtype, 40% (16/40) had GPVs, with a predominance of ATM gene (15% - 6/40) and BRCA2 with only 2.5% (1/40). Finally, HER2-enriched subtype presented a mutation rate of 30.8% (4/13) with contribution of BRCA2 of 7.5% (1/13) and non-BRCA1/2 of 23% (3/13). Variants of uncertain significance (VUS) were identified in 77.6% (249/321) of the patients and the number of VUS was increased in patients with Asian and Native American ancestry. Conclusion The multigene panel contributed to identify GPVs in genes other than BRCA1/2, increasing the positivity of the genetic test from 9.6% (BRCA1/2) to 25.2% and, considering only the most clinically relevant BC predisposing genes, to 16.2%. These results indicate that women with clinical criteria for hereditary BC may benefit from a multigene panel testing, as it allows identifying GPVs in genes that directly impact the clinical management of these patients and family members.
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Affiliation(s)
- Daniele Paixão
- Oncogenetics Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Giovana Tardin Torrezan
- Clinical and Functional Genomics Group, International Research Center/CIPE, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
- National Institute of Science and Technology in Oncogenomics and Therapeutic Innovation (INCITO), São Paulo, SP, Brazil
| | - Karina Miranda Santiago
- Clinical and Functional Genomics Group, International Research Center/CIPE, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Samuel Terkper Ahuno
- Tri-Institutional PhD Program in Computational Biology and Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Emmanuel Dias-Neto
- National Institute of Science and Technology in Oncogenomics and Therapeutic Innovation (INCITO), São Paulo, SP, Brazil
- Genomic Medicine Group, - International Research Center/CIPE, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Israel Tojal da Silva
- National Institute of Science and Technology in Oncogenomics and Therapeutic Innovation (INCITO), São Paulo, SP, Brazil
- Bioinformatics and Computational Biology Group, - International Research Center/CIPE, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - William D. Foulkes
- Program in Cancer Genetics, Department of Oncology and Human Genetics, McGill University, Montreal, QC, Canada
| | - Paz Polak
- Computational Biology, C2i Genomics, New York, NY, United States
| | - Dirce Maria Carraro
- Clinical and Functional Genomics Group, International Research Center/CIPE, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
- National Institute of Science and Technology in Oncogenomics and Therapeutic Innovation (INCITO), São Paulo, SP, Brazil
- *Correspondence: Dirce Maria Carraro,
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Magnoni F, Sacchini V, Veronesi P, Bianchi B, Bottazzoli E, Tagliaferri V, Mazzotta E, Castelnovo G, Deguidi G, Rossi EMC, Corso G. Surgical Management of Inherited Breast Cancer: Role of Breast-Conserving Surgery. Cancers (Basel) 2022; 14:cancers14133245. [PMID: 35805017 PMCID: PMC9265273 DOI: 10.3390/cancers14133245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Which should be the optimal surgical approach to breast cancer in the presence of high penetrance gene mutation represents a current clinical and scientific issue, lively debated and studied. Does inherited breast cancer always mean bilateral mastectomy? Scientific research is questioning the oncological safety of a conservative surgical approach in hereditary breast cancer. The present narrative review aims to explore the scientific panorama on this faceted and significant theme. Abstract Recent studies have demonstrated that hereditary breast cancer (BC) has a prevalence of 5–10% among all BC diagnoses. Nowadays, significant technological advances in the identification of an increasingly broad spectrum of genetic mutations allow for the discovery of an ever-growing number of inherited pathogenic (P) or likely pathogenic (LP) variants of breast cancer susceptibility genes. As the management of BC patients carrying mutations in the BRCA1/2 genes or other high-penetrance genes is currently a challenge, extensive research is being carried out and a lively scientific debate has been taking place on what the most appropriate local therapy, especially surgical treatment, of patients with inherited BC should be. In many studies, BC outcomes in BRCA carriers and non-carriers have been compared. A number of them showed that, when compared with mastectomy, breast-conserving surgery in BRCA patients is oncologically safe in terms of overall survival, although an increased risk of ipsilateral recurrence was reported. In these patients, devising a specific therapeutic strategy is an inevitably complex process, as it must take into consideration a series of factors, require a multimodal approach, guarantee personalization, strictly adhere to scientific international guidelines, and consider all available evidence. The present narrative review purposes to identify and illustrate evidence from significant selected studies that discussed those issues, as well as to suggest useful tools to clinicians managing this specific clinical condition in daily clinical practice.
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Affiliation(s)
- Francesca Magnoni
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
- Correspondence: ; Tel.: +39-0294371092
| | - Virgilio Sacchini
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Beatrice Bianchi
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Elisa Bottazzoli
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Valentina Tagliaferri
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Erica Mazzotta
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Giulia Castelnovo
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Giulia Deguidi
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Elisabetta Maria Cristina Rossi
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
| | - Giovanni Corso
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20041 Milan, Italy; (P.V.); (B.B.); (E.B.); (V.T.); (E.M.); (G.C.); (G.D.); (E.M.C.R.); (G.C.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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Kwong A, Ho CYS, Shin VY, Au CH, Luk WP, Fung LH, Chan TL, Chan KKL, Ngan HYS, Ma ESK. Germline mutations in Chinese ovarian cancer with or without breast cancer. Mol Genet Genomic Med 2022; 10:e1940. [PMID: 35608067 PMCID: PMC9266594 DOI: 10.1002/mgg3.1940] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/08/2022] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ovarian and breast cancers are known to have significant genetic components. Considering the differences in the mutation spectrum across ethnicity, it is important to identify hereditary breast and ovarian cancer (HBOC) genes mutation in Chinese for clinical management. METHODS Two cohorts of 451 patients with ovarian cancer only (OV) and 93 patients with both breast and ovarian (BROV) cancers were initially screened for BRCA1, BRCA2, TP53, and PTEN. 109 OV and 43 BROV patients with extensive clinical risk and were being tested negative, were then further characterized by 30-gene panel analysis. RESULTS Pathogenic BRCA1/2 variants were identified in 45 OV patients and 33 BROV patients, giving a prevalence of 10% and 35.5%, respectively. After the extended screening, mutations in other HBOC genes were identified in an additional 12.8% (14/109) of the OV cohort and 14% (6/43) in the BROV cohort. The most commonly mutated genes in the OV cohort were MSH2 (4.6%) while in the BROV cohort were MSH2 (4.7%) and PALB2 (4.7%). With this extended multigene testing strategy, pathogenic mutations were detected in 12.8% of OV patients (BRCAs: 10%; additional genes: 12.8%) and 40.9% (BRCAs: 35.5%; additional genes: 14%) of BROV patients. CONCLUSION Extended characterization of the contributions of HBOC genes to OV and BROV patients has significant impacts on further management in patients and their families, expanding the screening net for more asymptomatic individuals.
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Affiliation(s)
- Ava Kwong
- Department of Surgery, The University of Hong Kong, Pofulam, Hong Kong SAR.,Department of Surgery, University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Surgery, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR.,Hong Kong Hereditary Breast Cancer Family Registry, Shau Kei Wan, Hong Kong SAR
| | - Cecilia Yuen Sze Ho
- Department of Molecular Pathology, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR
| | - Vivian Yvonne Shin
- Department of Surgery, The University of Hong Kong, Pofulam, Hong Kong SAR
| | - Chun Hang Au
- Department of Molecular Pathology, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR
| | - Wing Pan Luk
- Department of Medical Physics and Research, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR
| | - Ling Hiu Fung
- Department of Medical Physics and Research, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR
| | - Tsun-Leung Chan
- Hong Kong Hereditary Breast Cancer Family Registry, Shau Kei Wan, Hong Kong SAR.,Department of Molecular Pathology, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR
| | - Karen Kar Loen Chan
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pofulam, Hong Kong SAR
| | - Hextan Yuen Sheung Ngan
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Pofulam, Hong Kong SAR
| | - Edmond Shiu Kwan Ma
- Hong Kong Hereditary Breast Cancer Family Registry, Shau Kei Wan, Hong Kong SAR.,Department of Molecular Pathology, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR
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Ujfaludi Z, Kuthi L, Pankotai-Bodó G, Bankó S, Sükösd F, Pankotai T. Novel Diagnostic Value of Driver Gene Transcription Signatures to Characterise Clear Cell Renal Cell Carcinoma, ccRCC. Pathol Oncol Res 2022; 28:1610345. [PMID: 35586183 PMCID: PMC9108154 DOI: 10.3389/pore.2022.1610345] [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: 02/04/2022] [Accepted: 04/12/2022] [Indexed: 11/22/2022]
Abstract
Routine molecular tumour diagnostics are augmented by DNA-based qualitative and quantitative molecular techniques detecting mutations of DNA. However, in the past decade, it has been unravelled that the phenotype of cancer, as it’s an extremely complex disease, cannot be fully described and explained by single or multiple genetic variants affecting only the coding regions of the genes. Moreover, studying the manifestation of these somatic mutations and the altered transcription programming—driven by genomic rearrangements, dysregulation of DNA methylation and epigenetic landscape—standing behind the tumorigenesis and detecting these changes could provide a more detailed characterisation of the tumour phenotype. Consequently, novel comparative cancer diagnostic pipelines, including DNA- and RNA-based approaches, are needed for a global assessment of cancer patients. Here we report, that by monitoring the expression patterns of key tumour driver genes by qPCR, the normal and the tumorous samples can be separated into distinct categories. Furthermore, we also prove that by examining the transcription signatures of frequently affected genes at 3p25, 3p21 and 9p21.3 genomic regions, the ccRCC (clear cell renal cell carcinoma) and non-tumorous kidney tissues can be distinguished based on the mRNA level of the selected genes. Our results open new diagnostics possibilities where the mRNA signatures of tumour drivers can supplement the DNA-based approaches providing a more precise diagnostics opportunity leading to determine more precise therapeutic protocols.
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Affiliation(s)
- Zsuzsanna Ujfaludi
- Albert Szent-Györgyi Clinical Center, Albert Szent-Györgyi Medical School, Institute of Pathology, University of Szeged, Szeged, Hungary
| | - Levente Kuthi
- Albert Szent-Györgyi Clinical Center, Albert Szent-Györgyi Medical School, Institute of Pathology, University of Szeged, Szeged, Hungary
| | - Gabriella Pankotai-Bodó
- Albert Szent-Györgyi Clinical Center, Albert Szent-Györgyi Medical School, Institute of Pathology, University of Szeged, Szeged, Hungary
| | - Sarolta Bankó
- Albert Szent-Györgyi Clinical Center, Albert Szent-Györgyi Medical School, Institute of Pathology, University of Szeged, Szeged, Hungary
| | - Farkas Sükösd
- Albert Szent-Györgyi Clinical Center, Albert Szent-Györgyi Medical School, Institute of Pathology, University of Szeged, Szeged, Hungary
| | - Tibor Pankotai
- Albert Szent-Györgyi Clinical Center, Albert Szent-Györgyi Medical School, Institute of Pathology, University of Szeged, Szeged, Hungary
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8
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Abdel-Razeq H, Abujamous L, Abunasser M, Edaily S, Bater R. Prevalence and predictors of germline BRCA1 and BRCA2 mutations among young patients with breast cancer in Jordan. Sci Rep 2021; 11:14906. [PMID: 34290354 PMCID: PMC8295261 DOI: 10.1038/s41598-021-94403-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 06/24/2021] [Indexed: 11/09/2022] Open
Abstract
BRCA1 and BRCA2 mutations are not uncommon in breast cancer patients. Western studies show that such mutations are more prevalent among younger patients. This study evaluates the prevalence of germline mutations in BRCA1 and BRCA2 among breast cancer patients diagnosed at age 40 or younger in Jordan. Blood samples of patients with breast cancer diagnosed at age 40 years or younger were obtained for DNA extraction and BRCA sequencing. Mutations were classified as benign/likely benign (non-carrier), pathogenic/likely pathogenic variant (carrier) and variant of uncertain significance (VUS). Genetic testing and counseling were completed on 616 eligible patients. Among the whole group, 75 (12.2%) had pathogenic or likely pathogenic variants; two of the BRCA2 mutations were novel. In multivariate analysis, triple-negative disease (Odd Ratio [OR]: 5.37; 95% CI 2.88-10.02, P < 0.0001), breast cancer in ≥ 2 family members (OR: 4.44; 95% CI 2.52-7.84, P < 0.0001), and a personal history ≥ 2 primary breast cancers (OR: 3.43; 95% CI 1.62-7.24, P = 0.001) were associated with higher mutation rates. In conclusion, among young Jordanian patients with breast cancer, mutation rates are significantly higher in patients with triple-negative disease, personal history of breast cancer and those with two or more close relatives with breast cancer.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box: 1269, Amman, 11941, Jordan.
- School of Medicine, University of Jordan, Amman, Jordan.
| | - Lama Abujamous
- Department of Cell Therapy & Applied Genomic, King Hussein Cancer Center, Amman, Jordan
| | - Mahmoud Abunasser
- Department of Internal Medicine, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box: 1269, Amman, 11941, Jordan
| | - Sara Edaily
- Department of Internal Medicine, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box: 1269, Amman, 11941, Jordan
| | - Rayan Bater
- Department of Internal Medicine, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box: 1269, Amman, 11941, Jordan
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9
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Medendorp NM, Hillen MA, Visser LNC, Aalfs CM, Duijkers FAM, van Engelen K, Ausems MGEM, Verhoef S, Stiggelbout AM, Smets EMA. A randomized experimental study to test the effects of discussing uncertainty during cancer genetic counseling: different strategies, different outcomes? Eur J Hum Genet 2021; 29:789-799. [PMID: 33437034 PMCID: PMC8110589 DOI: 10.1038/s41431-020-00799-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/14/2020] [Accepted: 12/10/2020] [Indexed: 01/29/2023] Open
Abstract
Uncertainty is increasingly discussed during genetic counseling due to innovative techniques, e.g., multigene panel testing. Discussions about uncertainty may impact counselees variably, depending on counselors' communication styles. Ideally, the discussion of uncertainty enables counselees to cope with uncertainty and make well-informed decisions about testing. We examined the impact of how counselors convey uncertainty and address counselees' uncertainty, and explored the role of individual characteristics. Therefore, a randomized controlled experiment using videos was conducted. Former counselees (N = 224) viewed one video depicting a genetic consultation about multigene panel testing. The extent of counselors' communication of uncertainty (comprehensive vs. the essence) and their response to counselees' uncertainty expressions (providing information vs. providing space for emotions vs. normalizing and counterbalancing uncertainty) were systematically manipulated. Individual characteristics, e.g., uncertainty tolerance, were assessed, as well as outcome variables (primary outcomes: feelings of uncertainty and information recall). No effects were found on primary outcomes. Participants were most satisfied when the essence was communicated, combined with providing information or providing space responses (p = 0.002). Comprehensive information resulted in less perceived steering toward testing (p = 0.005). Participants with lower uncertainty tolerance or higher trait anxiety were less confident about their understanding when receiving comprehensive information (p = 0.025). Participants seeking information experienced less uncertainty (p = 0.003), and trusted their counselor more (p = 0.028), when the counselor used information providing responses. In sum, the impact of discussing uncertainty primarily depends on individual characteristics. Practical guidelines should address how to tailor the discussion of uncertainty.
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Affiliation(s)
- Niki M Medendorp
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Leonie N C Visser
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cora M Aalfs
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floor A M Duijkers
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Klaartje van Engelen
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Margreet G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Senno Verhoef
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
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10
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Reyes KG, Clark C, Gerhart M, Newson AJ, Ormond KE. "I wish that there was more info": characterizing the uncertainty experienced by carriers of pathogenic ATM and/or CHEK2 variants. Fam Cancer 2021; 21:143-155. [PMID: 33855648 DOI: 10.1007/s10689-021-00251-3] [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] [Received: 01/12/2021] [Accepted: 04/04/2021] [Indexed: 12/29/2022]
Abstract
Little is known about what uncertainties patients experience after being identified to carry a pathogenic variant in a moderate-risk cancer gene as a result of undergoing multigene panel testing for cancer susceptibility. Data regarding cancer risk estimates and effectiveness of risk management strategies for these variants continues to evolve, which has the potential to evoke uncertainty. Acknowledging uncertainty during pre- and post-test discussions is imperative to helping individuals to adapt to their results. A better understanding of this population's experience of uncertainty is needed to facilitate such discussions and is the aim of the current study. Semi-structured interviews (30-60 min in length), informed by Han and colleagues' taxonomy of uncertainty in clinical genomic sequencing, were conducted to assess motivations to pursue genetic testing, areas of perceived uncertainty, and strategies for managing uncertainty among 20 carriers of pathogenic variants in two moderate-risk genes, ATM and CHEK2. We found that participants pursue genetic testing with the expectation that results will clarify cancer risks and approaches to management. Participants experience uncertainties aligning with Han's taxonomy relating to the ambiguity of specific cancer risk estimates and effectiveness of certain risk management strategies. These uncertainties influenced decisions around the uptake of risk management strategies, which were additionally impacted by clinicians' uncertainty towards such strategies. Participants employ a variety of uncertainty management approaches to cope with their anxieties. Clinicians may wish to use these findings to facilitate patient adaptation to the implications of multigene panel testing for cancer susceptibility during both pre- and post-test counseling sessions.
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Affiliation(s)
- Kathryn G Reyes
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Cheyla Clark
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Meredith Gerhart
- Cancer Genetics and Genomics, Stanford Health Care, Stanford, CA, USA
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney Health Ethics, University of Sydney, Sydney, NSW, Australia
| | - Kelly E Ormond
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA. .,Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA.
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11
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Reid S, Pal T. Update on multi-gene panel testing and communication of genetic test results. Breast J 2020; 26:1513-1519. [PMID: 32639074 PMCID: PMC7484453 DOI: 10.1111/tbj.13971] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022]
Abstract
With technological advances, multi-gene panel testing has become increasingly used to identify patients at risk for hereditary breast cancer (HBC). There are currently evidence-based interventions and breast cancer screening strategies that exist for cancer prevention and early detection among patients with HBC. Moreover, in addition to the personal impact of identifying HBC, this information may be shared with at-risk family members to amplify the benefits of testing and subsequent care among those at high risk. Opportunities and challenges with the utilization of updated multi-gene panel testing for HBC, including: (a) tumor sequencing with germline consequences; (b) genetic counseling implications; and (c) strategies to improve the communication of genetic test results to family members will be reviewed. With the advances and expansion of genetic testing, all health care providers need to be updated on both the importance and complexities of HBC counseling and testing, in order to optimize patient care.
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Affiliation(s)
- Sonya Reid
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tuya Pal
- Vanderbilt University Medical Center, Nashville, Tennessee
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12
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Kwong A, Shin VY, Chen J, Cheuk IWY, Ho CYS, Au CH, Chan KKL, Ngan HYS, Chan TL, Ford JM, Ma ESK. Germline Mutation in 1338 BRCA-Negative Chinese Hereditary Breast and/or Ovarian Cancer Patients: Clinical Testing with a Multigene Test Panel. J Mol Diagn 2020; 22:544-554. [PMID: 32068069 DOI: 10.1016/j.jmoldx.2020.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 12/16/2019] [Accepted: 01/14/2020] [Indexed: 12/23/2022] Open
Abstract
Differences in the mutation spectrum across ethnicities suggest the importance of identifying genes in addition to common high penetrant genes to estimate the associated breast cancer risk in China. A total of 1338 high-risk breast cancer patients who tested negative for germline BRCA1, BRCA2, TP53, and PTEN mutations between 2007 and 2017 were selected from the Hong Kong Hereditary Breast Cancer Family Registry. Patient samples were subjected to next-generation DNA sequencing using a multigene panel (Color Genomics). All detected pathogenic variants were validated by bidirectional DNA sequencing. The sequencing data were coanalyzed by a bioinformatics pipeline developed in-house. Sixty-one pathogenic variants (4.6%) were identified in this cohort in 11 cancer predisposition genes. Most carriers (77.1%) had early onset of breast cancer (age <45 years), 32.8% had family members with breast cancer, and 11.5% had triple-negative breast cancer. The most common mutated genes were PALB2 (1.4%), RAD51D (0.8%), and ATM (0.8%). A total of 612 variants of unknown significance were identified in 494 patients, and 87.4% of the variants of unknown significance were missense mutations. Pathogenic variants in cancer predisposition genes beyond BRCA1, BRCA2, TP53, and PTEN were detected in an additional 4.6% of patients using the multigene panel. PALB2 (1.4%) and RAD51D (0.8%) were the most commonly mutated genes in patients who tested mutation negative by a four-gene panel.
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Affiliation(s)
- Ava Kwong
- Department of Surgery, The University of Hong Kong and The University of Hong Kong-Shenzhen Hospital, Hong Kong Special Administrative Region; Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region; Hong Kong Hereditary Breast Cancer Family Registry, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region.
| | - Vivian Y Shin
- Department of Surgery, The University of Hong Kong and The University of Hong Kong-Shenzhen Hospital, Hong Kong Special Administrative Region
| | - Jiawei Chen
- Department of Surgery, The University of Hong Kong and The University of Hong Kong-Shenzhen Hospital, Hong Kong Special Administrative Region
| | - Isabella W Y Cheuk
- Department of Surgery, The University of Hong Kong and The University of Hong Kong-Shenzhen Hospital, Hong Kong Special Administrative Region
| | - Cecilia Y S Ho
- Division of Molecular Pathology, Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region
| | - Chun H Au
- Division of Molecular Pathology, Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region
| | - Karen K L Chan
- Department of Obstetrics and Gynecology, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Hextan Y S Ngan
- Department of Obstetrics and Gynecology, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Tsun L Chan
- Hong Kong Hereditary Breast Cancer Family Registry, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region; Division of Molecular Pathology, Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region
| | - James M Ford
- Department of Medicine (Oncology), Stanford University School of Medicine, Stanford, California
| | - Edmond S K Ma
- Hong Kong Hereditary Breast Cancer Family Registry, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region; Division of Molecular Pathology, Department of Pathology, Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region
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13
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Gao X, Nan X, Liu Y, Liu R, Zang W, Shan G, Gai F, Zhang J, Li L, Cheng G, Song L. Comprehensive profiling of BRCA1 and BRCA2 variants in breast and ovarian cancer in Chinese patients. Hum Mutat 2019; 41:696-708. [PMID: 31825140 DOI: 10.1002/humu.23965] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 09/18/2019] [Accepted: 11/17/2019] [Indexed: 01/04/2023]
Abstract
The identification and interpretation of germline BRCA1/2 variants become increasingly important in breast and ovarian cancer (OC) treatment. However, there is no comprehensive analysis of the germline BRCA1/2 variants in a Chinese population. Here we performed a systematic review and meta-analysis on such variants from 94 publications. A total of 2,128 BRCA1/2 variant records were extracted, including 601 from BRCA1 and 632 from BRCA2. In addition, 414, 734, 449, and 307 variants were also recorded in the BIC, ClinVar, ENIGMA, and UMD databases, respectively, and 579 variants were newly reported. Subsequent analysis showed that the overall germline BRCA1/2 pathogenic variant frequency was 5.7% and 21.8% in Chinese breast and OC, respectively. Populations with high-risk factors exhibited a higher pathogenic variant percentage. Furthermore, the variant profile in Chinese is distinct from that in other ethnic groups with no distinct founder pathogenic variants. We also tested our in-house American College of Medical Genetics-guided pathogenicity interpretation procedure for Chinese BRCA1/2 variants. Our results achieved a consistency of 91.2-97.6% (5-grade classification) or 98.4-100% (2-grade classification) with public databases. In conclusion, this study represents the first comprehensive meta-analysis of Chinese BRCA1/2 variants and validates our in-house pathogenicity interpretation procedure, thereby providing guidance for further PARP inhibitor development and companion diagnostics in the Chinese population.
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Affiliation(s)
| | | | | | - Rui Liu
- Novogene Co. Ltd., Beijing, China
| | | | | | - Fei Gai
- Novogene Co. Ltd., Beijing, China
| | | | - Lei Li
- Novogene Co. Ltd., Beijing, China
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14
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Manahan ER, Kuerer HM, Sebastian M, Hughes KS, Boughey JC, Euhus DM, Boolbol SK, Taylor WA. Consensus Guidelines on Genetic` Testing for Hereditary Breast Cancer from the American Society of Breast Surgeons. Ann Surg Oncol 2019; 26:3025-3031. [PMID: 31342359 PMCID: PMC6733830 DOI: 10.1245/s10434-019-07549-8] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this consensus guideline is to outline recommendations for genetic testing that medical professionals can use to assess hereditary risk for breast cancer. METHODS Literature review included large datasets, basic and clinical science publications, and recent updated national guidelines. Genetic testing to assess hereditary risk of cancer is a complex, broad, and dynamic area of medical research. The dominant focus of this guideline is limited in scope to breast cancer. RESULTS There is a lack of consensus among experts regarding which genes among many should be tested in different clinical scenarios. There is also variation in the degree of consensus regarding the understanding of risk and appropriate clinical management of mutations in many genes. CONCLUSIONS Genetic testing should be made available to all patients with a personal history of breast cancer. Recent data are reviewed that support genetic testing being offered to each patient with breast cancer (newly diagnosed or with a personal history). If genetic testing is performed, such testing should include BRCA1/BRCA2 and PALB2, with other genes as appropriate for the clinical scenario and family history. For patients with newly diagnosed breast cancer, identification of a mutation may impact local treatment recommendations. Patients who had genetic testing previously may benefit from updated testing. Genetic testing should be made available to patients without a history of breast cancer who meet National Comprehensive Cancer Network guidelines. Finally, variants of uncertain significance are not clinically actionable and these patients should be managed based on their individual risk factors.
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Affiliation(s)
- Eric R Manahan
- Department of Surgery, Hamilton Medical Center, Dalton, GA, USA.
| | - Henry M Kuerer
- Department Breast Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Molly Sebastian
- Reinsch Pierce Family Center for Breast Health, Virginia Hospital Center, Arlington, VA, USA
| | - Kevin S Hughes
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | - David M Euhus
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Susan K Boolbol
- Department of Surgery, Mount Sinai Beth Israel, New York, NY, USA
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15
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Toss A, Molinaro E, Sammarini M, Del Savio MC, Cortesi L, Facchinetti F, Grandi G. Hereditary ovarian cancers: state of the art. Minerva Med 2019; 110:301-319. [DOI: 10.23736/s0026-4806.19.06091-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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16
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Esteban I, Lopez-Fernandez A, Balmaña J. A narrative overview of the patients' outcomes after multigene cancer panel testing, and a thorough evaluation of its implications for genetic counselling. Eur J Med Genet 2018; 62:342-349. [PMID: 30476626 DOI: 10.1016/j.ejmg.2018.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/08/2018] [Accepted: 11/22/2018] [Indexed: 01/07/2023]
Abstract
Massively parallel sequencing is being implemented in clinical practice through the use of multigene panel testing, whole exome sequencing and whole genome sequencing. In this manuscript we explore how the use of massively parallel sequencing, and in particular multigene cancer panel testing, is potentially changing the process of genetic counselling and how patients cope with pre-test genetic counselling and results. We found that the main challenges are around uncertainty, hopes and expectations and the amount and complexity of information that needs to be discussed. This may impact the process of genetic counselling, although genetic counsellors can still use their core skills and enhance some of them in order to evolve and meet patients' needs in the genomics era. Available data suggests that patients can cope with multigene cancer panels although more research is needed to fully understand the psychosocial implications of multigene cancer panels for patients, especially for those who have variants of unknown significance or moderate penetrance variants. Research is also needed to explore and develop communication models that maximize patients' understanding and empower them to make informed decisions.
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Affiliation(s)
- I Esteban
- Department of Clinical Genetics, Ninewells Hospital, Dundee, Scotland, UK.
| | - A Lopez-Fernandez
- High Risk and Cancer Prevention Unit, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - J Balmaña
- High Risk and Cancer Prevention Unit, Vall D'Hebron Institute of Oncology, Barcelona, Spain; Medical Oncology Department, Vall D'Hebron Hospital, Barcelona, Spain
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17
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Cragun DL, Kechik J, Pal T. Complexities of genetic screening and testing in hereditary colorectal cancer. SEMINARS IN COLON AND RECTAL SURGERY 2018. [DOI: 10.1053/j.scrs.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Krontiras H, Farmer M, Whatley J. Breast Cancer Genetics and Indications for Prophylactic Mastectomy. Surg Clin North Am 2018; 98:677-685. [PMID: 30005767 DOI: 10.1016/j.suc.2018.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
As more genetic information becomes available to inform breast cancer treatment, screening, and risk-reduction approaches, clinicians must become more knowledgeable about possible genetic testing and prevention strategies, including outcomes, benefits, risks, and limitations. The aim of this article is to define and distinguish high- and moderate-risk breast cancer predisposition genes, summarize the clinical recommendations that may be considered based on the identification of pathogenic variants (mutations) in these genes, and indications for risk-reducing and contralateral prophylactic mastectomy.
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Affiliation(s)
- Helen Krontiras
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Faculty Office Tower Suite 1153, 1720 2nd Avenue South, Birmingham, AL 35294-3411, USA.
| | - Meagan Farmer
- Department of Genetics, University of Alabama at Birmingham, Kaul Human Genetics Building, Suite 230, 720 20th Street, South Birmingham, AL 35294-0024, USA
| | - Julie Whatley
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Faculty Office Tower Suite 1153, 1720 2nd Avenue South, Birmingham, AL 35294-3411, USA
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19
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Hooker GW, Clemens KR, Quillin J, Vogel Postula KJ, Summerour P, Nagy R, Buchanan AH. Cancer Genetic Counseling and Testing in an Era of Rapid Change. J Genet Couns 2017; 26:1244-1253. [PMID: 28434142 DOI: 10.1007/s10897-017-0099-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/10/2017] [Indexed: 01/19/2023]
Abstract
The impacts of the Association for Molecular Pathology vs. Myriad Supreme Court decision regarding patenting DNA segments and multi-gene testing on cancer genetic counseling practice have not been well described. We aimed to assess genetic counselors' perceptions of how their genetic testing-related practices for hereditary breast and/or ovarian cancer (HBOC) changed after these events. One-hundred fifty-two genetic counselors from the National Society of Genetic Counselors Cancer Special Interest Group completed an anonymous, online, mixed-methods survey in November 2013. The survey presented four hypothetical patients and asked about changes in testing practice. Across the vignettes, a majority of participants reported specific changes in testing decisions following Association for Molecular Pathology vs. Myriad and availability of multi-gene testing. Ninety-three percent of participants reported changing the types of first- and second-line tests they order for HBOC; the degree of change varied geographically. Qualitative analysis indicated that some counselors have altered the counseling session content, trading depth of information for breadth and spending more time counseling about uncertainty. This study shows that cancer genetic counselors are adapting quickly to genetic testing changes, but with wide variability. Findings suggest future research to elucidate clinicians' and patients' preferences for guidance on the clinical implementation of next-generation sequencing.
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Affiliation(s)
| | | | - John Quillin
- Virginia Commonwealth University, Richmond, VA, USA
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20
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Kelly PA. Next Generation Sequencing and Multi-Gene Panel Testing: Implications for the Oncology Nurse. Semin Oncol Nurs 2017; 33:208-218. [PMID: 28390840 DOI: 10.1016/j.soncn.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To review past, current, and future events in genetics and discuss how genetic testing information personalizes cancer screening, detection, and treatment. A case study is presented to illustrate key points. DATA SOURCES National guidelines, evidence-based summaries, peer-reviewed studies, editorials, and web sites. CONCLUSION Multi-gene testing using next-generation sequencing has changed the landscape for hereditary cancer syndromes. IMPLICATIONS FOR NURSING PRACTICE Nurses have key roles in personalizing health care including recognizing the complexities of genetic testing, assessing family history, understanding gene/environment factors, referring for genetics consultations, and promoting registry studies. In order to be effective, nurses must stay current with the rapidly-changing technology and guidelines for genetic evaluations and testing.
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21
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Lumish HS, Steinfeld H, Koval C, Russo D, Levinson E, Wynn J, Duong J, Chung WK. Impact of Panel Gene Testing for Hereditary Breast and Ovarian Cancer on Patients. J Genet Couns 2017; 26:1116-1129. [PMID: 28357778 DOI: 10.1007/s10897-017-0090-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 02/28/2017] [Indexed: 12/13/2022]
Abstract
Recent advances in next generation sequencing have enabled panel gene testing, or simultaneous testing for mutations in multiple genes for a clinical condition. With more extensive and widespread genetic testing, there will be increased detection of genes with moderate penetrance without established clinical guidelines and of variants of uncertain significance (VUS), or genetic variants unknown to either be disease-causing or benign. This study surveyed 232 patients who underwent genetic counseling for hereditary breast and ovarian cancer to examine the impact of panel gene testing on psychological outcomes, patient understanding, and utilization of genetic information. The survey used standardized instruments including the Impact of Event Scale (IES), Multidimensional Impact of Cancer Risk Assessment (MICRA), Satisfaction with Decision Instrument (SWD), Ambiguity Tolerance Scale (AT-20), genetics knowledge, and utilization of genetic test results. Study results suggested that unaffected individuals with a family history of breast or ovarian cancer who received positive results were most significantly impacted by intrusive thoughts, avoidance, and distress. However, scores were also modestly elevated among unaffected patients with a family history of breast and ovarian cancer who received VUS, highlighting the impact of ambiguous results that are frequent among patients undergoing genetic testing with large panels of genes. Potential risk factors for increased genetic testing-specific distress in this study included younger age, black or African American race, Hispanic origin, lower education level, and lower genetic knowledge and highlight the need for developing strategies to provide effective counseling and education to these communities, particularly when genetic testing utilizes gene panels that more commonly return VUS. More detailed pre-test education and counseling may help patients appreciate the probability of various types of test results and how results would be used clinically, and allow them to make more informed decisions about the type of genetic testing to select.
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Affiliation(s)
- Heidi S Lumish
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hallie Steinfeld
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Carrie Koval
- Division of Clinical Genetics, New York Presbyterian Hospital, New York, NY, USA
| | - Donna Russo
- Division of Clinical Genetics, New York Presbyterian Hospital, New York, NY, USA
| | - Elana Levinson
- Division of Clinical Genetics, New York Presbyterian Hospital, New York, NY, USA
| | - Julia Wynn
- Division of Clinical Genetics, New York Presbyterian Hospital, New York, NY, USA
| | - James Duong
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA. .,Division of Molecular Genetics, 1150 St. Nicholas Avenue, Room 620, New York, NY, 10032, USA.
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22
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Kamps R, Brandão RD, Bosch BJVD, Paulussen ADC, Xanthoulea S, Blok MJ, Romano A. Next-Generation Sequencing in Oncology: Genetic Diagnosis, Risk Prediction and Cancer Classification. Int J Mol Sci 2017; 18:ijms18020308. [PMID: 28146134 PMCID: PMC5343844 DOI: 10.3390/ijms18020308] [Citation(s) in RCA: 282] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/19/2017] [Indexed: 12/17/2022] Open
Abstract
Next-generation sequencing (NGS) technology has expanded in the last decades with significant improvements in the reliability, sequencing chemistry, pipeline analyses, data interpretation and costs. Such advances make the use of NGS feasible in clinical practice today. This review describes the recent technological developments in NGS applied to the field of oncology. A number of clinical applications are reviewed, i.e., mutation detection in inherited cancer syndromes based on DNA-sequencing, detection of spliceogenic variants based on RNA-sequencing, DNA-sequencing to identify risk modifiers and application for pre-implantation genetic diagnosis, cancer somatic mutation analysis, pharmacogenetics and liquid biopsy. Conclusive remarks, clinical limitations, implications and ethical considerations that relate to the different applications are provided.
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Affiliation(s)
- Rick Kamps
- Department of Clinical Genetics: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6229HX Maastricht, The Netherlands.
| | - Rita D Brandão
- Department of Clinical Genetics: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6229HX Maastricht, The Netherlands.
| | - Bianca J van den Bosch
- Department of Clinical Genetics: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6229HX Maastricht, The Netherlands.
| | - Aimee D C Paulussen
- Department of Clinical Genetics: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6229HX Maastricht, The Netherlands.
| | - Sofia Xanthoulea
- Department of Gynaecology and Obstetrics: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6229HX Maastricht, The Netherlands.
| | - Marinus J Blok
- Department of Clinical Genetics: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6229HX Maastricht, The Netherlands.
| | - Andrea Romano
- Department of Gynaecology and Obstetrics: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6229HX Maastricht, The Netherlands.
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Cragun D, Kinney AY, Pal T. Care delivery considerations for widespread and equitable implementation of inherited cancer predisposition testing. Expert Rev Mol Diagn 2017; 17:57-70. [PMID: 27910721 PMCID: PMC5642111 DOI: 10.1080/14737159.2017.1267567] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION DNA sequencing advances through next-generation sequencing (NGS) and several practice changing events, have led to shifting paradigms for inherited cancer predisposition testing. These changes necessitated a means by which to maximize health benefits without unnecessarily inflating healthcare costs and exacerbating health disparities. Areas covered: NGS-based tests encompass multi-gene panel tests, whole exome sequencing, and whole genome sequencing, all of which test for multiple genes simultaneously, compared to prior sequencing practices through which testing was performed sequentially for one or two genes. Taking an ecological approach, this article synthesizes the current literature to consider the broad impact of these advances from the individual patient-, interpersonal-, organizational-, community- and policy-levels. Furthermore, the authors describe how multi-level factors that impact genetic testing and follow-up care reveal great potential to widen existing health disparities if these issues are not addressed. Expert commentary: As we consider ways to maximize patient benefit from testing in a cost effective manner, it is important to consider perspectives from multiple levels. This information is needed to guide the development of interventions such that the promise of genomic testing may be realized by all populations, regardless of race, ethnicity and ability to pay.
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Affiliation(s)
- Deborah Cragun
- University of South Florida, Department of Global Health, College of Public Health
| | - Anita Y Kinney
- University of New Mexico Comprehensive Cancer Center
- Department of Internal Medicine, University of New Mexico
| | - Tuya Pal
- Department of Cancer Epidemiology, Population Sciences, Moffitt Cancer Center
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Brédart A, Kop JL, De Pauw A, Caron O, Fajac A, Noguès C, Stoppa-Lyonnet D, Dolbeault S. Effect on perceived control and psychological distress of genetic knowledge in women with breast cancer receiving a BRCA1/2 test result. Breast 2016; 31:121-127. [PMID: 27837705 DOI: 10.1016/j.breast.2016.10.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 01/28/2023] Open
Abstract
Information provision during BRCA1/2 genetic counseling is complex and expected to be increasingly so with gene panel testing. This prospective study evaluated whether genetic knowledge in counselees with breast cancer (BC) after a pre-test genetic counseling visit (T1) enhance their feeling of personal control while minimizing distress after the notification of BRCA1/2 result (T2). At T1, 243 (89% response rate) counselees completed questionnaires on genetic knowledge (BGKQ), perceived cancer genetic risk; of which, at T2, 180 (66%) completed the BGKQ again, scales of anxiety/depression, distress specific to genetic risk, and perceived control. Multilevel models were performed accounting for clinician, and testing an effect of knowledge on psychological outcomes according to the adequacy of counselees' perceived genetic predisposition to cancer. The mean knowledge score was moderate at T1, decreased while not significantly differing by BRCA1/2 test result at T2. Knowledge at T1 had no direct effect on psychological outcomes, but in counselees who over-estimated their cancer genetic risk, higher knowledge at T1 predicted higher specific distress at T2. In BC affected counselees who over-estimate their cancer genetic risk, higher BRCA1/2 pre-test genetic knowledge seem to lead to increased specific distress. Identifying these BC affected counselees who over-estimate their genetic cancer risk and helping them to interpret their genetic knowledge instead of providing them with exhaustive genetic information could minimize their distress after test result receipt.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit 26 rue d'Ulm, 75005 Paris Cedex 05, France; University Paris Descartes, 71, Avenue Edouard Vaillant, 92774 Boulogne-Billancourt, France.
| | - Jean-Luc Kop
- Université de Lorraine, Inter-Psy, Inter-Psy, 3 Place Godefroy de Bouillon, BP 33 97, 54 015 Nancy Cedex, France
| | - Antoine De Pauw
- Institut Curie, Cancer Genetic Clinic, 26 rue d'Ulm, 75005 Paris Cedex 05, France
| | - Olivier Caron
- Gustave Roussy Hôpital Universitaire, Cancer Genetic Clinic, 114 rue Ed Vaillant, 94 805 Villejuif, France
| | - Anne Fajac
- Hôpital Tenon Service d'Histologie-Biologie Tumorale, AP-HP, ER2 UPMC Université Pierre et Marie Curie, 4 rue de la Chine, 75020, France
| | - Catherine Noguès
- Institut Paoli-Calmettes, 232, Boulevard Sainte Margueritte, Marseille, France
| | | | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit 26 rue d'Ulm, 75005 Paris Cedex 05, France; CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
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25
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Routine use of gene panel testing in hereditary breast cancer should be performed with caution. Crit Rev Oncol Hematol 2016; 108:33-39. [PMID: 27931838 DOI: 10.1016/j.critrevonc.2016.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/24/2016] [Accepted: 10/26/2016] [Indexed: 12/15/2022] Open
Abstract
Breast cancer is the most frequent cancer occurring in women. Ten percent of these cancers are considered hereditary. Among them, 30% are attributed to germline mutations in the tumor suppressor genes BRCA1 and BRCA2. Other genes of lower penetrance are also known, explaining together up to 40% of the hereditary risk of breast cancer. New techniques, such as next-generation sequencing, allow the simultaneous analysis of multiple genes in a cost-effective way. As a logical consequence, gene panel testing is entering clinical practice with the promise of personalized care. We however advocate that gene panel testing is not ready for non-specialist clinical use, as it generates many variants of unknown significance and includes more genes than are presently considered clinically useful. We hereby review the data for each gene that can change the risk management of patients carrying a pathogenic variant.
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Issues Arising in Psychological Consultations to Help Parents Talk to Minor and Young Adult Children about their Cancer Genetic Test Result: a Guide to Providers. J Genet Couns 2016; 26:251-260. [DOI: 10.1007/s10897-016-0010-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 08/21/2016] [Indexed: 10/20/2022]
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Marcus RK, Geurts JL, Grzybowski JA, Turaga KK, Clark Gamblin T, Strong KA, Johnston FM. Challenges to clinical utilization of hereditary cancer gene panel testing: perspectives from the front lines. Fam Cancer 2016; 14:641-9. [PMID: 26108897 DOI: 10.1007/s10689-015-9817-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Next generation sequencing (NGS) technology is rapidly being implemented into clinical practice. Qualitative research was performed to gain an improved understanding of the landscape surrounding the use of NGS in cancer genetics. A focus group was conducted at the Wisconsin Cancer Risk Programs Network biannual meeting. Free flowing discussion with occasional open-ended questions provided insights into the use of NGS. 19 genetic counselors and medical professionals participated. Three major themes were identified with respect to NGS and its use in cancer genetics: knowledge gaps, the evolving clinician role, and uncertain utility. Several corresponding subthemes were identified. With respect to knowledge gaps, participants expressed concern regarding unexpected results and variants of unknown significance, lack of data about NGS findings, absence of standardization regarding use of NGS and guidelines for interpretation, and discomfort with new technology. Regarding the evolving clinician role, necessary changes to the roles of genetic counselors and physicians were noted, as was the resultant impact on care received by patients and their families. Finally, the clinical and economic utility of NGS was questioned. While a shift from traditional Sanger sequencing to NGS is occurring in molecular genetic testing for disease susceptibility, there are several obstacles that need to be overcome before widespread adoption of this technology can occur. Furthermore, key aspects of NGS and it utility remain unexplored. Continued investigation into these subjects is necessary before this technology will consistently be of benefit to patients and their families.
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Affiliation(s)
- Rebecca K Marcus
- Division of Surgical Oncology, Department of Surgery, Froedtert and The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Jennifer L Geurts
- Division of Surgical Oncology, Department of Surgery, Froedtert and The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.,Human and Molecular Genetics Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jessica A Grzybowski
- Division of Surgical Oncology, Department of Surgery, Froedtert and The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.,Human and Molecular Genetics Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kiran K Turaga
- Division of Surgical Oncology, Department of Surgery, Froedtert and The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Froedtert and The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Kimberly A Strong
- Center for Bioethics and Medical Humanities, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Fabian M Johnston
- Division of Surgical Oncology, Department of Surgery, Froedtert and The Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
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Bunnell AE, Garby CA, Pearson EJ, Walker SA, Panos LE, Blum JL. The Clinical Utility of Next Generation Sequencing Results in a Community-Based Hereditary Cancer Risk Program. J Genet Couns 2016; 26:105-112. [PMID: 27276934 DOI: 10.1007/s10897-016-9985-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 05/31/2016] [Indexed: 01/07/2023]
Abstract
Since the 2013 Supreme Court ruling on BRCA1/BRCA2 patenting, hereditary cancer gene panels now include BRCA1 and BRCA2, making these panels an option for first-tier testing. However, questions remain about the clinical utility and implications of these panels for medical management with inclusion of genes of unknown to moderate penetrance. To better understand how use of these panels affected our practice, we reviewed patients who underwent testing in our clinic from July 1, 2013 through May 23, 2014. Indications for testing included personal and/or family history of breast and/or ovarian cancer. A total of 136 patients underwent panel testing via a single commercial laboratory; 12 (8.8 %) patients were positive for a pathogenic or likely pathogenic mutation (four BRCA2 mutations, two TP53 mutations, one CDH1 mutation, two ATM mutations, and one patient each with a CHEK2, NBN, or PALB2 mutation). Of these positive patients, 100 % met the National Comprehensive Cancer Network (NCCN) guidelines for Hereditary Breast and Ovarian Cancer genetic testing (2.2014). Mutations in seven of twelve (58 %) patients led to changes in medical management; three of seven (43 %) had a non-BRCA1 or BRCA2 gene mutation. Our findings suggest that there is clinical utility of panels that include genes of unknown to moderate penetrance.
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Affiliation(s)
- A E Bunnell
- Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, 3410 Worth St, Dallas, TX, 75248, USA
| | - C A Garby
- Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, 3410 Worth St, Dallas, TX, 75248, USA
| | - E J Pearson
- Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, 3410 Worth St, Dallas, TX, 75248, USA
| | - S A Walker
- Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, 3410 Worth St, Dallas, TX, 75248, USA
| | - L E Panos
- Ambry Genetic Laboratories, Aliso Viejo, CA, 92656, USA
| | - Joanne L Blum
- Baylor Charles A. Sammons Cancer Center, Baylor University Medical Center, 3410 Worth St, Dallas, TX, 75248, USA. .,Texas Oncology, Baylor Charles A. Sammons Cancer Center, 3410 Worth St, Dallas, TX, 75248, USA.
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Kapoor NS, Banks KC. Should multi-gene panel testing replace limited BRCA1/2 testing? A review of genetic testing for hereditary breast and ovarian cancers. World J Surg Proced 2016; 6:13-18. [DOI: 10.5412/wjsp.v6.i1.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 12/12/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
Clinical testing of patients for hereditary breast and ovarian cancer syndromes began in the mid-1990s with the identification of the BRCA1 and BRCA2 genes. Since then, mutations in dozens of other genes have been correlated to increased breast, ovarian, and other cancer risk. The following decades of data collection and patient advocacy allowed for improvements in medical, legal, social, and ethical advances in genetic testing. Technological advances have made it possible to sequence multiple genes at once in a panel to give patients a more thorough evaluation of their personal cancer risk. Panel testing increases the detection of mutations that lead to increased risk of breast, ovarian, and other cancers and can better guide individualized screening measures compared to limited BRCA testing alone. At the same time, multi-gene panel testing is more time-and cost-efficient. While the clinical application of panel testing is in its infancy, many problems arise such as lack of guidelines for management of newly identified gene mutations, high rates of variants of uncertain significance, and limited ability to screen for some cancers. Through on-going concerted efforts of pooled data collection and analysis, it is likely that the benefits of multi-gene panel testing will outweigh the risks in the near future.
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30
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Chang Y, Near AM, Butler KM, Hoeffken A, Edwards SL, Stroup AM, Kohlmann W, Gammon A, Buys SS, Schwartz MD, Peshkin BN, Kinney AY, Mandelblatt JS, Chang Y, Near AM, Butler KM, Hoeffken A, Edwards SL, Stroup AM, Kohlmann W, Gammon A, Buys SS, Schwartz MD, Peshkin BN, Kinney AY, Mandelblatt JS. Economic Evaluation Alongside a Clinical Trial of Telephone Versus In-Person Genetic Counseling for BRCA1/2 Mutations in Geographically Underserved Areas. J Oncol Pract 2016; 12:59, e1-13. [PMID: 26759468 PMCID: PMC4960460 DOI: 10.1200/jop.2015.004838] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE BRCA1/2 counseling and mutation testing is recommended for high-risk women, but geographic barriers exist, and no data on the costs and yields of diverse delivery approaches are available. METHODS We performed an economic evaluation with a randomized clinical trial comparing telephone versus in-person counseling at 14 locations (nine geographically remote). Costs included fixed overhead, variable staff, and patient time costs; research costs were excluded. Outcomes included average per-person costs for pretest counseling; mutations detected; and overall counseling, testing, and disclosure. Sensitivity analyses were performed to assess the impact of uncertainty. RESULTS In-person counseling was more costly per person counseled than was telephone counseling ($270 [range, $180 to $400] v $120 [range, $80 to $200], respectively). Counselors averaged 285 miles round-trip to deliver in-person counseling to the participants (three participants per session). There were no differences by arm in mutation detection rates (approximately 10%); therefore, telephone counseling was less costly per positive mutation detected than was in-person counseling ($37,160 [range, $36,080 to$38,920] v $40,330 [range, $38,010 to $43,870]). In-person counseling would only be less costly than telephone counseling if the most favorable assumptions were applied to in personc ounseling and the least favorable assumptions were applied to telephone counseling. CONCLUSION In geographically underserved areas, telephone counseling is less costly than in-person counseling.
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Affiliation(s)
- Yaojen Chang
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Aimee M. Near
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Karin M. Butler
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Amanda Hoeffken
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Sandra L. Edwards
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Antoinette M. Stroup
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Wendy Kohlmann
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Amanda Gammon
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Saundra S. Buys
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Marc D. Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Beth N. Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Anita Y. Kinney
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Jeanne S. Mandelblatt
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT,Corresponding author: Jeanne S. Mandelblatt, MD, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St NW, Suite 4100, Washington, DC 20007; e-mail:
| | - Yaojen Chang
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Aimee M Near
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Karin M Butler
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Amanda Hoeffken
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Sandra L Edwards
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Antoinette M Stroup
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Wendy Kohlmann
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Amanda Gammon
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Saundra S Buys
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Marc D Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Anita Y Kinney
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Jeanne S Mandelblatt
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Ahlborn LB, Steffensen AY, Jønson L, Djursby M, Nielsen FC, Gerdes AM, Hansen TVO. Identification of a breast cancer family double heterozygote for RAD51C and BRCA2 gene mutations. Fam Cancer 2015; 14:129-33. [PMID: 25154786 DOI: 10.1007/s10689-014-9747-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Next-generation sequencing has entered routine genetic testing of hereditary breast cancer. It has provided the opportunity to screen multiple genes simultaneously, and consequently has identified new complex genotypes. Here we report the first identification of a woman double heterozygote for mutations in the RAD51C and BRCA2 genes. The RAD51C missense mutation p.Arg258His has previously been identified in a homozygous state in a patient with Fanconi anemia. This mutation is known to affect the DNA repair function of the RAD51C protein. The BRCA2 p.Leu3216Leu synonymous mutation has not been described before and mini-gene splicing experiments revealed that the mutation results in skipping of exon 26 containing a part of the DNA-binding domain. We conclude that the woman has two potential disease-causing mutations and that predictive testing of family members should include both the RAD51C and BRCA2 mutation. This study illustrates the advantage of sequencing gene panels using next-generation sequencing in terms of genetic testing.
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Affiliation(s)
- Lise B Ahlborn
- Center for Genomic Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Mets S, Tryon R, Veach PM, Zierhut HA. Genetic Counselors' Experiences Regarding Communication of Reproductive Risks with Autosomal Recessive Conditions found on Cancer Panels. J Genet Couns 2015; 25:359-72. [PMID: 26454646 DOI: 10.1007/s10897-015-9892-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/21/2015] [Indexed: 12/11/2022]
Abstract
The development of hereditary cancer genetic testing panels has altered genetic counseling practice. Mutations within certain genes on cancer panels pose not only a cancer risk, but also a reproductive risk for autosomal recessive conditions such as Fanconi anemia, constitutional mismatch repair deficiency syndrome, and ataxia telangiectasia. This study aimed to determine if genetic counselors discuss reproductive risks for autosomal recessive conditions associated with genes included on cancer panels, and if so, under what circumstances these risks are discussed. An on-line survey was emailed through the NSGC list-serv. The survey assessed 189 cancer genetic counselors' experiences discussing reproductive risks with patients at risk to carry a mutation or variant of uncertain significance (VUS) in a gene associated with both an autosomal dominant cancer risk and an autosomal recessive syndrome. Over half (n = 82, 55 %) reported having discussed reproductive risks; the remainder (n = 66, 45 %) had not. Genetic counselors who reported discussing reproductive risks primarily did so when patients had a positive result and were of reproductive age. Reasons for not discussing these risks included when a patient had completed childbearing or when a VUS was identified. Most counselors discussed reproductive risk after obtaining results and not during the informed consent process. There is inconsistency as to if and when the discussion of reproductive risks is taking place. The wide variation in responses suggests a need to develop professional guidelines for when and how discussions of reproductive risk for autosomal recessive conditions identified through cancer panels should occur with patients.
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Affiliation(s)
- Sarah Mets
- Department of Genetics, Cell Biology, & Development, University of Minnesota, 321 Church Street, 6-160 Jackson Hall, Minneapolis, MN, 55455, USA
| | - Rebecca Tryon
- Fairview Health Services, Minneapolis, MN, 55455, USA
| | | | - Heather A Zierhut
- Department of Genetics, Cell Biology, & Development, University of Minnesota, 321 Church Street, 6-160 Jackson Hall, Minneapolis, MN, 55455, USA.
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Next-generation sequencing for hereditary breast and gynecologic cancer risk assessment. Curr Opin Obstet Gynecol 2015; 27:23-33. [PMID: 25502425 DOI: 10.1097/gco.0000000000000141] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW To summarize advances in next-generation sequencing and their application to breast and gynecologic cancer risk assessment. RECENT FINDINGS Next-generation sequencing panels of 6-112 cancer-associated genes are increasingly used in patient care. Studies report a 4-16% prevalence of mutations other than BRCA1/2 among patients who meet evidence-based practice guidelines for BRCA1/2 testing, with a high rate (15-88%) of uninterpretable variants of uncertain significance. Despite uncertainty about results interpretation and communication, there is early evidence of a benefit from multiple-gene sequencing panels for appropriately selected patients. SUMMARY Multiple-gene sequencing panels appear highly promising for the assessment of breast and gynecologic cancer risk, and they may usefully be administered in the context of cancer genetics expertise and/or clinical research protocols.
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Kurian AW, Ford JM. Multiple-Gene Panels and the Future of Genetic Testing. CURRENT BREAST CANCER REPORTS 2015. [DOI: 10.1007/s12609-015-0181-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hereditary ovarian cancer: not only BRCA 1 and 2 genes. BIOMED RESEARCH INTERNATIONAL 2015; 2015:341723. [PMID: 26075229 PMCID: PMC4449870 DOI: 10.1155/2015/341723] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/27/2015] [Accepted: 04/29/2015] [Indexed: 01/10/2023]
Abstract
More than one-fifth of ovarian tumors have hereditary susceptibility and, in about 65-85% of these cases, the genetic abnormality is a germline mutation in BRCA genes. Nevertheless, several other suppressor genes and oncogenes have been associated with hereditary ovarian cancers, including the mismatch repair (MMR) genes in Lynch syndrome, the tumor suppressor gene, TP53, in the Li-Fraumeni syndrome, and several other genes involved in the double-strand breaks repair system, such as CHEK2, RAD51, BRIP1, and PALB2. The study of genetic discriminators and deregulated pathways involved in hereditary ovarian syndromes is relevant for the future development of molecular diagnostic strategies and targeted therapeutic approaches. The recent development and implementation of next-generation sequencing technologies have provided the opportunity to simultaneously analyze multiple cancer susceptibility genes, reduce the delay and costs, and optimize the molecular diagnosis of hereditary tumors. Particularly, the identification of mutations in ovarian cancer susceptibility genes in healthy women may result in a more personalized cancer risk management with tailored clinical and radiological surveillance, chemopreventive approaches, and/or prophylactic surgeries. On the other hand, for ovarian cancer patients, the identification of mutations may provide potential targets for biologic agents and guide treatment decision-making.
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Patient feedback and early outcome data with a novel tiered-binned model for multiplex breast cancer susceptibility testing. Genet Med 2015; 18:25-33. [PMID: 25834950 DOI: 10.1038/gim.2015.19] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/19/2015] [Indexed: 01/18/2023] Open
Abstract
PURPOSE The risks, benefits, and utilities of multiplex panels for breast cancer susceptibility are unknown, and new counseling and informed consent models are needed. We sought to obtain patient feedback and early outcome data with a novel tiered-binned model for multiplex testing. METHODS BRCA1/2-negative and untested patients completed pre- and posttest counseling and surveys evaluating testing experiences and cognitive and affective responses to multiplex testing. RESULTS Of 73 patients, 49 (67%) completed pretest counseling. BRCA1/2-negative patients were more likely to proceed with multiplex testing (86%) than those untested for BRCA1/2 (43%; P < 0.01). Many patients declining testing reported concern for uncertainty and distress. Most patients would not change anything about their pre- (76%) or posttest (89%) counseling sessions. Thirty-three patients (72%) were classified as making an informed choice, including 81% of those who proceeded with multiplex testing. Knowledge increased significantly. Anxiety, depression, uncertainty, and cancer worry did not significantly increase with multiplex testing. CONCLUSION Some patients, particularly those without prior BRCA1/2 testing, decline multiplex testing. Most patients who proceeded with testing did not experience negative psychological responses, but larger studies are needed. The tiered-binned approach is an innovative genetic counseling and informed consent model for further study in the era of multiplex testing.Genet Med 18 1, 25-33.
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Abstract
PURPOSE OF REVIEW Breast cancer and gynecological cancers impact a significant portion of women each year. Identifying women at high risk is essential for implementation of screening and risk reduction recommendations. Risk assessment for these cancers involves an evaluation of many factors. This review discusses an overview of hereditary breast and gynecological cancers and the process of a cancer genetic risk assessment. RECENT FINDINGS Risk assessment models for breast cancer should be used with caution, especially in populations in which they are not validated. Additionally, the BRCAPRO model may underestimate the likelihood of BRCA mutations in certain populations.The utilization of next-generation sequencing panels is increasing. Benefits and limitations of panel testing are described in the literature. There are currently no guidelines for the use of panel testing; however, some reports of institutional experiences and recommendations are available. SUMMARY Cancer genetic risk assessment is complex, and models developed to estimate risk may not apply to all populations. Identifying genetic factors related to cancer risk is also becoming increasingly complex with the clinical implementation of panel testing. This testing approach should be critically evaluated by healthcare providers. Further research is needed to create evidence-based guidelines for panel testing and management recommendations for moderately penetrant genes.
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Marie Lewis K. Identifying hereditary cancer: Genetic counseling and cancer risk assessment. Curr Probl Cancer 2014; 38:216-25. [DOI: 10.1016/j.currproblcancer.2014.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bradbury AR, Patrick-Miller L, Long J, Powers J, Stopfer J, Forman A, Rybak C, Mattie K, Brandt A, Chambers R, Chung WK, Churpek J, Daly MB, Digiovanni L, Farengo-Clark D, Fetzer D, Ganschow P, Grana G, Gulden C, Hall M, Kohler L, Maxwell K, Merrill S, Montgomery S, Mueller R, Nielsen S, Olopade O, Rainey K, Seelaus C, Nathanson KL, Domchek SM. Development of a tiered and binned genetic counseling model for informed consent in the era of multiplex testing for cancer susceptibility. Genet Med 2014; 17:485-92. [PMID: 25297947 DOI: 10.1038/gim.2014.134] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/27/2014] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Multiplex genetic testing, including both moderate- and high-penetrance genes for cancer susceptibility, is associated with greater uncertainty than traditional testing, presenting challenges to informed consent and genetic counseling. We sought to develop a new model for informed consent and genetic counseling for four ongoing studies. METHODS Drawing from professional guidelines, literature, conceptual frameworks, and clinical experience, a multidisciplinary group developed a tiered-binned genetic counseling approach proposed to facilitate informed consent and improve outcomes of cancer susceptibility multiplex testing. RESULTS In this model, tier 1 "indispensable" information is presented to all patients. More specific tier 2 information is provided to support variable informational needs among diverse patient populations. Clinically relevant information is "binned" into groups to minimize information overload, support informed decision making, and facilitate adaptive responses to testing. Seven essential elements of informed consent are provided to address the unique limitations, risks, and uncertainties of multiplex testing. CONCLUSION A tiered-binned model for informed consent and genetic counseling has the potential to address the challenges of multiplex testing for cancer susceptibility and to support informed decision making and adaptive responses to testing. Future prospective studies including patient-reported outcomes are needed to inform how to best incorporate multiplex testing for cancer susceptibility into clinical practice.Genet Med 17 6, 485-492.
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Affiliation(s)
- Angela R Bradbury
- 1] Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA [2] Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA [3] Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Linda Patrick-Miller
- 1] Division of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA [2] Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, Illinois, USA
| | - Jessica Long
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacquelyn Powers
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jill Stopfer
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea Forman
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Christina Rybak
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Kristin Mattie
- Department of Hematology/Oncology, MD Anderson Cancer Center at Cooper, Camden, New Jersey, USA
| | - Amanda Brandt
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachelle Chambers
- Division of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Wendy K Chung
- 1] Department of Pediatrics, Columbia University Medical Center, New York, New York, USA [2] Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jane Churpek
- Division of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Laura Digiovanni
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dana Farengo-Clark
- Department of Hematology/Oncology, MD Anderson Cancer Center at Cooper, Camden, New Jersey, USA
| | - Dominique Fetzer
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pamela Ganschow
- Department of Internal Medicine, John H. Stroger, Jr. Hospital, Chicago, Illinois, USA
| | - Generosa Grana
- Department of Hematology/Oncology, MD Anderson Cancer Center at Cooper, Camden, New Jersey, USA
| | - Cassandra Gulden
- Division of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Michael Hall
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Lynne Kohler
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kara Maxwell
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shana Merrill
- Department of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susan Montgomery
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Rebecca Mueller
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah Nielsen
- Division of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Olufunmilayo Olopade
- 1] Division of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA [2] Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, Illinois, USA
| | - Kimberly Rainey
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Christina Seelaus
- Department of Internal Medicine, John H. Stroger, Jr. Hospital, Chicago, Illinois, USA
| | - Katherine L Nathanson
- 1] Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA [2] Department of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susan M Domchek
- 1] Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA [2] Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Angrist M, Jamal L. Living laboratory: whole-genome sequencing as a learning healthcare enterprise. Clin Genet 2014; 87:311-8. [PMID: 25045831 DOI: 10.1111/cge.12461] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 06/30/2014] [Accepted: 07/15/2014] [Indexed: 01/16/2023]
Abstract
With the proliferation of affordable large-scale human genomic data come profound and vexing questions about management of such data and their clinical uncertainty. These issues challenge the view that genomic research on human beings can (or should) be fully segregated from clinical genomics, either conceptually or practically. Here, we argue that the sharp distinction between clinical care and research is especially problematic in the context of large-scale genomic sequencing of people with suspected genetic conditions. Core goals of both enterprises (e.g. understanding genotype-phenotype relationships; generating an evidence base for genomic medicine) are more likely to be realized at a population scale if both those ordering and those undergoing sequencing for diagnostic reasons are routinely and longitudinally studied. Rather than relying on expensive and lengthy randomized clinical trials and meta-analyses, we propose leveraging nascent clinical-research hybrid frameworks into a broader, more permanent instantiation of exploratory medical sequencing. Such an investment could enlighten stakeholders about the real-life challenges posed by whole-genome sequencing, such as establishing the clinical actionability of genetic variants, returning 'off-target' results to families, developing effective service delivery models and monitoring long-term outcomes.
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Affiliation(s)
- M Angrist
- Science and Society, Social Science Research Institute and Sanford School of Public Policy, Duke University, Durham, NC, USA
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