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Park SY, Kim Y, Katapodi MC, Kim YJ, Chae H, Choi YJ, Ryu KH, Lee EG, Kong SY, Jung SY. Outcomes and effectiveness of decision aids for families affected by hereditary cancer syndromes: A scoping review. Genet Med 2025; 27:101424. [PMID: 40196937 DOI: 10.1016/j.gim.2025.101424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 03/14/2025] [Accepted: 03/26/2025] [Indexed: 04/09/2025] Open
Abstract
PURPOSE In the past 15 years, numerous decision aids (DAs) have been developed to assist families affected by hereditary cancer syndromes in decision-making for managing inheritance and cancer risk. We identified the range and characteristics of DAs, focusing on their development stage according to guideline recommendations, their outcomes, and effectiveness. METHODS A comprehensive search was conducted in MEDLINE, EMBASE, Cochrane, CINAHL, and PsycINFO, along with manual searches. Eligible articles reported DAs for supporting families affected by hereditary cancer syndromes, published in English from inception to July 2024. Quality was assessed using the Mixed-Methods Appraisal Tool. RESULTS From 15,066 records, 32 studies with a moderate risk of bias, reporting 23 unique DAs, were identified. Most DAs targeted women (69.6%) with hereditary breast and ovarian cancer syndrome (73.9%) in North America and Europe (81.3%), primarily supporting decisions on cancer risk-reduction strategies (56.5%) and genetic testing/counseling (47.8%). Only 4 DAs were consistent with guideline-recommended development process, including prototype development, alpha- and beta-testing. Development and alpha-testing outcomes included user experience, understandability, and psychological impact. Beta-testing evaluated decision-making capacity, quality of the decision-making process, psychological impact, and impact on decisions. DAs consistently improved decision-making capacity and quality of the decision-making process but showed variable effects on psychological outcomes and actual decision in risk management. CONCLUSION DAs are underdeveloped for genetic, racial, or gender minorities, according to guideline-recommended development process. Future research should develop DAs for broader populations and clarify their effectiveness, particularly regarding psychological outcomes.
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Affiliation(s)
- Sun Young Park
- College of Nursing, Daegu Catholic University, Daegu, Republic of Korea
| | - Youlim Kim
- College of Nursing, Kosin University, Pusan, Republic of Korea
| | - Maria C Katapodi
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Yeon-Joo Kim
- Department of Radiation Oncology, National Cancer Center, Goyang, Republic of Korea
| | - Heejung Chae
- Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Yoon-Jung Choi
- Department of Cancer Control and Population Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea; National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea; Center for Cancer Prevention and Detection, National Cancer Center, Goyang, Republic of Korea
| | - Kum Hei Ryu
- Department of Cancer Control and Population Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Eun-Gyeong Lee
- Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sun-Young Kong
- Department of Laboratory Medicine and Genetic Counseling Clinic, National Cancer Center, Goyang, Republic of Korea.
| | - So-Youn Jung
- Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea.
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Cheng HH, Shevach JW, Castro E, Couch FJ, Domchek SM, Eeles RA, Giri VN, Hall MJ, King MC, Lin DW, Loeb S, Morgan TM, Offit K, Pritchard CC, Schaeffer EM, Szymaniak BM, Vassy JL, Katona BW, Maxwell KN. BRCA1, BRCA2, and Associated Cancer Risks and Management for Male Patients: A Review. JAMA Oncol 2024; 10:1272-1281. [PMID: 39052257 PMCID: PMC12080741 DOI: 10.1001/jamaoncol.2024.2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Importance Half of all carriers of inherited cancer-predisposing variants in BRCA1 and BRCA2 are male, but the implications for their health are underrecognized compared to female individuals. Germline variants in BRCA1 and BRCA2 (also known as pathogenic or likely pathogenic variants, referred to here as BRCA1/2 PVs) are well known to significantly increase the risk of breast and ovarian cancers in female carriers, and knowledge of BRCA1/2 PVs informs established cancer screening and options for risk reduction. While risks to male carriers of BRCA1/2 PVs are less characterized, there is convincing evidence of increased risk for prostate cancer, pancreatic cancer, and breast cancer in males. There has also been a rapid expansion of US Food and Drug Administration-approved targeted cancer therapies, including poly ADP ribose polymerase (PARP) inhibitors, for breast, pancreatic, and prostate cancers associated with BRCA1/2 PVs. Observations This narrative review summarized the data that inform cancer risks, targeted cancer therapy options, and guidelines for early cancer detection. It also highlighted areas of emerging research and clinical trial opportunities for male BRCA1/2 PV carriers. These developments, along with the continued relevance to family cancer risk and reproductive options, have informed changes to guideline recommendations for genetic testing and strengthened the case for increased genetic testing for males. Conclusions and Relevance Despite increasing clinical actionability for male carriers of BRCA1/2 PVs, far fewer males than female individuals undergo cancer genetic testing. Oncologists, internists, and primary care clinicians should be vigilant about offering appropriate genetic testing to males. Identifying more male carriers of BRCA1/2 PVs will maximize opportunities for cancer early detection, targeted risk management, and cancer treatment for males, along with facilitating opportunities for risk reduction and prevention in their family members, thereby decreasing the burden of hereditary cancer.
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Affiliation(s)
- Heather H. Cheng
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA
- University of Washington, Department of Medicine (Hematology and Oncology), Seattle, WA
| | - Jeffrey W. Shevach
- Duke University School of Medicine, Division of Medical Oncology, Durham, NC
| | - Elena Castro
- Hospital Universitario 12 de Octubre, Department of Medical Oncology, Madrid, Spain
| | - Fergus J. Couch
- Mayo Clinic, Division of Experimental Pathology and Laboratory Medicine, Rochester, NY
| | - Susan M. Domchek
- Basser Center for BRCA and Abramson Cancer Center, University of Pennsylvania, Department of Medicine, Philadelphia, PA
| | - Rosalind A. Eeles
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London UK
| | - Veda N. Giri
- Yale School of Medicine and Yale Cancer Center, New Haven, CT
| | - Michael J. Hall
- Fox Chase Cancer Center, Department of Clinical Genetics, Philadelphia, PA
| | - Mary-Claire King
- University of Washington, Department of Medicine (Medical Genetics) and Department of Genome Sciences, Seattle, WA
| | - Daniel W. Lin
- Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA
- University of Washington, Department of Urology, Seattle, WA
| | - Stacy Loeb
- New York University School of Medicine, Department of Urology and Population Health, New York, NY
- Manhattan Veterans Affairs, Department of Surgery/Urology, New York, NY
| | - Todd M. Morgan
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, Clinical Genetics Service, New York, NY
| | - Colin C. Pritchard
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, WA
- Brotman Baty Institute for Precision Medicine, Seattle, WA
| | - Edward M. Schaeffer
- Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL
| | - Brittany M. Szymaniak
- Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL
| | - Jason L. Vassy
- Harvard Medical School at VA Boston Healthcare System, Boston, MA
| | - Bryson W. Katona
- Basser Center for BRCA and Abramson Cancer Center, University of Pennsylvania, Department of Medicine, Philadelphia, PA
| | - Kara N. Maxwell
- Basser Center for BRCA and Abramson Cancer Center, University of Pennsylvania, Department of Medicine, Philadelphia, PA
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA
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Odumegwu JN, Chavez-Yenter D, Goodman MS, Kaphingst KA. Associations between subjective social status and predictors of interest in genetic testing among women diagnosed with breast cancer at a young age. Cancer Causes Control 2024; 35:1201-1212. [PMID: 38700724 DOI: 10.1007/s10552-024-01878-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/02/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE Genetic testing for gene mutations which elevate risk for breast cancer is particularly important for women diagnosed at a young age. Differences remain in access and utilization to testing across social groups, and research on the predictors of interest in genetic testing for women diagnosed at a young age is limited. METHODS We examined the relationships between subjective social status (SSS) and variables previously identified as possible predictors of genetic testing, including genome sequencing knowledge, genetic worry, cancer worry, health consciousness, decision-making preferences, genetic self-efficacy, genetic-related beliefs, and subjective numeracy, among a cohort of women who were diagnosed with breast cancer at a young age. RESULTS In this sample (n = 1,076), those who had higher SSS had significantly higher knowledge about the limitations of genome sequencing (Odds Ratio (OR) = 1.11; 95% CI = 1.01-1.21) and significantly higher informational norms (OR = 1.93; 95% CI = 1.19-3.14) than those with lower SSS. Similarly, education (OR = 2.75; 95% CI = 1.79-4.22), health status (OR = 2.18; 95% CI = 1.44-3.31) were significant predictors among higher SSS women compared to lower SSS women in our multivariate analysis. Lower SSS women with low self-reported income (OR = 0.13; 95% CI = 0.08-0.20) had lower odds of genetic testing interest. Our results are consistent with some prior research utilizing proxy indicators for socioeconomic status, but our research adds the importance of using a multidimensional indicator such as SSS to examine cancer and genetic testing predictor outcomes. CONCLUSION To develop interventions to improve genetic knowledge, researchers should consider the social status and contexts of women diagnosed with breast cancer at a young age (or before 40 years old) to ensure equity in the distribution of genetic testing benefits.
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Affiliation(s)
- Jonathan N Odumegwu
- Department of Biostatistics, NYU School of Global Public Health, New York, NY, USA
| | - Daniel Chavez-Yenter
- Department of Communication, University of Utah, Salt Lake City, UT, USA.
- Cancer Control & Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA.
| | - Melody S Goodman
- Department of Biostatistics, NYU School of Global Public Health, New York, NY, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, USA
- Cancer Control & Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
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Lautz Z, Kautz-Freimuth S, Shukri A, Redaèlli M, Rhiem K, Schmutzler R, Stock S. Predictors of knowledge and knowledge gain after decision aid use among women with BRCA1/2 pathogenic variants. PATIENT EDUCATION AND COUNSELING 2024; 124:108248. [PMID: 38513456 DOI: 10.1016/j.pec.2024.108248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/01/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To identify factors contributing to baseline knowledge in women with BRCA1/2 pathogenic variants (PVs) and knowledge gain after decision aid (DA) use. METHODS Women with PVs in BRCA1 or BRCA2 genes were randomly assigned to an intervention group (IG) receiving DAs or a control group (CG). Of the total sample, 417 completed the baseline survey and were included in this analysis. Two multiple regression analyses were conducted: baseline data on socio-demographic, medical, decision-related and psychological variables were used to identify predictors for (1) baseline knowledge within the total group and (2) knowledge gain within the IG after DA use three months post study inclusion. RESULTS At baseline, higher education status, no breast cancer history, and lower decisional conflict related to higher knowledge within the total group. After DA use within the IG, higher baseline scores for decisional conflict predicted higher knowledge gain, and higher baseline scores for depression and intrusion predicted lower knowledge gain. CONCLUSIONS This study identified predictors of baseline knowledge and knowledge gain after DA use in women with BRCA1/2 PVs. PRACTICE IMPLICATIONS Awareness of facilitating and hindering factors on these women's knowledge can improve understanding of their health literacy and enable further targeted support interventions.
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Affiliation(s)
- Zoë Lautz
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany
| | - Sibylle Kautz-Freimuth
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany.
| | - Arim Shukri
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany
| | - Kerstin Rhiem
- Centre for Hereditary Breast and Ovarian Cancer and Centre for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50937 Cologne, Germany
| | - Rita Schmutzler
- Centre for Hereditary Breast and Ovarian Cancer and Centre for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, 50937 Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany
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Grutters LA, Christiaans I. Cascade genetic counseling and testing in hereditary syndromes: inherited cardiovascular disease as a model: a narrative review. Fam Cancer 2024; 23:155-164. [PMID: 38184510 PMCID: PMC11153290 DOI: 10.1007/s10689-023-00356-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Abstract
Inherited cardiovascular diseases cover the inherited cardiovascular disease familial hypercholesterolemia and inherited cardiac diseases, like inherited cardiomyopathies and inherited arrhythmia syndromes. Cascade genetic counseling and testing in inherited cardiovascular diseases have had three decades of academic attention. Inherited cardiovascular diseases affect around 1-2% of the population worldwide and cascade genetic counseling and testing are considered valuable since preventive measures and/or treatments are available. Cascade genetic counseling via a family-mediated approach leads to an uptake of genetic counseling and testing among at-risk relatives of around 40% one year after identification of the causal variant in the proband, with uptake remaining far from complete on the long-term. These findings align with uptake rates among relatives at-risk for other late onset medically actionable hereditary diseases, like hereditary cancer syndromes. Previous interventions to increase uptake have focused on optimizing the process of informing relatives through the proband and on contacting relatives directly. However, despite successful information dissemination to at-risk relatives, these approaches had little or no effect on uptake. The limited research into the barriers that impede at-risk relatives from seeking counseling has revealed knowledge, attitudinal, social and practical barriers but it remains unknown how these factors contribute to the decision-making process for seeking counseling in at-risk relatives. A significant effect on uptake of genetic testing has only been reached in the setting of familial hypercholesterolemia, where active information provision was accompanied by a reduction of health-system-related barriers. We propose that more research is needed on barriers -including health-system-related barriers- and how they hinder counseling and testing in at-risk relatives, so that uptake can be optimized by (adjusted) interventions.
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Affiliation(s)
- Laura A Grutters
- Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, 9700 RB, The Netherlands
| | - Imke Christiaans
- Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, 9700 RB, The Netherlands.
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Park SY, Kim Y, Katapodi MC, Kim YJ, Chae H, Choi YJ, Ryu KH, Lee EG, Kong SY, Jung SY. Healthcare Professionals' Learning Needs and Perspectives on Essential Information in Genetic Cancer Care: A Systematic Review. Cancers (Basel) 2024; 16:1963. [PMID: 38893084 PMCID: PMC11171145 DOI: 10.3390/cancers16111963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The increased demand for genetic testing and counseling necessitates healthcare professionals (HCPs) to improve their genetic competency through training programs. This systematic review identified HCPs' learning needs and their perspectives on essential information for families with hereditary cancer. METHODS This review covered studies published from 2013 to 2024 across five databases. Data were analyzed using a content analysis. RESULTS Thirteen studies involving 332 HCPs were analyzed. Most studies focused on the learning needs of physicians caring for families affected by Hereditary Breast and Ovarian Cancer in North America and Europe. HCPs required training emphasizing practical counseling skills over the basics of genetics. Learning needs varied by profession: physicians needed training in assessing cancer risk and supporting decision-making in risk management; nurses required information on resources and the genetic care system; genetic counselors sought guidance on family communication and planning. Essential information identified for families included risk-reducing strategies, personalized cancer risk assessment, family implications, psychological issues, (cascade) genetic testing, and social concerns. CONCLUSIONS The findings have implications for the development of training programs for HCPs, emphasizing the need for tailored training based on professions. Future research should explore the needs of HCPs caring for families with diverse hereditary cancers and cultural backgrounds.
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Affiliation(s)
- Sun-Young Park
- College of Nursing, Daegu Catholic University, Daegu 42472, Republic of Korea;
| | - Youlim Kim
- College of Nursing, Kosin University, Busan 49104, Republic of Korea;
| | - Maria C. Katapodi
- Department of Clinical Research, University of Basel, 4055 Basel, Switzerland;
| | - Yeon-Joo Kim
- Department of Radiation Oncology, National Cancer Center, Goyang 10408, Republic of Korea;
| | - Heejung Chae
- Center for Breast Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (H.C.); (E.-G.L.)
| | - Yoon-Jung Choi
- Department of Cancer Control & Population Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Republic of Korea; (Y.-J.C.); (K.H.R.)
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea
- Center for Cancer Prevention & Detection, National Cancer Center, Goyang 10408, Republic of Korea
| | - Kum Hei Ryu
- Department of Cancer Control & Population Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Republic of Korea; (Y.-J.C.); (K.H.R.)
| | - Eun-Gyeong Lee
- Center for Breast Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (H.C.); (E.-G.L.)
| | - Sun-Young Kong
- Department of Laboratory Medicine & Genetic Counseling Clinic, National Cancer Center, Goyang 10408, Republic of Korea
| | - So-Youn Jung
- Center for Breast Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (H.C.); (E.-G.L.)
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Hesse-Biber S, Seven M, Shea H, Dwyer AA. Intersectionality, BRCA Genetic Testing, and Intrafamilial Communication of Risk: A Qualitative Study. Cancers (Basel) 2024; 16:1766. [PMID: 38730719 PMCID: PMC11083191 DOI: 10.3390/cancers16091766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Significant health disparities exist in relation to pathogenic variants in BRCA1/2. This study aimed to better understand the barriers and facilitators to BRCA1/2 genetic testing and intrafamilial communication of risk in racially and ethnically diverse individuals. We conducted qualitative interviews with non-Hispanic White (n = 11) and Black, Indigenous, People of Color (BIPOC) individuals (n = 14) who underwent testing for pathogenic BRCA1/2 variants. We employed template analysis, case study analysis, and comparative case study analysis to examine healthcare experiences related to genetic testing as well as intrafamilial communication of risk. Applying an intersectional lens, we sought to inform more person-centered approaches to precision healthcare and help dismantle disparities in genomic healthcare. Template analysis revealed salient factors at the individual (psychosocial well-being), interpersonal/familial, and healthcare system levels. A two-part case study analysis provided insights into how race/ethnicity, cultural norms, and socioeconomic status interact with systemic and structural inequities to compound disparities. These findings underscore the need for person-centered, tailored, and culturally sensitive approaches to understanding and addressing the complexities surrounding testing and the communication of BRCA risk. Applying an intersectional lens can inform more person-centered approaches to precision healthcare and may help to surmount existing disparities.
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Affiliation(s)
- Sharlene Hesse-Biber
- Department of Sociology, Boston College, Chestnut Hill, MA 02467, USA; (S.H.-B.); (H.S.)
| | - Memnun Seven
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Hannah Shea
- Department of Sociology, Boston College, Chestnut Hill, MA 02467, USA; (S.H.-B.); (H.S.)
| | - Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 02467, USA;
- P50 Massachusetts General Hospital, Harvard Center for Reproductive Medicine, Boston, MA 02114, USA
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8
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Bedrosian I, Somerfield MR, Achatz MI, Boughey JC, Curigliano G, Friedman S, Kohlmann WK, Kurian AW, Laronga C, Lynce F, Norquist BS, Plichta JK, Rodriguez P, Shah PD, Tischkowitz M, Wood M, Yadav S, Yao K, Robson ME. Germline Testing in Patients With Breast Cancer: ASCO-Society of Surgical Oncology Guideline. J Clin Oncol 2024; 42:584-604. [PMID: 38175972 DOI: 10.1200/jco.23.02225] [Citation(s) in RCA: 63] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE To develop recommendations for germline mutation testing for patients with breast cancer. METHODS An ASCO-Society of Surgical Oncology (SSO) panel convened to develop recommendations based on a systematic review and formal consensus process. RESULTS Forty-seven articles met eligibility criteria for the germline mutation testing recommendations; 18 for the genetic counseling recommendations. RECOMMENDATIONS BRCA1/2 mutation testing should be offered to all newly diagnosed patients with breast cancer ≤65 years and select patients >65 years based on personal history, family history, ancestry, or eligibility for poly(ADP-ribose) polymerase (PARP) inhibitor therapy. All patients with recurrent breast cancer who are candidates for PARP inhibitor therapy should be offered BRCA1/2 testing, regardless of family history. BRCA1/2 testing should be offered to women who develop a second primary cancer in the ipsilateral or contralateral breast. For patients with prior history of breast cancer and without active disease, testing should be offered to patients diagnosed ≤65 years and selectively in patients diagnosed after 65 years, if it will inform personal and family risk. Testing for high-penetrance cancer susceptibility genes beyond BRCA1/2 should be offered to those with supportive family histories; testing for moderate-penetrance genes may be offered if necessary to inform personal and family cancer risk. Patients should be provided enough pretest information for informed consent; those with pathogenic variants should receive individualized post-test counseling. Variants of uncertain significance should not impact management, and patients with such variants should be followed for reclassification. Referral to providers experienced in clinical cancer genetics may help facilitate patient selection and interpretation of expanded testing, and provide counseling of individuals without pathogenic germline variants but with significant family history.Additional information is available at www.asco.org/breast-cancer-guidelines.
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Affiliation(s)
| | | | | | | | - Giuseppe Curigliano
- University of Milan, Italy
- European Institute of Oncology, IRCCS, Milano, Italy
| | - Sue Friedman
- FORCE (Facing Our Risk of Cancer Empowered), Tampa, FL
| | - Wendy K Kohlmann
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | | | | | | | | | | | - Patricia Rodriguez
- Hereditary Cancer Risk Assessment Program, Virginia Cancer Specialists, Arlington, VA
| | - Payal D Shah
- Basser Center for BRCA & Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | | | | | - Katherine Yao
- Division of Surgical Oncology at NorthShore University Health System, Evanston, IL
| | - Mark E Robson
- Memorial Sloan Kettering Cancer Center, New York, NY
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Baroutsou V, Duong V, Signorini A, Saccilotto R, Ciorba FM, Bürki N, Caiata-Zufferey M, Ryu JM, Kim SW, Lim MC, Monnerat C, Zürrer-Härdi U, Kim J, Heinimann K, Graffeo R, Park JS, Rabaglio M, Chappuis PO, Kim S, Katapodi MC, on behalf of the CASCADE and K-CASCADE Consortia. Acceptability and Usability of the Family Gene Toolkit for Swiss and Korean Families Harboring BRCA1/BRAC2 Pathogenic Variants: A Web-Based Platform for Cascade Genetic Testing. Cancers (Basel) 2023; 15:4485. [PMID: 37760455 PMCID: PMC10527353 DOI: 10.3390/cancers15184485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
The study adapted the Family Gene Toolkit and developed a customized web application for Swiss and Korean families harboring BRCA1 or BRCA2 pathogenic variants to support family communication of genetic testing results and promote cascade genetic testing among at-risk relatives. In the first step, narrative data from 68 women with BRCA1/BRCA2 pathogenic variants and clinician feedback informed a culturally sensitive adaptation of the content consistent with current risk management guidelines. In the second step, the Information Technology team developed the functions and the interface of the web application that will host the intervention. In the third step, a new sample of 18 women from families harboring BRCA1/BRCA2 pathogenic variants tested the acceptability and usability of the intervention using "think-aloud" interviews and a questionnaire. Participants expressed high levels of satisfaction with the intervention. They provided positive feedback for the information regarding active coping, strategies to enhance family communication, interactive elements, and illustrative stories. They reported that the information was useful and the web application was easy to navigate. Findings suggest that the Family Gene Toolkit is well-designed and can increase rates of cascade testing among at-risk relatives. Its efficacy will be tested in a subsequent randomized trial.
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Affiliation(s)
- Vasiliki Baroutsou
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland; (V.B.); (V.D.); (A.S.); (R.S.)
| | - Vu Duong
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland; (V.B.); (V.D.); (A.S.); (R.S.)
| | - Alice Signorini
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland; (V.B.); (V.D.); (A.S.); (R.S.)
| | - Ramon Saccilotto
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland; (V.B.); (V.D.); (A.S.); (R.S.)
| | - Florina M. Ciorba
- Department of Mathematics and Computer Science, University of Basel, 4051 Basel, Switzerland;
| | - Nicole Bürki
- Women’s Clinic, University Hospital Basel, 4031 Basel, Switzerland;
| | - Maria Caiata-Zufferey
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland;
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Sung-Won Kim
- Department of Breast Surgery, Breast Care Center, Dairim St Mary’s Hospital, Seoul 07442, Republic of Korea;
| | - Myong Cheol Lim
- Division of Tumor Immunology, Center for Gynecologic Cancer Research Institute and Hospital, National Cancer Center, Goyang 10408, Republic of Korea;
| | - Christian Monnerat
- Department of Medical Oncology, Hospital of Jura, 2800 Delemont, Switzerland;
| | - Ursina Zürrer-Härdi
- Department of Medical Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
| | - Jisun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Karl Heinimann
- Institute for Medical Genetics and Pathology, University Hospital Basel, 4031 Basel, Switzerland;
- Research Group Human Genomics, Department of Biomedicine, University of Basel, 4031 Basel, Switzerland
| | - Rossella Graffeo
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland;
| | - Ji Soo Park
- Hereditary Cancer Clinic, Cancer Prevention Center, Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03772, Republic of Korea;
| | - Manuela Rabaglio
- Department of Medical Oncology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland;
| | - Pierre Olivier Chappuis
- Unit of Oncogenetics, Division of Precision Oncology, University Hospitals of Geneva, 1205 Geneva, Switzerland;
- Division of Genetic Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Sue Kim
- College of Nursing, Yonsei University, Seoul 03722, Republic of Korea;
| | - Maria C. Katapodi
- Department of Clinical Research, Faculty of Medicine, University of Basel, 4055 Basel, Switzerland; (V.B.); (V.D.); (A.S.); (R.S.)
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Takahashi M. Cancer survivorship care: challenges and opportunities in Japan. Jpn J Clin Oncol 2023; 53:757-763. [PMID: 37279595 DOI: 10.1093/jjco/hyad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023] Open
Abstract
This article discusses the current international scope and practices of cancer survivorship care and the challenges and opportunities of survivorship care in Japan. Cancer is a common illness in Japan; however, the national cancer control plan focuses only on limited survivorship-related issues, and there is no official national-level survivorship care strategy that addresses the diverse unmet needs of survivors. There is an urgent need to discuss and implement measures for quality survivorship care delivery under the current healthcare system in Japan. The Development of Survivorship Care Coordination Model Research Group, 2022, organized under the National Cancer Center Japan research grant from 2019 to 2022, identified four tasks that are required to realize quality survivorship care: (i) providing education opportunities for survivorship care stakeholders to raise awareness about the concept and the necessity of cancer survivorship care, (ii) providing training opportunities and cancer survivorship care certification for community healthcare providers, (iii) enforcing the economic basis of survivorship care and (iv) creating simpler systems that are organically linked with existing care systems. Collaboration among multiple players is indispensable to developing the philosophy of survivorship care and efficient care delivery. For this purpose, we need a platform where diverse players can participate equally towards the same goal: cancer survivors' optimal wellness.
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Affiliation(s)
- Miyako Takahashi
- Japan Cancer Survivorship Network, Iwate Medical University, The Jikei University School of Medicine, Tokyo, Japan
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