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Transvaginal laparoscopic salpingo-oophorectomy: an oncological risk-reducing procedure. Future Sci OA 2020; 6:FSO429. [PMID: 31915530 PMCID: PMC6920739 DOI: 10.2144/fsoa-2019-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Since the first natural orifice transluminal endoscopic surgery procedure, renewed interest has arisen in further developing and advancing minimal access surgery. We introduce a natural orifice endoscopic approach for a bilateral salpingo-oophorectomy. Patients & methods: Using the vagina as a natural orifice, we performed a transvaginal laparoscopic salpingo-oophorectomy to remove bilateral adnexa in patients with a strong family history of ovarian and/or breast cancer and those positive for BRCA1/2 mutation. Results: Total 36 women underwent transvaginal laparoscopic salpingo-oophorectomy. Conversion to routine laparoscopy was required in eight patients to complete the operation. No peri-operative complications were noted. Conclusion: We describe a novel approach in gynecological surgery. Our technique proved to be safe and efficient with the advantage of avoiding any abdominal scars. This article describes a novel, keyhole surgical approach to remove tubes and ovaries in a female patient. The approach is known as a ‘natural orifice endoscopic approach’ and involves using the vagina as a natural orifice. Both tubes and ovaries were removed in patients with a strong family history of ovarian and/or breast cancer and those positive for BRCA1/2 genetic mutation. Two ports are inserted into the vagina to access the abdomen with both specimens subsequently retrieved vaginally. Total 36 women underwent the procedure with no complications. The technique proved to be safe and efficient with the advantage of avoiding any abdominal scars compared with routine keyhole surgery.
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Marino MA, Gucalp A, Leithner D, Keating D, Avendano D, Bernard-Davila B, Morris EA, Pinker K, Jochelson MS. Mammographic screening in male patients at high risk for breast cancer: is it worth it? Breast Cancer Res Treat 2019; 177:705-711. [PMID: 31280425 PMCID: PMC6745275 DOI: 10.1007/s10549-019-05338-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the utility of mammography for breast cancer screening in a population of males at increased risk for breast cancer. METHODS In this HIPAA-compliant institutional review board-approved single-institution study, mammography records and clinical data of 827 male patients who underwent digital mammography from September 2011-July 2018 were analyzed via the electronic medical record. 664 of these men presented with masses, pain, or nipple discharge and were excluded from this study. The remaining 163 asymptomatic men with familial and/or personal history of breast cancer, or with a known germline mutation in BRCA, underwent screening mammography and were included in this analysis. RESULTS 163 asymptomatic men (age: mean 63 years, range 24-87 years) underwent 806 screening mammograms. 125/163 (77%) had a personal history of breast cancer and 72/163 (44%) had a family history of breast cancer. 24/163 (15%) were known mutation carriers: 4/24 (17%) BRCA1 and 20/24 (83%) BRCA2. 792/806 (98%) of the screening mammograms were negative (BI-RADS 1 or 2); 10/806 (1.2%) were classified as BI-RADS 3, all of which were eventually downgraded to BI-RADS 2 on follow-up. 4/806 (0.4%) mammograms were abnormal (BI-RADS 4/5): all were malignant. The cancer detection rate in this cohort was 4.9 cancers/1000 examinations. CONCLUSIONS In our cohort, screening mammography yielded a cancer detection rate of 4.9 cancers/1000 examinations which is like the detection rate of screening mammography in a population of women at average risk, indicating that screening mammography is of value in male patients at high risk for breast cancer.
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Affiliation(s)
- Maria Adele Marino
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Ayca Gucalp
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Doris Leithner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Delia Keating
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Daly Avendano
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
- Department Breast Imaging, Breast Cancer Center TecSalud, ITESM Monterrey, Monterrey, Nuevo Leon, Mexico
| | - Blanca Bernard-Davila
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
- Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA.
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Baildam AD. Current knowledge of risk reducing mastectomy: Indications, techniques, results, benefits, harms. Breast 2019; 46:48-51. [PMID: 31082761 DOI: 10.1016/j.breast.2019.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/28/2019] [Indexed: 12/18/2022] Open
Abstract
The last twenty years have seen a complete change in society's attitude to the strategy of risk reduction of breast cancer in high-risk individuals by means of proactive mastectomy. Once termed 'prophylactic mastectomy', risk reducing mastectomy (RRM) was considered two decades ago not only extreme, but in some quarters almost unethical. RRM is now commonly undertaken in specialist breast units for women at high individual breast cancer risk, by virtue of an inherited breast cancer related gene mutation or from calculated high statistical risk from family history data, and the efficacy of RRM in reducing subsequent incident diagnoses of breast cancer has been published from a number of centres. RRM is offered routinely in conjunction with total breast reconstruction, using the whole range of reconstructive surgical techniques. The public announcement by the actor Angelina Jolie in 2013 that she had inherited and harboured a BRCA1 gene mutation, and was undergoing RRM and breast reconstruction to lower her intrinsic breast cancer risk, had a significant effect on public attitudes and perception. Whilst there are other means of lowering breast cancer risk by means of selective oestrogen receptor modulators, such as tamoxifen and raloxifene, their lowering effect on risk of breast cancer remains substantially less than that afforded by surgical removal of 'at risk' breast tissue. The progressive development and increasing sophistication of techniques of breast reconstructive surgery has paralleled the trend for more RRM surgery, and the substantial majority of women who opt for RRM choose immediate breast reconstruction.
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Affiliation(s)
- Andrew D Baildam
- Consultant Oncoplastic Breast Surgeon, King Edward VII's Hospital London, UK.
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Lewis RS, George A, Rusby JE. Nipple-sparing mastectomy in women at high risk of developing breast cancer. Gland Surg 2018; 7:325-336. [PMID: 29998082 DOI: 10.21037/gs.2018.04.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nipple-sparing mastectomy is a valuable addition to the options available for women at high risk of developing breast cancer. In this review, we summarize current knowledge about the high-risk genes, BRCA1, BRCA2 and TP53 and the associated guidelines with regard to risk-reducing surgery. We consider other genetic risks and high-risk lesions. We discuss the literature on bilateral mastectomy for breast cancer risk-reduction, and the results of nipple-sparing mastectomy in particular. Finally, we report on patient satisfaction with these procedures and the impact that nipple-sparing mastectomy may have on women at high-risk of breast cancer.
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Affiliation(s)
- Rebecca S Lewis
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust and the Institute for Cancer Research, Sutton, UK
| | - Angela George
- Department of Cancer Genetics, Institute for Cancer Research and the Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | - Jennifer E Rusby
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust and the Institute for Cancer Research, Sutton, UK
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Mourits MJ, de Bock GH. European/U.S. Comparison and Contrasts in Ovarian Cancer Screening and Prevention in a High-Risk Population. Am Soc Clin Oncol Educ Book 2017; 37:124-127. [PMID: 28561729 DOI: 10.1200/edbk_180330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The history of screening and prevention of ovarian cancer among high-risk women in the United States and Europe is one of mutual inspiration, with researchers learning from each others' findings and insights and collaborating with investigators from both sides of the Atlantic ocean. Examples of simultaneous and joint development of knowledge and scientific points of view include the paradigm shift from ovarian to fallopian tube high-grade serous cancer and the cessation of simultaneous adoption of ovarian cancer screening by clinicians in both the United States and Europe. Examples of joint efforts with fruitful results include international collaboration in large population-based, genome-wide association studies and in epidemiologic database studies. Research in the field of hereditary ovarian cancer is a great example of mutual inspiration and joint efforts for the purpose of improving knowledge and health care for women with hereditary ovarian cancer.
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Affiliation(s)
- Marian J Mourits
- From the Departments of Gynecologic Oncology and Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - G H de Bock
- From the Departments of Gynecologic Oncology and Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Makris GM, Marinelis A, Battista MJ, Chrelias C, Papantoniou N. An ovarian mass after breast cancer: Metachronous carcinoma or metastasis? A case report. Int J Surg Case Rep 2016; 31:106-108. [PMID: 28129608 PMCID: PMC5266487 DOI: 10.1016/j.ijscr.2016.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 12/28/2016] [Indexed: 01/02/2023] Open
Abstract
In the presence of an ovarian mass after breast cancer, differentiating between primary and secondary lesions can be a difficult task. This case report presents a 45-year-old patient with an ovarian mass two years after the diagnosis of breast cancer. Imaging, histology and predominantly immunohistochemistry may provide valuable tools in the assessment of ambiguous cases. Differences in the immunohistochemical profile of primary tumor and metastases should be anticipated.
Introduction Differentiating between primary and secondary ovarian cancer can be a difficult task. In hereditary conditions breast malignancies and primary ovarian cancer often coexist. Presentation of case We present a 45-year-old patient with an ovarian mass two years after the diagnosis of a lobular, triple negative breast carcinoma. There was concern whether the lesion represented a metachronous ovarian cancer or a metastasis of the lobular carcinoma. The final histological examination showed a metastatic lesion, deriving from the lobular breast carcinoma, as evidenced by the immunohistochemical profile; nevertheless, there were changes in hormonal receptor expression in the metastatic lesion compared to the primary, triple negative tumor. The patient underwent genetic testing for BRCA1 and BRCA2 mutations and was negative. In the adjuvant setting the patient received 6 cycles of chemotherapy with carboplatin and paclitaxel; eighteen months later, the patient remains without disease recurrence. Discussion and conclusion This case report highlights the role of imaging, histology and predominantly immunohistochemistry as valuable tools in the assessment of ambiguous ovarian lesions after breast cancer.
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Affiliation(s)
- Georgios-Marios Makris
- Department of Obstetrics and Gynecology, Athens Euroclinic Hospital, Athens Greece; Gynecological Oncology Unit, Third Department of Obstetrics and Gynecology, General University Hospital "Attikon", University of Athens, Athens, Greece.
| | - Alexandros Marinelis
- Department of Obstetrics and Gynecology, Athens Euroclinic Hospital, Athens Greece
| | | | - Charalampos Chrelias
- Gynecological Oncology Unit, Third Department of Obstetrics and Gynecology, General University Hospital "Attikon", University of Athens, Athens, Greece
| | - Nikolaos Papantoniou
- Gynecological Oncology Unit, Third Department of Obstetrics and Gynecology, General University Hospital "Attikon", University of Athens, Athens, Greece
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Tiller K, Meiser B, Gaff C, Kirk J, Dudding T, Phillips KA, Friedlander M, Tucker K. A Randomized Controlled Trial of a Decision Aid for Women at Increased Risk of Ovarian Cancer. Med Decis Making 2016; 26:360-72. [PMID: 16855125 DOI: 10.1177/0272989x06290486] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To carry out a randomized controlled trial of a decision aid for women at increased risk of developing ovarian cancer to facilitate decision making regarding risk management options. Methods. This randomized trial, conducted through 6 familial cancer centers, compared the efficacy of tailored decision aid to that of a general educational pamphlet in preparing women for decision making. Participants. 131 women with a family history of breast and/or ovarian cancer or of hereditary nonpolyposis colorectal cancer. Outcome measures. Decisional conflict, knowledge about ovarian cancer risk management options, and psychological adjustment were reassessed at 3 time points. Results. Compared to those who received the pamphlet (control), women who received the decision aid (intervention) were significantly more likely to report a high degree of acceptability of the educational material at both follow-up assessment time points. Findings indicate neither group experienced significant increases in psychological distress at either follow-up assessment time points relative to baseline. Two weeks postintervention, the intervention group demonstrated a significant decrease in decisional conflict compared to the control group (t = 2.4, P < 0.025) and a trend for a greater increase in knowledge about risk management options (t = 2.1, P = 0.037). No significant differences were found 6 months postintervention. Conclusion. This form of educational material is successful in increasing knowledge about risk management options and in reducing decisional conflict in the shorter term. The decision aid is an effective and acceptable strategy for patient education to facilitate an inclusive and informed decision-making process about managing ovarian cancer risk.
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Affiliation(s)
- K Tiller
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia.
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Bonfanti M, Gambino ML, Pisani S, Carnevali I, Pinotti G, Croce D, Capella C, Sessa F, Tibiletti MG. A cost analysis of inherited colorectal cancer care in Varese Province. J Cancer Policy 2016. [DOI: 10.1016/j.jcpo.2016.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yao L, Sun J, Zhang J, He Y, Ouyang T, Li J, Wang T, Fan Z, Fan T, Lin B, Xie Y. Breast cancer risk in Chinese women with BRCA1 or BRCA2 mutations. Breast Cancer Res Treat 2016; 156:441-445. [DOI: 10.1007/s10549-016-3766-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/21/2016] [Indexed: 12/19/2022]
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Chiarelli AM, Prummel MV, Muradali D, Majpruz V, Horgan M, Carroll JC, Eisen A, Meschino WS, Shumak RS, Warner E, Rabeneck L. Effectiveness of Screening With Annual Magnetic Resonance Imaging and Mammography: Results of the Initial Screen From the Ontario High Risk Breast Screening Program. J Clin Oncol 2014; 32:2224-30. [DOI: 10.1200/jco.2013.52.8331] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The Ontario Breast Screening Program expanded in July 2011 to screen women age 30 to 69 years at high risk for breast cancer with annual magnetic resonance imaging (MRI) and digital mammography. To the best of our knowledge, this is the first organized screening program for women at high risk for breast cancer. Patients and Methods Performance measures after assessment were compared with screening results for 2,207 women with initial screening examinations. The following criteria were used to determine eligibility: known mutation in BRCA1, BRCA2, or other gene predisposing to a markedly increased risk of breast cancer, untested first-degree relative of a gene mutation carrier, family history consistent with hereditary breast cancer syndrome and estimated personal lifetime breast cancer risk ≥ 25%, or radiation therapy to the chest (before age 30 years and at least 8 years previously). Results The recall rate was significantly higher among women who had abnormal MRI alone (15.1%; 95% CI, 13.8% to 16.4%) compared with mammogram alone (6.4%; 95% CI, 5.5% to 7.3%). Of the 35 breast cancers detected (16.3 per 1,000; 95% CI, 11.2 to 22.2), none were detected by mammogram alone, 23 (65.7%) were detected by MRI alone (10.7 per 1,000; 95% CI, 6.7 to 15.8), and 25 (71%) were detected among women who were known gene mutation carriers (30.8 per 1,000, 95% CI, 19.4 to 43.7). The positive predictive value was highest for detection based on mammogram and MRI (12.4%; 95% CI, 7.3% to 19.3%). Conclusion Screening with annual MRI combined with mammography has the potential to be effectively implemented into an organized breast screening program for women at high risk for breast cancer. This could be considered an important management option for known BRCA gene mutation carriers.
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Affiliation(s)
- Anna M. Chiarelli
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Maegan V. Prummel
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Derek Muradali
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Vicky Majpruz
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Meaghan Horgan
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - June C. Carroll
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Andrea Eisen
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Wendy S. Meschino
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Rene S. Shumak
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Ellen Warner
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
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Kumar NB, Vadaparampil ST, Mahajan N, Lilienfeld HS, Lee JH, Laronga C, Hakam A, Hein JJ, Egan KM, Arun B, Pal T. Metformin- A Promising Agent for Chemoprevention in BRCA1 Carriers. ACTA ACUST UNITED AC 2012; 1. [PMID: 26097796 PMCID: PMC4474476 DOI: 10.4172/2161-1041.1000104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nagi B Kumar
- Departments of Cancer Epidemiology The University of Texas MD Anderson Cancer Center, Houston, Texas ; Oncological Sciences University of South Florida College of Medicine, Tampa Florida
| | - Susan T Vadaparampil
- Health Outcomes and Behavior, The University of Texas MD Anderson Cancer Center, Houston, Texas ; Oncological Sciences University of South Florida College of Medicine, Tampa Florida
| | - Nupam Mahajan
- Molecular Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas ; Oncological Sciences University of South Florida College of Medicine, Tampa Florida
| | - Howard S Lilienfeld
- Breast Cancer, The University of Texas MD Anderson Cancer Center, Houston, Texas ; Oncological Sciences University of South Florida College of Medicine, Tampa Florida
| | - Ji-Hyun Lee
- Departments of Cancer Epidemiology The University of Texas MD Anderson Cancer Center, Houston, Texas ; Breast Cancer, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christine Laronga
- Breast Cancer, The University of Texas MD Anderson Cancer Center, Houston, Texas ; Oncological Sciences University of South Florida College of Medicine, Tampa Florida
| | - Ardeshir Hakam
- Pathology, at the H. Lee Moffitt Cancer Center & Research Institute ; Oncological Sciences University of South Florida College of Medicine, Tampa Florida
| | - John J Hein
- Departments of Cancer Epidemiology The University of Texas MD Anderson Cancer Center, Houston, Texas ; Oncological Sciences University of South Florida College of Medicine, Tampa Florida
| | - Kathleen M Egan
- Departments of Cancer Epidemiology The University of Texas MD Anderson Cancer Center, Houston, Texas ; Oncological Sciences University of South Florida College of Medicine, Tampa Florida
| | - Banu Arun
- Breast Medical Oncology and Clinical Cancer Prevention, and Co-Director of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tuya Pal
- Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas ; Oncological Sciences University of South Florida College of Medicine, Tampa Florida
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Chéreau E, Uzan C, Balleyguier C, Chevalier J, de Paillerets BB, Caron O, Rimareix F, Mathieu MC, Koskas M, Bourgier C, André F, Dromain C, Delaloge S. Characteristics, Treatment, and Outcome of Breast Cancers Diagnosed in BRCA1 and BRCA2 Gene Mutation Carriers in Intensive Screening Programs Including Magnetic Resonance Imaging. Clin Breast Cancer 2010; 10:113-8. [DOI: 10.3816/cbc.2010.n.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Hodgson S. Advances in cancer genetics. Clin Med (Lond) 2009; 9:151-3. [PMID: 19435122 PMCID: PMC4952668 DOI: 10.7861/clinmedicine.9-2-151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gidoni Y, Holzer H, Tulandi T, Tan SL. Fertility preservation in patients with non-oncological conditions. Reprod Biomed Online 2008; 16:792-800. [PMID: 18549688 DOI: 10.1016/s1472-6483(10)60144-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In addition to cancers, many non-oncological conditions, including chromosomal abnormalities and autoimmune disorders, are currently treated with gonadotoxic agents that can lead to premature ovarian failure. Because of the young age of some of the women affected by these conditions, attempts to preserve fertility and ovarian function are recommended. To date, retrieval of immature oocytes followed by in-vitro maturation and vitrification has been found to be especially useful for women who cannot undergo ovarian stimulation, or when there is a contraindication.
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Affiliation(s)
- Yariv Gidoni
- Department of Obstetrics and Gynecology, McGill University, 687 Pine Avenue West, Montreal, H3A 1A1, Quebec, Canada
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Bermejo-Pérez MJ, Márquez-Calderón S, Llanos-Méndez A. Cancer surveillance based on imaging techniques in carriers of BRCA1/2 gene mutations: a systematic review. Br J Radiol 2008; 81:172-9. [PMID: 18208856 DOI: 10.1259/bjr/21074350] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We have systematically reviewed the literature focusing on the performance of surveillance programmes and imaging techniques for the early diagnosis of breast and ovarian cancer in women carrying mutations in BRCA1/2 genes. A search for relevant articles published between 1996 and 2005 (inclusive) was run on Medline, Embase and other databases. Of the 749 articles retrieved, only 13 met the inclusion criteria. Of these, 12 provided information on breast cancer surveillance, 1 on ovarian cancer surveillance and a further study addressed both cancer types. A critical appraisal of the studies was performed using a tool for the quality assessment of diagnostic accuracy studies (QUADAS). The synthesis of results is qualitative. All studies on imaging techniques for the diagnosis of breast cancer indicated that screening MRI had the highest sensitivity (between 77% and 100%). Breast cancer surveillance programmes, including MRI, achieved the highest diagnostic performance (between 83% and 95%) for all women. However, it must be taken into account that biases that may affect the validity of the outcomes were seen in the evaluated studies. Also, MRI is an expensive test with a low positive predictive value and, to date, MRI screening has not been proven to reduce mortality rates in women carrying BRCA1/2 gene mutations. As a result of the scant information and low quality of the papers reviewed, no definitive conclusion could be drawn on the performance of ovarian cancer surveillance in women carrying BRCA1/2 mutations.
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Condello C, Gesuita R, Pensabene M, Spagnoletti I, Capuano I, Baldi C, Carle F, Contegiacomo A. Distress and Family Functioning in Oncogenetic Counselling for Hereditary and Familial Breast and/or Ovarian Cancers. J Genet Couns 2007; 16:625-34. [PMID: 17701329 DOI: 10.1007/s10897-007-9102-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 03/28/2007] [Indexed: 12/20/2022]
Abstract
We conducted a psychological assessment during oncogenetic counseling for hereditary breast/ovarian cancer. Anxiety and depression were assessed with the HAD scale, and family functioning and satisfaction with FACES III. HAD was administered at baseline (t(1)), at risk communication (t(2)), at genetic test result communication, or at first surveillance in not tested subjects (t(3)); FACES III was administered at baseline only. We analysed a total of 185 questionnaires administered to the 37 subjects studied. Although not pathological, distress was significantly higher at t(2) and t(3) (p = 0.027 and p = 0.039, respectively). Health and marital status were significantly associated with distress. In a disease-free condition, anxiety was higher (p = 0.027) at t(2), and for single status, depression increased from t(1) to t(2) (p = 0.026). Families were perceived to be well functioning, and subjects were satisfied with their families. The data collected in this analysis could help to improve the quality of oncogenetic counselling in clinical practice.
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Affiliation(s)
- C Condello
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
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Hermsen BBJ, Verheijen RHM, Menko FH, Gille JJP, van Uffelen K, Blankenstein MA, Meijer S, van Diest PJ, Kenemans P, von Mensdorff-Pouilly S. Humoral immune responses to MUC1 in women with a BRCA1 or BRCA2 mutation. Eur J Cancer 2007; 43:1556-63. [PMID: 17532207 DOI: 10.1016/j.ejca.2007.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 03/06/2007] [Accepted: 04/02/2007] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Breast cancer patients with early disease and a natural humoral response to MUC1 have a favourable prognosis, suggesting a possible role of MUC1 antibodies (ab) in controlling haematogenous tumour dissemination and outgrowth. The aim of the study was to evaluate humoral immune responses to MUC1 in women at hereditary high risk of breast cancer to investigate whether this immune response could play a role in the prevention of disease. MATERIALS AND METHODS CA15.3 (U/mL), and IgG and IgM ab to MUC1 (arbitrary units per mL, Arb-U/mL) were measured in serum samples obtained from 422 women at hereditary high risk of breast/ovarian cancer, of whom 127 BRCA1/2 carriers, attending the Familial Cancer Clinic of the VU University Medical Centre, and from 370 age-matched healthy controls. Serum samples obtained from women who developed breast cancer (N=12) or breast cancer recurrence (N=17), and from women who underwent prophylactic mastectomy (N=12) and had no breast lesions were also tested. RESULTS CA15.3 ranked significantly higher in mutation carriers than in controls (P=0.03). MUC1 IgG ab levels ranked significantly lower in BRCA1/2 mutation carriers than in controls (P=0.003). MUC1 IgG levels were not significantly different (P=0.53) between women who developed primary breast cancer (median 0.72Arb-U/ml, range 0.52-2.44Arb-U/ml) and women who underwent prophylactic mastectomy and had no breast lesions (median 1.04Arb-U/ml, range 0.43-2.88Arb-U/ml). CONCLUSION Serum levels of natural IgG ab to MUC1 are lower in BRCA1/2 mutation carriers than in healthy controls. Furthermore, in contrast to previous results in women with sporadic breast cancer, no elevated MUC1 IgG ab were seen in women at hereditary high risk who developed breast cancer. Prophylactic immunotherapy with MUC1 substrates may be a strategy to reduce the risk of breast cancer in BRCA1/2 mutation carriers, strengthening tumour immune surveillance.
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Affiliation(s)
- B B J Hermsen
- Department of Obstetrics and Gynaecology, VU University Medical Centre, De Boelenlaan 1117, 1081 HV Amsterdam, The Netherlands.
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Laki F, Kirova YM, This P, Plancher C, Asselain B, Sastre X, Stoppa-Lyonnet D, Salmon R. Prophylactic salpingo-oophorectomy in a series of 89 women carrying aBRCA1 or aBRCA2 mutation. Cancer 2007; 109:1784-90. [PMID: 17351952 DOI: 10.1002/cncr.22603] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Prophylactic salpingo-oophorectomy (SO), which is recommended in BRCA1/2 mutation carriers, still needs to be reappraised. METHODS In all, 89 BRCA1/BRCA2 mutation carriers underwent SO between 1994-2004. Past medical and familial history, SO, results and survival after SO were analyzed. RESULTS The series consisted of 56 BRCA1 and 33 BRCA2 mutation carriers. All but 1 had a family history of breast (BC) and/or ovarian cancer; 42 BRCA1 and 31 BRCA2 had a personal history of BC. The median age at SO was 44 (BRCA1) and 49.5 (BRCA2) years for women without previous BC (not significant) and 48 (BRCA1) and 53 BRCA2) years (P=.03) for women with previous BC. Occult ovarian (n=2) and/or fallopian (n=3) carcinomas were found in 4 patients (4.5%): 1 experienced recurrence (4 years), 2 are disease-free (26 and 38 months of follow-up), and 1 died from BC (12 months). Among the other 69 patients with previous BC (median follow-up, 42 months), 14 developed ipsilateral or contralateral BC and 8 developed metastatic disease. Among the 16 patients without previous BC (median follow-up, 27 months), 3 developed BC. Of the 89 patients, 85 are still alive: 3 died from BC and 1 died from pancreatic cancer. No peritoneal malignancy was observed. CONCLUSIONS This study shows that prophylactic SO remains an important option for BRCA1/2 mutation carriers as asymptomatic ovarian/fallopian cancers were found in 4.5% of patients. However, a longer follow-up and larger series are required to more precisely evaluate the benefits of this procedure in terms of BC incidence, peritoneal malignancy, or recurrence.
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Affiliation(s)
- Fatima Laki
- Department of Surgery, Institut Curie, Paris, France.
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Baildam AD. Best surgical prophylaxis - risk-reducing mastectomy for women at high personal risk of breast cancer. Breast 2006; 15 Suppl 2:S21-5. [PMID: 17382857 DOI: 10.1016/s0960-9776(07)70013-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Andrew D Baildam
- Department of Breast Surgery, Withington Hospital, South Manchester University Hospitals Trust, Manchester UK
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Pistorius S, Kruger S, Hohl R, Plaschke J, Distler W, Saeger HD, Schackert HK. Occult endometrial cancer and decision making for prophylactic hysterectomy in hereditary nonpolyposis colorectal cancer patients. Gynecol Oncol 2006; 102:189-94. [PMID: 16476474 DOI: 10.1016/j.ygyno.2005.12.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2005] [Revised: 12/16/2005] [Accepted: 12/19/2005] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVE Hereditary nonpolyposis colorectal cancer (HNPCC) is the most frequent form of hereditary colorectal cancer. In addition to the high lifetime risk for colorectal cancer in mutation carriers, there is also a remarkably increased risk for endometrial cancer (EC). METHODS In this retrospective study, clinical and molecular approach to the individual decision making as to whether or not to perform a prophylactic hysterectomy in a subset of HNPCC patients is discussed. 147 female patients meeting at least one criterion of the Bethesda guidelines were included in this analysis between 1995 and 2003. After clinical and genetic counseling, patients gave informed written consent and microsatellite analysis, immunohistochemistry and sequencing of the mismatch repair genes MLH1, MSH2 and MSH6 was performed. RESULTS 11 of the analyzed patients had a personal history of EC and had undergone previous hysterectomy at ages 26 to 62 years. Prophylactic hysterectomy with oophorectomy was considered in postmenopausal women meeting the Amsterdam criteria and/or carrying a disease causing mismatch repair gene mutation who were operated on because of diagnosed colorectal cancer in our center for hereditary cancer. This procedure was performed in 4 patients. None of them had shown any symptoms of a gynecologic malignancy. Preoperative gynecological examination showed no evidence for EC or ovarian cancer in these patients. Postoperative histological examination showed EC stage T1b N0 M0 in 2 patients. CONCLUSIONS Since the efficiency of gynecological surveillance is uncertain, prophylactic hysterectomy could be an option for a subset of HNPCC patients and mutation carriers.
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Affiliation(s)
- Steffen Pistorius
- Department of Visceral, Thoracic and Vascular Surgery, University of Technology Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
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Kuhl CK. MR Imaging for Surveillance of Women at High Familial Risk for Breast Cancer. Magn Reson Imaging Clin N Am 2006; 14:391-402, vii. [PMID: 17098180 DOI: 10.1016/j.mric.2006.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The adequate management of individuals who carry a high lifetime risk for breast cancer is still an unsettled issue. This holds especially true for subjects with documented or suspected germline mutation of a breast cancer susceptibility gene. These women face a lifetime risk for breast cancer of up to 80%, which is, of course, significant. Still, this means that approximately one fifth of women never develop the disease. The perceived mutilating effects of preventive mastectomy make the decision for surgical prevention difficult for most women. Secondary prevention aims at identifying familial breast cancer at the earliest possible stage. During recent years, considerable evidence has been accumulated that breast MR imaging is substantially more sensitive than mammography and breast ultrasound regarding the identification of familial breast cancer. It should be considered an integral part of a surveillance program for women at increased familial risk for breast cancer, be it with or without documented mutation of a breast cancer susceptibility gene.
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Affiliation(s)
- Christiane K Kuhl
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany.
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Gaarenstroom KN, van der Hiel B, Tollenaar RAEM, Vink GR, Jansen FW, van Asperen CJ, Kenter GG. Efficacy of screening women at high risk of hereditary ovarian cancer: results of an 11-year cohort study. Int J Gynecol Cancer 2006; 16 Suppl 1:54-9. [PMID: 16515568 DOI: 10.1111/j.1525-1438.2006.00480.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The outcome of screening and prophylactic surgery in 269 women at high risk of hereditary ovarian cancer is reported. Screening was performed using transvaginal ultrasound and serum CA125 testing. Mean follow-up was 26 months (583 person-years). A total of 113 (42%) of 269 women had a pathogenic BRCA1 or BRCA2 mutation, and 127 (47%) of 269 women underwent salpingo-oophorectomy. No occult cancers were found. In eight women having both elevated CA125 levels and abnormal ultrasound findings, a malignancy was found. Four of these cancers (one borderline, one stage Ia, one stage IIIb, and one stage IIIc ovarian or peritoneal cancer) were detected at the first screening visit. One stage IIIb and one stage IIIc cancer were detected at the second screening visit after 12 months, and two interval stage IIIc and IV cancers were detected 8 and 10 months after the first screening visit. No peritoneal carcinoma was found among those 114 women who underwent bilateral salpingo-oophorectomy with normal or benign pathology results, after a mean follow-up of 16 months (152 person-years). We conclude that the efficacy of screening women at high risk of ovarian cancer seems poor because the majority of cancers were detected at an advanced stage.
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Affiliation(s)
- K N Gaarenstroom
- Department of Gynecology, , Leiden University Medical Center, Leiden, The Netherlands
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Jacobi CE, Nagelkerke NJD, van Houwelingen JHC, de Bock GH. Breast cancer screening, outside the population-screening program, of women from breast cancer families without proven BRCA1/BRCA2 mutations: a simulation study. Cancer Epidemiol Biomarkers Prev 2006; 15:429-36. [PMID: 16537697 DOI: 10.1158/1055-9965.epi-05-0223] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE We assessed the cost-effectiveness of mammography screening for women under the age of 50, from breast cancer families without proven BRCA1/BRCA2 mutations, because current criteria for screening healthy women from breast cancer families are not evidence-based. METHODS We did simulation studies with mathematical models on the cost-effectiveness of mammography screening of women under the age of 50 with breast cancer family histories. Breast cancer screening was simulated with varying screening intervals (6, 12, 18, and 24 months) and screening cohorts (starting at ages 30, 35, 40, and 45, and continuing to age 50). Incremental costs of screening were compared with those of women ages 50 to 52 years, the youngest age group currently routinely screened in the nationwide screening program of the Netherlands, to determine cost-effectiveness. Sensitivity analyses were done to explore the effects of model assumptions. The cost-effectiveness of breast cancer screening for women over the age of 50 was not debated. RESULTS The most effective screening interval was found to be 12 months, which, however, seems only to be cost-effective in a small group of women under the age of 50 with at least two affected relatives, including at least one affected in the first degree diagnosed under the age of 50. Significantly, early breast cancer screening never seemed to be cost-effective in women with only one affected first-degree or second-degree relative. CONCLUSION Annual breast cancer screening with mammography for women under the age of 50 seems to be cost-effective in women with strong family histories of breast cancer, even when no BRCA1/BRCA2 mutation was found in affected family members.
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Affiliation(s)
- Catharina E Jacobi
- Department of Medical Decision Making (J10-S), Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
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Kriege M, Brekelmans CTM, Boetes C, Muller SH, Zonderland HM, Obdeijn IM, Manoliu RA, Kok T, Rutgers EJT, de Koning HJ, Klijn JGM. Differences between first and subsequent rounds of the MRISC breast cancer screening program for women with a familial or genetic predisposition. Cancer 2006; 106:2318-26. [PMID: 16615112 DOI: 10.1002/cncr.21863] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Within the Dutch MRI Screening (MRISC) study, a Dutch multicenter screening study for hereditary breast cancer, the authors investigated whether previously reported increased diagnostic accuracy of magnetic resonance imaging (MRI) compared with mammography would be maintained during subsequent screening rounds. METHODS From November 1999 to October 2003, 1909 eligible women were included in the study. Screening parameters and tumor characteristics of different rounds were calculated and compared. The authors defined 3 different types of imaging screening rounds: first round in women never screened by imaging before, first round in women screened by imaging (mainly mammography) before, and subsequent rounds. RESULTS The difference in sensitivity for invasive cancers between mammography and MRI was largest in the first round of women previously screened with mammography (20.0 vs. 93.3%; P=.003), but also in subsequent rounds, there was a significant difference in favor of MRI (29.4 vs. 76.5%; P=.02). The difference in false-positive rate between mammography and MRI was also largest in the first round of women previously screened with mammography (5.5 vs. 14.0%; P<.001), and it remained significant in subsequent rounds (4.6 vs. 8.2%; P<.001). Screen-detected tumors were smaller and more often lymph node negative than symptomatic tumors in age-matched control patients, but no major differences in tumor stage were found between tumors detected at subsequent rounds compared with those in the first round. CONCLUSIONS In subsequent rounds, a significantly higher sensitivity and better discriminating capacity of MRI compared with mammography was maintained, and a favorable tumor stage compared with age-matched symptomatic controls. As results of these subsequent screening rounds were most predictive for long-term effects, the authors expect that this screening program will contribute to a decrease of breast cancer mortality in these high-risk women.
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Affiliation(s)
- Mieke Kriege
- The Rotterdam Family Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, Netherlands
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Kriege M, Brekelmans CTM, Obdeijn IM, Boetes C, Zonderland HM, Muller SH, Kok T, Manoliu RA, Besnard APE, Tilanus-Linthorst MMA, Seynaeve C, Bartels CCM, Kaas R, Meijer S, Oosterwijk JC, Hoogerbrugge N, Tollenaar RAEM, Rutgers EJT, de Koning HJ, Klijn JGM. Factors Affecting Sensitivity and Specificity of Screening Mammography and MRI in Women with an Inherited Risk for Breast Cancer. Breast Cancer Res Treat 2006; 100:109-19. [PMID: 16791481 DOI: 10.1007/s10549-006-9230-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 03/11/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The MRISC study is a screening study, in which women with an increased risk of hereditary breast cancer are screened by a yearly mammography and MRI, and half-yearly clinical breast examination. The sensitivity found in this study was 40% for mammography and 71% for MRI and the specificity was 95 and 90%, respectively. In the current subsequent study we investigated whether these results are influenced by age, a BRCA1/2 mutation, menopausal status and breast density. PATIENTS AND METHODS From November 1999 to October 2003, 1909 eligible women were screened and 50 breast cancers were detected. For the current analysis, data of 4134 screening rounds and 45 detected breast cancers were used. For both imaging modalities, screening parameters, receiver operating characteristic (ROC) curves and uni- and multivariate odds ratios (ORs) were calculated. All analyses were separately performed for age at entry (< 40, 40-49, > or =50), mutation status, menopausal status and breast density. RESULTS Sensitivity of MRI was decreased in women with high breast density (adjusted OR 0.08). False-positive rates of both mammography (OR(adj) 1.67) and MRI (OR(adj) 1.21) were increased by high breast density, that of MRI by pre-menopausal status (OR(adj) 1.70), young age (OR(adj) 1.58 for women 40-49 years versus women > or =50 years) and decreased in BRCA1/2 mutation carriers (OR(adj) 0.74). In all investigated subgroups the discriminating capacity (measured by the area under the ROC-curve) was higher for MRI than for mammography, with the largest differences for BRCA1/2 mutation carriers (0.237), for women between 40 and 49 years (0.227) and for women with a low breast density (0.237). CONCLUSIONS This report supports the earlier recommendation that MRI should be a standard screening method for breast cancer in BRCA1/2 mutation carriers.
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Affiliation(s)
- Mieke Kriege
- Family Cancer Clinic, Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA Rotterdam, the Netherlands
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Avard D, Bridge P, Bucci LM, Chiquette J, Dorval M, Durocher F, Easton D, Godard B, Goldgar D, Knoppers BM, Laframboise R, Lespérance B, Plante M, Tavtigian SV, Vézina H, Wilson B, Simard J. Partnering in oncogenetic research--the INHERIT BRCAs experience: opportunities and challenges. Fam Cancer 2006; 5:3-13. [PMID: 16528603 DOI: 10.1007/s10689-005-2570-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Today it is common to conduct research in collaboration with colleagues from different disciplines and institutions. The INterdisciplinary HEalth Research International Team on BReast CAncer susceptibility (INHERIT BRCAs), involves Canadian and international experts from diverse fields working with health service providers, patients and collaborators from the World Health Organization and other European networks. Evidence-based information and knowledge transfer drive our efforts to advance genomic research to understand the genetic basis of cancer susceptibility and treatment response. Several goals reveal the interdisciplinary team approach: (a) to estimate the prevalence and penetrance of BRCA1 and BRCA2 mutations and their deleterious impact upon different populations; (b) to pinpoint novel breast cancer susceptibility loci; (c) to assess the efficacy of clinical interventions; (d) to address changes in quality of life and health-related behaviour from the decision to undergo genetics testing and during follow-up; (e) to evaluate legal, social and ethical implications; and, finally; (f) to promote professional and public education by facilitating the transfer of research findings to clinical practice and informing policy makers. The lessons learned by the INHERIT research team and future challenges are presented.
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Affiliation(s)
- Denise Avard
- Centre de Recherche en Droit Public, Faculty of Law, University of Montreal, Montreal, Canada.
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Oei AL, Massuger LF, Bulten J, Ligtenberg MJ, Hoogerbrugge N, de Hullu JA. Surveillance of women at high risk for hereditary ovarian cancer is inefficient. Br J Cancer 2006; 94:814-9. [PMID: 16495917 PMCID: PMC2361371 DOI: 10.1038/sj.bjc.6603015] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
To determine the effectiveness of annual gynaecological screening (pelvic examination, transvaginal ultrasound, and CA-125), a prospective cohort study of women at high risk for hereditary ovarian cancer was conducted. Women were offered DNA analysis followed by either annual screening or prophylactic bilateral salpingo-oophorectomy (BSO). Study population consisted of 512 high-risk women (median follow-up 2.07 years, range 0–9.4 years): 265 women (52%) had a BRCA mutation. Persisting abnormalities indicated diagnostic surgery in 24 women resulting in one primary ovarian cancer FIGO stage IIIc was found. The effectiveness of screening was studied by calculating the probability of finding ovarian cancers in the BRCA-1 and BRCA-2 carrier group and comparing this to the identified number of ovarian cancers. The number of ovarian cancer patients found at surveillance was in accordance with the predicted number of ovarian cancers. A total number of 169 women underwent prophylactic BSO: one ovarian cancer stage IIb was found. In conclusion, the surveillance programme for hereditary ovarian cancer does identify patients with ovarian cancer but is very inefficient considering the high number of surveillance visits and the advanced stage of ovarian cancer in the identified patient. For prevention of advanced stage ovarian cancer, prophylactic BSO from age 35–40 years is a more efficient alternative.
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Affiliation(s)
- A L Oei
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Kuhl CK, Schrading S, Leutner CC, Morakkabati-Spitz N, Wardelmann E, Fimmers R, Kuhn W, Schild HH. Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol 2005; 23:8469-76. [PMID: 16293877 DOI: 10.1200/jco.2004.00.4960] [Citation(s) in RCA: 730] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To compare the effectiveness of mammography, breast ultrasound, and magnetic resonance imaging (MRI) for surveillance of women at increased familial risk for breast cancer (lifetime risk of 20% or more). PATIENTS AND METHODS We conducted a surveillance cohort study of 529 asymptomatic women who, based on their family history and/or mutational analysis, were suspected or proven to carry a breast cancer susceptibility gene (BRCA). A total of 1,542 annual surveillance rounds were completed with a mean follow-up of 5.3 years. Diagnostic accuracies of the three imaging modalities used alone or in different combinations were compared. RESULTS Forty-three breast cancers were identified in the total cohort (34 invasive, nine ductal carcinoma-in-situ). Overall sensitivity of diagnostic imaging was 93% (40 of 43 breast cancers); overall node-positive rate was 16%, and one interval cancer occurred (one of 43 cancers, or 2%). In the analysis by modality, sensitivity was low for mammography (33%) and ultrasound (40%) or the combination of both (49%). MRI offered a significantly higher sensitivity (91%). The sensitivity of mammography in the higher risk groups was 25%, compared with 100% for MRI. Specificity of MRI (97.2%) was equivalent to that of mammography (96.8%). CONCLUSION Mammography alone, and also mammography combined with breast ultrasound, seems insufficient for early diagnosis of breast cancer in women who are at increased familial risk with or without documented BRCA mutation. If MRI is used for surveillance, diagnosis of intraductal and invasive familial or hereditary cancer is achieved with a significantly higher sensitivity and at a more favorable stage.
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Kuhl CK, Kuhn W, Schild H. Management of women at high risk for breast cancer: New imaging beyond mammography. Breast 2005; 14:480-6. [PMID: 16185869 DOI: 10.1016/j.breast.2005.08.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The management of women with an increased lifetime risk of breast cancer is a difficult task. This is especially true for women with a documented mutation in a breast cancer susceptibility gene (BRCA), and also for those who tested negative for a mutation, but have a family history that is suggestive of familial breast cancer. Primary prevention by prophylactic mastectomy has been shown to reduce breast cancer incidence in these women, but this intervention is still not considered a "first-line" option in the majority of guidelines. Instead, secondary prevention (intensified surveillance) is recommended. However, due to the early onset of familial breast cancer, screening must start at a substantially younger age than in women at average risk. This, together with the fact that familial breast cancers may differ from sporadic cancers in many aspects, will have a significant impact on the design and on the success rates of surveillance protocols. This article describes the different management options that exist for women at increased genetic risk and provides a survey of the current evidence regarding mammographic and non-mammographic imaging techniques. The conclusion is that mammographic screening, with or without concomitant ultrasound and clinical breast examination, is probably not sufficient to ensure an early diagnosis of familial breast cancer. If MRI is integrated in surveillance programs, early diagnosis seems to be possible. Still, the efficacy of screening even with MRI is unclear in terms of morbidity and mortality, and this lack of evidence must be communicated to women at high genetic risk.
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Affiliation(s)
- C K Kuhl
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
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van Dooren S, Seynaeve C, Rijnsburger AJ, Duivenvoorden HJ, Essink-Bot ML, Tilanus-Linthorst MMA, Klijn JGM, de Koning HJ, Tibben A. Exploring the course of psychological distress around two successive control visits in women at hereditary risk of breast cancer. Eur J Cancer 2005; 41:1416-25. [PMID: 15913982 DOI: 10.1016/j.ejca.2005.03.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Revised: 02/17/2005] [Accepted: 03/11/2005] [Indexed: 10/25/2022]
Abstract
In this article we determined the course of psychological distress during a breast cancer surveillance program in women at increased risk of developing hereditary breast cancer (BC). The sample comprised of 357 unaffected women (mean age 40.5 years) adhering to a surveillance programme (MRISC-study). Before and after two successive biannual surveillance appointments, the Impact of Event Scale (BC-specific distress) and the Hospital Anxiety and Depression Scale (general distress) were administered, totalling four measurement moments. In general, psychological distress remained within normal limits and decreased significantly after a surveillance appointment, except for breast cancer specific distress after the second appointment. Scheduled imaging examinations were not significantly related to distress. The course of BC specific distress differed significantly for risk over-estimators and for young (<40 years) excessive breast self examiners. The course of general distress differed significantly for women closely involved in a sister's BC-process. These more vulnerable subgroups may be in need of extra counselling and care.
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Affiliation(s)
- Silvia van Dooren
- Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands.
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van Dijk S, Otten W, Timmermans DRM, van Asperen CJ, Meijers-Heijboer H, Tibben A, Breuning MH, Kievit J. What’s the message? Interpretation of an uninformative BRCA1/2 test result for women at risk of familial breast cancer. Genet Med 2005; 7:239-45. [PMID: 15834241 DOI: 10.1097/01.gim.0000159902.34833.26] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To test the "false-reassurance hypothesis," which suggests that women who receive an uninformative BRCA1/2 test result may incorrectly conclude that they no longer have an elevated risk, with possible harmful consequences for adherence to breast surveillance guidelines. METHODS A prospective questionnaire design was used to compare 183 women with an uninformative BRCA test result (94 affected and 89 unaffected) with 41 proven BRCA mutation-carriers and 49 true negatives before and after BRCA1/2 test disclosure. RESULTS After DNA-test disclosure, test applicants differed from each other with regard to their perception of the likelihood of carrying a deleterious gene (P < 0.0001). The BRCA mutation carriers reported the highest perceived likelihood and the true negatives reported the lowest. Compared to the predisclosure measures, women who received an uninformative DNA test result reported a lower perceived risk after disclosure (P < 0.0001), suggesting a relatively high level of reassurance because of the test result. However, after DNA-test disclosure, only 12 women concluded that the risk of carrying a mutation was nonexistent, and perceived likelihood was significantly associated with the pedigree-based risk assessment (P = 0.0001). Moreover, despite the significant decrease in perceived likelihood for uninformative women, intention to obtain mammograms did not change (P = 0.71); it remained at the same almost optimal level as for BRCA mutation carriers. CONCLUSION No support was found for the suggestion that the nature of uninformative test results is often misunderstood. Moreover, an uninformative test result did not affect the positive mammography intentions of both affected and unaffected women.
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Affiliation(s)
- Sandra van Dijk
- Department of Medical Decision-making, Leiden University Medical Center, Leiden, The Netherlands
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van Dijk S, van Asperen CJ, Jacobi CE, Vink GR, Tibben A, Breuning MH, Otten W. Variants of uncertain clinical significance as a result of BRCA1/2 testing: impact of an ambiguous breast cancer risk message. ACTA ACUST UNITED AC 2005; 8:235-9. [PMID: 15727245 DOI: 10.1089/gte.2004.8.235] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The identification of an increasing number of variants of uncertain clinical significance (VUCS) in genetic testing for hereditary breast cancer poses serious problems for genetic counseling, because no data are available about the psychosocial impact of discussing such an unclear risk message. The current study is the first to present data on how test applicants actually understand and cope with such a result if communicated by a geneticist. We compared 10 women who received a VUCS result with 34 women who carried the deleterious mutation, 37 women who did not carry the deleterious mutation or 'true negatives,' and 160 women who received a so-called inconclusive result before and after test disclosure. Women, with whom a VUCS result was discussed, reported quite a high level of comprehension of the result. In addition, compared with the pretest measures, they did not report a higher level of perceived risk (p = 0.58) and even reported a decrease in breast cancer distress (p = 0.03). They were very comparable to women who received an inconclusive result on all post-disclosure measures. Our results suggest that discussing a VUCS result in genetic counseling does not give rise for concern.
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Affiliation(s)
- Sandra van Dijk
- Department of Medical Decision-Making, Leiden University Medical Center, Leiden, The Netherlands.
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35
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Vasen HFA, Tesfay E, Boonstra H, Mourits MJE, Rutgers E, Verheyen R, Oosterwijk J, Beex L. Early detection of breast and ovarian cancer in families with BRCA mutations. Eur J Cancer 2005; 41:549-54. [PMID: 15737559 DOI: 10.1016/j.ejca.2004.10.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Accepted: 10/26/2004] [Indexed: 11/22/2022]
Abstract
Women at risk of breast and ovarian cancer due to a genetic predisposition may opt for preventive surgery or surveillance. The aim of this study was to determine the effectiveness of surveillance in families with a BRCA mutation. Sixty-eight BRCA-families underwent surveillance using annual mammography, transvaginal ultrasound, and estimation of CA125. Two hundred and two women had at least one breast examination, and 138 at least one examination of the ovaries. After a mean follow-up of 33 months, breast cancer was detected in 21 women, four with lymph node metastases. After a mean follow-up of 37 months, six advanced ovarian cancers were detected. The percentage of metastatic breast cancers in the current study appeared to be acceptable. However, because these women have a high-risk of developing breast cancer, they still have a substantial risk of developing metastatic disease under surveillance. Surveillance for ovarian cancer was not effective.
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Affiliation(s)
- H F A Vasen
- Department of Clinical Oncology, Leiden University Medical Center, The Netherlands.
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36
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Arver B, Haegermark A, Platten U, Lindblom A, Brandberg Y. Evaluation of psychosocial effects of pre-symptomatic testing for breast/ovarian and colon cancer pre-disposing genes: a 12-month follow-up. Fam Cancer 2004; 3:109-16. [PMID: 15340261 DOI: 10.1023/b:fame.0000039863.89137.f9] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A prospective study of psychosocial consequences following predictive testing for inherited mutations in breast/ovarian and colon cancer susceptibility genes BRCA1, BRCA2, MLH1, and MSH2 was performed. Eighty-seven healthy women were tested for known family mutations and self-assessment scales were used to evaluate anxiety, depression and quality of life. Extensive pre- and post-test information was given. Questionnaires were responded before testing and four times after during the following year. A statistically significant decrease in anxiety mean scores over time was observed among the studied participants. The levels of depression in cancer genes carriers decreased over time while, surprisingly the levels in non-carriers increased. Compared to a normative Swedish sample all women tested showed similar levels of anxiety but women tested for breast cancer genes showed statistically lower levels of depression. Vitality dropped initially after disclosure of the testing of colon cancer genes carriers, followed by increasing levels. No change in vitality or in other quality of life parameters was seen in the other groups and the levels were similar to Swedish norm data. Most tested individuals were satisfied with the testing procedure including genetic counselling and testing and all of them but one would redo the testing. Healthy self-referred women going through predictive breast/ovarian or colon cancer gene testing, including extensive pre- and post-test information and support, in general, will not experience adverse psychological consequences.
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Affiliation(s)
- Brita Arver
- Department of Molecular Medicine, Clinical Genetic Unit, Karolinska University Hospital, Stockholm, Sweden.
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37
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Contegiacomo A, Pensabene M, Capuano I, Tauchmanova L, Federico M, Turchetti D, Cortesi L, Marchetti P, Ricevuto E, Cianci G, Venuta S, Barbieri V, Silingardi V. An oncologist-based model of cancer genetic counselling for hereditary breast and ovarian cancer. Ann Oncol 2004; 15:726-32. [PMID: 15111339 DOI: 10.1093/annonc/mdh183] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We describe a multistep model of cancer genetic counselling designed to promote awareness, and disease surveillance and preventive measures for hereditary and familial breast and ovarian cancer. PATIENTS AND METHODS Step T0 of the model entails information giving; this is followed by pedigree analysis and risk estimation (T1), risk communication and genetic testing (T2), and genetic test result communication (T3). User consent was required to proceed from one step to the next. Surveillance and preventive measures are proposed to at-risk users. Of the 311 subjects who requested cancer genetic counselling, consent data to each counselling step were available for 295: 93 were disease-free, 187 had breast cancer, 12 had ovarian cancer and three had breast plus ovarian cancer. RESULTS Consent was high at T0 (98.39%), T1 (96.40%) and T2 (99.65%). Consent decreased at the crucial points of counselling: T2 (87.71%) and T3 [genetic test result communication (85.08%), and extension of counselling to and testing of relatives (65.36%)]. CONCLUSIONS The model fosters the user's knowledge about cancer and favours identification of at-risk subjects. Furthermore, by promoting awareness about genetic testing and surveillance measures, the algorithm enables users to make a fully informed choice of action in case of predisposing or familial cancer risk.
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Affiliation(s)
- A Contegiacomo
- Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy.
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Robson M. Breast Cancer Surveillance in Women with Hereditary Risk Due to BRCA1 or BRCA2 Mutations. Clin Breast Cancer 2004; 5:260-8; discussion 269-71. [PMID: 15507170 DOI: 10.3816/cbc.2004.n.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Women with germline mutations in BRCA1 or BRCA2 are known to be at substantially elevated risk for breast cancer. With increasing acceptance of genetic testing, significant numbers of mutation carriers are being identified, but evidence-based guidelines for the management of women at hereditary risk are lacking. This article reviews the most commonly recommended modalities employed in breast cancer surveillance for women at increased risk. It is apparent that the standard techniques of breast self-examination, clinical breast examination, and mammography are suboptimal for the identification of hereditary breast cancer. At least half of the cancers in this population appear to be detected by physical examination in the intervals between routine radiographic surveillance. Host factors (eg, breast density) and tumor features (rapid proliferative rates) likely contribute to the relative insensitivity of mammography. These factors may be mitigated by the deployment of screening techniques for breast cancer such as ultrasound and magnetic resonance imaging. However, the effect of incremental screening on either stage at diagnosis or breast cancer mortality has not been defined. In addition, the impact of the relatively limited specificity of these techniques on the quality of life (QOL) of women at risk has not been studied. Further research is needed to evaluate the effect of incremental radiographic screening on outcomes, to delineate the best way to integrate the different modalities in terms of sequencing and frequency, and to identify interventions that will minimize the impact of intensive surveillance programs on the QOL of the women engaged in them.
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Affiliation(s)
- Mark Robson
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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40
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Rijnsburger AJ, Essink-Bot ML, van Dooren S, Borsboom GJJM, Seynaeve C, Bartels CCM, Klijn JGM, Tibben A, de Koning HJ. Impact of screening for breast cancer in high-risk women on health-related quality of life. Br J Cancer 2004; 91:69-76. [PMID: 15199386 PMCID: PMC2364757 DOI: 10.1038/sj.bjc.6601912] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The effectiveness of intensive surveillance in women at high risk for breast cancer due to a familial or genetic predisposition is uncertain and is currently being evaluated in a Dutch magnetic resonance imaging (MRI) screening (MRISC) study, in which annual imaging consists of mammography and MRI. Unfavourable side effects on health-related quality of life may arise from this screening process. We examined the short-term effects of screening for breast cancer in high-risk women on generic health-related quality of life and distress. A total of 519 participants in the MRISC study were asked to complete generic health-status questionnaires (SF-36, EQ-5D) as well as additional questionnaires for distress and items relating to breast cancer screening, at three different time points around screening. The study population showed significantly better generic health-related quality of life scores compared to age-/sex-adjusted reference scores from the general population. Neither generic health-related quality of life scores nor distress scores among the study sample (n=334) showed significant changes over time. The impact of the screening process on generic health status did not differ between risk categories. Relatively more women reported mammography as quite to very painful (30.1%) compared to MRI. Anxiety was experienced by 37% of the women undergoing MRI. We conclude that screening for breast cancer in high-risk women does not have an unfavourable impact on short-term generic health-related quality of life and general distress. In this study, high-risk women who opted for regular breast cancer screening had a better health status than women from the general population.
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Affiliation(s)
- A J Rijnsburger
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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Tinley ST, Houfek J, Watson P, Wenzel L, Clark MB, Coughlin S, Lynch HT. Screening adherence in BRCA1/2 families is associated with primary physicians' behavior. ACTA ACUST UNITED AC 2004; 125A:5-11. [PMID: 14755459 DOI: 10.1002/ajmg.a.20431] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This study provides an assessment of long-term breast and ovarian cancer screening behaviors and the variables associated with adherence with screening among women with or at 50% for having a BRCA1/2 mutation. Participants in the study included 112 women (33 mutation carriers and 79 at 50% risk). Data was collected through a mailed questionnaire, which included items to assess screening behaviors in the last 2 years, risk perception, cancer specific distress, adherence determinants, specific barriers, and cancer history. Statistical analysis included descriptive statistics and non-parametric tests to describe bivariate associations and regression analysis. Adherence rates were 72% for annual mammography, 21% for semi-annual clinical breast exam (CBE), 29% for monthly breast self-exam (BSE), and 19% for annual transvaginal ultrasound (US). Only one participant was adherent with semi-annual CA125. Variables that had a significant association (P < 0.05) with at least one screening modality included: a lack of time, marital status, education, cancer history, provider concern, perceived screening utility, confidence in ability to overcome barriers, cancer specific distress, and risk perception. Primary physician behavior, either in terms of screening recommendations or screening performance in the case of CBE, had significant independent association with adherence to mammography, CBE, and US screening recommendations. The results of this study highlight the essential role that primary physicians play in supporting their very high-risk patients' adherence.
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Affiliation(s)
- Susan T Tinley
- Creighton University, Preventive Medicine, Omaha, Nebraska 68178, USA.
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Madan AK, Aliabadi-Wahle S, Beech DJ. Physicians-in-training recommendations for prophylactic bilateral mastectomies. Breast J 2003; 9:397-402. [PMID: 12968961 DOI: 10.1046/j.1524-4741.2003.09507.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The decision to recommend bilateral prophylactic mastectomy (PBM), one treatment modality used to reduce the development of breast carcinoma, may be influenced by physician bias. This investigation tested the hypothesis that there are physician-in-training biases in recommendations of PBM. All second-year medical students, general surgical residents, and internal medicine residents at our institution participated in a survey in which they were asked at what percent risk of developing breast carcinoma the physicians-in-training would recommend PBM for 1) their patients, 2) themselves, and 3) their significant others, as applicable. A total of 198 physicians-in-training responded. Univariate analysis demonstrated an association between both the type of physician-in-training (p<0.03) and gender (p<0.004) with the percent risk for which respondents would recommend PBM. However, with multivariate analysis, only gender was associated with percent risk (p<0.05). Physicians-in-training also chose PBM at a lower risk for their significant others than for themselves (67.5% versus 57.2%; p<0.02). Respondents also chose PBM at a similar risk for themselves or significant others as for their patients (r=0.83, r=0.98; p<0.001). This investigation suggests that males (compared to females) are more likely to recommend PBM for the prevention of breast cancer.
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Affiliation(s)
- Atul K Madan
- Department of Surgery, Tulane University School of Medicine, Tulane University, New Orleans, LA, USA
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43
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44
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van Asperen CJ, Tollenaar RAEM, Krol-Warmerdam EMM, Blom J, Hoogendoorn WE, Seynaeve CMJC, Brekelmans CTM, Devilee P, Cornelisse CJ, Klijn JGM, de Bock GH. Possible consequences of applying guidelines to healthy women with a family history of breast cancer. Eur J Hum Genet 2003; 11:633-6. [PMID: 12891386 DOI: 10.1038/sj.ejhg.5201021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Possible effects of consistently applying published guidelines on healthy women with breast cancer in their family history were analysed. We investigated 1060 unrelated breast cancer patients and calculated the numbers of first-degree relatives that would be referred to a familial cancer clinic if the guidelines were consistently applied. A first-degree relative was considered a candidate for referral if she was female, without breast cancer at the moment of the interview, alive and over the age of 24. The criteria for referral were based on one Dutch and two British guidelines. According to the Dutch guideline, for one affected woman with breast cancer, 0.25 (95% CI 0.22-0.28) healthy first-degree female relatives should be offered a consultation at a familial cancer clinic (FCC). Application of the British guidelines would lead to a similar number of referrals. Of all healthy first-degree female relatives, who should be referred to an FCC, 34-37% had an index case among their family who was already known at a genetic department. If current guidelines are consistently applied, a sharp increase in referrals to FCCs may be expected. These guidelines, however, are arbitrary and only limited data are available on the efficacy of this surveillance for high-risk healthy women.
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Affiliation(s)
- C J van Asperen
- Center for Human and Clinical Genetics, Department of Clinical Genetics, Leiden University Medical Center, The Netherlands.
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45
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Scott CI, Iorgulescu DG, Thorne HJ, Henderson MA, Phillips KA. Clinical, pathological and genetic features of women at high familial risk of breast cancer undergoing prophylactic mastectomy. Clin Genet 2003; 64:111-21. [PMID: 12859406 DOI: 10.1034/j.1399-0004.2003.00097.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Prophylactic mastectomy (PM) is a risk-management option for women at high familial risk of breast cancer (BC). This study describes the PM experience of women enrolled in a large observational cohort study involving families with a history of hereditary breast cancer. Within 357 multiple-case BC families [119 (33%) BRCA1 or BRCA2 mutation positive], identified via family cancer clinics, 49 cases of PM [21 (43%) BRCA1 or BRCA2 mutation positive] were identified and their clinical, pathological and genetic features reviewed. Families with at least one incidence of PM displayed stronger breast/ovarian cancer histories than did families without PM. Median age at time of PM was 45 years (range 28-58). Ten cases (21%) were bilateral PMs in unaffected women and 39 cases were contralateral PMs in women with prior invasive BC (71%) or ductal carcinoma in situ (DCIS) (8%). Most (88%) underwent total mastectomy. Unnecessary axillary surgery occurred in eight subjects (16%). Malignant histology was found in three PM specimens (6%). Prior to genetic testing, PM was performed in two women who were subsequently shown not to carry the mutation specific to their family. Optimal utilization of genetic testing to guide surgical decision making, appropriate surgical technique and careful pathology examination of PM specimens, are important issues to consider prior to PM in women at high familial risk of BC.
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Affiliation(s)
- C I Scott
- Department of Hematology and Medical Oncology, Familial Cancer Center, Peter MacCallum Cancer Institute, St Andrew's Place, East Melbourne, Victoria, 3002, Australia
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46
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Eerola H, Aittomäki K, Asko-Seljavaara S, Nevanlinna H, von Smitten K. Hereditary breast cancer and handling of patients at risk. Scand J Surg 2003; 91:280-7. [PMID: 12449472 DOI: 10.1177/145749690209100312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The identification of BRCA1 and BRCA2, the two known genes causing a dominantly inherited susceptibility for breast and ovarian cancer has allowed genetic testing and identification of high risk individuals in a proportion of breast cancer families. In the future, when both the surveillance methods and prophylactic measures will be further developed this will have even more important clinical value in the management of breast cancer families. To date, as prophylactic mastectomy and/or oophorectomy have been shown to offer a significant risk reduction, these should be considered at least for known mutation carriers. Before considering this, patients should be referred for genetic counseling including risk assessment and genetic testing. Identification of a mutation in the family facilitates carrier detection by allowing predictive testing of healthy individuals. In mutation positive families, a negative test result for an individual has great value as it releases from coping with high risk of cancer and from intensive surveillance. When prophylactic surgery is considered, young age is an important determinant. A skin-sparing mastectomy with implant or autologous tissue transfer is the reconstruction method of choice. Other options like surveillance or chemoprevention can be accepted, but their uncertainty should be pointed out.
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Affiliation(s)
- H Eerola
- Department of Oncology, Maria Hospital, Helsinki, Finland
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47
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Tiller K, Meiser B, Reeson E, Tucker M, Andrews L, Gaff C, Kirk J, Phillips KA, Friedlander M. A decision aid for women at increased risk for ovarian cancer. Int J Gynecol Cancer 2003; 13:15-22. [PMID: 12631214 DOI: 10.1046/j.1525-1438.2003.13018.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This paper reviews changes that have occurred within and without the medical profession that have fostered an increasing demand for decision aids as adjuncts to practitioners' counseling to prepare patients for decision making. In the absence of data on the efficacy of ovarian cancer screening and prophylactic strategies, decisions about optimal care are difficult for both women and their doctors. Because surveillance and preventive options are an area of great uncertainty, a decision aid has been developed specifically aimed at facilitating decisions involving ovarian cancer risk management options. This was achieved by reviewing and integrating the available literature on models of medical decision making, patient preferences for information and involvement in decision making, the utility of decision aids, and management options for ovarian cancer risk. Findings indicate that patients wish to be informed participants in the decision-making process and that decision aids are an acceptable and effective method of providing quality information in a format that facilitates an inclusive model of shared decision making. A decision aid designed for women at increased risk of ovarian cancer that facilitates informed decision making may be a valuable addition to patient support. A randomized controlled trial of this type of educational material will provide timely and much needed evidence on its acceptability and efficacy.
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Affiliation(s)
- K Tiller
- Hereditary Cancer Clinic, Prince of Wales Hospital,
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48
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Møller P, Borg A, Evans DG, Haites N, Reis MM, Vasen H, Anderson E, Steel CM, Apold J, Goudie D, Howell A, Lalloo F, Maehle L, Gregory H, Heimdal K. Survival in prospectively ascertained familial breast cancer: analysis of a series stratified by tumour characteristics, BRCA mutations and oophorectomy. Int J Cancer 2002; 101:555-9. [PMID: 12237897 DOI: 10.1002/ijc.10641] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dedicated clinics have been established for the early diagnosis and treatment of women at risk for inherited breast cancer, but the effects of such interventions are currently unproven. This second report on prospectively diagnosed inherited breast cancer from the European collaborating centres supports the previous conclusions and adds information on genetic heterogeneity and the effect of oophorectomy. Of 249 patients, 20% had carcinoma in situ (CIS), 54% had infiltrating cancer without spread (CaN0) and 26% had cancer with spread (CaN+). Five-year survival was 100% for CIS, 94% for CaN0 and 72% for CaN+ (p = 0.007). Thirty-six patients had BRCA1 mutations, and 8 had BRCA2 mutations. Presence of BRCA1 mutation was associated with infiltrating cancer, high grade and lack of oestrogen receptor (p < 0.05 for all 3 characteristics). For BRCA1 mutation carriers, 5-year survival was 63% vs. 91% for noncarriers (p = 0.04). For CaN0 patients, mutation carriers had 75% 5-year disease-free survival vs. 96% for noncarriers (p = 0.01). Twenty-one of the mutation carriers had undergone prophylactic oophorectomy, prior to or within 6 months of diagnosis in 13 cases. All but 1 relapse occurred in the 15 who had kept their ovaries, (p < 0.01); no relapse occurred in those who had removed the ovaries within 6 months (p = 0.04) Contralateral cancer was more frequently observed in mutation noncarriers, but this finding did not reach statistical significance. Our findings support the concept that BRCA1 cancer is biologically different from other inherited breast cancers. While current screening protocols appear satisfactory for the majority of women at risk of familial breast cancer, this may not be the case for BRCA1 mutation carriers. The observed effect of oophorectomy was striking.
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Affiliation(s)
- Pål Møller
- Section of Genetic Counselling, Department of Cancer Genetics, Norwegian Radium Hospital, Oslo, Norway.
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Tiller K, Meiser B, Butow P, Clifton M, Thewes B, Friedlander M, Tucker K. Psychological impact of prophylactic oophorectomy in women at increased risk of developing ovarian cancer: a prospective study. Gynecol Oncol 2002; 86:212-9. [PMID: 12144830 DOI: 10.1006/gyno.2002.6737] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The objectives of this study were twofold: to prospectively assess whether expressed intention to undergo prophylactic oophorectomy translated into uptake and to evaluate the psychological impact of the procedure in a sample of unaffected women with a strong family history of breast/ovarian cancer. METHODS Ninety-five women, initially assessed at the time of their first attendance at a familial cancer clinic, were followed-up 3 years later. A total of 22 women (23.2%) in this study had undergone a prophylactic oophorectomy. Ten women (10.5%) who had undergone a prophylactic oophorectomy during the 3-year follow-up period were compared to 73 women (76.9%) who did not have a prophylactic oophorectomy. Twelve women (12.6%) who had the procedure prior to study entry were also assessed for psychological adjustment and associated information needs. RESULTS Age emerged as a significant predictor of uptake of prophylactic oophorectomy (chi(2) = 7.13, P = 0.009). Among those who had the procedure after study entry, a significant reduction in ovarian cancer anxiety was observed (Z = -2.19, P = 0.029). Of the 22 women who had undergone a prophylactic oophorectomy in total (both before and after study entry), 86.4% reported a high degree of satisfaction with their decision to have the procedure. A low level of screening uptake was also reported by women who did not have a prophylactic oophorectomy but for whom screening was recommended. CONCLUSION Findings demonstrate that prophylactic oophorectomy is successful in reducing anxiety about ovarian cancer. The results also suggest that women perceive that the benefit of anxiety reduction may outweigh the potentially adverse effects of the procedure, given that women expressed a high level of satisfaction with their decision.
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Affiliation(s)
- K Tiller
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia.
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Abstract
Screening mammography, despite its limitations, remains the best means for diagnosing breast cancer in asymptomatic women. Regarding the continuing controversies concerning the age at which screening should start, evidence supports beginning regular screening at age 40 in women at average risk . Similarly, evidence suggests that the screening interval should be yearly, especially in younger women. Rather than an arbitrary age at which screening should stop, the decision on screening elderly women should be made on an individual basis, taking into account level of health and life expectancy. More work needs to be done on determining the optimum screening strategies for high-risk women. As to the interpretation of screening mammography, a certain level of observer variability and of false-negative and false-positive readings are inherent in the process. These should be kept to a minimum through efforts by the interpreting radiologist to improve performance through auditing of individual results and continuing education. The impact of double reading and computer-aided detection in the interpretation of screening mammograms warrants further evaluation in terms of efficacy and cost-effectiveness. Despite these continuing controversies, mortality from breast cancer in the United States has been decreasing steadily for the past 25 years. The magnitude of the decrease has been reported to range from 8% to 25%. Although some of this decrease may be attributable to improvements in the treatment of breast cancer, early detection through screening mammography has undoubtedly played a role in this mortality reduction. The controversies that surround the issue of screening should not detract from the fact that screening mammography has proved to save lives.
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Affiliation(s)
- Carol H Lee
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA.
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