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Caeser R, Chiang J, Tan ES, Tai ES, Ngeow J. Cascade testing for hereditary cancer in Singapore: how population genomics help guide clinical policy. Fam Cancer 2024; 23:133-140. [PMID: 38662262 DOI: 10.1007/s10689-024-00376-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/26/2024]
Abstract
Hereditary Cancer makes up around 5-10% of all cancers. It is important to diagnose hereditary cancer in a timely fashion, as not only do patients require long-term care from a young age, but their relatives also require management. The main approach to capture at-risk relatives is cascade testing. It involves genetic testing of relatives of the first detected carrier of a pathogenic variant in a family i.e. the proband. The current standard of care for cascade testing is a patient-mediated approach. Probands are then advised to inform and encourage family members to undergo genetic testing. In Singapore, cascade testing is inefficient, around 10-15%, lower than the 30% global average. Here, we describe the cascade testing process and its effort to increase testing in Singapore. Precision Health Research, Singapore (PRECISE), was set up to coordinate Singapore's National Precision Medicine strategy and has awarded five clinical implementation pilots, with one of them seeking to identify strategies for how cascade testing for hereditary cancer can be increased in a safe and cost-efficient manner. Achieving this will be done through addressing barriers such as cost, manpower shortages, exploring a digital channel for contacting at-risk relatives, and getting a deeper insight into why genetic testing gets declined. If successful, it will likely result in care pathways that are a cost-effective public health intervention for identifying individuals at risk. Surveillance and management of those unaffected at-risk individuals, if caught early, will result in improved patient outcomes, and further reduce the healthcare burden for the economy.
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Affiliation(s)
- Rebecca Caeser
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jianbang Chiang
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Ee Shien Tan
- Duke-National University of Singapore (NUS) Medical School, National University of Singapore, Singapore, Singapore
- Genetics Service, Department of Pediatrics, Kadang Kerbau (KK) Women's and Children's Hospital, Singapore, Singapore
| | - E Shyong Tai
- Duke-National University of Singapore (NUS) Medical School, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Precision Health Research, Singapore, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore.
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Grutters LA, Christiaans I. Cascade genetic counseling and testing in hereditary syndromes: inherited cardiovascular disease as a model: a narrative review. Fam Cancer 2024; 23:155-164. [PMID: 38184510 PMCID: PMC11153290 DOI: 10.1007/s10689-023-00356-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Abstract
Inherited cardiovascular diseases cover the inherited cardiovascular disease familial hypercholesterolemia and inherited cardiac diseases, like inherited cardiomyopathies and inherited arrhythmia syndromes. Cascade genetic counseling and testing in inherited cardiovascular diseases have had three decades of academic attention. Inherited cardiovascular diseases affect around 1-2% of the population worldwide and cascade genetic counseling and testing are considered valuable since preventive measures and/or treatments are available. Cascade genetic counseling via a family-mediated approach leads to an uptake of genetic counseling and testing among at-risk relatives of around 40% one year after identification of the causal variant in the proband, with uptake remaining far from complete on the long-term. These findings align with uptake rates among relatives at-risk for other late onset medically actionable hereditary diseases, like hereditary cancer syndromes. Previous interventions to increase uptake have focused on optimizing the process of informing relatives through the proband and on contacting relatives directly. However, despite successful information dissemination to at-risk relatives, these approaches had little or no effect on uptake. The limited research into the barriers that impede at-risk relatives from seeking counseling has revealed knowledge, attitudinal, social and practical barriers but it remains unknown how these factors contribute to the decision-making process for seeking counseling in at-risk relatives. A significant effect on uptake of genetic testing has only been reached in the setting of familial hypercholesterolemia, where active information provision was accompanied by a reduction of health-system-related barriers. We propose that more research is needed on barriers -including health-system-related barriers- and how they hinder counseling and testing in at-risk relatives, so that uptake can be optimized by (adjusted) interventions.
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Affiliation(s)
- Laura A Grutters
- Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, 9700 RB, The Netherlands
| | - Imke Christiaans
- Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, 9700 RB, The Netherlands.
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Rodriguez NJ, Syngal S. Expanding access to genetic testing for pancreatic cancer. Fam Cancer 2024:10.1007/s10689-024-00389-w. [PMID: 38733419 DOI: 10.1007/s10689-024-00389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/04/2024] [Indexed: 05/13/2024]
Abstract
Among individuals with pancreatic ductal adenocarcinoma (PDAC) 5-10% have a pathogenic germline variant (PGV) in a PDAC susceptibility gene. Guidelines recommend genetic testing among all individuals with PDAC. Additionally, at-risk relatives of PDAC patients benefit from their own genetic education, risk assessment, and testing. Multigene panel testing (MGPT) can identify individuals with inherited cancer risk who can benefit from early cancer surveillance and risk reduction strategies. This manuscript discusses various healthcare delivery models for MGPT including traditional in-person genetic counseling, novel integrated in-person infrastructures, telemedicine genetics care via telephone- or video-visits and direct-to-consumer testing. Barriers and facilitators to care on the individual, provider, and system level are also outlined including specific considerations for historically marginalized communities.
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Affiliation(s)
- Nicolette Juliana Rodriguez
- Division of Gastroenterology, Hepatology and Endoscopy | Brigham and Women's Hospital, Division of Cancer Genetics and Prevention | Dana-Farber Cancer Institute Instructor of Medicine, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Sapna Syngal
- Center for Cancer Genetics and Prevention Dana-Farber Cancer Institute, Gastrointestinal Cancer Genetics and Prevention Program, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
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Chiang J, Chua Z, Chan JY, Sule AA, Loke WH, Lum E, Ong MEH, Graves N, Ngeow J. Strategies to improve implementation of cascade testing in hereditary cancer syndromes: a systematic review. NPJ Genom Med 2024; 9:26. [PMID: 38570510 PMCID: PMC10991315 DOI: 10.1038/s41525-024-00412-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Abstract
Hereditary cancer syndromes constitute approximately 10% of all cancers. Cascade testing involves testing of at-risk relatives to determine if they carry the familial pathogenic variant. Despite growing efforts targeted at improving cascade testing uptake, current literature continues to reflect poor rates of uptake, typically below 30%. This study aims to systematically review current literature on intervention strategies to improve cascade testing, assess the quality of intervention descriptions and evaluate the implementation outcomes of listed interventions. We searched major databases using keywords and subject heading of "cascade testing". Interventions proposed in each study were classified according to the Effective Practice and Organization of Care (EPOC) taxonomy. Quality of intervention description was assessed using the TIDieR checklist, and evaluation of implementation outcomes was performed using Proctor's Implementation Outcomes Framework. Improvements in rates of genetic testing uptake was seen in interventions across the different EPOC taxonomy strategies. The average TIDieR score was 7.3 out of 12. Items least reported include modifications (18.5%), plans to assess fidelity/adherence (7.4%) and actual assessment of fidelity/adherence (7.4%). An average of 2.9 out of 8 aspects of implementation outcomes were examined. The most poorly reported outcomes were cost, fidelity and sustainability, with only 3.7% of studies reporting them. Most interventions have demonstrated success in improving cascade testing uptake. Uptake of cascade testing was highest with delivery arrangement (68%). However, the quality of description of interventions and assessment of implementation outcomes are often suboptimal, hindering their replication and implementation downstream. Therefore, further adoption of standardized guidelines in reporting of interventions and formal assessment of implementation outcomes may help promote translation of these interventions into routine practice.
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Affiliation(s)
- Jianbang Chiang
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore, 169857, Singapore
| | - Ziyang Chua
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
| | - Jia Ying Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
| | - Ashita Ashish Sule
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Wan Hsein Loke
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Elaine Lum
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Marcus Eng Hock Ong
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, 169608, Singapore
| | - Nicholas Graves
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore.
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore, 169857, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore.
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Jacobs MF, Goldman JW, Austin S, Koeppe ES, Murad AM, Koschmann CJ, Chinnaiyan AM, Mody RJ. Family Recall of and Response to Germline Pathologic Variants Found on Paired Tumor-Germline Sequencing in Pediatric Oncology. JCO Precis Oncol 2024; 8:e2300539. [PMID: 38484211 PMCID: PMC10954074 DOI: 10.1200/po.23.00539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Paired tumor-germline sequencing can identify somatic variants for targeted therapy and germline pathogenic variants (GPVs) causative of hereditary cancer/tumor predisposition syndromes. It is unknown how patients/families in pediatric oncology use information about an identified GPV. We assessed recall of germline results and actions taken on the basis of findings. METHODS We completed phone surveys with patients (and/or their parent) with GPVs identified via a single academic medical center's paired tumor-germline sequencing study. Seven hundred forty pediatric (aged 0-25 years) oncology patients were enrolled in this sequencing study between May 2012 and August 2021. Ninety-six participants (13.0%) had at least one GPV identified and were therefore eligible for this survey. The parent/guardian (for patients younger than 18 years or deceased patients) or patients themselves (if 18 years or older) were contacted. Survey topics included germline result recall, experience with genetic counseling, changes to patient's cancer treatment/screening, sharing of results with family members, and lifestyle changes. RESULTS Fifty-three surveys (response rate, 55.2%) were completed between October 2021 and June 2022. Thirty-seven (69.8%) respondents correctly recalled the identified GPV. Discussing results with a genetic counselor (P = .0001), having a GPV related to the cancer/tumor diagnosis (P = .002), and non-Hispanic White race/ethnicity (P = .02) were associated with accurate recall. Twenty-five respondents (47.2%) reported a change in the child's cancer treatment and/or screening recommendations, 17 respondents (32.1%) made a lifestyle change on the basis of the results, and 44 respondents (83.0%) shared results with at least one family member. CONCLUSION While most respondents remembered that a GPV was identified in the patient, some did not recall having a GPV found, and others recalled germline findings incorrectly. Future work may determine patient/family preferences for timing/method of result return to optimize patient recall and use of germline results.
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Affiliation(s)
- Michelle F. Jacobs
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | | | - Sarah Austin
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| | - Erika S. Koeppe
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | | | | - Arul M. Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI
| | - Rajen J. Mody
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
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Bednar EM, Rauh-Hain JA, Garcia JJ, de Aguinaga N, Powell MA, Peral SL, Nitecki R, Jorgensen K, Rudy NL, Lu KH, Leath CA, Scarinci IC. Experiences of Family Communication and Cascade Genetic Testing for Hereditary Cancer in Medically Underserved Populations-A Qualitative Study. Cancer Prev Res (Phila) 2024; 17:19-28. [PMID: 37913800 PMCID: PMC10872900 DOI: 10.1158/1940-6207.capr-23-0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/22/2023] [Accepted: 10/31/2023] [Indexed: 11/03/2023]
Abstract
We sought to explore the intrafamilial communication and cascade genetic testing (CGT) experiences of patients with hereditary cancer from diverse, medically underserved populations and their relatives. Participants included patients receiving oncology care at an urban, safety net hospital in Texas or comprehensive cancer center in Alabama and their first-degree relatives. In-depth semi-structured qualitative interviews were completed wherein patients shared their experiences with genetic counseling (GC), genetic testing (GT), and communicating their results to relatives. Relatives shared their experiences receiving information from the patient and considering CGT. Interviews were transcribed, coded, and themes were identified. Of 25 participating patients, most recalled key aspects of GC and their GT results. Most (80%) patients shared their results with relatives, but only some relatives underwent CGT; patients reported low perceived susceptibility to hereditary cancer as a common barrier to CGT for their relatives. Of 16 participating relatives, most reported feeling distress upon learning the patient's GT results. Relatives were fearful of learning their own CGT results but identified prevention and early detection as CGT benefits. Interviews identified opportunities during family communication to improve relatives' perceived susceptibility to hereditary cancer. Tailored resources may support patients and relatives experiencing distress and fear during GT. PREVENTION RELEVANCE This study of intrafamilial communication and cascade genetic testing experiences of patients with hereditary cancer and their relatives from diverse, medically underserved populations identified relatives' perceived susceptibility to hereditary cancer risks, distress, and fear as frequent reactions and barriers to testing. These results may inform future hereditary cancer prevention efforts.
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Affiliation(s)
- Erica M. Bednar
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jose J. Garcia
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Sylvia L. Peral
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roni Nitecki
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Natasha L. Rudy
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen H. Lu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Westbrook L, Miltenburg D, Souter V, Maisenbacher MK, Howard KL, Sha Y, Yavari M, Kypraios N, Rodriguez A, Weitzel JN. Hereditary cancer testing in a diverse sample across three breast imaging centers. Breast Cancer Res Treat 2024; 203:365-372. [PMID: 37861889 PMCID: PMC10787882 DOI: 10.1007/s10549-023-07137-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Up to 10% of all breast cancers (BC) are attributed to inherited pathogenic variants (PV) in BC susceptibility genes; however, most carriers of PVs remain unidentified. Here, we sought to determine the yield of hereditary cancer gene PVs among diverse women attending breast imaging centers, who could benefit from enhanced surveillance and/or risk reduction interventions. METHODS This cross-sectional retrospective cohort study included consecutive women, unselected for personal or family cancer history, who were offered genetic testing for hereditary cancer genes at the time of breast imaging at three centers (November 2020-March 2022). RESULTS Among 1943 patients (median age: 66 years), self-reported race/ethnicity was White (34.5%), Hispanic (27.7%), African American (17.9%), Asian (4.5%), Ashkenazi Jewish (0.6%), Other (3.5%), and missing (13.0%). Thirty-nine patients (2%) were identified as carriers of a PV in an autosomal dominant clinically actionable hereditary breast and ovarian cancer (HBOC)-related or Lynch syndrome gene, most frequently, BRCA2 (6/39; 15.4%), PALB2 (8/39; 20.5%), CHEK2 (10/39; 25.6%), and PMS2 (5/39; 12.8%). Of the 34 PVs with known race/ethnicity, 47% were detected among non-White patients. Overall, 354/1,943 (18.2%) of patients met NCCN guidelines for HBOC gene testing and only 15/39 (38.5%) patients with an autosomal dominant clinically actionable PV met guidelines. CONCLUSION This population health approach extended the reach of genetic cancer risk assessment in a diverse population and highlighted the limits of a guideline-based approach. This may help address inequity in access to risk-appropriate screening and cancer prevention.
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Affiliation(s)
| | | | | | | | | | - Youbao Sha
- Natera, Inc., 13011 McCallen Pass, Austin, TX, 78753, USA
| | - Maygol Yavari
- Natera, Inc., 13011 McCallen Pass, Austin, TX, 78753, USA
| | | | | | - Jeffrey N Weitzel
- Natera, Inc., 13011 McCallen Pass, Austin, TX, 78753, USA.
- Precision Prevention, The Kansas University Comprehensive Cancer Center, Kansas City, KS, 66160, USA.
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Ahsan MD, Levi SR, Webster EM, Bergeron H, Lin J, Narayan P, Nelson BB, Li X, Fowlkes RK, Brewer JT, Thomas C, Christos PJ, Chapman-Davis E, Cantillo E, Holcomb K, Sharaf RN, Frey MK. Do people with hereditary cancer syndromes inform their at-risk relatives? A systematic review and meta-analysis. PEC INNOVATION 2023; 2:100138. [PMID: 37214514 PMCID: PMC10194207 DOI: 10.1016/j.pecinn.2023.100138] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/28/2023] [Accepted: 02/14/2023] [Indexed: 05/24/2023]
Abstract
Purpose To evaluate rates of familial disclosure of hereditary cancer syndrome information. Methods A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines (PROSPERO no.: CRD42020134276). Key electronic databases were searched to identify studies evaluating hereditary cancer syndrome cascade relative disclosure. Eligible studies were subjected to meta-analysis. Results Thirty-four studies met inclusion criteria. Among 11,711 included relatives, 70% (95% CI 60 - 78%) were informed of their risk of carrying a cancer-associated pathogenic variant; of 2,875 relatives informed of their risk who were evaluated for uptake of cascade testing, 43% (95% CI 27 - 61%) completed testing. Rates of disclosure were higher among female vs male relatives (79% [95% CI 73% - 84%] vs 67% [95% CI 57% - 75%]) and first-degree vs second-degree relatives (83% [95% CI 77% - 88%] vs 58% [95% CI 45 - 69%]). Conclusion Nearly one-third of at-risk relatives remain uninformed of their risk of carrying a cancer-associated pathogenic variant. Even among those informed, fewer than half subsequently complete genetic testing, representing a critical missed opportunity for precision cancer prevention. Innovation Five studies evaluating interventions to improve disclosure rates were generally ineffective. Urgent work is needed to elucidate barriers to relative disclosure by probands to develop targeted interventions that can optimize proband-mediated cascade genetic testing rates.
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Affiliation(s)
- Muhammad Danyal Ahsan
- Corresponding author at: Division of Gynecologic Oncology, Weill Cornell Medicine, United States of America
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Tercyak KP, DeMarco TA, Schneider KA, Luta G, Isaacs C, Garber JE, Sleiman MM, Yockel MR, Peshkin BN. Results of a randomized controlled trial of a decision support intervention for disclosing maternal BRCA genetic test results to children and adolescents. PEC INNOVATION 2023; 2:100129. [PMID: 37214493 PMCID: PMC10194096 DOI: 10.1016/j.pecinn.2023.100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 05/24/2023]
Abstract
Objective Evaluate the impact of a targeted family communication intervention for mothers undergoing genetic counseling and testing (GCT) for BRCA gene alterations. Methods Following BRCA GCT, mothers (N = 204; M age = 45 y) were randomized to either a control condition (self-help print materials) or intervention (printed decision support guide, based on behavioral decision making theory in health care) for supporting choices about disclosing maternal genetic test results to children and adolescents. Behavioral assessments were administered prior to maternal GCT and after receipt of results: primary outcomes were maternal disclosure to children and parent-child communication quality. Results Mothers in the intervention were > 2x likely to disclose their BRCA test results to their children compared to those in the control condition (odds ratio [OR] = 2.33, 95% confidence interval [CI] = 1.06, 5.10; p = .04). This effect was moderated by children's ages: mothers of preteens (<13 y) assigned to the intervention were >3x likely to disclose their results (OR = 3.74, 95% CI = 1.49, 9.41; p = .005). In adjusted models, intervention was also associated with favorable changes in the quality of parent-child communication (95% CI = 0.30, 9.00; p < .05). Conclusion Decision support improves parent-child communication outcomes about GCT for hereditary breast-ovarian cancer. Innovation This trial is among the first to empirically evaluate the outcomes of a behavioral intervention to support family communication of maternal BRCA risk information to children.
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Affiliation(s)
- Kenneth P. Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | | | - George Luta
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Marcelo M. Sleiman
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Mary Rose Yockel
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Beth N. Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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Cragun DL, Hunt PP, Dean M, Weidner A, Shields AK, Tezak A, Pal T. Applying the framework for developing and evaluating complex interventions to increase family communication about hereditary cancer. PEC INNOVATION 2023; 2:100133. [PMID: 37214492 PMCID: PMC10194404 DOI: 10.1016/j.pecinn.2023.100133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 05/24/2023]
Abstract
Objective Evaluate an intervention to increase family communication (FC) of positive hereditary cancer test results using the Framework for Developing and Evaluating Complex Interventions (FDECI). Methods We developed 'programme theory' during the FDECI development phase by aligning intervention components with behavior change techniques (BCTs) and theoretical factors expected to improve FC. During the feasibility phase, we obtained feedback from 12 stakeholder interviews. Results Intervention components aligned with a total of 14 unique BCTs for which prior evidence links the BCT to theoretical factors that influence behavior change. Constructive stakeholder feedback included: more information desired, rewording to support autonomy by highlighting options, and improvements to navigation, visuals, and audio. Positive comments included: comprehensiveness of materials, modeling of conversations, and usefulness of the materials for helping a person prepare to share positive test results. Conclusion The first FDECI phases were helpful for improving the intervention and planning our ongoing effectiveness and future implementation phases. Innovation Our application of the FDECI is novel, including plans to test our 'programme theory' using coincidence analysis (CNA) to determine who accesses which intervention materials, how utilizing certain materials impact the aligned theoretical factors, and whether these in turn make a difference in the behavioral outcome.
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Affiliation(s)
- Deborah L. Cragun
- University of South Florida, College of Public Health, Tampa, FL, United States of America
| | - Paige Phillips Hunt
- University of South Florida, College of Public Health, Tampa, FL, United States of America
| | - Marleah Dean
- University of South Florida, Department of Communication, Tampa, FL; Health Outcomes & Behavior Program, Moffitt Cancer Center, Tampa, FL, United States of America
- Moffitt Cancer Center, Health Outcomes & Behavior Program, Tampa, FL, United States of America
| | - Anne Weidner
- Vanderbilt University Medical Center, Department of Medicine; Vanderbilt-Ingram Cancer Center, Nashville, TN, United States of America
| | - Andrea K. Shields
- University of South Florida, College of Public Health, Tampa, FL, United States of America
| | - Ann Tezak
- Vanderbilt University Medical Center, Department of Medicine; Vanderbilt-Ingram Cancer Center, Nashville, TN, United States of America
| | - Tuya Pal
- Vanderbilt University Medical Center, Department of Medicine; Vanderbilt-Ingram Cancer Center, Nashville, TN, United States of America
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Agiannitopoulos K, Potska K, Katseli A, Ntogka C, Tsaousis GN, Pepe G, Bouzarelou D, Tsoulos N, Papathanasiou A, Ziogas D, Venizelos V, Markopoulos C, Iosifidou R, Karageorgopoulou S, Giassas S, Natsiopoulos I, Papazisis K, Vasilaki-Antonatou M, Psyrri A, Koumarianou A, Matthaios D, Zairi E, Blidaru A, Banu E, Jinga DC, Laçin Ş, Özdoğan M, Papadopoulou E, Nasioulas G. Only 32.3% of Breast Cancer Families with Pathogenic Variants in Cancer Genes Utilized Cascade Genetic Testing. Cancers (Basel) 2023; 15:5218. [PMID: 37958392 PMCID: PMC10649031 DOI: 10.3390/cancers15215218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Hereditary cancer predisposition syndromes are responsible for approximately 5-10% of all diagnosed cancer cases. In order to identify individuals at risk in a cost-efficient manner, family members of individuals carrying pathogenic alterations are tested only for the specific variant that was identified in their carrier relative. The purpose of this study was to investigate the clinical use and implementation of cascade family testing (CFT) in families of breast cancer patients with pathogenic/likely pathogenic variants (PVs/LPVs) in cancer-related predisposition genes. METHODS Germline sequencing was carried out with NGS technology using a 52-gene panel, and cascade testing was performed by Sanger sequencing or MLPA. RESULTS In a cohort of 1785 breast cancer patients (families), 20.3% were found to have PVs/LPVs. Specifically, 52.2%, 25.1%, and 22.7% of patients had positive findings in high-, intermediate-, and low-penetrance breast cancer susceptibility genes, respectively. Although CFT was recommended to all families, only 117 families (32.3%) agreed to proceed with genetic testing. Among the first-degree relatives who underwent CFT, 70.3% were female, and 108 of 121 (89.3%) were cancer free. Additionally, 42.7%, 36.7%, and 20.6% were offspring, siblings, and parents of the subject, respectively. Our data suggest that CFT was mostly undertaken (104/117, 88.8%) in families with positive findings in high-risk genes. CONCLUSIONS Cascade family testing can be a powerful tool for primary cancer prevention by identifying at-risk family members. It is of utmost importance to implement genetic counseling approaches leading to increased awareness and communication of genetic testing results.
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Affiliation(s)
- Konstantinos Agiannitopoulos
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Kevisa Potska
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Anastasia Katseli
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Christina Ntogka
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Georgios N. Tsaousis
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Georgia Pepe
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Dimitra Bouzarelou
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Nikolaos Tsoulos
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - Athanasios Papathanasiou
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | | | | | | | | | | | - Stylianos Giassas
- IASO, General Maternity and Gynecology Clinic, 15123 Athens, Greece; (S.K.); (S.G.)
| | | | | | | | - Amanta Psyrri
- Section of Medical Oncology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (A.K.)
| | - Anna Koumarianou
- Section of Medical Oncology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.P.); (A.K.)
| | | | - Eleni Zairi
- St. Luke’s Hospital, 55236 Thessaloniki, Greece;
| | - Alexandru Blidaru
- Alexandru Trestioreanu Bucharest Oncology Institute, 022328 Bucharest, Romania;
| | - Eugeniu Banu
- Saint Constantin Hospital, 500299 Brasov, Romania;
| | | | - Şahin Laçin
- Department of Medical Oncology, Koc University Faculty of Medicine, 34010 Istanbul, Turkey;
| | - Mustafa Özdoğan
- Division of Medical Oncology, Memorial Antalya Hospital, 07025 Antalya, Turkey;
| | - Eirini Papadopoulou
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
| | - George Nasioulas
- Genekor Medical S.A., 15344 Athens, Greece; (K.P.); (A.K.); (C.N.); (G.N.T.); (G.P.); (D.B.); (N.T.); (A.P.); (E.P.); (G.N.)
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12
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Katz SJ, Abrahamse P, Hodan R, Kurian AW, Rankin A, Tocco RS, Rios-Ventura S, Ward KC, An LC. Cascade Genetic Risk Education and Testing in Families With Hereditary Cancer Syndromes: A Pilot Study. JCO Oncol Pract 2023; 19:e848-e858. [PMID: 36921235 PMCID: PMC10332838 DOI: 10.1200/op.22.00677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/07/2023] [Indexed: 03/17/2023] Open
Abstract
PURPOSE Cascade genetic risk evaluation in families with hereditary cancer can reduce the burden of disease but the rate of germline genetic testing in relatives of patients at risk is low. METHODS We identified all 277 women diagnosed with breast cancer in Georgia in 2017 who linked to a clinically actionable germline pathogenic variant through a Surveillance, Epidemiology, and End Results registry-variant linkage initiative. We surveyed them, and then invited eligible respondents to an online platform hosted by a navigator that offered cancer genetic risk education and germline genetic testing to untested relatives. We randomly assigned patient-family clusters at the time of the patient enrollment offer to free versus $50 (USD) test cost. Patients invited relatives to join the study through personalized e-mail. Enrolled relatives received online cancer genetic education and the opportunity to order clinical germline genetic testing through the platform. The primary outcome was the number of relatives who ordered genetic testing. RESULTS One hundred twenty-five of 277 patients completed surveys (45.2%). Most respondents were eligible for the trial offer (113 of 125; 90.4%). In the free testing arm, 20 of 56 eligible patients participated (35.7% of eligible respondents) and they invited 28 relatives: 12 relatives enrolled and 10 ordered testing. In the $50 (USD) arm, 16 of 57 eligible patients participated (28.1%) and they invited 38 relatives: 18 relatives enrolled and 17 ordered testing. CONCLUSION Cascade genetic testing in families with hereditary cancer syndromes accrued through a population-based cancer registry can be achieved through an online platform that offers genetic risk education and low-cost testing to relatives. A modest charge did not appear to influence the percentage of participating patients, numbers of participating relatives, and numbers of relatives who received genetic testing.
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Affiliation(s)
- Steven J. Katz
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Department of Health Management and Policy, School of Public Health, University of Michigan Ann Arbor, MI
| | - Paul Abrahamse
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Rachel Hodan
- Cancer Genetics, Stanford Health Care, Stanford, CA
| | - Allison W. Kurian
- Department of Medicine, Stanford University, Stanford, CA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA
| | - Aaron Rankin
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Rachel S. Tocco
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Sonia Rios-Ventura
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA
| | - Kevin C. Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lawrence C. An
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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13
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Stefka J, Streff H, Liu P, Towne M, Smith HS. Cascade testing after exome sequencing: Retrospective analysis of linked family data at 2 US laboratories. Genet Med 2023; 25:100818. [PMID: 36852743 DOI: 10.1016/j.gim.2023.100818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 02/26/2023] Open
Abstract
PURPOSE Cascade testing, the process of testing a proband's at-risk relatives, is integral to realizing the full value of genomic sequencing. However, there is little empirical evidence on the uptake of cascade testing after a positive exome sequencing (ES) result in a population of probands with diverse clinical indications. METHODS We retrospectively reviewed administrative data from 2 US clinical laboratories that perform ES. For each proband with a positive ES result, we used linked family data to describe the frequency of relatives' cascade testing performed at the same laboratory, variant detection yield of cascade tests, and characteristics of probands and relatives categorized on the basis of cascade testing completion. RESULTS Among the 3723 positive ES results across both laboratories, 426 relatives of 282 probands completed cascade testing (uptake = 7.6%). An average of 1.5 relatives (SD = 0.9) were tested per proband. Of the 426 relatives tested, 200 had a variant of interest detected (variant detection yield = 47.0%). CONCLUSION In our real-world data analysis, a small proportion of probands with a positive ES result subsequently had relatives complete cascade testing at the same laboratory. However, approximately half of the tested relatives received a clinically significant result that could have implications for clinical management or reproductive planning. Additional research on ways to increase cascade testing uptake is warranted.
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Affiliation(s)
- Julie Stefka
- Genetic Counseling Program, School of Health Professions, Baylor College of Medicine, Houston, TX; Clinical Diagnostics, Ambry Genetics, Aliso Viejo, CA.
| | - Haley Streff
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Pengfei Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX; Baylor Genetics, Houston, TX
| | - Meghan Towne
- Medical Sciences, Ambry Genetics, Aliso Viejo, CA
| | - Hadley Stevens Smith
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX; Precision Medicine Translational Research Center (PROMoTeR), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
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14
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Spaander MCW, Zauber AG, Syngal S, Blaser MJ, Sung JJ, You YN, Kuipers EJ. Young-onset colorectal cancer. Nat Rev Dis Primers 2023; 9:21. [PMID: 37105987 PMCID: PMC10589420 DOI: 10.1038/s41572-023-00432-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/29/2023]
Abstract
In the past decades the incidence of colorectal cancer (CRC) in people under the age of 50 years has increased, which is referred to as early-onset CRC or young-onset CRC (YO-CRC). YO-CRC is expected to account for 11% of colon cancers and 23% of rectal cancers by 2030. This trend is observed in different parts of the world and in both men and women. In 20% of patients with YO-CRC, a hereditary cancer syndrome is found as the underlying cause; however, in the majority of patients no genetic predisposition is present. Beginning in the 1950s, major changes in lifestyle such as antibiotic use, low physical activity and obesity have affected the gut microbiome and may be an important factor in YO-CRC development. Owing to a lack of screening, patients with YO-CRC are often diagnosed with advanced-stage disease. Long-term treatment-related complications should be taken into account in these younger patients, making the more traditional sequential approaches of drug therapy not always the most appropriate option. To better understand the underlying mechanism and define relationships between environmental factors and YO-CRC development, long-term prospective studies are needed with lifestyle data collected from childhood.
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Affiliation(s)
- Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center/Erasmus MC Cancer Institute, Rotterdam, Netherlands.
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sapna Syngal
- Brigham and Women's Hospital, Boston, MA, USA
- Dana Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Martin J Blaser
- Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, NJ, USA
| | - Joseph J Sung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Y Nancy You
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center/Erasmus MC Cancer Institute, Rotterdam, Netherlands
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15
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Kanesvaran R, Chia PL, Chiong E, Chua MLK, Ngo NT, Ow S, Sim HG, Tan MH, Tay KH, Wong ASC, Wong SW, Tan PH. An approach to genetic testing in patients with metastatic castration-resistant prostate cancer in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023. [DOI: 10.47102/annals-acadmedsg.2022372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Introduction: There has been a rapid evolution in the treatment strategies for metastatic castration-resistant prostate cancer (mCRPC) following the identification of targetable mutations, making genetic testing essential for patient selection. Although several international guidelines recommend genetic testing for patients with mCRPC, there is a lack of locally endorsed clinical practice guidelines in Singapore.
Method: A multidisciplinary specialist panel with representation from medical and radiation oncology, urology, pathology, interventional radiology, and medical genetics discussed the challenges associated with patient selection, genetic counselling and sample processing in mCRPC.
Results: A clinical model for incorporating genetic testing into routine clinical practice in Singapore was formulated. Tumour testing with an assay that is able to detect both somatic and germline mutations should be utilised. The panel also recommended the “mainstreaming” approach for genetic counselling in which pre-test counselling is conducted by the managing clinician and post-test discussion with a genetic counsellor, to alleviate the bottlenecks at genetic counselling stage in Singapore. The need for training of clinicians to provide pre-test genetic counselling and educating the laboratory personnel for appropriate sample processing that facilitates downstream genetic testing was recognised. Molecular tumour boards and multidisciplinary discussions are recommended to guide therapeutic decisions in mCRPC. The panel also highlighted the issue of reimbursement for genetic testing to reduce patient-borne costs and increase the reach of genetic testing among this patient population.
Conclusion: This article aims to provide strategic and implementable recommendations to overcome the challenges in genetic testing for patients with mCRPC in Singapore.
Keywords: Clinical model, genetic counselling, genetic testing, homologous recombination repair genes, metastatic castration-resistant prostate cancer
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Frey MK, Ahsan MD, Bergeron H, Lin J, Li X, Fowlkes RK, Narayan P, Nitecki R, Rauh-Hain JA, Moss HA, Baltich Nelson B, Thomas C, Christos PJ, Hamilton JG, Chapman-Davis E, Cantillo E, Holcomb K, Kurian AW, Lipkin S, Offit K, Sharaf RN. Cascade Testing for Hereditary Cancer Syndromes: Should We Move Toward Direct Relative Contact? A Systematic Review and Meta-Analysis. J Clin Oncol 2022; 40:4129-4143. [PMID: 35960887 PMCID: PMC9746789 DOI: 10.1200/jco.22.00303] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Evidence-based guidelines recommend cascade genetic counseling and testing for hereditary cancer syndromes, providing relatives the opportunity for early detection and prevention of cancer. The current standard is for patients to contact and encourage relatives (patient-mediated contact) to undergo counseling and testing. Direct relative contact by the medical team or testing laboratory has shown promise but is complicated by privacy laws and lack of infrastructure. We sought to compare outcomes associated with patient-mediated and direct relative contact for hereditary cancer cascade genetic counseling and testing in the first meta-analysis on this topic. MATERIALS AND METHODS We conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO No.: CRD42020134276). We searched key electronic databases to identify studies evaluating hereditary cancer cascade testing. Eligible trials were subjected to meta-analysis. RESULTS Eighty-seven studies met inclusion criteria. Among relatives included in the meta-analysis, 48% (95% CI, 38 to 58) underwent cascade genetic counseling and 41% (95% CI, 34 to 48) cascade genetic testing. Compared with the patient-mediated approach, direct relative contact resulted in significantly higher uptake of genetic counseling for all relatives (63% [95% CI, 49 to 75] v 35% [95% CI, 24 to 48]) and genetic testing for first-degree relatives (62% [95% CI, 49 to 73] v 40% [95% CI, 32 to 48]). Methods of direct contact included telephone calls, letters, and e-mails; respective rates of genetic testing completion were 61% (95% CI, 51 to 70), 48% (95% CI, 37 to 59), and 48% (95% CI, 45 to 50). CONCLUSION Most relatives at risk for hereditary cancer do not undergo cascade genetic counseling and testing, forgoing potentially life-saving medical interventions. Compared with patient-mediated contact, direct relative contact increased rates of cascade genetic counseling and testing, arguing for a shift in the care delivery paradigm, to be confirmed by randomized controlled trials.
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Affiliation(s)
| | | | | | - Jenny Lin
- Weill Cornell Medicine, New York, NY
| | - Xuan Li
- Weill Cornell Medicine, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, New York, NY
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17
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Higgs E, Wain KE, Wynn J, Cho MT, Higgins S, Blaisdell D, Dugan D, Valek S, Cohen S. Measuring quality and value in genetic counseling: The current landscape and future directions. J Genet Couns 2022; 32:315-324. [PMID: 36385723 DOI: 10.1002/jgc4.1657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022]
Abstract
Genetic counselors strive to provide high-quality genetic services. To do so, it is essential to define quality in genetic counseling and identify opportunities for improvement. This Professional Issues article provides an overview of the evaluation of healthcare quality in genetic counseling. The National Society of Genetic Counselors' Research, Quality, and Outcomes Committee partnered with Discern Health, a value-based healthcare policy consulting firm, to develop a care continuum model of genetic counseling. Using the proposed model, currently available quality measures relevant to genetic counseling in the US healthcare system were assessed, allowing for the identification of gaps and priority areas for further development. A total of 560 quality measures were identified that can be applied to various aspects of the care continuum model across a range of clinical specialty areas in genetic counseling, although few measures were specific to genetic counseling or genetic conditions. Areas where quality measures were lacking included: attitudes toward genetic testing, family communication, stigma, and issues of justice, equity, diversity, and inclusion. We discuss these findings and other strategies for an evidence-based approach to quality in genetic counseling. Strategic directions for the genetic counseling profession should include a consolidated approach to research on quality and value of genetic counseling, development of quality metrics and patient-experience measures, and engagement with other improvement activities. These strategies will allow for benchmarking, performance improvement, and future implementation in accountability programs which will strengthen genetic counseling as a profession that provides evidence-based high-quality care to all patients.
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Affiliation(s)
- Emily Higgs
- Cardiovascular Genetics Program, University of California San Francisco California USA
| | | | - Julia Wynn
- Department of Pediatrics Columbia University Irving Medical Center New York New York USA
| | - Megan T. Cho
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health Bethesda Maryland USA
| | | | - David Blaisdell
- Discern Health, Part of Real Chemistry San Francisco California USA
| | - Donna Dugan
- Discern Health, Part of Real Chemistry San Francisco California USA
| | - Sara Valek
- Discern Health, Part of Real Chemistry San Francisco California USA
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18
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Relatives from Hereditary Breast and Ovarian Cancer and Lynch Syndrome Families Forgoing Genetic Testing: Findings from the Swiss CASCADE Cohort. J Pers Med 2022; 12:jpm12101740. [PMID: 36294879 PMCID: PMC9605198 DOI: 10.3390/jpm12101740] [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] [Received: 09/13/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
Cascade genetic testing of relatives from families with pathogenic variants associated with hereditary breast and ovarian cancer (HBOC) or Lynch syndrome (LS) has important implications for cancer prevention. We compared the characteristics of relatives from HBOC or LS families who did not have genetic testing (GT (−) group) with those who had genetic testing (GT (+) group), regardless of the outcome. Self-administered surveys collected cross-sectional data between September 2017 and December 2021 from relatives participating in the CASCADE cohort. We used multivariable logistic regression with LASSO variable selection. Among n = 115 relatives who completed the baseline survey, 38% (n = 44) were in the GT (−) group. Being male (OR: 2.79, 95% CI: 1.10–7.10) and without a previous cancer diagnosis (OR: 4.47, 95% CI: 1.03–19.42) increased the odds of being untested by almost three times. Individuals from families with fewer tested relatives had 29% higher odds of being untested (OR: 0.71, 95% CI: 0.55–0.92). Reasons for forgoing cascade testing were: lack of provider recommendation, lack of time and interest in testing, being afraid of discrimination, and high out-of-pocket costs. Multilevel interventions designed to increase awareness about clinical implications of HBOC and LS in males, referrals from non-specialists, and support for testing multiple family members could improve the uptake of cascade testing.
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19
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Whitaker KD, Obeid E, Daly MB, Hall MJ. Cascade Genetic Testing for Hereditary Cancer Risk: An Underutilized Tool for Cancer Prevention. JCO Precis Oncol 2022; 5:1387-1396. [PMID: 34994636 DOI: 10.1200/po.21.00163] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Kristen D Whitaker
- Department of Clinical Genetics, Fox Chase Cancer Center. Philadelphia, PA
| | - Elias Obeid
- Department of Clinical Genetics, Fox Chase Cancer Center. Philadelphia, PA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center. Philadelphia, PA
| | - Michael J Hall
- Department of Clinical Genetics, Fox Chase Cancer Center. Philadelphia, PA
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20
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Cragun D, Beckstead J, Farmer M, Hooker G, Dean M, Matloff E, Reid S, Tezak A, Weidner A, Whisenant JG, Pal T. IMProving care After inherited Cancer Testing (IMPACT) study: protocol of a randomized trial evaluating the efficacy of two interventions designed to improve cancer risk management and family communication of genetic test results. BMC Cancer 2021; 21:1099. [PMID: 34645413 PMCID: PMC8513202 DOI: 10.1186/s12885-021-08822-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Implementing genetic testing for inherited cancer predisposition into routine clinical care offers a tremendous opportunity for cancer prevention and early detection. However, genetic testing itself does not improve outcomes; rather, outcomes depend on implemented follow-up care. The IMPACT study is a hybrid type I randomized effectiveness-implementation trial to simultaneously evaluate the effectiveness of two interventions for individuals with inherited cancer predisposition focused on: 1) increasing family communication (FC) of genetic test results; and 2) improving engagement with guideline-based cancer risk management (CRM). METHODS This prospective study will recruit a racially, geographically, and socioeconomically diverse population of individuals with a documented pathogenic/likely pathogenic (P/LP) variant in an inherited cancer gene. Eligible participants will be asked to complete an initial trial survey and randomly assigned to one of three arms: A) GeneSHARE, a website designed to increase FC of genetic test results; B) My Gene Counsel's Living Lab Report, a digital tool designed to improve understanding of genetic test results and next steps, including CRM guidelines; or C) a control arm in which participants continue receiving standard care. Follow-up surveys will be conducted at 1, 3, and 12 months following randomization. These surveys include single-item measures, scales, and indices related to: 1) FC and CRM behaviors and behavioral factors following the COM-B theoretical framework (i.e., capability, opportunity, and motivation); 2) implementation outcomes (i.e., acceptability, appropriateness, exposure, and reach); and 3) other contextual factors (i.e., sociodemographic and clinical factors, and uncertainty, distress, and positive aspects of genetic test results). The primary outcomes are an increase in FC of genetic test results (Arm A) and improved engagement with guideline-based CRM without overtreatment or undertreatment (Arm B) by the 12-month follow-up survey. DISCUSSION Our interventions are designed to shift the paradigm by which individuals with P/LP variants in inherited cancer genes are provided with information to enhance FC of genetic test results and engagement with guideline-based CRM. The information gathered through evaluating the effectiveness and implementation of these real-world approaches is needed to modify and scale up adaptive, stepped interventions that have the potential to maximize FC and CRM. TRIAL REGISTRATION This study is registered at Clinicaltrials.gov (NCT04763915, date registered: February 21, 2021). PROTOCOL VERSION September 17th, 2021 Amendment Number 04.
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Affiliation(s)
- Deborah Cragun
- College of Public Health, University of South Florida, 13201 Bruce B Downs Boulevard, IDRB 304, Tampa, FL, 33612, USA
| | - Jason Beckstead
- College of Public Health, University of South Florida, 13201 Bruce B Downs Boulevard, IDRB 304, Tampa, FL, 33612, USA
| | - Meagan Farmer
- My Gene Counsel, PO Box 612, Branford, CT, 06405, USA
| | - Gillian Hooker
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Marleah Dean
- Department of Communication, University of South Florida, 4202 East Fowler Avenue, CIS 3043, Tampa, FL, 33620, USA
- Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Ellen Matloff
- My Gene Counsel, PO Box 612, Branford, CT, 06405, USA
| | - Sonya Reid
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Ann Tezak
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Anne Weidner
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Jennifer G Whisenant
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA
| | - Tuya Pal
- Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2810, Nashville, TN, 37212, USA.
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21
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Dwyer AA, Hesse-Biber S, Shea H, Zeng Z, Yi S. Coping response and family communication of cancer risk in men harboring a BRCA mutation: A mixed methods study. Psychooncology 2021; 31:486-495. [PMID: 34582073 DOI: 10.1002/pon.5831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Providing genetic counseling and genetic testing to at-risk blood relatives (cascade screening) is important for improving BRCA cancer outcomes. Intra-familial communication of risk is critical for cascade screening efforts yet relatively little is known about men's role in communicating BRCA risk. We sought to examine men's coping response to their BRCA status and intra-familial communication of risk to inform the development of tailored interventions that could promote cascade screening. METHODS We employed a sequential mixed-methods design. First, we measured coping response (quantitative) using the Multidimensional Impact of Cancer Risk Assessment (MICRA). MICRA scores were compared between BRCA+ men, BRCA- men and BRCA+ women. Subsequently, we used template analysis to analyze qualitative interviews exploring coping and intra-familial communication of risk. The Theory of Planned Behavior (TPB) served as a guiding framework for identifying intervention targets. RESULTS BRCA+ men (n = 36) had significantly higher levels of distress (p < 0.001), uncertainty (p < 0.001) and negative experiences (p < 0.05) compared to BRCA- male counterparts (n = 23). BRCA+ men had significantly lower distress (p < 0.001) and uncertainty (p < 0.001) than BRCA+ women (n = 406). Qualitative analysis of in-depth interviews with BRCA+ men (n = 35) identified promoters and barriers to active coping response and intra-familial communication of risk. Mapping results onto the TPB identified targets for tailoring person-centered approaches for men addressing beliefs/attitude, subjective norms, and perceived behavioral control. CONCLUSIONS Men and women appear to have different coping responses to learning their BRCA status. Developing tailored (sex-based), theory informed interventions may help promote intra-familial communication of BRCA risk and support cascade screening.
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Affiliation(s)
- Andrew A Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA.,Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Hannah Shea
- Department of Sociology, Boston College, Chestnut Hill, Massachusetts, USA
| | - Ziwei Zeng
- Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts, USA
| | - Shiya Yi
- Department of Measurement, Evaluation, Statistics and Assessment, Boston College, Chestnut Hill, Massachusetts, USA
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O'Neill SC, Hamilton JG, Conley CC, Peshkin BN, Sacca R, McDonnell GA, Isaacs C, Robson ME, Tercyak KP. Improving our model of cascade testing for hereditary cancer risk by leveraging patient peer support: a concept report. Hered Cancer Clin Pract 2021; 19:40. [PMID: 34565430 PMCID: PMC8474818 DOI: 10.1186/s13053-021-00198-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/16/2021] [Indexed: 01/22/2023] Open
Abstract
Consensus and evidence suggest that cascade testing is critical to achieve the promise of cancer genetic testing. However, barriers to cascade testing include effective family communication of genetic risk information and family members' ability to cope with genetic risk. These barriers are further complicated by the developmental needs of unaffected family members during critical windows for family communication and adaptation. Peer support could address these barriers. We provide two illustrative examples of ongoing BRCA1/2-related clinical trials that apply a peer support model to improve family communication and functioning. Peer support can augment currently available genetic services to facilitate adjustment to and effective use of cancer genetic risk information. Importantly, this scalable approach can address the presence of cancer risk within families across multiple developmental stages. This applies a family-centered perspective that accommodates all potentially at-risk relatives. This peer support model can be further applied to emerging topics in clinical genetics to expand reach and impact.
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Affiliation(s)
- Suzanne C O'Neill
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA.
| | | | - Claire C Conley
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA
| | - Beth N Peshkin
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA
| | - Rosalba Sacca
- Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA
| | - Mark E Robson
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - Kenneth P Tercyak
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA
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23
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Stuttgen Finn K, Pacyna JE, Tsou C, Samadder NJ, Sharp RR. Factors that Influence Intent to Share Genetic Information Related to Cancer Risk with Family Members. JOURNAL OF HEALTH COMMUNICATION 2021; 26:545-552. [PMID: 34473010 PMCID: PMC10869109 DOI: 10.1080/10810730.2021.1968078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We describe factors influencing patient decisions to share positive cancer genetic test results with family members. We focused on patients who were diagnosed with several different cancer types but did not have a family history that was suggestive of an inherited risk. Participants were recruited from Mayo Clinic and had been recently diagnosed with cancer. An 80+ gene panel was performed. Before receiving genetic test results, patients completed a 49-item survey on their intent to share their results with relatives. 1,721 (57.7%) of 2,984 individuals who elected to pursue genetic testing completed the survey. Most patients planned to share cancer-related genetic results with a spouse or partner (97.0%), at least one adult child (92.2%), at least one sibling (86.2%), and with at least one parent (70.3%). Familial support scores and familial communication scores were predictive of intent to share cancer-related genetic test results. Our data highlight differences in family communication capacity and support that are important for clinicians to consider when supporting patients who wish to share cancer-related genetic test results with family members. Our data point to several potential interventional strategies that might increase the likelihood of cancer-related genetic test results being shared with family members at risk.
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Affiliation(s)
- Kelsey Stuttgen Finn
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Cindy Tsou
- Center for Individualized Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Niloy J Samadder
- Center for Individualized Medicine, Mayo Clinic, Phoenix, Arizona, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Phoenix, Arizona, USA
- Department of Clinical Genomics, Mayo Clinic, Phoenix, Arizona, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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24
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Kast K, Häfner J, Schröck E, Jahn A, Werner C, Meisel C, Wimberger P. Recommendation and Acceptance of Counselling for Familial Cancer Risk in Newly Diagnosed Breast Cancer Cases. Breast Care (Basel) 2021; 17:153-158. [DOI: 10.1159/000517021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/11/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> In clinical routine, not every patient who is offered genetic counselling and diagnostics in order to investigate a familial cancer risk predisposition opts for it. Little is known about acceptance of counselling and testing in newly diagnosed breast cancer cases in Germany. <b><i>Methods:</i></b> All primary breast cancer cases and patients with DCIS (ductal carcinoma in situ) treated at the University Hospital of Dresden between 2016 and 2019 were included. The number of tumor board recommendations for genetic counselling on the basis of the GC-HBOC risk criteria was recorded. Acceptance was analyzed by number of cases with counselling in the GC-HBOC-Center Dresden. <b><i>Results:</i></b> Of 996 primary breast cancer and DCIS cases, 262 (26.3%) were eligible for genetic counselling. Recommendation for genetic counselling was accepted by 64.1% (168/262). Of these 90.5% (152/168) opted for molecular genetic analysis. The acceptance rate for counselling increased between 2016 and 2019 from 58.3 to 72.6%. Altogether, 20.4% (31/152) patients were found to carry a pathogenic variant in the breast cancer genes <i>BRCA1</i> or <i>BRCA2</i>. <b><i>Conclusion:</i></b> Acceptance of recommendation is increasing as clinical consequences augment. Optimization in providing information about hereditary cancer risk and in accessibility of counselling and testing is required to further improve acceptance of recommendation.
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25
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Response to Carlson. Genet Med 2021; 23:1169-1170. [PMID: 33758374 DOI: 10.1038/s41436-020-01095-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/29/2020] [Indexed: 11/08/2022] Open
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26
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Vuković P, Peccatori FA, Massarotti C, Miralles MS, Beketić-Orešković L, Lambertini M. Preimplantation genetic testing for carriers of BRCA1/2 pathogenic variants. Crit Rev Oncol Hematol 2020; 157:103201. [PMID: 33333149 DOI: 10.1016/j.critrevonc.2020.103201] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/12/2022] Open
Abstract
The detection of germline BRCA1/2 pathogenic variant has relevant implications for the patients and their family members. Family planning, prophylactic surgery and the possibility of preimplantation genetic testing for monogenic disorders (PGT-M) to avoid transmittance of pathogenic variants to the offspring are relevant topics in this setting. PGT-M is valuable option for BRCA carriers, but it remains a controversial and underdiscussed topic. Although the advances in PGT technologies have improved pregnancy rate, there are still several important challenges associated with its use. The purpose of this review is to report the current evidence on PGT-M for BRCA1/2 carriers, ethical concerns and controversy associated with its use, reproductive implications of BRCA pathogenic variants, underlying areas in which an educational effort would be beneficial as well as possibilities for future research efforts in the field.
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Affiliation(s)
- Petra Vuković
- Division of Radiotherapy and Medical Oncology, University Hospital for Tumors, University Hospital Center Sestre Milosrdnice, Zagreb, 10000, Croatia.
| | - Fedro Alessandro Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Program, IEO European Institute of Oncology IRCCS, Milan, 20125, Italy.
| | - Claudia Massarotti
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, 16132, Italy.
| | | | - Lidija Beketić-Orešković
- Division of Radiotherapy and Medical Oncology, University Hospital for Tumors, University Hospital Center Sestre Milosrdnice, Zagreb, 10000, Croatia; Department of Clinical Oncology, School of Medicine, University of Zagreb, Zagreb, 10000, Croatia.
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, 16132, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, 16126, Italy.
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27
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Cragun D, Weidner A, Tezak A, Clouse K, Pal T. Family communication of genetic test results among women with inherited breast cancer genes. J Genet Couns 2020; 30:701-709. [PMID: 33174380 DOI: 10.1002/jgc4.1356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/01/2020] [Accepted: 10/07/2020] [Indexed: 01/12/2023]
Abstract
Identification of inherited breast cancer may guide care. These benefits can be amplified through communication of genetic test results with at-risk family members and subsequent family testing (FT). Females with a pathogenic/likely pathogenic (P/LP) variant in BRCA1/2, PALB2, CHEK2, and/or ATM were surveyed about family communication (FC) of genetic test results and FT. Comparisons were made across genes. The 235 participants with P/LP variants (186 BRCA1/2, 28 PALB2, 15 CHEK2, and 6 ATM) had a median age of 54 and most were non-Hispanic whites (89%) with a prior breast cancer diagnosis (61%). When controlling for other variables, FC was higher among younger participants (p<.0001), those with high FC self-efficacy (p=.019), and those with P/LP variants in BRCA1/2 compared to PALB2 (p =.040) and ATM/CHEK2 (p =.032). Higher rates of FC and FT were also observed among female relatives and relatives of closer kinship. Overall 94% of participants would find one or more resources helpful with FC and 70% reported using FC resources when telling family members about their genetic test result. The three most commonly used resources included the following: (a) a family sharing letter (38%); (b) printed materials (30%); and (c) web-based information (23%). Among the 86% who spoke with a genetic counselor (GC), 93% were given at least one FC resource and the three most common resources GCs provided to participants overlapped with the resources participants would find helpful and those that were used. Our results suggest lower FC and FT rates among women with P/LP variants in genes other than BRCA1/2, the reasons for which should be evaluated in future studies. As more data to refine cancer risks and management are generated across these other inherited breast cancer genes, strategies to improve FC and FT are needed to amplify the benefits of genetic testing.
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Affiliation(s)
- Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Anne Weidner
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ann Tezak
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kate Clouse
- Vanderbilt Institute for Global Health, Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Tuya Pal
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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28
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Pollard S, Kalloger S, Weymann D, Sun S, Nuk J, Schrader KA, Regier DA. Genetic testing for hereditary cancer syndromes: patient recommendations for improved risk communication. Health Expect 2020; 23:884-892. [PMID: 32338425 PMCID: PMC7495068 DOI: 10.1111/hex.13062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/18/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022] Open
Abstract
Background Multi‐gene panel testing is replacing single‐gene testing for patients with suspected hereditary cancer syndromes. The detection of a hereditary cancer syndrome allows tested individuals to initiate enhanced primary and secondary prevention efforts—where available—with a view to reduce disease burden. Current policy prevents testing programmes from communicating genetic test results with potentially affected family members, yet it is well documented that tested individuals face multiple challenges in initiating such discussions with relatives. Objective In response to this challenge, we sought patient recommendations about how to improve genetic risk communication to enhance interfamilial discussions about primary and secondary disease prevention. Design We conducted 25 semi‐structured interviews with individuals who received genetic testing through British Columbia’s Hereditary Cancer Program between 2017 and 2018. Interviews were professionally transcribed and analysed using a constant comparative approach. Results Participants described difficulty engaging in conversations with relatives who were resistant to receiving genetic risk information, when communicating with younger relatives and where participants reported strained familial relationships. Participants recommended that testing facilities provide a summary of results and implications and that resources be made available to prepare patients for challenging discussions with family members. Discussion Our study demonstrates that individuals undergoing genetic testing for suspected hereditary cancer syndromes would benefit from additional supportive resources alongside genetic counselling. Providing this on‐going support will enhance the accurate and transparent communication of risk to facilitate the uptake of cascade testing and enhanced prevention strategies.
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Affiliation(s)
- Samantha Pollard
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Steve Kalloger
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deirdre Weymann
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Sophie Sun
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada.,Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Nuk
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada.,Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kasmintan A Schrader
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada.,Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Molecular Oncology, BC Cancer, Vancouver, BC, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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