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Nguyen NH, Dodd-Eaton EB, Corredor JL, Woodman-Ross J, Green S, Gutierrez AM, Arun BK, Wang W. Validating Risk Prediction Models for Multiple Primaries and Competing Cancer Outcomes in Families With Li-Fraumeni Syndrome Using Clinically Ascertained Data. J Clin Oncol 2024:JCO2301926. [PMID: 38569124 DOI: 10.1200/jco.23.01926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/02/2023] [Accepted: 02/07/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE There exists a barrier between developing and disseminating risk prediction models in clinical settings. We hypothesize that this barrier may be lifted by demonstrating the utility of these models using incomplete data that are collected in real clinical sessions, as compared with the commonly used research cohorts that are meticulously collected. MATERIALS AND METHODS Genetic counselors (GCs) collect family history when patients (ie, probands) come to MD Anderson Cancer Center for risk assessment of Li-Fraumeni syndrome, a genetic disorder characterized by deleterious germline mutations in the TP53 gene. Our clinical counseling-based (CCB) cohort consists of 3,297 individuals across 124 families (522 cases of single primary cancer and 125 cases of multiple primary cancers). We applied our software suite LFSPRO to make risk predictions and assessed performance in discrimination using AUC and in calibration using observed/expected (O/E) ratio. RESULTS For prediction of deleterious TP53 mutations, we achieved an AUC of 0.78 (95% CI, 0.71 to 0.85) and an O/E ratio of 1.66 (95% CI, 1.53 to 1.80). Using the LFSPRO.MPC model to predict the onset of the second cancer, we obtained an AUC of 0.70 (95% CI, 0.58 to 0.82). Using the LFSPRO.CS model to predict the onset of different cancer types as the first primary, we achieved AUCs between 0.70 and 0.83 for sarcoma, breast cancer, or other cancers combined. CONCLUSION We describe a study that fills in the critical gap in knowledge for the utility of risk prediction models. Using a CCB cohort, our previously validated models have demonstrated good performance and outperformed the standard clinical criteria. Our study suggests that better risk counseling may be achieved by GCs using these already-developed mathematical models.
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Affiliation(s)
- Nam H Nguyen
- The University of Texas MD Anderson Cancer Center, Department of Bioinformatics and Computation Biology, Houston, TX
- Rice University, Department of Statistics, Houston, TX
| | - Elissa B Dodd-Eaton
- The University of Texas MD Anderson Cancer Center, Department of Bioinformatics and Computation Biology, Houston, TX
| | - Jessica L Corredor
- The University of Texas MD Anderson Cancer Center, Department of Clinical Cancer Genetics, Houston, TX
| | - Jacynda Woodman-Ross
- The University of Texas MD Anderson Cancer Center, Department of Clinical Cancer Genetics, Houston, TX
| | - Sierra Green
- The University of Texas MD Anderson Cancer Center, Department of Clinical Cancer Genetics, Houston, TX
| | - Angelica M Gutierrez
- The University of Texas MD Anderson Cancer Center, Department of Breast Medical Oncology, Houston, TX
| | - Banu K Arun
- The University of Texas MD Anderson Cancer Center, Department of Clinical Cancer Genetics, Houston, TX
- The University of Texas MD Anderson Cancer Center, Department of Breast Medical Oncology, Houston, TX
| | - Wenyi Wang
- The University of Texas MD Anderson Cancer Center, Department of Bioinformatics and Computation Biology, Houston, TX
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Speiser D, Bick U. Primary Prevention and Early Detection of Hereditary Breast Cancer. Breast Care (Basel) 2023; 18:448-454. [PMID: 38125920 PMCID: PMC10730103 DOI: 10.1159/000533391] [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: 04/16/2023] [Accepted: 08/01/2023] [Indexed: 12/23/2023] Open
Abstract
Background Primary prevention and early detection of hereditary breast cancer has been one of the main topics of breast cancer research in recent decades. The knowledge of risk factors for breast cancer has been increasing continuously just like the recommendations for risk management. Pathogenic germline variants (mutations, class 4/5) of risk genes are significant susceptibility factors in healthy individuals. At the same time, germline mutations serve as biomarkers for targeted therapy in breast cancer treatment. Therefore, management of healthy mutation carriers to enable primary prevention is in the focus as much as the consideration of pathogenic germline variants for therapeutic decisions. Since 1996, the German Consortium has provided quality-assured care for counselees and patients with familial burden of breast and ovarian cancer. Summary Currently, there are 23 university centers with over 100 cooperating DKG-certified breast and gynecological cancer centers. These centers provide standardized, evidence-based, and knowledge-generating care, which includes aspects of primary as well as secondary and tertiary prevention. An important aspect of quality assurance and development was the inclusion of the HBOC centers in the certification system of the German Cancer Society (GCS). Since 2020, the centers have been regularly audited and their quality standards continuously reviewed according to quality indicators adapted to the current state of research. The standard of care at GC-HBOC' centers involves the evaluation as well as evolution of various aspects of care like inclusion criteria, identification of new risk genes, management of variants of unknown significance (class 3), evaluation of risk-reducing options, intensified surveillance, and communication of risks. Among these, the possibility of intensified surveillance in the GC-HBOC for early detection of breast cancer is an important component of individual risk management for many counselees. As has been shown in recent years, in carriers of pathogenic variants in high-risk genes, this approach enables the detection of breast cancer at very early, more favorable stages although no reduction of mortality has been demonstrated yet. The key component of the intensified surveillance is annual contrast-enhanced breast MRI, supplemented by up to biannual breast ultrasound and mammography usually starting at age 40. Key Messages Apart from early detection, the central goal of care is the prevention of cancer. By utilizing individualized risk calculation, the optimal timeframe for risk-reducing surgery can be estimated, and counselees can be supported in reaching preference-sensitive decisions.
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Affiliation(s)
- Dorothee Speiser
- HBOC-Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Bick
- HBOC-Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Nguyen NH, Dodd-Eaton EB, Corredor JL, Woodman-Ross J, Green S, Hernandez ND, Gutierrez Barrera AM, Arun BK, Wang W. Validating risk prediction models for multiple primaries and competing cancer outcomes in families with Li-Fraumeni syndrome using clinically ascertained data at a single institute. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.31.23294849. [PMID: 37693464 PMCID: PMC10491358 DOI: 10.1101/2023.08.31.23294849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Purpose There exists a barrier between developing and disseminating risk prediction models in clinical settings. We hypothesize this barrier may be lifted by demonstrating the utility of these models using incomplete data that are collected in real clinical sessions, as compared to the commonly used research cohorts that are meticulously collected. Patients and methods Genetic counselors (GCs) collect family history when patients (i.e., probands) come to MD Anderson Cancer Center for risk assessment of Li-Fraumeni syndrome, a genetic disorder characterized by deleterious germline mutations in the TP53 gene. Our clinical counseling-based (CCB) cohort consists of 3,297 individuals across 124 families (522 cases of single primary cancer and 125 cases of multiple primary cancers). We applied our software suite LFSPRO to make risk predictions and assessed performance in discrimination using area under the curve (AUC), and in calibration using observed/expected (O/E) ratio. Results For prediction of deleterious TP53 mutations, we achieved an AUC of 0.81 (95% CI, 0.70 - 0.91) and an O/E ratio of 0.96 (95% CI, 0.70 - 1.21). Using the LFSPRO.MPC model to predict the onset of the second cancer, we obtained an AUC of 0.70 (95% CI, 0.58 - 0.82). Using the LFSPRO.CS model to predict the onset of different cancer types as the first primary, we achieved AUCs between 0.70 and 0.83 for sarcoma, breast cancer, or other cancers combined. Conclusion We describe a study that fills in the critical gap in knowledge for the utility of risk prediction models. Using a CCB cohort, our previously validated models have demonstrated good performance and outperformed the standard clinical criteria. Our study suggests better risk counseling may be achieved by GCs using these already-developed mathematical models.
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Affiliation(s)
- Nam H. Nguyen
- The University of Texas MD Anderson Cancer Center, Department of Bioinformatics and Computation Biology, Houston, TX
- Rice University, Department of Statistics, Houston, TX
| | - Elissa B. Dodd-Eaton
- The University of Texas MD Anderson Cancer Center, Department of Bioinformatics and Computation Biology, Houston, TX
| | - Jessica L. Corredor
- The University of Texas MD Anderson Cancer Center, Department of Clinical Cancer Genetics, Houston, TX
| | - Jacynda Woodman-Ross
- The University of Texas MD Anderson Cancer Center, Department of Clinical Cancer Genetics, Houston, TX
| | - Sierra Green
- The University of Texas MD Anderson Cancer Center, Department of Clinical Cancer Genetics, Houston, TX
| | - Nathaniel D. Hernandez
- The University of Texas MD Anderson Cancer Center, Department of Clinical Cancer Genetics, Houston, TX
| | | | - Banu K. Arun
- The University of Texas MD Anderson Cancer Center, Department of Breast Medical Oncology, Houston, TX
| | - Wenyi Wang
- The University of Texas MD Anderson Cancer Center, Department of Bioinformatics and Computation Biology, Houston, TX
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Møller NB, Boonen DS, Feldner ES, Hao Q, Larsen M, Lænkholm AV, Borg Å, Kvist A, Törngren T, Jensen UB, Boonen SE, Thomassen M, Terkelsen T. Validation of the BOADICEA model for predicting the likelihood of carrying pathogenic variants in eight breast and ovarian cancer susceptibility genes. Sci Rep 2023; 13:8536. [PMID: 37237042 PMCID: PMC10220031 DOI: 10.1038/s41598-023-35755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/23/2023] [Indexed: 05/28/2023] Open
Abstract
BOADICEA is a comprehensive risk prediction model for breast and/or ovarian cancer (BC/OC) and for carrying pathogenic variants (PVs) in cancer susceptibility genes. In addition to BRCA1 and BRCA2, BOADICEA version 6 includes PALB2, CHEK2, ATM, BARD1, RAD51C and RAD51D. To validate its predictions for these genes, we conducted a retrospective study including 2033 individuals counselled at clinical genetics departments in Denmark. All counselees underwent comprehensive genetic testing by next generation sequencing on suspicion of hereditary susceptibility to BC/OC. Likelihoods of PVs were predicted from information about diagnosis, family history and tumour pathology. Calibration was examined using the observed-to-expected ratio (O/E) and discrimination using the area under the receiver operating characteristics curve (AUC). The O/E was 1.11 (95% CI 0.97-1.26) for all genes combined. At sub-categories of predicted likelihood, the model performed well with limited misestimation at the extremes of predicted likelihood. Discrimination was acceptable with an AUC of 0.70 (95% CI 0.66-0.74), although discrimination was better for BRCA1 and BRCA2 than for the other genes in the model. This suggests that BOADICEA remains a valid decision-making aid for determining which individuals to offer comprehensive genetic testing for hereditary susceptibility to BC/OC despite suboptimal calibration for individual genes in this population.
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Affiliation(s)
- Nanna Bæk Møller
- Department of Clinical Genetics, Aarhus University Hospital, Brendstrupgårdsvej 21, 8200, Aarhus N, Denmark
| | - Desirée Sofie Boonen
- Department of Clinical Genetics, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Elisabeth Simone Feldner
- Department of Clinical Genetics, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Qin Hao
- Department of Clinical Genetics, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Martin Larsen
- Department of Clinical Genetics, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Anne-Vibeke Lænkholm
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Åke Borg
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anders Kvist
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Therese Törngren
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Uffe Birk Jensen
- Department of Clinical Genetics, Aarhus University Hospital, Brendstrupgårdsvej 21, 8200, Aarhus N, Denmark
| | - Susanne Eriksen Boonen
- Department of Clinical Genetics, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.
| | - Thorkild Terkelsen
- Department of Clinical Genetics, Aarhus University Hospital, Brendstrupgårdsvej 21, 8200, Aarhus N, Denmark.
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De Silva DL, Stafford L, Skandarajah AR, Sinclair M, Devereux L, Hogg K, Kentwell M, Park A, Lal L, Zethoven M, Jayawardana MW, Chan F, Butow PN, James PA, Mann GB, Campbell IG, Lindeman GJ. Universal genetic testing for women with newly diagnosed breast cancer in the context of multidisciplinary team care. Med J Aust 2023; 218:368-373. [PMID: 37005005 PMCID: PMC10952347 DOI: 10.5694/mja2.51906] [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: 09/07/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE To determine the feasibility of universal genetic testing of women with newly diagnosed breast cancer, to estimate the incidence of pathogenic gene variants and their impact on patient management, and to evaluate patient and clinician acceptance of universal testing. DESIGN, SETTING, PARTICIPANTS Prospective study of women with invasive or high grade in situ breast cancer and unknown germline status discussed at the Parkville Breast Service (Melbourne) multidisciplinary team meeting. Women were recruited to the pilot (12 June 2020 - 22 March 2021) and expansion phases (17 October 2021 - 8 November 2022) of the Mutational Assessment of newly diagnosed breast cancer using Germline and tumour genomICs (MAGIC) study. MAIN OUTCOME MEASURES Germline testing by DNA sequencing, filtered for nineteen hereditary breast and ovarian cancer genes that could be classified as actionable; only pathogenic variants were reported. Surveys before and after genetic testing assessed pilot phase participants' perceptions of genetic testing, and psychological distress and cancer-specific worry. A separate survey assessed clinicians' views on universal testing. RESULTS Pathogenic germline variants were identified in 31 of 474 expanded study phase participants (6.5%), including 28 of 429 women with invasive breast cancer (6.5%). Eighteen of the 31 did not meet current genetic testing eligibility guidelines (probability of a germline pathogenic variant ≥ 10%, based on CanRisk, or Manchester score ≥ 15). Clinical management was changed for 24 of 31 women after identification of a pathogenic variant. Including 68 further women who underwent genetic testing outside the study, 44 of 542 women carried pathogenic variants (8.1%). Acceptance of universal testing was high among both patients (90 of 103, 87%) and clinicians; no decision regret or adverse impact on psychological distress or cancer-specific worry were reported. CONCLUSION Universal genetic testing following the diagnosis of breast cancer detects clinically significant germline pathogenic variants that might otherwise be missed because of testing guidelines. Routine testing and reporting of pathogenic variants is feasible and acceptable for both patients and clinicians.
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Affiliation(s)
- Dilanka L De Silva
- The University of MelbourneMelbourneVIC
- Parkville Familial Cancer CentrePeter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneVIC
- Memorial Sloan Kettering Cancer CenterNew YorkNYUnited States of America
| | - Lesley Stafford
- The University of MelbourneMelbourneVIC
- The Royal Melbourne HospitalMelbourneVIC
| | - Anita R Skandarajah
- The University of MelbourneMelbourneVIC
- The Royal Melbourne HospitalMelbourneVIC
| | | | - Lisa Devereux
- The University of MelbourneMelbourneVIC
- Peter MacCallum Cancer CentreMelbourneVIC
| | - Kirsten Hogg
- The University of MelbourneMelbourneVIC
- Walter and Eliza Hall Institute of Medical ResearchMelbourneVIC
| | - Maira Kentwell
- The University of MelbourneMelbourneVIC
- Parkville Familial Cancer CentrePeter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneVIC
| | - Allan Park
- The Royal Melbourne HospitalMelbourneVIC
| | - Luxi Lal
- The Royal Melbourne HospitalMelbourneVIC
- Peter MacCallum Cancer CentreMelbourneVIC
- Walter and Eliza Hall Institute of Medical ResearchMelbourneVIC
| | | | - Madawa W Jayawardana
- The University of MelbourneMelbourneVIC
- Peter MacCallum Cancer CentreMelbourneVIC
| | - Fiona Chan
- The Royal Children's Hospital MelbourneMelbourneVIC
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence‐based Decision Making, the University of SydneySydneyNSW
| | - Paul A James
- The University of MelbourneMelbourneVIC
- Parkville Familial Cancer CentrePeter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneVIC
- The Royal Melbourne HospitalMelbourneVIC
- Peter MacCallum Cancer CentreMelbourneVIC
| | - G Bruce Mann
- The University of MelbourneMelbourneVIC
- The Royal Melbourne HospitalMelbourneVIC
- Royal Women's HospitalMelbourneVIC
| | - Ian G Campbell
- The University of MelbourneMelbourneVIC
- Peter MacCallum Cancer CentreMelbourneVIC
| | - Geoffrey J Lindeman
- The University of MelbourneMelbourneVIC
- Parkville Familial Cancer CentrePeter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneVIC
- Peter MacCallum Cancer CentreMelbourneVIC
- Walter and Eliza Hall Institute of Medical ResearchMelbourneVIC
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Ding YC, Adamson AW, Bakhtiari M, Patrick C, Park J, Laitman Y, Weitzel JN, Bafna V, Friedman E, Neuhausen SL. Variable number tandem repeats (VNTRs) as modifiers of breast cancer risk in carriers of BRCA1 185delAG. Eur J Hum Genet 2023; 31:216-222. [PMID: 36434258 PMCID: PMC9905572 DOI: 10.1038/s41431-022-01238-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/10/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
Despite substantial efforts in identifying both rare and common variants affecting disease risk, in the majority of diseases, a large proportion of unexplained genetic risk remains. We propose that variable number tandem repeats (VNTRs) may explain a proportion of the missing genetic risk. Herein, in a pilot study with a retrospective cohort design, we tested whether VNTRs are causal modifiers of breast cancer risk in 347 female carriers of the BRCA1 185delAG pathogenic variant, an important group given their high risk of developing breast cancer. We performed targeted-capture to sequence VNTRs, called genotypes with adVNTR, tested the association of VNTRs and breast cancer risk using Cox regression models, and estimated the effect size using a retrospective likelihood approach. Of 303 VNTRs that passed quality control checks, 4 VNTRs were significantly associated with risk to develop breast cancer at false discovery rate [FDR] < 0.05 and an additional 4 VNTRs had FDR < 0.25. After determining the specific risk alleles, there was a significantly earlier age at diagnosis of breast cancer in carriers of the risk alleles compared to those without the risk alleles for seven of eight VNTRs. One example is a VNTR in exon 2 of LINC01973 with a per-allele hazard ratio of 1.58 (1.07-2.33) and 5.28 (2.79-9.99) for the homozygous risk-allele genotype. Results from this first systematic study of VNTRs demonstrate that VNTRs may explain a proportion of the unexplained genetic risk for breast cancer.
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Affiliation(s)
- Yuan Chun Ding
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Aaron W Adamson
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Mehrdad Bakhtiari
- Department of Computer Science and Engineering, University of California San Diego, San Diego, CA, USA
| | - Carmina Patrick
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Jonghun Park
- Department of Computer Science and Engineering, University of California San Diego, San Diego, CA, USA
| | - Yael Laitman
- Oncogenetics Unit, Institute of Human Genetics, Sheba Medical Center, Ramat Gan, Israel
| | - Jeffrey N Weitzel
- Latin American School of Oncology, Tuxla Gutierrez, Chiapas, MX and Natera, San Carlos, CA, USA
| | - Vineet Bafna
- Department of Computer Science and Engineering, University of California San Diego, San Diego, CA, USA
| | - Eitan Friedman
- Oncogenetics Unit, Institute of Human Genetics, Sheba Medical Center, Ramat Gan, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Center for Preventive Personalized Medicine, Assuta Medical Center, Tel Aviv, Israel
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA.
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Yurgelun MB, Uno H, Furniss CS, Ukaegbu C, Horiguchi M, Yussuf A, LaDuca H, Chittenden A, Garber JE, Syngal S. Development and Validation of the PREMMplus Model for Multigene Hereditary Cancer Risk Assessment. J Clin Oncol 2022; 40:4083-4094. [PMID: 35960913 PMCID: PMC9746785 DOI: 10.1200/jco.22.00120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE With the availability of multigene panel testing (MGPT) for hereditary cancer risk assessment, clinicians need to assess the likelihood of pathogenic germline variants (PGVs) across numerous genes in parallel. This study's aim was to develop and validate a clinical prediction model (PREMMplus) for MGPT risk assessment. MATERIALS AND METHODS PREMMplus was developed in a single-institution cohort of 7,280 individuals who had undergone MGPT. Logistic regression models with Least Absolute Shrinkage and Selection Operator regularization were used to examine candidate predictors (age, sex, ethnicity, and personal/family history of 18 cancers/neoplasms) to estimate one's likelihood of carrying PGVs in 19 genes (broadly categorized by phenotypic overlap and/or relative penetrance: 11 category A [APC, BRCA1/2, CDH1, EPCAM, MLH1, MSH2, MSH6, biallelic MUTYH, PMS2, and TP53] and eight category B genes [ATM, BRIP1, CDKN2A, CHEK2, PALB2, PTEN, RAD51C, and RAD51D]). Model performance was validated in nonoverlapping data sets of 8,691 and 14,849 individuals with prior MGPT ascertained from clinic- and laboratory-based settings, respectively. RESULTS PREMMplus (score ≥ 2.5%) had 93.9%, 91.7%, and 89.3% sensitivity and 98.3%, 97.5%, and 97.8% negative-predictive value (NPV) for identifying category A gene PGV carriers in the development and validation cohorts, respectively. PREMMplus assessment (score ≥ 2.5%) had 89.9%, 85.6%, and 84.2% sensitivity and 95.0%, 93.5%, and 93.5% NPV, respectively, for identifying category A/B gene PGV carriers. Decision curve analyses support MGPT for individuals predicted to have ≥ 2.5% probability of a PGV. CONCLUSION PREMMplus accurately identifies individuals with PGVs in a diverse spectrum of cancer susceptibility genes with high sensitivity/NPV. Individuals with PREMMplus scores ≥ 2.5% should be considered for MGPT.
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Affiliation(s)
- Matthew B. Yurgelun
- Dana-Farber Cancer Institute, Boston, MA,Harvard Medical School, Boston, MA,Brigham & Women's Hospital, Boston, MA
| | - Hajime Uno
- Dana-Farber Cancer Institute, Boston, MA,Harvard Medical School, Boston, MA
| | | | | | - Miki Horiguchi
- Dana-Farber Cancer Institute, Boston, MA,Harvard Medical School, Boston, MA
| | | | | | | | - Judy E. Garber
- Dana-Farber Cancer Institute, Boston, MA,Harvard Medical School, Boston, MA,Brigham & Women's Hospital, Boston, MA
| | - Sapna Syngal
- Dana-Farber Cancer Institute, Boston, MA,Harvard Medical School, Boston, MA,Brigham & Women's Hospital, Boston, MA,Sapna Syngal, MD, MPH, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215; Twitter: @SapnaSyngal; e-mail:
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8
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Paduano F, Colao E, Fabiani F, Rocca V, Dinatolo F, Dattola A, D’Antona L, Amato R, Trapasso F, Baudi F, Perrotti N, Iuliano R. Germline Testing in a Cohort of Patients at High Risk of Hereditary Cancer Predisposition Syndromes: First Two-Year Results from South Italy. Genes (Basel) 2022; 13:genes13071286. [PMID: 35886069 PMCID: PMC9319682 DOI: 10.3390/genes13071286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
Germline pathogenic variants (PVs) in oncogenes and tumour suppressor genes are responsible for 5 to 10% of all diagnosed cancers, which are commonly known as hereditary cancer predisposition syndromes (HCPS). A total of 104 individuals at high risk of HCPS were selected by genetic counselling for genetic testing in the past 2 years. Most of them were subjects having a personal and family history of breast cancer (BC) selected according to current established criteria. Genes analysis involved in HCPS was assessed by next-generation sequencing (NGS) using a custom cancer panel with high- and moderate-risk susceptibility genes. Germline PVs were identified in 17 of 104 individuals (16.3%) analysed, while variants of uncertain significance (VUS) were identified in 21/104 (20.2%) cases. Concerning the germline PVs distribution among the 13 BC individuals with positive findings, 8/13 (61.5%) were in the BRCA1/2 genes, whereas 5/13 (38.4%) were in other high- or moderate-risk genes including PALB2, TP53, ATM and CHEK2. NGS genetic testing showed that 6/13 (46.1%) of the PVs observed in BC patients were detected in triple-negative BC. Interestingly, the likelihood of carrying the PVs in the moderate-to-high-risk genes calculated by the cancer risk model BOADICEA was significantly higher in pathogenic variant carriers than in negative subjects. Collectively, this study shows that multigene panel testing can offer an effective diagnostic approach for patients at high risk of hereditary cancers.
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Affiliation(s)
- Francesco Paduano
- Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro, Italy; (E.C.); (F.F.); (V.R.); (F.D.); (A.D.); (L.D.); (R.A.); (F.T.); (F.B.); (N.P.)
- Department of Health Sciences, Campus S. Venuta, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
- Stem Cells and Medical Genetics Units, Tecnologica Research Institute and Marrelli Health, 88900 Crotone, Italy
- Correspondence: (F.P.); (R.I.)
| | - Emma Colao
- Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro, Italy; (E.C.); (F.F.); (V.R.); (F.D.); (A.D.); (L.D.); (R.A.); (F.T.); (F.B.); (N.P.)
| | - Fernanda Fabiani
- Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro, Italy; (E.C.); (F.F.); (V.R.); (F.D.); (A.D.); (L.D.); (R.A.); (F.T.); (F.B.); (N.P.)
| | - Valentina Rocca
- Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro, Italy; (E.C.); (F.F.); (V.R.); (F.D.); (A.D.); (L.D.); (R.A.); (F.T.); (F.B.); (N.P.)
- Department of Experimental and Clinical Medicine, Campus S. Venuta, University Magna Graecia of Catanzaro, Viale Europa, Località Germaneto, 88100 Catanzaro, Italy
| | - Francesca Dinatolo
- Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro, Italy; (E.C.); (F.F.); (V.R.); (F.D.); (A.D.); (L.D.); (R.A.); (F.T.); (F.B.); (N.P.)
| | - Adele Dattola
- Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro, Italy; (E.C.); (F.F.); (V.R.); (F.D.); (A.D.); (L.D.); (R.A.); (F.T.); (F.B.); (N.P.)
| | - Lucia D’Antona
- Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro, Italy; (E.C.); (F.F.); (V.R.); (F.D.); (A.D.); (L.D.); (R.A.); (F.T.); (F.B.); (N.P.)
- Department of Health Sciences, Campus S. Venuta, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Rosario Amato
- Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro, Italy; (E.C.); (F.F.); (V.R.); (F.D.); (A.D.); (L.D.); (R.A.); (F.T.); (F.B.); (N.P.)
- Department of Health Sciences, Campus S. Venuta, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Francesco Trapasso
- Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro, Italy; (E.C.); (F.F.); (V.R.); (F.D.); (A.D.); (L.D.); (R.A.); (F.T.); (F.B.); (N.P.)
- Department of Experimental and Clinical Medicine, Campus S. Venuta, University Magna Graecia of Catanzaro, Viale Europa, Località Germaneto, 88100 Catanzaro, Italy
| | - Francesco Baudi
- Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro, Italy; (E.C.); (F.F.); (V.R.); (F.D.); (A.D.); (L.D.); (R.A.); (F.T.); (F.B.); (N.P.)
- Department of Health Sciences, Campus S. Venuta, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Nicola Perrotti
- Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro, Italy; (E.C.); (F.F.); (V.R.); (F.D.); (A.D.); (L.D.); (R.A.); (F.T.); (F.B.); (N.P.)
- Department of Health Sciences, Campus S. Venuta, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Rodolfo Iuliano
- Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro, Italy; (E.C.); (F.F.); (V.R.); (F.D.); (A.D.); (L.D.); (R.A.); (F.T.); (F.B.); (N.P.)
- Department of Health Sciences, Campus S. Venuta, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
- Correspondence: (F.P.); (R.I.)
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9
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Liberto JM, Chen SY, Shih IM, Wang TH, Wang TL, Pisanic TR. Current and Emerging Methods for Ovarian Cancer Screening and Diagnostics: A Comprehensive Review. Cancers (Basel) 2022; 14:2885. [PMID: 35740550 PMCID: PMC9221480 DOI: 10.3390/cancers14122885] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023] Open
Abstract
With a 5-year survival rate of less than 50%, ovarian high-grade serous carcinoma (HGSC) is one of the most highly aggressive gynecological malignancies affecting women today. The high mortality rate of HGSC is largely attributable to delays in diagnosis, as most patients remain undiagnosed until the late stages of -disease. There are currently no recommended screening tests for ovarian cancer and there thus remains an urgent need for new diagnostic methods, particularly those that can detect the disease at early stages when clinical intervention remains effective. While diagnostics for ovarian cancer share many of the same technical hurdles as for other cancer types, the low prevalence of the disease in the general population, coupled with a notable lack of sensitive and specific biomarkers, have made the development of a clinically useful screening strategy particularly challenging. Here, we present a detailed review of the overall landscape of ovarian cancer diagnostics, with emphasis on emerging methods that employ novel protein, genetic, epigenetic and imaging-based biomarkers and/or advanced diagnostic technologies for the noninvasive detection of HGSC, particularly in women at high risk due to germline mutations such as BRCA1/2. Lastly, we discuss the translational potential of these approaches for achieving a clinically implementable solution for screening and diagnostics of early-stage ovarian cancer as a means of ultimately improving patient outcomes in both the general and high-risk populations.
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Affiliation(s)
- Juliane M. Liberto
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; (J.M.L.); (I.-M.S.); (T.-L.W.)
| | - Sheng-Yin Chen
- School of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan;
| | - Ie-Ming Shih
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; (J.M.L.); (I.-M.S.); (T.-L.W.)
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA;
| | - Tza-Huei Wang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA;
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Johns Hopkins Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Tian-Li Wang
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; (J.M.L.); (I.-M.S.); (T.-L.W.)
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA;
| | - Thomas R. Pisanic
- Johns Hopkins Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD 21218, USA
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10
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Ang BH, Ho WK, Wijaya E, Kwan PY, Ng PS, Yoon SY, Hasan SN, Lim JMC, Hassan T, Tai MC, Allen J, Lee A, Taib NAM, Yip CH, Hartman M, Lim SH, Tan EY, Tan BKT, Tan SM, Tan VKM, Ho PJ, Khng AJ, Dunning AM, Li J, Easton DF, Antoniou AC, Teo SH. Predicting the Likelihood of Carrying a BRCA1 or BRCA2 Mutation in Asian Patients With Breast Cancer. J Clin Oncol 2022; 40:1542-1551. [PMID: 35143328 PMCID: PMC7614269 DOI: 10.1200/jco.21.01647] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/15/2021] [Accepted: 12/14/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE With the development of poly (ADP-ribose) polymerase inhibitors for treatment of patients with cancer with an altered BRCA1 or BRCA2 gene, there is an urgent need to ensure that there are appropriate strategies for identifying mutation carriers while balancing the increased demand for and cost of cancer genetics services. To date, the majority of mutation prediction tools have been developed in women of European descent where the age and cancer-subtype distributions are different from that in Asian women. METHODS In this study, we built a new model (Asian Risk Calculator) for estimating the likelihood of carrying a pathogenic variant in BRCA1 or BRCA2 gene, using germline BRCA genetic testing results in a cross-sectional population-based study of 8,162 Asian patients with breast cancer. We compared the model performance to existing mutation prediction models. The models were evaluated for discrimination and calibration. RESULTS Asian Risk Calculator included age of diagnosis, ethnicity, bilateral breast cancer, tumor biomarkers, and family history of breast cancer or ovarian cancer as predictors. The inclusion of tumor grade improved significantly the model performance. The full model was calibrated (Hosmer-Lemeshow P value = .614) and discriminated well between BRCA and non-BRCA pathogenic variant carriers (area under receiver operating curve, 0.80; 95% CI, 0.75 to 0.84). Addition of grade to the existing clinical genetic testing criteria targeting patients with breast cancer age younger than 45 years reduced the proportion of patients referred for genetic counseling and testing from 37% to 33% (P value = .003), thereby improving the overall efficacy. CONCLUSION Population-specific customization of mutation prediction models and clinical genetic testing criteria improved the accuracy of BRCA mutation prediction in Asian patients.
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Affiliation(s)
| | - Weang Kee Ho
- Cancer Research Malaysia, Subang Jaya, Malaysia
- Faculty of Science and Engineering, School of Mathematical Sciences, University of Nottingham Malaysia, Jalan Broga, Semenyih, Selangor, Malaysia
| | | | | | - Pei Sze Ng
- Cancer Research Malaysia, Subang Jaya, Malaysia
| | | | | | | | | | | | - Jamie Allen
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Andrew Lee
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Nur Aishah Mohd Taib
- Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
- Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
| | | | - Mikael Hartman
- Department of Surgery, National University Hospital and NUHS, Singapore, Singapore
| | - Swee Ho Lim
- Breast Department, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Ern Yu Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Institute of Molecular and Cell Biology, Singapore, Singapore
| | - Benita K. T. Tan
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Su-Ming Tan
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore, Singapore
| | - Veronique K. M. Tan
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore
| | - Peh Joo Ho
- Laboratory of Women’s Health and Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Alexis J. Khng
- Laboratory of Women’s Health and Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Alison M. Dunning
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Jingmei Li
- Laboratory of Women’s Health and Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Douglas F. Easton
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Antonis C. Antoniou
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Soo Hwang Teo
- Cancer Research Malaysia, Subang Jaya, Malaysia
- Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
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11
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BREAst screening Tailored for HEr (BREATHE)-A study protocol on personalised risk-based breast cancer screening programme. PLoS One 2022; 17:e0265965. [PMID: 35358246 PMCID: PMC8970365 DOI: 10.1371/journal.pone.0265965] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/22/2022] [Indexed: 12/29/2022] Open
Abstract
Routine mammography screening is currently the standard tool for finding cancers at an early stage, when treatment is most successful. Current breast screening programmes are one-size-fits-all which all women above a certain age threshold are encouraged to participate. However, breast cancer risk varies by individual. The BREAst screening Tailored for HEr (BREATHE) study aims to assess acceptability of a comprehensive risk-based personalised breast screening in Singapore. Advancing beyond the current age-based screening paradigm, BREATHE integrates both genetic and non-genetic breast cancer risk prediction tools to personalise screening recommendations. BREATHE is a cohort study targeting to recruit ~3,500 women. The first recruitment visit will include questionnaires and a buccal cheek swab. After receiving a tailored breast cancer risk report, participants will attend an in-person risk review, followed by a final session assessing the acceptability of our risk stratification programme. Risk prediction is based on: a) Gail model (non-genetic), b) mammographic density and recall, c) BOADICEA predictions (breast cancer predisposition genes), and d) breast cancer polygenic risk score. For national implementation of personalised risk-based breast screening, exploration of the acceptability within the target populace is critical, in addition to validated predication tools. To our knowledge, this is the first study to implement a comprehensive risk-based mammography screening programme in Asia. The BREATHE study will provide essential data for policy implementation which will transform the health system to deliver a better health and healthcare outcomes.
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12
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Guo F, Hirth JM, Fuchs EL, Cofie LE, Brown V, Kuo YF, Fernandez ME, Berenson AB. Knowledge, Attitudes, Willingness to Pay, and Patient Preferences About Genetic Testing and Subsequent Risk Management for Cancer Prevention. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:362-369. [PMID: 32642924 PMCID: PMC7794087 DOI: 10.1007/s13187-020-01823-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Knowledge, attitudes, and patient preferences about genetic testing and subsequent risk management for cancer prevention among average risk populations are understudied, especially among Hispanics. This study was to assess these items by conducting an in-person survey in this understudied population. We conducted in-person surveys using a self-administered, structured questionnaire among young women in 2017. Survey questions were adapted from other validated surveys. This study had 677 participants in the final analyses. Data were collected in 2017 and analyzed in 2018 and 2019. Participants had little knowledge about genes or breast cancer risk, but most felt that genetic testing for cancer prevention is "a good idea" (87.0%), "a reassuring idea" (84.0%), and that "everyone should get the test" (87.7%). Most (64.0%) of these women would pay up to $25 for the test, 29.3% would pay $25-$500, and < 10% would pay more than $500 for the test. When asked about a hypothetical scenario of high breast cancer risk, 34.2% Hispanics and 24.5% non-Hispanics would choose chemoprevention. Women would be less likely to choose risk reduction procedures, such as mastectomy (19.6% among Hispanics and 15.1% among non-Hispanics) and salpingo-oophorectomy (11.8% among Hispanics and 10.7% among non-Hispanics). In this low-income, mostly Hispanic population, knowledge about genetic testing and cancer risk is poor, but most have positive opinions about genetic testing for cancer prevention. However, their strong preference for chemoprevention and lesser preference for prophylactic surgeries in a hypothetical scenario underscore the importance of genetic counseling and education.
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Affiliation(s)
- Fangjian Guo
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA.
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA.
| | - Jacqueline M Hirth
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
| | - Erika L Fuchs
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
| | - Leslie E Cofie
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Veronica Brown
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
| | - Yong-Fang Kuo
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
- Office of Biostatistics, Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX, USA
- Institute for Translational Science, The University of Texas Medical Branch, Galveston, TX, USA
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Abbey B Berenson
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX, 77555-0587, USA
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13
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Clift AK, Dodwell D, Lord S, Petrou S, Brady SM, Collins GS, Hippisley-Cox J. The current status of risk-stratified breast screening. Br J Cancer 2022; 126:533-550. [PMID: 34703006 PMCID: PMC8854575 DOI: 10.1038/s41416-021-01550-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/25/2021] [Accepted: 09/14/2021] [Indexed: 12/23/2022] Open
Abstract
Apart from high-risk scenarios such as the presence of highly penetrant genetic mutations, breast screening typically comprises mammography or tomosynthesis strategies defined by age. However, age-based screening ignores the range of breast cancer risks that individual women may possess and is antithetical to the ambitions of personalised early detection. Whilst screening mammography reduces breast cancer mortality, this is at the risk of potentially significant harms including overdiagnosis with overtreatment, and psychological morbidity associated with false positives. In risk-stratified screening, individualised risk assessment may inform screening intensity/interval, starting age, imaging modality used, or even decisions not to screen. However, clear evidence for its benefits and harms needs to be established. In this scoping review, the authors summarise the established and emerging evidence regarding several critical dependencies for successful risk-stratified breast screening: risk prediction model performance, epidemiological studies, retrospective clinical evaluations, health economic evaluations and qualitative research on feasibility and acceptability. Family history, breast density or reproductive factors are not on their own suitable for precisely estimating risk and risk prediction models increasingly incorporate combinations of demographic, clinical, genetic and imaging-related parameters. Clinical evaluations of risk-stratified screening are currently limited. Epidemiological evidence is sparse, and randomised trials only began in recent years.
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Affiliation(s)
- Ash Kieran Clift
- Cancer Research UK Oxford Centre, Department of Oncology, University of Oxford, Oxford, UK.
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Simon Lord
- Department of Oncology, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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14
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Reisel D, Baran C, Manchanda R. Preventive population genomics: The model of BRCA related cancers. ADVANCES IN GENETICS 2021; 108:1-33. [PMID: 34844711 DOI: 10.1016/bs.adgen.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Preventive population genomics offers the prospect of population stratification for targeting screening and prevention and tailoring care to those at greatest risk. Within cancer, this approach is now within reach, given our expanding knowledge of its heritable components, improved ability to predict risk, and increasing availability of effective preventive strategies. Advances in technology and bioinformatics has made population-testing technically feasible. The BRCA model provides 30 years of insight and experience of how to conceive of and construct care and serves as an initial model for preventive population genomics. Population-based BRCA-testing in the Jewish population is feasible, acceptable, reduces anxiety, does not detrimentally affect psychological well-being or quality of life, is cost-effective and is now beginning to be implemented. Population-based BRCA-testing and multigene panel testing in the wider general population is cost-effective for numerous health systems and can save thousands more lives than the current clinical strategy. There is huge potential for using both genetic and non-genetic information in complex risk prediction algorithms to stratify populations for risk adapted screening and prevention. While numerous strides have been made in the last decade several issues need resolving for population genomics to fulfil its promise and potential for maximizing precision prevention. Healthcare systems need to overcome significant challenges associated with developing delivery pathways, infrastructure expansion including laboratory services, clinical workforce training, scaling of management pathways for screening and prevention. Large-scale real world population studies are needed to evaluate context specific population-testing implementation models for cancer risk prediction, screening and prevention.
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Affiliation(s)
- Dan Reisel
- EGA Institute for Women's Health, University College London, London, United Kingdom
| | - Chawan Baran
- Wolfson Institute of Preventive Medicine, CRUK Barts Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Ranjit Manchanda
- Wolfson Institute of Preventive Medicine, CRUK Barts Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Department of Gynaecological Oncology, St Bartholomew's Hospital, London, United Kingdom; Department of Health Services Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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15
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Shen L, Zhang S, Wang K, Wang X. Familial Breast Cancer: Disease Related Gene Mutations and Screening Strategies for Chinese Population. Front Oncol 2021; 11:740227. [PMID: 34926254 PMCID: PMC8671637 DOI: 10.3389/fonc.2021.740227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/12/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND About 5%-10% of the breast cancer cases have a hereditary background, and this subset is referred to as familial breast cancer (FBC). In this review, we summarize the susceptibility genes and genetic syndromes associated with FBC and discuss the FBC screening and high-risk patient consulting strategies for the Chinese population. METHODS We searched the PubMed database for articles published between January 2000 and August 2021. Finally, 380 pieces of literature addressing the genes and genetic syndromes related to FBC were included and reviewed. RESULTS We identified 16 FBC-related genes and divided them into three types (high-, medium-, and low-penetrance) of genes according to their relative risk ratios. In addition, six genetic syndromes were found to be associated with FBC. We then summarized the currently available screening strategies for FBC and discussed those available for high-risk Chinese populations. CONCLUSION Multiple gene mutations and genetic disorders are closely related to FBC. The National Comprehensive Cancer Network (NCCN) guidelines recommend corresponding screening strategies for these genetic diseases. However, such guidelines for the Chinese population are still lacking. For screening high-risk groups in the Chinese population, genetic testing is recommended after genetic counseling.
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Affiliation(s)
| | | | | | - Xiaochen Wang
- Department of Breast Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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16
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De Silva DL, James PA, Mann GB, Lindeman GJ. Universal genetic testing of patients with newly diagnosed breast cancer - ready for prime time? Med J Aust 2021; 215:449-453. [PMID: 34676562 DOI: 10.5694/mja2.51317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Dilanka L De Silva
- Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC.,Memorial Sloan Kettering Cancer Center, New York, USA
| | - Paul A James
- Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - G Bruce Mann
- University of Melbourne, Melbourne, VIC.,Royal Melbourne and Royal Women's Hospitals, Melbourne, VIC.,Peter MacCallum Cancer Centre, Melbourne, VIC
| | - Geoffrey J Lindeman
- Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC.,Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC
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17
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Wendt C, Muranen TA, Mielikäinen L, Thutkawkorapin J, Blomqvist C, Jiao X, Ehrencrona H, Tham E, Arver B, Melin B, Kuchinskaya E, Stenmark Askmalm M, Paulsson-Karlsson Y, Einbeigi Z, von Wachenfeldt Väppling A, Kalso E, Tasmuth T, Kallioniemi A, Aittomäki K, Nevanlinna H, Borg Å, Lindblom A. A search for modifying genetic factors in CHEK2:c.1100delC breast cancer patients. Sci Rep 2021; 11:14763. [PMID: 34285278 PMCID: PMC8292481 DOI: 10.1038/s41598-021-93926-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/28/2021] [Indexed: 12/26/2022] Open
Abstract
The risk of breast cancer associated with CHEK2:c.1100delC is 2-threefold but higher in carriers with a family history of breast cancer than without, suggesting that other genetic loci in combination with CHEK2:c.1100delC confer an increased risk in a polygenic model. Part of the excess familial risk has been associated with common low-penetrance variants. This study aimed to identify genetic loci that modify CHEK2:c.1100delC-associated breast cancer risk by searching for candidate risk alleles that are overrepresented in CHEK2:c.1100delC carriers with breast cancer compared with controls. We performed whole-exome sequencing in 28 breast cancer cases with germline CHEK2:c.1100delC, 28 familial breast cancer cases and 70 controls. Candidate alleles were selected for validation in larger cohorts. One recessive synonymous variant, rs16897117, was suggested, but no overrepresentation of homozygous CHEK2:c.1100delC carriers was found in the following validation. Furthermore, 11 non-synonymous candidate alleles were suggested for further testing, but no significant difference in allele frequency could be detected in the validation in CHEK2:c.1100delC cases compared with familial breast cancer, sporadic breast cancer and controls. With this method, we found no support for a CHEK2:c.1100delC-specific genetic modifier. Further studies of CHEK2:c.1100delC genetic modifiers are warranted to improve risk assessment in clinical practice.
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Affiliation(s)
- Camilla Wendt
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
| | - Taru A Muranen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Lotta Mielikäinen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jessada Thutkawkorapin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Carl Blomqvist
- Department of Oncology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Xiang Jiao
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Hans Ehrencrona
- Department of Clinical Genetics and Pathology, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Emma Tham
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Brita Arver
- Department of Oncology-Pathology, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Beatrice Melin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Ekaterina Kuchinskaya
- Department of Clinical Genetics, Department of Clinical Experimental Medicine, Linköping University, Linköping, Sweden
| | - Marie Stenmark Askmalm
- Department of Clinical Genetics, Department of Clinical Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Zakaria Einbeigi
- Department of Oncology, Sahlgrenska University Hospital, 41345, Göteborg, Sweden
| | | | - Eija Kalso
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tiina Tasmuth
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anne Kallioniemi
- TAYS Cancer Centre and Faculty of Medicine and Health Technology, Tampere University; Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - Kristiina Aittomäki
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Åke Borg
- Department of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, Lund, Sweden
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Stockholm, Sweden
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18
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Park MS, Weissman SM, Postula KJV, Williams CS, Mauer CB, O'Neill SM. Utilization of breast cancer risk prediction models by cancer genetic counselors in clinical practice predominantly in the United States. J Genet Couns 2021; 30:1737-1747. [PMID: 34076301 DOI: 10.1002/jgc4.1442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 01/07/2023]
Abstract
Risk assessment in cancer genetic counseling is essential in identifying individuals at high risk for developing breast cancer to recommend appropriate screening and management options. Historically, many breast cancer risk prediction models were developed to calculate an individual's risk to develop breast cancer or to carry a pathogenic variant in the BRCA1 or BRCA2 genes. However, how or when genetic counselors use these models in clinical settings is currently unknown. We explored genetic counselors' breast cancer risk model usage patterns including frequency of use, reasons for using or not using models, and change in usage since the adoption of multi-gene panel testing. An online survey was developed and sent to members of the National Society of Genetic Counselors; board-certified genetic counselors whose practice included cancer genetic counseling were eligible to participate in the study. The response rate was estimated at 23% (243/1,058), and respondents were predominantly working in the United States. The results showed that 93% of all respondents use at least one breast cancer risk prediction model in their clinical practice. Among the six risk models selected for the study, the Tyrer-Cuzick (IBIS) model was used most frequently (95%), and the BOADICEA model was used least (40%). Determining increased or decreased surveillance and breast MRI eligibility were the two most common reasons for most model usage, while time consumption and difficulty in navigation were the two most common reasons for not using models. This study provides insight into perceived benefits and limitations of risk models in clinical use in the United States, which may be useful information for software developers, genetic counseling program curriculum developers, and currently practicing cancer genetic counselors.
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Affiliation(s)
- Min Seon Park
- Northwestern Medical Group, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine Graduate Program in Genetic Counseling, Chicago, IL, USA
| | | | | | - Carmen S Williams
- Northwestern Medical Group, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine Graduate Program in Genetic Counseling, Chicago, IL, USA
| | | | - Suzanne M O'Neill
- Northwestern University Feinberg School of Medicine Graduate Program in Genetic Counseling, Chicago, IL, USA
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19
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Kim G, Bahl M. Assessing Risk of Breast Cancer: A Review of Risk Prediction Models. JOURNAL OF BREAST IMAGING 2021; 3:144-155. [PMID: 33778488 DOI: 10.1093/jbi/wbab001] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Indexed: 12/17/2022]
Abstract
Accurate and individualized breast cancer risk assessment can be used to guide personalized screening and prevention recommendations. Existing risk prediction models use genetic and nongenetic risk factors to provide an estimate of a woman's breast cancer risk and/or the likelihood that she has a BRCA1 or BRCA2 mutation. Each model is best suited for specific clinical scenarios and may have limited applicability in certain types of patients. For example, the Breast Cancer Risk Assessment Tool, which identifies women who would benefit from chemoprevention, is readily accessible and user-friendly but cannot be used in women under 35 years of age or those with prior breast cancer or lobular carcinoma in situ. Emerging research on deep learning-based artificial intelligence (AI) models suggests that mammographic images contain risk indicators that could be used to strengthen existing risk prediction models. This article reviews breast cancer risk factors, describes the appropriate use, strengths, and limitations of each risk prediction model, and discusses the emerging role of AI for risk assessment.
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Affiliation(s)
- Geunwon Kim
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Manisha Bahl
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
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20
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Mansfield CA, Metcalfe KA, Snyder C, Lindeman GJ, Posner J, Friedman S, Lynch HT, Narod SA, Evans DG, Liede A. Preferences for breast cancer prevention among women with a BRCA1 or BRCA2 mutation. Hered Cancer Clin Pract 2020; 18:20. [PMID: 33014209 PMCID: PMC7526374 DOI: 10.1186/s13053-020-00152-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background Women with a BRCA1 or BRCA2 mutation have high lifetime risks of developing breast and ovarian cancer. The decision to embark on risk reduction strategies is a difficult and personal one. We surveyed an international group of women with BRCA mutations and measured choices and sequence of breast cancer risk reduction strategies. Methods Women with a BRCA1/2 mutation and no previous cancer diagnosis were recruited from the US, Canada, the UK, Australia, and from a national advocacy group. Using an online survey, we asked about cancer-risk reduction preferences including for one of two hypothetical medicines, randomly assigned, and women’s recommendations for a hypothetical woman (Susan, either a 25- or 36-year-old). Sunburst diagrams were generated to illustrate hierarchy of choices. Results Among 598 respondents, mean age was 40.9 years (range 25–55 years). Timing of the survey was 4.8 years (mean) after learning their positive test result and 33% had risk-reducing bilateral salpingo-oophorectomy (RRBSO) and bilateral mastectomy (RRBM), while 19% had RRBSO only and 16% had RRBM only. Although 30% said they would take a hypothetical medicine, 6% reported taking a medicine resembling tamoxifen. Respondents were 1.5 times more likely to select a hypothetical medicine for risk reduction when Susan was 25 than when Susan was 36. Women assigned to 36-year-old Susan were more likely to choose a medicine if they had a family member diagnosed with breast cancer and personal experience taking tamoxifen. Conclusions Women revealed a willingness to undergo surgeries to achieve largest reduction in breast cancer risk, although this would not be recommended for a younger woman in her 20s. The goal of achieving the highest degree of cancer risk reduction is the primary driver for women with BRCA1 or BRCA2 mutations in selecting an intervention and a sequence of interventions, regardless of whether it is non-surgical or surgical.
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Affiliation(s)
- Carol A Mansfield
- RTI Health Solutions, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, Durham, NC 27709-12194 USA
| | - Kelly A Metcalfe
- Women's College Hospital, University of Toronto, Toronto, Canada
| | - Carrie Snyder
- Creighton University, Omaha, NE USA.,CHI Health Creighton University Medical Center, Omaha, NE USA
| | - Geoffrey J Lindeman
- The Royal Melbourne Hospital, Parkville, Australia.,Peter MacCallum Cancer Centre, Melbourne, VIC Australia.,The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC Australia.,The University of Melbourne, Parkville, VIC Australia
| | - Joshua Posner
- RTI Health Solutions, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, Durham, NC 27709-12194 USA
| | - Sue Friedman
- Facing Our Risk of Cancer Empowered (FORCE) Advocacy Organization, Tampa, Florida USA
| | | | | | - Steven A Narod
- Women's College Hospital, University of Toronto, Toronto, Canada
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine, MAHSC, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
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21
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Ataseven B, Tripon D, Rhiem K, Harter P, Schneider S, Heitz F, Baert T, Traut A, Pauly N, Ehmann S, Plett H, Schmutzler RK, du Bois A. Prevalence of BRCA1 and BRCA2 Mutations in Patients with Primary Ovarian Cancer - Does the German Checklist for Detecting the Risk of Hereditary Breast and Ovarian Cancer Adequately Depict the Need for Consultation? Geburtshilfe Frauenheilkd 2020; 80:932-940. [PMID: 32905297 PMCID: PMC7467803 DOI: 10.1055/a-1222-0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/14/2020] [Indexed: 01/09/2023] Open
Abstract
BackgroundBRCA1/2
mutations are the leading cause of hereditary epithelial ovarian cancer (EOC). The German Consortium for Hereditary Breast and Ovarian Cancer has defined inclusion criteria, which are retrievable as a checklist and facilitate genetic counselling/testing for affected persons with a mutation probability of ≥ 10%. Our objective was to evaluate the prevalence of the
BRCA1/2
mutation(s) based on the checklist score (CLS).
Methods
A retrospective data analysis was performed on EOC patients with a primary diagnosis treated between 1/2011 – 5/2019 at the Central Essen Clinics, where a
BRCA1/2
genetic analysis result and a CLS was available. Out of 545 cases with a
BRCA1/2
result (cohort A), 453 cases additionally had an extended gene panel result (cohort B).
Results
A
BRCA1/2
mutation was identified in 23.3% (127/545) in cohort A, pathogenic mutations in non-
BRCA1/2
genes were revealed in a further 6.2% in cohort B. In cohort A, 23.3% (127/545) of patients had a
BRCA1
(n = 92) or
BRCA2
(n = 35) mutation. Singular EOC (CLS 2) was present in 40.9%. The prevalence for a
BRCA1/2
mutation in cohort A was 10.8%, 17.2%, 25.0%, 35.1%, 51.4% and 66.7% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively. The mutation prevalence in cohort B was 15.9%, 16.4%, 28.2%, 40.4%, 44.8% and 62.5% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively.
Conclusions
The
BRCA1/2
mutation prevalence in EOC patients positively correlates with a rising checklist score. Already with singular EOC, the prevalence of a
BRCA1/2
mutation exceeds the required 10% threshold. Our data support the recommendation of the S3 guidelines Ovarian Cancer of offering genetic testing to all patients with EOC. Optimisation of the checklist with clear identification of the testing indication in this population should therefore be aimed for.
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Affiliation(s)
- Beyhan Ataseven
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen.,Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der LMU München, München
| | - Denise Tripon
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinik Köln, Köln
| | - Philipp Harter
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Stephanie Schneider
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Florian Heitz
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen.,Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie (CVK) und Klinik für Gynäkologie (CBF), Charité - Universitätsmedizin Berlin, Berlin
| | - Thais Baert
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen.,Abteilung für Onkologie und Tumorimmunologie, KU Leuven, Leuven, Belgien
| | - Alexander Traut
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Nina Pauly
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Sarah Ehmann
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
| | - Helmut Plett
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen.,Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie (CVK) und Klinik für Gynäkologie (CBF), Charité - Universitätsmedizin Berlin, Berlin
| | - Rita K Schmutzler
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinik Köln, Köln
| | - Andreas du Bois
- Abteilung für Gynäkologie und Gynäkologische Onkologie, Evang. Kliniken Essen-Mitte, Essen
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22
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Juchli F, Zangger M, Schueck A, von Wolff M, Stute P. Chronic non-communicable disease risk calculators - An overview, part I. Maturitas 2020; 143:25-35. [PMID: 33308633 DOI: 10.1016/j.maturitas.2020.07.009] [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: 04/30/2020] [Revised: 06/21/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022]
Abstract
This review identifies the different risk assessment tools that stratify the individual's risk of four of the eight leading causes of death in women: breast cancer, lung cancer, colorectal cancer and osteoporosis. It will be followed by the publication of a second paper that summarizes the risk assessment tools for the other four leading causes of death (myocardial infarction, stroke, diabetes mellitus type 2 and dementia). The different tools were compared by their use of different variables and validation criteria. To corroborate the validation process, validation study papers were considered for each risk assessment tool. Four tables, one for each illness, were designed. The tables provide an outline for each risk assessment tool, which includes its inventor/company, required variables, advantages, disadvantages and validity. These tables simplify the comparison of the different tools and enable the identification of the most suitable one for each patient.
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Affiliation(s)
- Fabienne Juchli
- Department of General Internal Medicine, Muri Hospital, Muri, Switzerland
| | - Martina Zangger
- Department of General Internal Medicine, Thun Hospital, Thun, Switzerland
| | - Andrea Schueck
- Department of Anesthesiology, Lachen Hospital, Lachen, Switzerland
| | - Michael von Wolff
- Department of Obstetrics and Gynecology, University Women's Hospital, Bern, Switzerland
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Women's Hospital, Bern, Switzerland.
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23
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Danladi CD, Serakinci N. Risk Prediction Model Development for Late On-Set Breast Cancer Screening in Low- and Middle-Income Societies: A Model Study for North Cyprus. Healthcare (Basel) 2020; 8:healthcare8030213. [PMID: 32708661 PMCID: PMC7551407 DOI: 10.3390/healthcare8030213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Early detection of breast cancer alters the prognosis and tools that can predict the risk for breast cancer in women will have a significant impact on healthcare systems in low- and middle-income regions, such as North Cyprus. Objective: In this study, we developed a simple breast cancer risk model for the women of North Cyprus. Methods: Data from 655 women, consisting of 318 breast cancer cases and 337 hospital-based controls, was used to develop and internally validate the model, external validation was carried out using, 653 women consisting of 126 cases and 527 controls. Data were obtained from medical records and interviews after informed consent. Results: A model was derived that consisted of age ≥50 years and <50 years and the presence and absence of >1 first-degree relatives (FDR) with breast cancer. From internal and external validations the model’s AUCs were, 0.66 (95% CI = 0.62–0.70) and 0.69 (95% CI = 0.63–0.74) respectively. Conclusions: A unique model for risk prediction of breast cancer was developed to aid in identifying high-risk women from North Cyprus that can benefit from mammogram screening. Further study on a large scale that includes environmental risk factors is warranted.
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Affiliation(s)
- Ceasar Dubor Danladi
- Department of Medical Genetics, Institute of Health Sciences, Near East University, Nicosia 99138, Turkish Republic of North Cyprus;
| | - Nedime Serakinci
- Department of Medical Genetics, Faculty of Medicine, Near East University, Nicosia 99138, Turkish Republic of North Cyprus
- Department of Molecular Biology and Genetics, Faculty of Art and Sciences, Near East University, Nicosia 99138, Turkish Republic of North Cyprus
- Correspondence: ; Tel.: +90-392-675-1000
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24
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Chelmow D, Pearlman MD, Young A, Bozzuto L, Dayaratna S, Jeudy M, Kremer ME, Scott DM, O'Hara JS. Executive Summary of the Early-Onset Breast Cancer Evidence Review Conference. Obstet Gynecol 2020; 135:1457-1478. [PMID: 32459439 PMCID: PMC7253192 DOI: 10.1097/aog.0000000000003889] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/23/2020] [Accepted: 03/12/2020] [Indexed: 12/23/2022]
Abstract
The Centers for Disease Control and Prevention launched the Bring Your Brave campaign to increase knowledge about early-onset breast cancer, defined as breast cancer in women aged 18-45 years. The American College of Obstetricians and Gynecologists convened a panel of experts in breast disease from the Society for Academic Specialists in General Obstetrics and Gynecology to review relevant literature, validated tools, best practices, and practice guidelines as a first step toward developing educational materials for women's health care providers about early-onset breast cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at an in-person meeting of stakeholder professional and patient advocacy organizations in April 2019. This article summarizes the relevant literature, existing guidance, and validated tools to guide health care providers in the prevention, early detection, and special considerations of early-onset breast cancer. Substantive knowledge gaps were noted and summarized to provide guidance for future research.
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Affiliation(s)
- David Chelmow
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia; the Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan; the Department of Women's Health, the University of Texas at Austin Dell Medical School, Austin, Texas; the Departments of Obstetrics and Gynecology and Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; the Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia, Pennsylvania; Southeast Kaiser Permanente Medical Group, Atlanta, Georgia; the Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; the Department of Obstetrics and Gynecology, University of Connecticut Medical School, Farmington, Connecticut; and the American College of Obstetricians and Gynecologists, Washington, DC
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25
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Jones S, Turton P, Achuthan R. Impact of family history risk assessment on surgical decisions and imaging surveillance at breast cancer diagnosis. Ann R Coll Surg Engl 2020; 102:590-593. [PMID: 32436722 DOI: 10.1308/rcsann.2020.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In June 2013, the National Institute for Health and Care Excellence (NICE) published guidance on the management of women with a family history (FH) of breast cancer (BC) and a personal diagnosis of BC. When diagnosed with BC, pressure of timely treatment takes priority and there is potential for a significant FH to be overlooked. This can affect treatment options and follow-up imaging (FUI) surveillance. METHODS The practice in our breast unit was compared with the NICE guidance with regard to arranging appropriate FUI and referral to the genetics team for women diagnosed with BC with a FH of BC. Data were obtained retrospectively on 200 women with BC, identified from the breast multidisciplinary team meetings from January to March 2014. Initial audit showed poor compliance with recording of FH. A standardised history taking proforma was produced for clinic use. A re-audit was conducted on a further 200 women between May and July 2016. RESULTS In the initial audit, FH was taken in 151 women (76%) compared with 174 women (87%) in the re-audit. Thirty-seven women (25%) were thought to be of moderate risk (MR) or high risk (HR) based on FH in the first audit. Re-audit identified 35 women (20%) with MR or HR FH. Under half (43%) of the women of HR were referred to the genetics team initially; this increased to 70% in the second audit. While almost half (46%) of the women with MR or HR had inappropriate FUI in the initial audit, this fell to 11% in the re-audit. CONCLUSIONS A proportion of women diagnosed with BC would fall into the MR or HR categories as defined in the NICE FH guidance. Inadequate recording of FH could result in inadequate FUI surveillance and in some cases missing the opportunity for a genetic referral to assess suitability for gene testing.
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Affiliation(s)
- S Jones
- Leeds Teaching Hospital NHS Trust, UK
| | - P Turton
- Leeds Teaching Hospital NHS Trust, UK
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26
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Pessôa-Pereira D, Evangelista AF, Causin RL, da Costa Vieira RA, Abrahão-Machado LF, Santana IVV, da Silva VD, de Souza KCB, de Oliveira-Silva RJ, Fernandes GC, Reis RM, Palmero EI, Marques MMC. miRNA expression profiling of hereditary breast tumors from BRCA1- and BRCA2-germline mutation carriers in Brazil. BMC Cancer 2020; 20:143. [PMID: 32087690 PMCID: PMC7036228 DOI: 10.1186/s12885-020-6640-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background MicroRNAs (miRNAs) are small non-coding RNAs involved in post-transcriptional gene expression regulation and have been described as key regulators of carcinogenesis. Aberrant miRNA expression has been frequently reported in sporadic breast cancers, but few studies have focused on profiling hereditary breast cancers. In this study, we aimed to identify specific miRNA signatures in hereditary breast tumors and to compare with sporadic breast cancer and normal breast tissues. Methods Global miRNA expression profiling using NanoString technology was performed on 43 hereditary breast tumors (15 BRCA1, 14 BRCA2, and 14 BRCAX), 23 sporadic breast tumors and 8 normal breast tissues. These normal breast tissues derived from BRCA1- and BRCA2- mutation carriers (n = 5) and non-mutation carriers (n = 3). Subsequently, we performed receiver operating characteristic (ROC) curve analyses to evaluate the diagnostic performance of differentially expressed miRNAs. Putative target genes of each miRNAs considered as potential biomarkers were identified using miRDIP platform and used for pathway enrichment analysis. Results miRNA expression analyses identified several profiles that were specific to hereditary breast cancers. A total of 25 miRNAs were found to be differentially expressed (fold change: > 2.0 and p < 0.05) and considered as potential biomarkers (area under the curve > 0.75) in hereditary breast tumors compared to normal breast tissues, with an expressive upregulation among BRCAX cases. Furthermore, bioinformatic analysis revealed that these miRNAs shared target genes involved in ErbB, FoxO, and PI3K-Akt signaling pathways. Conclusions Our results showed that miRNA expression profiling can differentiate hereditary from sporadic breast tumors and normal breast tissues. These miRNAs were remarkably deregulated in BRCAX hereditary breast cancers. Therefore, miRNA signatures can be used as potential novel diagnostic biomarkers for the prediction of BRCA1/2- germline mutations and may be useful for future clinical management.
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Affiliation(s)
| | | | - Rhafaela Lima Causin
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil
| | | | | | | | | | | | | | | | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil.,Life and Health Sciences Research Institute (ICVS), Medical School, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Edenir Inêz Palmero
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil.,Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, SP, Brazil.,Department of Oncogenetics, Barretos Cancer Hospital, Barretos, SP, Brazil.,Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, SP, Brazil
| | - Márcia Maria Chiquitelli Marques
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil. .,Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, SP, Brazil. .,Tumor Biobank, Barretos Cancer Hospital, Barretos, SP, Brazil.
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27
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Terkelsen T, Christensen LL, Fenton DC, Jensen UB, Sunde L, Thomassen M, Skytte AB. Population frequencies of pathogenic alleles of BRCA1 and BRCA2: analysis of 173 Danish breast cancer pedigrees using the BOADICEA model. Fam Cancer 2020; 18:381-388. [PMID: 31435815 DOI: 10.1007/s10689-019-00141-9] [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] [Indexed: 01/11/2023]
Abstract
The Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) calculates the probability that a woman carries a pathogenic variant in BRCA1 or BRCA2 based on her pedigree and the population frequencies of pathogenic alleles of BRCA1 (0.0006394) and BRCA2 (0.00102) in the United Kingdom (UK). BOADICEA allows the clinician to define the population frequencies of pathogenic alleles of BRCA1 and BRCA2 for other populations but only includes preset values for the Ashkenazy Jewish and Icelandic populations. Among 173 early-onset breast cancer pedigrees in Denmark, BOADICEA discriminated well between carriers and non-carriers of pathogenic variants (area under the receiver operating characteristics curve: 0.81; 95% CI 0.74-0.86) but underestimated the frequency of carriers of pathogenic variants in BRCA1 or BRCA2 as measured by the observed-to-expected ratio (O/E 1.83; 95% CI 1.18-2.84). This reflects findings from older studies of BOADICEA in UK, German, Italian, and Chinese populations, all accounting for the different calibration for different carrier probabilities. To improve the performance of BOADICEA for non-UK populations, we developed a method to derive population frequencies of pathogenic alleles of BRCA1 and BRCA2. Compared to the UK population frequencies, we estimated the Danish population frequencies of pathogenic alleles to be higher for BRCA1 (0.0015; 95% CI 0.00064-0.0034) and lower for BRCA2 (0.00052; 95% CI 0.00018-0.0017) after adjusting for the different calibration of BOADICEA for different carrier probabilities. Incorporating additional population frequencies into BOADICEA could improve its performance for non-UK populations.
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Affiliation(s)
- Thorkild Terkelsen
- Department of Clinical Genetics, Aarhus University Hospital, Brendstrupgaardsvej 21C, 8200, Aarhus N, Denmark.
| | | | | | - Uffe Birk Jensen
- Department of Clinical Genetics, Aarhus University Hospital, Brendstrupgaardsvej 21C, 8200, Aarhus N, Denmark
| | - Lone Sunde
- Department of Clinical Genetics, Aarhus University Hospital, Brendstrupgaardsvej 21C, 8200, Aarhus N, Denmark
| | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Anne-Bine Skytte
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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28
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Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, Doubeni CA, Epling JW, Kubik M, Landefeld CS, Mangione CM, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2019; 322:652-665. [PMID: 31429903 DOI: 10.1001/jama.2019.10987] [Citation(s) in RCA: 261] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Potentially harmful mutations of the breast cancer susceptibility 1 and 2 genes (BRCA1/2) are associated with increased risk for breast, ovarian, fallopian tube, and peritoneal cancer. For women in the United States, breast cancer is the most common cancer after nonmelanoma skin cancer and the second leading cause of cancer death. In the general population, BRCA1/2 mutations occur in an estimated 1 in 300 to 500 women and account for 5% to 10% of breast cancer cases and 15% of ovarian cancer cases. OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer. EVIDENCE REVIEW The USPSTF reviewed the evidence on risk assessment, genetic counseling, and genetic testing for potentially harmful BRCA1/2 mutations in asymptomatic women who have never been diagnosed with BRCA-related cancer, as well as those with a previous diagnosis of breast, ovarian, tubal, or peritoneal cancer who have completed treatment and are considered cancer free. In addition, the USPSTF reviewed interventions to reduce the risk for breast, ovarian, tubal, or peritoneal cancer in women with potentially harmful BRCA1/2 mutations, including intensive cancer screening, medications, and risk-reducing surgery. FINDINGS For women whose family or personal history is associated with an increased risk for harmful mutations in the BRCA1/2 genes, or who have an ancestry associated with BRCA1/2 gene mutations, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are moderate. For women whose personal or family history or ancestry is not associated with an increased risk for harmful mutations in the BRCA1/2 genes, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are small to none. Regardless of family or personal history, the USPSTF found adequate evidence that the overall harms of risk assessment, genetic counseling, genetic testing, and interventions are small to moderate. CONCLUSIONS AND RECOMMENDATION The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. (B recommendation) The USPSTF recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history or ancestry is not associated with potentially harmful BRCA1/2 gene mutations. (D recommendation).
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Affiliation(s)
| | - Douglas K Owens
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Stanford University, Stanford, California
| | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York
| | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | | | | | | | | | | | | | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Nelson HD, Pappas M, Cantor A, Haney E, Holmes R. Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer in Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2019; 322:666-685. [PMID: 31429902 DOI: 10.1001/jama.2019.8430] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Pathogenic mutations in breast cancer susceptibility genes BRCA1 and BRCA2 increase risks for breast, ovarian, fallopian tube, and peritoneal cancer in women; interventions reduce risk in mutation carriers. OBJECTIVE To update the 2013 US Preventive Services Task Force review on benefits and harms of risk assessment, genetic counseling, and genetic testing for BRCA1/2-related cancer in women. DATA SOURCES Cochrane libraries; MEDLINE, PsycINFO, EMBASE (January 1, 2013, to March 6, 2019, for updates; January 1, 1994, to March 6, 2019, for new key questions and populations); reference lists. STUDY SELECTION Discriminatory accuracy studies, randomized clinical trials (RCTs), and observational studies of women without recently diagnosed BRCA1/2-related cancer. DATA EXTRACTION AND SYNTHESIS Data on study methods, setting, population characteristics, eligibility criteria, interventions, numbers enrolled and lost to follow-up, outcome ascertainment, and results were abstracted. Two reviewers independently assessed study quality. MAIN OUTCOMES AND MEASURES Cancer incidence and mortality; discriminatory accuracy of risk assessment tools for BRCA1/2 mutations; benefits and harms of risk assessment, genetic counseling, genetic testing, and risk-reducing interventions. RESULTS For this review, 103 studies (110 articles; N = 92 712) were included. No studies evaluated the effectiveness of risk assessment, genetic counseling, and genetic testing in reducing incidence and mortality of BRCA1/2-related cancer. Fourteen studies (n = 43 813) of 8 risk assessment tools to guide referrals to genetic counseling demonstrated moderate to high accuracy (area under the receiver operating characteristic curve, 0.68-0.96). Twenty-eight studies (n = 8060) indicated that genetic counseling was associated with reduced breast cancer worry, anxiety, and depression; increased understanding of risk; and decreased intention for testing. Twenty studies (n = 4322) showed that breast cancer worry and anxiety were higher after testing for women with positive results and lower for others; understanding of risk was higher after testing. In 8 RCTs (n = 54 651), tamoxifen (relative risk [RR], 0.69 [95% CI, 0.59-0.84]; 4 trials), raloxifene (RR, 0.44 [95% CI, 0.24-0.80]; 2 trials), and aromatase inhibitors (RR, 0.45 [95% CI, 0.26-0.70]; 2 trials) were associated with lower risks of invasive breast cancer compared with placebo; results were not specific to mutation carriers. Mastectomy was associated with 90% to 100% reduction in breast cancer incidence (6 studies; n = 2546) and 81% to 100% reduction in breast cancer mortality (1 study; n = 639); oophorectomy was associated with 69% to 100% reduction in ovarian cancer (2 studies; n = 2108); complications were common with mastectomy. CONCLUSIONS AND RELEVANCE Among women without recently diagnosed BRCA1/2-related cancer, the benefits and harms of risk assessment, genetic counseling, and genetic testing to reduce cancer incidence and mortality have not been directly evaluated by current research.
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Affiliation(s)
- Heidi D Nelson
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Miranda Pappas
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Amy Cantor
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Elizabeth Haney
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Rebecca Holmes
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
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Breast cancer risk assessment: Evaluation of screening tools for genetics referral. J Am Assoc Nurse Pract 2019; 31:562-572. [PMID: 31425377 DOI: 10.1097/jxx.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The United States Preventative Services Task Force (USPSTF) recommends breast cancer risk-screening tools to help primary care providers determine which unaffected patients to refer to genetic specialists. The USPSTF does not recommend one tool above others. The purpose of this study was to compare tool performance in identifying women at risk for breast cancer. METHODS Pedigrees of 85 women aged 40-74 years with first-degree female relative with breast cancer were evaluated using five tools: Family History Screen-7 (FHS-7), Pedigree Assessment Tool, Manchester Scoring System, Referral Screening Tool, and Ontario Family History Assessment Tool (Ontario-FHAT). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to describe each tool's ability to identify women with elevated risk as defined by Claus Model calculations (lifetime risk ≥15%). Receiver operating curves were plotted. Differences between areas under the curve were estimated and compared through logistic regression to assess for differences in tool performance. CONCLUSIONS Claus calculations identified 14 of 85 women with elevated risk. Two tools, Ontario-FHAT and FHS-7, identified all women with elevated risk (sensitivity 100%). The FHS-7 tool flagged all participants (specificity 0%). The Ontario-FHAT flagged 59 participants as needing referral (specificity 36.2%) and had a NPV of 100%. Area under the curve values were not significantly different between tools (all p values > .05), and thus were not helpful in discriminating between the tools. IMPLICATIONS FOR PRACTICE The Ontario-FHAT outperformed other tools in sensitivity and NPV; however, low specificity and PPV must be balanced against these findings. Thus, the Ontario-FHAT can help determine which women would benefit from referral to genetics specialists.
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Hung FH, Wang YA, Jian JW, Peng HP, Hsieh LL, Hung CF, Yang MM, Yang AS. Evaluating BRCA mutation risk predictive models in a Chinese cohort in Taiwan. Sci Rep 2019; 9:10229. [PMID: 31308460 PMCID: PMC6629692 DOI: 10.1038/s41598-019-46707-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 07/03/2019] [Indexed: 12/02/2022] Open
Abstract
Accurate estimation of carrier probabilities of cancer susceptibility gene mutations is an important part of pre-test genetic counselling. Many predictive models are available but their applicability in the Asian population is uncertain. We evaluated the performance of five BRCA mutation risk predictive models in a Chinese cohort of 647 women, who underwent germline DNA sequencing of a cancer susceptibility gene panel. Using areas under the curve (AUCs) on receiver operating characteristics (ROC) curves as performance measures, the models did comparably well as in western cohorts (BOADICEA 0.75, BRCAPRO 0.73, Penn II 0.69, Myriad 0.68). For unaffected women with family history of breast or ovarian cancer (n = 144), BOADICEA, BRCAPRO, and Tyrer-Cuzick models had excellent performance (AUC 0.93, 0.92, and 0.92, respectively). For women with both personal and family history of breast or ovarian cancer (n = 241), all models performed fairly well (BOADICEA 0.79, BRCAPRO 0.79, Penn II 0.75, Myriad 0.70). For women with personal history of breast or ovarian cancer but no family history (n = 262), most models did poorly. Between the two well-performed models, BOADICEA underestimated mutation risks while BRCAPRO overestimated mutation risks (expected/observed ratio 0.67 and 2.34, respectively). Among 424 women with personal history of breast cancer and available tumor ER/PR/HER2 data, the predictive models performed better for women with triple negative breast cancer (AUC 0.74 to 0.80) than for women with luminal or HER2 overexpressed breast cancer (AUC 0.63 to 0.69). However, incorporating ER/PR/HER2 status into the BOADICEA model calculation did not improve its predictive accuracy.
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Affiliation(s)
- Fei-Hung Hung
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Yong Alison Wang
- Koo Foundation Sun-Yat Sen Cancer Center, Taipei, Taiwan. .,National Yang Ming University School of Medicine, Taipei, Taiwan.
| | - Jhih-Wei Jian
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Hung-Pin Peng
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | | | - Chen-Fang Hung
- Koo Foundation Sun-Yat Sen Cancer Center, Taipei, Taiwan
| | - Max M Yang
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - An-Suei Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan.
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Oliva L, Lozano R, Llácer C, Aragón I, Pajares BI, Sáez MI, Herrera-Imbroda B, Montesa A, Hernández D, Villatoro R, Otero A, Correa R, Grau G, Peinado P, Pacheco MI, García-Galisteo E, Rueda A, Machuca FJ, Alba E, Márquez-Aragonés A, Olmos D, Castro E. Risk Prediction Tools Available for Germline BRCA1/2 Mutations Underperform in Prostate Cancer Patients. Eur Urol Oncol 2019; 4:315-318. [PMID: 31307957 DOI: 10.1016/j.euo.2019.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/02/2019] [Accepted: 06/18/2019] [Indexed: 12/26/2022]
Abstract
Early identification of germline BRCA1/2 mutations may be relevant for the management of patients with prostate cancer (PC) and to prevent future breast and ovarian cancers in their relatives. Several prediction tools have been developed to estimate the likelihood of a germline BRCA1/2 mutation and are widely used to optimize screening in breast and ovarian cancer patients. We aimed to elucidate the proportion of PC patients with known BRCA1/2 mutations who would have qualified for testing using two risk calculation models (BRCAPRO and the Manchester scoring system [MSS]). We analyzed 106 families with known BRCA1/BRCA2 mutations, including 23 with PC cases. Only 30% and 48% of PC patients who were known BRCA1/BRCA2 mutations carriers would have qualified for testing using BRCAPRO and MSS, respectively. A median of two breast and/or ovarian cancer cases per family had occurred between the first PC identified in a carrier and the cancer case leading to germline testing. PATIENT SUMMARY: We tested two models developed to predict the probability of inherited BRCA1/BRCA2 mutations and found that these tools underperform in men with prostate cancer and should not be used to optimize testing in this population.
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Affiliation(s)
- Lucía Oliva
- UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain; CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain
| | - Rebeca Lozano
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain; Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Center, Madrid, Spain
| | - Casilda Llácer
- UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain; CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain
| | - Isabel Aragón
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain; Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Center, Madrid, Spain
| | - Bella I Pajares
- UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain
| | - María Isabel Sáez
- UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain; CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain
| | - Bernardo Herrera-Imbroda
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain; Urology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Alvaro Montesa
- UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain; CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain
| | - David Hernández
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain; Urology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Rosa Villatoro
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain; Medical Oncology Department, Hospital Universitario Costa del Sol, Marbella, Spain
| | - Ana Otero
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain; Radiation Oncology Department, Hospital Regional Universitario Virgen de la Victoria, Málaga, Spain
| | - Raquel Correa
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain; Radiation Oncology Department, Hospital Regional Universitario Virgen de la Victoria, Málaga, Spain
| | - Gala Grau
- UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain; CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain
| | - Pablo Peinado
- UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain; CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain
| | - María Isabel Pacheco
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain; Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Center, Madrid, Spain
| | | | - Antonio Rueda
- UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain
| | | | - Emilio Alba
- UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain
| | - Antonia Márquez-Aragonés
- UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain
| | - David Olmos
- CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain; Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Center, Madrid, Spain
| | - Elena Castro
- UGCI Oncología Médica, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga, Spain; CNIO-IBIMA Genitourinary Cancer Research Unit, Institute of Biomedical Research in Malaga, Málaga, Spain; Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Center, Madrid, Spain.
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Wendt C, Margolin S. Identifying breast cancer susceptibility genes - a review of the genetic background in familial breast cancer. Acta Oncol 2019; 58:135-146. [PMID: 30606073 DOI: 10.1080/0284186x.2018.1529428] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Heritage is the most important risk factor for breast cancer. About 15-20% of breast cancer is familial, referring to affected women who have one or more first- or second-degree relatives with the disease. The heritable component in these families is substantial, especially in families with aggregation of breast cancer with low age at onset. Identifying breast cancer susceptibility genes: Since the discovery of the highly penetrant autosomal dominant susceptibility genes BRCA1 and BRCA2 in the 1990s, several more breast cancer genes that confer a moderate to high risk of breast cancer have been identified. Furthermore, during the last decade, advances in genomic technologies have led to large scale genotyping in genome-wide association studies that have identified a considerable amount of common low penetrance loci. In total, the high risk genes, BRCA1, BRCA2, TP53, STK11, CD1 and PTEN account for approximately 20% of the familial risk. Moderate risk variants account for up to 5% of the inherited familial risk. The more than 180 identified low-risk loci explain 18% of the familial risk. Altogether more than half of the genetic background in familial breast cancer remains unclear. Other genes and low risk loci that explain a part the remaining fraction will probably be identified. Clinical aspects and future perspectives: Definitive clinical recommendations can be drawn only for carriers of germline variants in a limited number of high and moderate risk genes for which an association with breast cancer has been established. Future progress in evaluating previously identified breast cancer candidate variants and low risk loci as well as exploring new ones can play an important role in improving individual risk prediction in familial breast cancer.
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Affiliation(s)
- Camilla Wendt
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Sara Margolin
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Brédart A, Kop JL, Antoniou AC, Cunningham AP, De Pauw A, Tischkowitz M, Ehrencrona H, Schmidt MK, Dolbeault S, Rhiem K, Easton DF, Devilee P, Stoppa-Lyonnet D, Schmutlzer R. Clinicians' use of breast cancer risk assessment tools according to their perceived importance of breast cancer risk factors: an international survey. J Community Genet 2019; 10:61-71. [PMID: 29508368 PMCID: PMC6325038 DOI: 10.1007/s12687-018-0362-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/20/2018] [Indexed: 01/31/2023] Open
Abstract
The BOADICEA breast cancer (BC) risk assessment model and its associated Web Application v3 (BWA) tool are being extended to incorporate additional genetic and non-genetic BC risk factors. From an online survey through the BOADICEA website and UK, Dutch, French and Swedish national genetic societies, we explored the relationships between the usage frequencies of the BWA and six other common BC risk assessment tools and respondents' perceived importance of BC risk factors. Respondents (N = 443) varied in age, country and clinical seniority but comprised mainly genetics health professionals (82%) and BWA users (93%). Oncology professionals perceived reproductive, hormonal (exogenous) and lifestyle BC risk factors as more important in BC risk assessment compared to genetics professionals (p values < 0.05 to 0.0001). BWA was used more frequently by respondents who gave high weight to breast tumour pathology and low weight to personal BC history as BC risk factors. BWA use was positively related to the weight given to hormonal BC risk factors. The importance attributed to lifestyle and BMI BC risk factors was not associated with the use of BWA or any of the other tools. Next version of the BWA encompassing additional BC risk factors will facilitate more comprehensive BC risk assessment in genetics and oncology practice.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-Oncology Unit, 26 rue d'Ulm, 75005 Cedex 05, Paris, France.
- University Paris Descartes, 71 avenue Edouard Vaillant, 92774, Boulogne-Billancourt, France.
| | - Jean-Luc Kop
- Université de Lorraine, 2LPN-CEMA, 23 boulevard Albert 1er-BP, 60446-54001 Cedex, Nancy, France
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Worts Causeway, CB1 8RN, University of Cambridge, Cambridge, UK
| | - Alex P Cunningham
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Worts Causeway, CB1 8RN, University of Cambridge, Cambridge, UK
| | - Antoine De Pauw
- Institut Curie, Cancer genetic clinic, 26 rue d'Ulm, 75005, Paris Cedex 05, France
| | - Marc Tischkowitz
- Department of Medical Genetics, University of Cambridge, Box 238, Level 6 Addenbrooke's Treatment Centre Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Hans Ehrencrona
- Department of Clinical Genetics, Laboratory Medicine, Office for Medical Services and Department of Clinical Genetics, Lund University, 221 85, Lund, Sweden
| | - Marjanka K Schmidt
- Netherlands Cancer Institute, Division of Molecular Pathology, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-Oncology Unit, 26 rue d'Ulm, 75005 Cedex 05, Paris, France
- CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 avenue Paul Vaillant-Couturier, 94807, Villejuif, France
| | - Kerstin Rhiem
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital and Faculty of Medicine, Kerpener Str. 34, I 50931, Cologne, Germany
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Worts Causeway, CB1 8RN, University of Cambridge, Cambridge, UK
| | - Peter Devilee
- Department of Human Genetics, Department of Pathology, Leiden University Medical Centre, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Rita Schmutlzer
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital and Faculty of Medicine, Kerpener Str. 34, I 50931, Cologne, Germany
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Population-based genetic testing of asymptomatic women for breast and ovarian cancer susceptibility. Genet Med 2018; 21:913-922. [PMID: 30254378 DOI: 10.1038/s41436-018-0277-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/09/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The identification of carriers of hereditary breast and ovarian cancer (HBOC) gene variants through family cancer history alone is suboptimal, and most population-based genetic testing studies have been limited to founder mutations in high-risk populations. Here, we determine the clinical utility of identifying actionable variants in a healthy cohort of women. METHODS Germline DNA from a subset of healthy Australian women participating in the lifepool project was screened using an 11-gene custom sequencing panel. Women with clinically actionable results were invited to attend a familial cancer clinic (FCC) for post-test genetic counseling and confirmatory testing. Outcomes measured included the prevalence of pathogenic variants, and the uptake rate of genetic counseling, risk reduction surgery, and cascade testing. RESULTS Thirty-eight of 5908 women (0.64%) carried a clinically actionable pathogenic variant. Forty-two percent of pathogenic variant carriers did not have a first-degree relative with breast or ovarian cancer and 89% pursued referral to an FCC. Forty-six percent (6/13) of eligible women pursued risk reduction surgery, and the uptake rate of cascade testing averaged 3.3 family members per index case. CONCLUSION Within our cohort, HBOC genetic testing was well accepted, and the majority of high-risk gene carriers identified would not meet eligibility criteria for genetic testing based on their existing family history.
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Liede A, Cai M, Crouter TF, Niepel D, Callaghan F, Evans DG. Risk-reducing mastectomy rates in the US: a closer examination of the Angelina Jolie effect. Breast Cancer Res Treat 2018; 171:435-442. [PMID: 29808287 PMCID: PMC6096880 DOI: 10.1007/s10549-018-4824-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/03/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE In 2013, Angelina Jolie disclosed in the New York Times (NYT) that she had undergone risk-reducing bilateral mastectomy (RRBM) after learning that she was a BRCA1 mutation carrier. We examined the rates of BRCA testing and RRBM from 1997 to 2016, and quantified trends before and after the Jolie op-ed. METHODS This observational study of insurance claims data representative of the commercially-insured US population (Truven MarketScan® database) measured BRCA testing and RRBM rates among females ≥ 18 years. Censoring events were breast cancer or ovarian cancer diagnosis, last follow-up date (September 2016), or death. Interrupted time series analyses were used to quantify trends before and after the op-ed. RESULTS Angelina Jolie's NYT op-ed led to a statistically significant increase in the uptake of genetic testing and in RRBM among women without previous diagnosis of breast or ovarian cancer in the US population, and in women who did not undergo testing for BRCA (P < 0.0001 for both). The rate (slope) of RRBM among women who were previously tested for BRCA (P = 0.70) was unchanged. After excluding women with in-situ tumors, the editorial's effect became less pronounced, suggesting that high-risk women with in-situ breast cancers were most influenced by Jolie's announcement. CONCLUSION The Angelina Effect-a term coined by Time magazine to describe the rise in internet searches related to breast cancer genetics and counseling-represents a long-lasting impact of celebrity on public health awareness as significant increases in genetic testing and mastectomy rates were observed and sustained in subsequent years.
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Affiliation(s)
- Alexander Liede
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Mona Cai
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Tamara Fidler Crouter
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
- SimulStat Incorporated, Solana Beach, CA, USA
| | | | - Fiona Callaghan
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - D Gareth Evans
- Genomic Medicine, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
- Central Manchester University Hospitals NHS Foundation Trust, Saint Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK.
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de Silva TS, Russell VR, Henry FP, Thiruchelvam PTR, Hadjiminas DJ, Al-Mufti R, Hogben RK, Hunter J, Wood S, Jallali N, Leff DR. Streamlining Decision Making in Contralateral Risk-Reducing Mastectomy: Impact of PREDICT and BOADICEA Computations. Ann Surg Oncol 2018; 25:3057-3063. [PMID: 30019305 PMCID: PMC6132413 DOI: 10.1245/s10434-018-6593-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 01/04/2023]
Abstract
Introduction Patients with sporadic breast cancer (BC) have low contralateral breast cancer risk (CLBCR; approximately 0.7% per annum) and contralateral prophylactic mastectomy (CPM) offers no survival advantage. CPM with autologous reconstruction (AR) has major morbidity and resource implications. Objective The aim of this study was to review the impact of PREDICT survival estimates and lifetime CLBCR scores on decision making for CPM in patients with unilateral BC. Methods Of n = 272 consecutive patients undergoing mastectomy and AR, 252 were included. Five- and 10-year survival was computed with the PREDICT(V2) online prognostication tool, using age and clinicopathological factors. Based on family history (FH) and tumor biology, CLBCR was calculated using validated BODICEA web-based software. Survival scores were correlated against CLBCR estimates to identify patients receiving CPM with ‘low’ CLBCR (< 30% lifetime risk) and poor prognosis (5-year survival < 80%). Patients with ‘high’ CLBCR receiving unilateral mastectomy (UM) were similarly identified (UK National Institute of Health and Care Excellence [NICE] criteria for CPM, ≥ 30% lifetime BC risk). Justifications motivating CPM were investigated. Results Of 252 patients, 215 had UM and 37 had bilateral mastectomy and AR. Only 23 (62%) patients receiving CPM fulfilled the NICE criteria. Of 215 patients, 5 (2.3%) failed to undergo CPM despite high CLBCR and good prognosis. CPMs were performed, at the patient’s request, for no clear justification (n = 8), contralateral non-invasive disease, and/or FH (n = 5), FH alone (n = 4) and ipsilateral cancer recurrence-related anxiety (n = 3). Conclusion In the absence of prospective risk estimates of CLBCR and prognosis, certain patients receive CPM and reconstruction despite modest CLBCR, yet a proportion of patients with good prognoses and substantial risk are not undergoing CPM.
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Affiliation(s)
| | | | - Francis Patrick Henry
- Plastics and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | - Judith Hunter
- Plastics and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Simon Wood
- Plastics and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Navid Jallali
- Plastics and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Daniel Richard Leff
- Breast Unit, Imperial College Healthcare NHS Trust, London, UK. .,Department of Surgery and Cancer, BioSurgery and Surgical Technology, 10th Floor, QEQM Wing, St Mary's Hospital, Paddington, London, W2 1NY, UK.
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Cao A, Huang L, Shao Z. The Preventive Intervention of Hereditary Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1026:41-57. [PMID: 29282679 DOI: 10.1007/978-981-10-6020-5_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Approximately 5-10% of breast cancer is considered to be hereditary. Familial breast cancers exhibit a dominant hereditary pattern, which typically have an early age of onset and are accompanied by symptoms of ovarian cancer, bilateral breast cancer, or male breast cancer. BRCA gene mutation carriers should be regarded as high-risk groups for breast cancer, which necessitates early examination of breast cancer. Studies have built up kinds of predictive models and recommended that female BRCA mutation carriers should receive breast self-test training and take monthly breast self-examination. Familial or hereditary breast cancer family members are high-risk groups, and their risks of breast cancer can be reduced by chemoprevention, including dietary composition adjustment and application of endocrine drugs. In recent years, large-scale clinical trials have shown the important role of chemoprevention in reducing the occurrence of hereditary breast cancer. Prophylactic mastectomy is also suitable for healthy women with high breast cancer risk factors. It can reduce the incidence rate of breast cancer in high-risk women by 90% and decrease the breast cancer mortality rate in medium-risk and high-risk women by 100% and 81%, respectively.
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Affiliation(s)
- Ayong Cao
- Department of Breast Surgery, Shanghai Cancer Center/Cancer Institute, Fudan University, No.270 Dong'an Road, Shanghai, China
| | - Liang Huang
- Department of Breast Surgery, Shanghai Cancer Center/Cancer Institute, Fudan University, No.270 Dong'an Road, Shanghai, China
| | - Zhimin Shao
- Department of Breast Surgery, Shanghai Cancer Center/Cancer Institute, Fudan University, No.270 Dong'an Road, Shanghai, China.
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Lim KK, Yoon SY, Mohd Taib NA, Shabaruddin FH, Dahlui M, Woo YL, Thong MK, Teo SH, Chaiyakunapruk N. Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:395-406. [PMID: 29572724 DOI: 10.1007/s40258-018-0384-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Previous studies showed that offering BRCA mutation testing to population subgroups at high risk of harbouring the mutation may be cost effective, yet no evidence is available for low- or middle-income countries (LMIC) and in Asia. We estimated the cost effectiveness of BRCA mutation testing in early-stage breast cancer patients with high pre-test probability of harbouring the mutation in Malaysia, an LMIC in Asia. METHODS We developed a decision analytic model to estimate the lifetime costs and quality-adjusted life-years (QALYs) accrued through BRCA mutation testing or routine clinical surveillance (RCS) for a hypothetical cohort of 1000 early-stage breast cancer patients aged 40 years. In the model, patients would decide whether to accept testing and to undertake risk-reducing mastectomy, oophorectomy, tamoxifen, combinations or neither. We calculated the incremental cost-effectiveness ratio (ICER) from the health system perspective. A series of sensitivity analyses were performed. RESULTS In the base case, testing generated 11.2 QALYs over the lifetime and cost US$4815 per patient whereas RCS generated 11.1 QALYs and cost US$4574 per patient. The ICER of US$2725/QALY was below the cost-effective thresholds. The ICER was sensitive to the discounting of cost, cost of BRCA mutation testing and utility of being risk-free, but the ICERs remained below the thresholds. Probabilistic sensitivity analysis showed that at a threshold of US$9500/QALY, 99.9% of simulations favoured BRCA mutation testing over RCS. CONCLUSIONS Offering BRCA mutation testing to early-stage breast cancer patients identified using a locally-validated risk-assessment tool may be cost effective compared to RCS in Malaysia.
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Affiliation(s)
- Ka Keat Lim
- Health Systems and Services Research, Duke NUS Medical School, 8 College Road, 169857, Singapore, Republic of Singapore
- Healthcare Statistics Unit, National Clinical Research Centre, 3rd Floor, MMA House, 124 Jalan Pahang, 53000, Kuala Lumpur, Malaysia
| | - Sook Yee Yoon
- Cancer Research Malaysia, 2nd floor, Outpatient Centre, Subang Jaya Medical Centre, 47500, Subang Jaya, Selangor, Malaysia
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Fatiha Hana Shabaruddin
- Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Maznah Dahlui
- Julius Centre, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yin Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Meow Keong Thong
- Department of Paediatrics, Faculty Of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Soo Hwang Teo
- Cancer Research Malaysia, 2nd floor, Outpatient Centre, Subang Jaya Medical Centre, 47500, Subang Jaya, Selangor, Malaysia
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Muang, Phitsanulok, Thailand.
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform , Monash University Malaysia, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
- School of Pharmacy, University of Wisconsin, Madison, USA.
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Watanabe G, Chiba N, Nomizu T, Furuta A, Sato K, Miyashita M, Tada H, Suzuki A, Ohuchi N, Ishida T. Increased centrosome number in BRCA-related breast cancer specimens determined by immunofluorescence analysis. Cancer Sci 2018; 109:2027-2035. [PMID: 29601120 PMCID: PMC5989840 DOI: 10.1111/cas.13595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/04/2018] [Accepted: 03/21/2018] [Indexed: 01/25/2023] Open
Abstract
BRCA‐related breast carcinoma can be prevented through prophylactic surgery and an intensive follow‐up regimen. However, BRCA genetic tests cannot be routinely performed, and some BRCA mutations could not be defined as deleterious mutations or normal variants. Therefore, an easy functional assay of BRCA will be useful to evaluate BRCA status. As it has been reported that BRCA functions in the regulation of centrosome number, we focused on centrosome number in cancer tissues. Here, 70 breast cancer specimens with known BRCA status were analyzed using immunofluorescence of γ‐tubulin (a marker of centrosome) foci. The number of foci per cell was higher in cases with BRCA mutation compared to wild‐type cases, that is, 1.9 (95% confidence interval [CI], 1.5‐2.3) vs 0.5 (95% CI, 0.2‐0.8) (P < .001). Specifically, foci numbers per cell in BRCA1 and BRCA2 mutation cases were 1.2 (95% CI, 0.6‐1.8) and 2.2 (95% CI, 1.7‐2.6), respectively, both higher than those in wild‐type cases (P = .042 and P < .0001, respectively). The predictive value of γ‐tubulin foci as determined by area under the curve (AUC = 0.86) for BRCA status was superior to BRCAPRO (AUC = 0.69), Myriad Table (AUC = 0.61), and KOHBRA BRCA risk calculator (AUC = 0.65) pretest values. The use of γ‐tubulin foci to predict BRCA status had sensitivity = 83% (19/23), specificity = 89% (42/47), and positive predictive value = 77% (20/26). Thus, γ‐tubulin immunofluorescence, a functional assessment of BRCA, can be used as a new prospective test of BRCA status.
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Affiliation(s)
- Gou Watanabe
- Division of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Natsuko Chiba
- Department of Cancer Biology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Tadashi Nomizu
- Department of Surgery, Hoshi General Hospital, Fukushima, Japan
| | - Akihiko Furuta
- Department of Breast Surgery, Ishinomaki Red Cross Hospital, Ishinomaki, Japan
| | - Kaolu Sato
- Department of Breast Surgery, Ishinomaki Red Cross Hospital, Ishinomaki, Japan
| | - Minoru Miyashita
- Division of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Tada
- Division of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akihiko Suzuki
- Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Noriaki Ohuchi
- Division of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takanori Ishida
- Division of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Stone J. Should breast cancer screening programs routinely measure mammographic density? J Med Imaging Radiat Oncol 2018; 62:151-158. [DOI: 10.1111/1754-9485.12652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 08/05/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jennifer Stone
- Centre for Genetic Origins of Health and Disease; Curtin University and The University of Western Australia; Perth Western Australia Australia
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Assessing the effectiveness of NICE criteria for stratifying breast cancer risk in a UK cohort. Eur J Hum Genet 2018; 26:599-603. [PMID: 29335492 DOI: 10.1038/s41431-017-0072-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/03/2017] [Accepted: 11/18/2017] [Indexed: 11/09/2022] Open
Abstract
Breast cancer risk is a common indication for referral to clinical genetics services. UK National Institute of Health and Care Excellence (NICE) guidelines use family history (FH) to stratify by 10-year risk of breast cancer from age 40. Patients are stratified into population risk (PR, 10-year risk <3%), moderate (MR, 3-8%) and high risk (HR, >8%). Women at increased risk are offered screening at or prior to age 40. To assess the clinical effectiveness of current risk stratification, FH data were obtained for all unaffected women with a FH of breast cancer aged <50, referred to cancer genetics from 2000-2010. Patients were risk stratified by NICE criteria, identifying patients who subsequently developed breast cancer. A total of 1409 women had 15,414 patient years of follow-up. Thirty invasive breast cancers developed, 13 in MR and 13 in HR women. Kaplan-Meier analysis demonstrated no significant difference in the rate of breast cancer development between PR and MR women from ages 40 to 49 (Log rank p = 0.431). There was a significant difference between ages 40 and 49 years between PR and HR women (p = 0.036), but not on exclusion of BRCA mutation carriers (p = 0.136). NICE absolute 10-year risk thresholds between ages 40 and 49 were not met in any risk group, when risk was estimated using the guidelines (PR = 0.82%, MR = 1.68%, HR = 3.56%). Our data suggest that improved criteria are required for risk assessment prior to age 50 and screening resources may be best focussed on those with highly penetrant mutations in cancer risk genes.
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Brédart A, Kop JL, Antoniou AC, Cunningham AP, De Pauw A, Tischkowitz M, Ehrencrona H, Dolbeault S, Robieux L, Rhiem K, Easton DF, Devilee P, Stoppa-Lyonnet D, Schmutlzer R. Use of the BOADICEA Web Application in clinical practice: appraisals by clinicians from various countries. Fam Cancer 2018; 17:31-41. [PMID: 28623477 PMCID: PMC5770489 DOI: 10.1007/s10689-017-0014-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The 'BOADICEA' Web Application (BWA) used to assess breast cancer risk, is currently being further developed, to integrate additional genetic and non-genetic factors. We surveyed clinicians' perceived acceptability of the existing BWA v3. An online survey was conducted through the BOADICEA website, and the British, Dutch, French and Swedish genetics societies. Cross-sectional data from 443 participants who provided at least 50% responses were analysed. Respondents varied in age and, clinical seniority, but mainly comprised women (77%) and genetics professionals (82%). Some expressed negative opinions about the scientific validity of BOADICEA (9%) and BWA v3 risk presentations (7-9%). Data entry time (62%), clinical utility (22%) and ease of communicating BWA v3 risks (13-17%) received additional negative appraisals. In multivariate analyses, controlling for gender and country, data entry time was perceived as longer by genetic counsellors than clinical geneticists (p < 0.05). Respondents who (1) considered hormonal BC risk factors as more important (p < 0.01), and (2) communicated numerical risk estimates more frequently (p < 0.001), judged BWA v3 of lower clinical utility. Respondents who carried out less frequent clinical activity (p < 0.01) and respondents with '11 to 15 years' seniority (p < 0.01) had less favourable opinions of BWA v3 risk presentations. Seniority of '6 to 10 years' (p < 0.05) and more frequent numerical risk communication (p < 0.05) were associated with higher fear of communicating the BWA v3 risks to patients. The level of genetics training did not affect opinions. Further development of BWA should consider technological, genetics service delivery and training initiatives.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, 26 rue d'Ulm, 75005, Paris Cedex 05, France.
- University Paris Descartes, 71 avenue Edouard Vaillant, 92774, Boulogne-Billancourt, France.
| | - Jean-Luc Kop
- Université de Lorraine, Inter-Psy, 3 Place Godefroy de Bouillon, 54015, Nancy Cedex, France
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Alex P Cunningham
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Antoine De Pauw
- Institut Curie, Cancer Genetic Clinic, 26 rue d'Ulm, 75005, Paris Cedex 05, France
| | - Marc Tischkowitz
- Department of Medical Genetics, University of Cambridge, Level 6 Addenbrooke's Treatment Centre Cambridge Biomedical Campus, Box 238, Cambridge, CB2 0QQ, UK
| | - Hans Ehrencrona
- Department of Clinical Genetics, Laboratory Medicine, Office for Medical Services and Department of Clinical Genetics, Lund University, Universitetssjukhuset, 221 85, Lund, Sweden
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, 26 rue d'Ulm, 75005, Paris Cedex 05, France
- CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 Avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France
| | - Léonore Robieux
- University Paris Descartes, 71 avenue Edouard Vaillant, 92774, Boulogne-Billancourt, France
| | - Kerstin Rhiem
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital and Faculty of Medicine, Kerpener Str. 34 I, 50931, Cologne, Germany
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Peter Devilee
- Department of Human Genetics, Department of Pathology, Leiden University Medical Centre, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Rita Schmutlzer
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital and Faculty of Medicine, Kerpener Str. 34 I, 50931, Cologne, Germany
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Analysis of BRCA1/2 Mutations and Performance of Manchester Scoring System in High Risk Iranian Breast Cancer Patients: A Pilot Study. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.60392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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45
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Chew W, Moorakonda RB, Courtney E, Soh H, Li ST, Chen Y, Shaw T, Allen JC, Evans DGR, Ngeow J. Evaluation of the relative effectiveness of the 2017 updated Manchester scoring system for predicting BRCA1/2 mutations in a Southeast Asian country. J Med Genet 2017; 55:344-350. [PMID: 29275357 DOI: 10.1136/jmedgenet-2017-105073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/23/2017] [Accepted: 12/02/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Germline mutations in the BRCA1 and BRCA2 genes have significant clinical implications for both risk-reducing and early surveillance management. The third and most recent revision of the Manchester scoring system (MSS3) used to distinguish patients indicated for germline BRCA1/2 testing included further adjustments for triple negative breast cancer, high-grade serous ovarian cancer and human epidermal growth factor 2 (HER2) receptor status. This study aims to evaluate the relative effectiveness of MSS3 in a Southeast Asian population. METHODS All patients in our centre were tested using next-generation sequencing (NGS) panels that included full gene sequencing as well as coverage for large deletions/duplications in BRCA1/2. We calculated MSS1-3 scores for index patients between 2014 and 2017 who had undergone BRCA1/2 genetic testing and recorded their genetic test results. MSS1-3 outcomes were compared using receiver operating characteristic analysis, while associations with predictors were investigated using Fisher's exact test and logistics regression. Calculations were performed using Medcalc17. RESULTS Of the 330 included patients, 47 (14.2%) were found to have a germline mutation in BRCA1 or BRCA2. A positive HER2 receptor was associated with a lower likelihood of a BRCA1/2mutation (OR=0.125, 95% CI 0.016 to 0.955; P=0.007), while high-grade serous ovarian cancer was conversely associated with an increased likelihood of a BRCA1/2 mutation (OR=5.128, 95% CI 1.431 to 18.370; P=0.012). At the 10% threshold, 43.0% (142/330) of patients were indicated for testing under MSS3, compared with 35.8% (118/330) for MSS1% and 36.4% (120/330) for MSS2. At the 10% threshold, MSS3 sensitivity was 91.5% and specificity 65.0%, significantly better than the previous MSS1 (P=0.037) and MSS2 (P=0.032) models. CONCLUSION Our results indicate that the updated MSS3 outperforms previous iterations and relative to the Manchester population, is just as effective in identifying patients with BRCA1/2 mutations in a Southeast Asian population.
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Affiliation(s)
- Winston Chew
- Division of Medical Oncology, National Cancer Centre Singapore, Cancer Genetics Service, Singapore, Singapore
| | - Rajesh Babu Moorakonda
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.,Singapore Clinical Research Institute, Singapore, Singapore
| | - Eliza Courtney
- Division of Medical Oncology, National Cancer Centre Singapore, Cancer Genetics Service, Singapore, Singapore
| | - Hazel Soh
- Division of Medical Oncology, National Cancer Centre Singapore, Cancer Genetics Service, Singapore, Singapore
| | - Shao Tzu Li
- Division of Medical Oncology, National Cancer Centre Singapore, Cancer Genetics Service, Singapore, Singapore
| | - Yanni Chen
- Division of Medical Oncology, National Cancer Centre Singapore, Cancer Genetics Service, Singapore, Singapore
| | - Tarryn Shaw
- Division of Medical Oncology, National Cancer Centre Singapore, Cancer Genetics Service, Singapore, Singapore
| | - John Carson Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Dafydd Gareth R Evans
- Manchester Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Joanne Ngeow
- Division of Medical Oncology, National Cancer Centre Singapore, Cancer Genetics Service, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,Institute of Molecular and Cell Biology, Agency for Science Technology and Research (A*Star), Singapore, Singapore
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46
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Powers B, Pal T, Laronga C. Considerations in Testing for Inherited Breast Cancer Predisposition in the Era of Personalized Medicine. Surg Oncol Clin N Am 2017; 27:1-22. [PMID: 29132555 DOI: 10.1016/j.soc.2017.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Technological advances realized through next-generation sequencing technologies coupled with the loss of the ability to patent genes have led to reduction in costs for genetic testing. As a result, more people are being identified with inherited breast cancer syndromes that may affect recommendations for surveillance and risk reduction. Surgeons, at the forefront for patients newly diagnosed with breast cancer, must keep current with the changing landscape of genetics to continue to provide appropriate counsel and care. This article provides an overview of individuals at risk for inherited cancer predisposition and recommendations for surveillance and management.
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Affiliation(s)
- Benjamin Powers
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, 10920 N. Mckinley Drive, Tampa, FL 33612, USA
| | - Tuya Pal
- Department of Medicine, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Christine Laronga
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, 10920 N. Mckinley Drive, Tampa, FL 33612, USA.
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Teixeira N, Maistro S, Del Pilar Estevez Diz M, Mourits MJ, Oosterwijk JC, Folgueira MAK, de Bock GH. Predictability of BRCA1/2 mutation status in patients with ovarian cancer: How to select women for genetic testing in middle-income countries. Maturitas 2017; 105:113-118. [PMID: 28619461 DOI: 10.1016/j.maturitas.2017.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 05/22/2017] [Accepted: 06/01/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate the accuracy of algorithms for predicting BRCA1/2 germ-line mutation carrier probability, and to identify factors that could improve their performance among Brazilian women with ovarian cancer (OC). STUDY DESIGN In this cross-sectional study, we enrolled patients (unselected for family history of cancer) undergoing treatment or follow-up for OC in a single centre in Brazil. Clinical and demographic data, including family history of cancer, were obtained. Blood samples were collected for genetic testing. MAIN OUTCOME MEASURES The entire coding sequence of BRCA1 and BRCA2 was evaluated for mutations. Mutation carrier probability was calculated using BOADICEA, BRCAPRO, Myriad and the Manchester score. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curves (AUC) were calculated for each algorithm. Logistic regression was used to detect additional factors associated with BRCA1/2 status, and these were added to the algorithms before recalculating the AUCs. RESULTS BRCA1/2 mutations were identified in 19 of the 100 included patients. BOADICEA outperformed other algorithms (sensitivity, 73.7%; specificity, 87.7%; AUC, 0.87, with a threshold of a 10% risk of mutation). Later menarche was associated with the presence of a BRCA1/2 mutation. Although adding age at menarche resulted in a larger AUC for all models, this increase was significant only for the Myriad algorithm. CONCLUSION A BOADICEA risk evaluation of 10% or more most accurately predicted BRCA1/2 status, and the inclusion of age at menarche tended to improve the performance of all algorithms. Using these tools could reduce the number of tests, but at the expense of missing a significant proportion of mutation carriers.
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Affiliation(s)
- Natalia Teixeira
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Center of Translational Oncology Investigation (CTO), Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Simone Maistro
- Center of Translational Oncology Investigation (CTO), Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Del Pilar Estevez Diz
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marian J Mourits
- Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan C Oosterwijk
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maria Aparecida Koike Folgueira
- Center of Translational Oncology Investigation (CTO), Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Moghadasi S, Grundeken V, Janssen LAM, Dijkstra NH, Rodríguez-Girondo M, van Zelst-Stams WAG, Oosterwijk JC, Ausems MGEM, Oldenburg RA, Adank MA, Blom EW, Ruijs MWG, van Os TAM, van Deurzen CHM, Martens JWM, Schroder CP, Wijnen JT, Vreeswijk MPG, van Asperen CJ. Performance of BRCA1/2 mutation prediction models in male breast cancer patients. Clin Genet 2017; 93:52-59. [PMID: 28589637 DOI: 10.1111/cge.13065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/12/2017] [Accepted: 06/01/2017] [Indexed: 01/11/2023]
Abstract
To establish whether existing mutation prediction models can identify which male breast cancer (MBC) patients should be offered BRCA1 and BRCA2 diagnostic DNA screening, we compared the performance of BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm), BRCAPRO (BRCA probability) and the Myriad prevalence table ("Myriad"). These models were evaluated using the family data of 307 Dutch MBC probands tested for BRCA1/2, 58 (19%) of whom were carriers. We compared the numbers of observed vs predicted carriers and assessed the Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) for each model. BOADICEA predicted the total number of BRCA1/2 mutation carriers quite accurately (observed/predicted ratio: 0.94). When a cut-off of 10% and 20% prior probability was used, BRCAPRO showed a non-significant better performance (observed/predicted ratio BOADICEA: 0.81, 95% confidence interval [CI]: [0.60-1.09] and 0.79, 95% CI: [0.57-1.09], vs. BRCAPRO 1.02, 95% CI: [0.75-1.38] and 0.94, 95% CI: [0.68-1.31], respectively). Myriad underestimated the number of carriers in up to 69% of the cases. BRCAPRO showed a non-significant, higher AUC than BOADICEA (0.798 vs 0.776). Myriad showed a significantly lower AUC (0.671). BRCAPRO and BOADICEA can efficiently identify MBC patients as BRCA1/2 mutation carriers. Besides their general applicability, these tools will be of particular value in countries with limited healthcare resources.
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Affiliation(s)
- S Moghadasi
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, the Netherlands
| | - V Grundeken
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, the Netherlands
| | - L A M Janssen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, the Netherlands
| | - N H Dijkstra
- Dutch Breast Cancer Research Group, Amsterdam, the Netherlands
| | - M Rodríguez-Girondo
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, the Netherlands
| | - W A G van Zelst-Stams
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J C Oosterwijk
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - M G E M Ausems
- Department of Genetics, University Medical Centre, Utrecht, the Netherlands
| | - R A Oldenburg
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - M A Adank
- Department of Clinical Genetics, VU University Medical Centre, Amsterdam, the Netherlands
| | - E W Blom
- Department Clinical Genetics, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - M W G Ruijs
- Department of Clinical Genetics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - T A M van Os
- Department of Clinical Genetics, Academic Medical Centre, Amsterdam, the Netherlands
| | - C H M van Deurzen
- Department of Pathology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - J W M Martens
- Department of Medical Oncology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - C P Schroder
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - J T Wijnen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Human Genetics, Leiden University Medical Centre, Leiden, the Netherlands
| | - M P G Vreeswijk
- Department of Human Genetics, Leiden University Medical Centre, Leiden, the Netherlands
| | - C J van Asperen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, the Netherlands
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Evans DG, Harkness EF, Plaskocinska I, Wallace AJ, Clancy T, Woodward ER, Howell TA, Tischkowitz M, Lalloo F. Pathology update to the Manchester Scoring System based on testing in over 4000 families. J Med Genet 2017; 54:674-681. [PMID: 28490612 DOI: 10.1136/jmedgenet-2017-104584] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/03/2017] [Accepted: 04/09/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND While the requirement for thresholds for testing for mutations in BRCA1/2 is being questioned, they are likely to remain for individuals unaffected by a relevant cancer. It is still useful to provide pretesting likelihoods, but models need to take into account tumour pathology. METHODS The Manchester Scoring System (MSS) is a well-used, simple, paper-based model for assessing carrier probability that already incorporates pathology data. We have used mutation testing data from 4115 unrelated samples from affected non-Jewish individuals alongside tumour pathology to further refine the scoring system. RESULTS Adding additional points for high-grade serous ovarian cancer <60 (HGSOC=+2) and adding grade score to those with triple-negative breast cancer, while reducing the score for those with HER2+ breast cancer (-6), resulted in significantly improved sensitivity and minor improvements in specificity to the MSS. Sporadic HGSOC <60 years thus reached a score of 15-19 points within the 10% grouping consistent with the 15/113-13.2% that were identified with a BRCA1/2 pathogenic variant. Validation in a population series of ovarian cancer from Cambridge showed high sensitivity at the 10% threshold 15/17 (88.2%). CONCLUSIONS The new pathology-adjusted Manchester score MSS3 appears to provide an effective and simple-to-use estimate of the 10% and 20% thresholds for BRCA1/2 likelihood. For unaffected individuals, the 20-point (20%) threshold in their affected first-degree relative can be used to determine eligibility at the 10% threshold.
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Affiliation(s)
- D Gareth Evans
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Centre, Division of Evolution and Genomic Medicine, University of Manchester, Manchester, UK.,Prevent Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Manchester Breast Centre, The Christie, Manchester, UK.,Department of Medical Oncology, The Christie, Manchester, UK
| | - Elaine F Harkness
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Inga Plaskocinska
- Department of Medical Genetics and National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Andrew J Wallace
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Tara Clancy
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Emma R Woodward
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Centre, Division of Evolution and Genomic Medicine, University of Manchester, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Tony A Howell
- Prevent Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, UK.,Department of Medical Oncology, The Christie, Manchester, UK
| | - Marc Tischkowitz
- Department of Medical Genetics and National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Fiona Lalloo
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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50
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Cintolo-Gonzalez JA, Braun D, Blackford AL, Mazzola E, Acar A, Plichta JK, Griffin M, Hughes KS. Breast cancer risk models: a comprehensive overview of existing models, validation, and clinical applications. Breast Cancer Res Treat 2017; 164:263-284. [DOI: 10.1007/s10549-017-4247-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/12/2017] [Indexed: 01/01/2023]
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