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Zhao L, Lynch L, Eiriksson L. Information needs of Lynch syndrome and BRCA 1/2 mutation carriers considering risk-reducing gynecological surgery: a qualitative study of the decision-making process. Hered Cancer Clin Pract 2024; 22:5. [PMID: 38698439 PMCID: PMC11067152 DOI: 10.1186/s13053-024-00278-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Risk-reducing gynecological surgery (RRGS) is a prophylactic procedure that may be offered to BRCA1, BRCA2, and Lynch syndrome (LS) mutation carriers to reduce the risk of developing gynecological cancer. This study was conducted to better understand patients' information needs and evaluate how patients weigh different sources of information in their decision-making process surrounding RRGS. METHODS This study used a qualitative approach to understanding women's perspectives towards RRGS. Semi-structured interviews were conducted virtually with 8 women. Women offered RRGS between 35 and 70 years of age who are English-speaking and have an identifiable BRCA or LS mutation were included. Data from interviews was coded with constant comparative analysis to develop themes. RESULTS Of the eight women, six had selected to undergo either prophylactic hysterectomy or oophorectomy: 5 decided yes to RRGS; 1 decided no; 2 were undecided. Thematic analysis found that the key factors affecting women's decisions around prophylactic surgery were cancer risk, surgical menopause, and psychological readiness. To make an informed decision, women relied most heavily on information provided by healthcare professionals (e.g. doctors, genetic counselors) and family members with prior cancer experience. However, some women reported that they did not feel adequately informed enough to make a decision and identified COVID-19 as a significant barrier affecting access to information. CONCLUSION This qualitative study revealed the key sources of information influencing attitudes regarding RRGS and how women consulted different sources of information to reach a decision. Results underscore the need for greater attention to women's information needs in the context of psychological readiness, particularly amidst the pandemic. Research involving a larger sample size may help to better inform how support can be provided to individuals with BRCA and LS mutations considering RRGS.
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Affiliation(s)
- Lucy Zhao
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Lorrie Lynch
- Cancer Genetics Clinic, Juravinski Hospital and Cancer Centre, Hamilton, Canada
| | - Lua Eiriksson
- Division of Gynecologic Oncology, Juravinski Hospital and Cancer Centre, Hamilton, Canada
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
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Parisi MA, Caggana M, Cohen JL, Gold NB, Morris JA, Orsini JJ, Urv TK, Wasserstein MP. When is the best time to screen and evaluate for treatable genetic disorders?: A lifespan perspective. Am J Med Genet C Semin Med Genet 2023; 193:44-55. [PMID: 36876995 PMCID: PMC10475244 DOI: 10.1002/ajmg.c.32036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/10/2023] [Accepted: 01/21/2023] [Indexed: 03/07/2023]
Abstract
This paper focuses on the question of, "When is the best time to identify an individual at risk for a treatable genetic condition?" In this review, we describe a framework for considering the optimal timing for pursuing genetic and genomic screening for treatable genetic conditions incorporating a lifespan approach. Utilizing the concept of a carousel that represents the four broad time periods when critical decisions might be made around genetic diagnoses during a person's lifetime, we describe genetic testing during the prenatal period, the newborn period, childhood, and adulthood. For each of these periods, we describe the objectives of genetic testing, the current status of screening or testing, the near-term vision for the future of genomic testing, the advantages and disadvantages of each approach, and the feasibility and ethical considerations of testing and treating. The notion of a "Genomics Passbook" is one where an early genomic screening evaluation could be performed on each individual through a public health program, with that data ultimately serving as a "living document" that could be queried and/or reanalyzed at prescribed times during the lifetime of that person, or in response to concerns about symptoms of a genetic disorder in that individual.
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Affiliation(s)
- Melissa A Parisi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Michele Caggana
- Wadsworth Center, New York State Department of Health, Division of Genetics, Albany, New York, USA
| | | | - Nina B Gold
- Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Jill A Morris
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Joseph J Orsini
- New York State Department of Health, Wadsworth Center, Albany, New York, USA
| | - Tiina K Urv
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Melissa P Wasserstein
- Albert Einstein College of Medicine and the Children's Hospital at Montefiore, Bronx, New York, USA
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Poaty H, Bouya LB, Lumaka A, Mongo-Onkouo A, Gassaye D. PMS2 Pathogenic Variant in Lynch Syndrome-Associated Colorectal Cancer with Polyps. Glob Med Genet 2023; 10:1-5. [PMID: 36644715 PMCID: PMC9833889 DOI: 10.1055/s-0042-1759888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/25/2022] [Indexed: 01/13/2023] Open
Abstract
Background Lynch syndrome (LS) is an autosomal dominant condition due to the germline mutation in the mismatch repair (MMR) genes including MLH1 , MSH2 , MSH6, and PMS2 (post-meiotic segregation increased 2). The MMR mutation carriers have high risk for cancers. Pathogenic PMS2 variants are rarely reported in LS-associated colorectal cancer (CRC) with colorectal polyps. The aim of the study was to investigate the genetic etiology of CRC in an individual with CRC with multiple colorectal polyps and a family history of cancers. Patients and Methods The index patient was an African male affected by CRC with multiple colorectal polyps. The clinical diagnostic for LS was based on the Amsterdam II criteria and pedigree. Next-generation sequencing with inherited cancer genes panel was used to detect the pathogenic variant. Results The patient fulfilled the Amsterdam II criteria and the pedigree revealed a family history of recurrent CRC. A deleterious PMS2 germline heterozygous mutation c.2192_2196delTAACT was detected. Conclusion Our study supports the notion that LS may be associated with polyps and shows the predisposition of PMS2 heterozygous mutation in LS-associated CRC at young age.
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Affiliation(s)
- Henriette Poaty
- Embryology and Genetic Laboratory, Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo,Department of Clinical Sciences, Institute of Research on Health Sciences, Brazzaville, Congo,Address for correspondence Henriette Poaty, MD Embryology and Genetic Laboratory, Faculty of Health Sciences, Marien Ngouabi UniversityBP 2672, BrazzavilleRepublic of Congo
| | - Lauria Batamba Bouya
- Embryology and Genetic Laboratory, Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo
| | - Aimé Lumaka
- Centre de Génétique de l'Université de Kinshasa, DR Congo,Service de Génétique Humaine, Sart Tilman, Avenue de l'Hôpital 13, 4000, Liège, Belgium
| | - Arnaud Mongo-Onkouo
- Embryology and Genetic Laboratory, Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo,Gastro-Enterology and Internal Medicine Service, CHU Brazzaville, Congo
| | - Deby Gassaye
- Embryology and Genetic Laboratory, Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo,Gastro-Enterology and Internal Medicine Service, CHU Brazzaville, Congo
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George SHL, Donenberg T, Alexis C, DeGennaro V, Dyer H, Yin S, Ali J, Butler R, Chin SN, Curling D, Lowe D, Lunn J, Turnquest T, Wharfe G, Cerbon D, Barreto-Coelho P, Schlumbrecht MP, Akbari MR, Narod SA, Hurley JE. Gene Sequencing for Pathogenic Variants Among Adults With Breast and Ovarian Cancer in the Caribbean. JAMA Netw Open 2021; 4:e210307. [PMID: 33646313 PMCID: PMC7921902 DOI: 10.1001/jamanetworkopen.2021.0307] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Rates of breast and ovarian cancer are high in the Caribbean; however, to date, few published data quantify the prevalence of inherited cancer in the Caribbean population. OBJECTIVE To determine whether deleterious variants in genes that characterize the hereditary breast and ovarian cancer syndrome are associated with the development of breast and ovarian cancer in the English- and Creole-speaking Caribbean populations. DESIGN, SETTING, AND PARTICIPANTS This multisite genetic association study used data from germline genetic test results between June 2010 and June 2018 in the Bahamas, Cayman Islands, Barbados, Dominica, Jamaica, Haiti, and Trinidad and Tobago. Next-generation sequencing on a panel of 30 genes and multiplex ligation-dependent probe amplification (BRCA1 and BRCA2) were performed. Medical records were reviewed at time of study enrollment. Women and men diagnosed with breast and ovarian cancer with at least 1 grandparent born in the participating study sites were included; 1018 individuals were eligible and consented to participate in this study. Data were analyzed from November 4, 2019, to May 6, 2020. EXPOSURES Breast and/or ovarian cancer diagnosis. MAIN OUTCOMES AND MEASURES Rate of inherited breast and ovarian cancer syndrome and spectrum and types of variants. RESULTS Of 1018 participants, 999 (98.1%) had breast cancer (mean [SD] age, 46.6 [10.8] years) and 21 (2.1%) had ovarian cancer (mean [SD] age, 47.6 [13.5] years). Three individuals declined to have their results reported. A total of 144 of 1015 (14.2%) had a pathogenic or likely pathogenic (P/LP) variant in a hereditary breast and ovarian cancer syndrome gene. A total of 64% of variant carriers had P/LP variant in BRCA1, 23% in BRCA2, 9% in PALB2 and 4% in RAD51C, CHEK2, ATM, STK11 and NBN. The mean (SD) age of variant carriers was 40.7 (9.2) compared with 47.5 (10.7) years in noncarriers. Individuals in the Bahamas had the highest proportion of hereditary breast and ovarian cancer (23%), followed by Barbados (17.9%), Trinidad (12%), Dominica (8.8%), Haiti (6.7%), Cayman Islands (6.3%), and Jamaica (4.9%). In Caribbean-born women and men with breast cancer, having a first- or second-degree family member with breast cancer was associated with having any BRCA1 or BRCA2 germline variant (odds ratio, 1.58; 95% CI, 1.24-2.01; P < .001). A BRCA1 vs BRCA2 variant was more strongly associated with triple negative breast cancer (odds ratio, 6.33; 95% CI, 2.05-19.54; P = .001). CONCLUSIONS AND RELEVANCE In this study, among Caribbean-born individuals with breast and ovarian cancer, 1 in 7 had hereditary breast and ovarian cancer. The proportion of hereditary breast and ovarian cancer varied by island and ranged from 23% in the Bahamas to 4.9% in Jamaica. Each island had a distinctive set of variants.
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Affiliation(s)
- Sophia H. L. George
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, Florida
- Sylvester Comprehensive Cancer Center, Miami, Florida
- Leonard Miller School of Medicine, University of Miami, Miami, Florida
| | - Talia Donenberg
- Sylvester Comprehensive Cancer Center, Miami, Florida
- Leonard Miller School of Medicine, University of Miami, Miami, Florida
- Department of Genetics, University of Miami, Miami, Florida
| | - Cheryl Alexis
- Faculty of Medical Sciences, University of West Indies-Cave Hill, Barbados
| | | | - Hedda Dyer
- Ross University School of Medicine, Commonwealth of Dominica (now in Barbados)
| | - Sook Yin
- Cayman Islands Cancer Society, Grand Cayman, Cayman Islands
| | - Jameel Ali
- St. James Medical Complex, Northwest Regional Health Authority, Port-of-Spain, Trinidad and Tobago
| | - Raleigh Butler
- Princess Margaret Hospital, University of the West Indies, School of Clinical Medicine and Research, Nassau, Bahamas
| | - Sheray N. Chin
- Department of Pathology, University of West Indies-Mona, Kingston, Jamaica
| | - DuVaughn Curling
- Princess Margaret Hospital, University of the West Indies, School of Clinical Medicine and Research, Nassau, Bahamas
| | - Dwight Lowe
- Department of Pathology, University of West Indies-Mona, Kingston, Jamaica
| | - John Lunn
- Princess Margaret Hospital, University of the West Indies, School of Clinical Medicine and Research, Nassau, Bahamas
| | - Theodore Turnquest
- Princess Margaret Hospital, University of the West Indies, School of Clinical Medicine and Research, Nassau, Bahamas
| | - Gilian Wharfe
- Department of Pathology, University of West Indies-Mona, Kingston, Jamaica
| | - Danielle Cerbon
- Sylvester Comprehensive Cancer Center, Miami, Florida
- Division of Medical Oncology, Department of Medicine, University of Miami, Miami, Florida
| | - Priscila Barreto-Coelho
- Sylvester Comprehensive Cancer Center, Miami, Florida
- Division of Medical Oncology, Department of Medicine, University of Miami, Miami, Florida
| | - Matthew P. Schlumbrecht
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, Florida
- Sylvester Comprehensive Cancer Center, Miami, Florida
- Leonard Miller School of Medicine, University of Miami, Miami, Florida
| | - Mohammad R. Akbari
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Steven A. Narod
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Judith E. Hurley
- Sylvester Comprehensive Cancer Center, Miami, Florida
- Leonard Miller School of Medicine, University of Miami, Miami, Florida
- Division of Medical Oncology, Department of Medicine, University of Miami, Miami, Florida
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