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Zogopoulos G, Haimi I, Sanoba SA, Everett JN, Wang Y, Katona BW, Farrell JJ, Grossberg AJ, Paiella S, Klute KA, Bi Y, Wallace MB, Kwon RS, Stoffel EM, Wadlow RC, Sussman DA, Merchant NB, Permuth JB, Golan T, Raitses-Gurevich M, Lowy AM, Liau J, Jeter JM, Lindberg JM, Chung DC, Earl J, Brentnall TA, Schrader KA, Kaul V, Huang C, Chandarana H, Smerdon C, Graff JJ, Kastrinos F, Kupfer SS, Lucas AL, Sears RC, Brand RE, Parmigiani G, Simeone DM. The Pancreatic Cancer Early Detection (PRECEDE) Study is a Global Effort to Drive Early Detection: Baseline Imaging Findings in High-Risk Individuals. J Natl Compr Canc Netw 2024; 22:158-166. [PMID: 38626807 DOI: 10.6004/jnccn.2023.7097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/09/2023] [Indexed: 04/19/2024]
Abstract
BACKGROUND Pancreatic adenocarcinoma (PC) is a highly lethal malignancy with a survival rate of only 12%. Surveillance is recommended for high-risk individuals (HRIs), but it is not widely adopted. To address this unmet clinical need and drive early diagnosis research, we established the Pancreatic Cancer Early Detection (PRECEDE) Consortium. METHODS PRECEDE is a multi-institutional international collaboration that has undertaken an observational prospective cohort study. Individuals (aged 18-90 years) are enrolled into 1 of 7 cohorts based on family history and pathogenic germline variant (PGV) status. From April 1, 2020, to November 21, 2022, a total of 3,402 participants were enrolled in 1 of 7 study cohorts, with 1,759 (51.7%) meeting criteria for the highest-risk cohort (Cohort 1). Cohort 1 HRIs underwent germline testing and pancreas imaging by MRI/MR-cholangiopancreatography or endoscopic ultrasound. RESULTS A total of 1,400 participants in Cohort 1 (79.6%) had completed baseline imaging and were subclassified into 3 groups based on familial PC (FPC; n=670), a PGV and FPC (PGV+/FPC+; n=115), and a PGV with a pedigree that does not meet FPC criteria (PGV+/FPC-; n=615). One HRI was diagnosed with stage IIB PC on study entry, and 35.1% of HRIs harbored pancreatic cysts. Increasing age (odds ratio, 1.05; P<.001) and FPC group assignment (odds ratio, 1.57; P<.001; relative to PGV+/FPC-) were independent predictors of harboring a pancreatic cyst. CONCLUSIONS PRECEDE provides infrastructure support to increase access to clinical surveillance for HRIs worldwide, while aiming to drive early PC detection advancements through longitudinal standardized clinical data, imaging, and biospecimen captures. Increased cyst prevalence in HRIs with FPC suggests that FPC may infer distinct biological processes. To enable the development of PC surveillance approaches better tailored to risk category, we recommend adoption of subclassification of HRIs into FPC, PGV+/FPC+, and PGV+/FPC- risk groups by surveillance protocols.
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Affiliation(s)
| | - Ido Haimi
- 2New York University Langone Health, New York, NY
| | | | | | - Yifan Wang
- 1McGill University Health Centre, Montreal, Quebec, Canada
| | - Bryson W Katona
- 3University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | | | - Salvatore Paiella
- 6General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | | | - Yan Bi
- 8Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | | | | | - Talia Golan
- 13Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maria Raitses-Gurevich
- 13Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Joy Liau
- 14UC San Diego Health, La Jolla, CA
| | | | | | - Daniel C Chung
- 17Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Julie Earl
- 18Ramón y Cajal Health Research Institute, Madrid, Spain
| | | | | | - Vivek Kaul
- 21University of Rochester Medical Center, Rochester, NY
| | | | | | | | - John J Graff
- 22Arbor Research Collaborative for Health, Ann Arbor, MI
| | - Fay Kastrinos
- 23Columbia University Irving Medical Center/Herbert Irving Comprehensive Cancer Center, New York, NY
| | | | - Aimee L Lucas
- 25Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Giovanni Parmigiani
- 27Dana-Farber Cancer Institute and Harvard T.H. Chan School of Public Health, Boston, MA
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Katona BW, Klute K, Brand RE, Everett JN, Farrell JJ, Hawthorne K, Kaul V, Kupfer SS, Paiella S, Simeone DM, Sussman DA, Zogopoulos G, Lucas AL, Kastrinos F. Racial, Ethnic, and Sex-based Disparities among High-risk Individuals Undergoing Pancreatic Cancer Surveillance. Cancer Prev Res (Phila) 2023; 16:343-352. [PMID: 37259800 DOI: 10.1158/1940-6207.capr-22-0529] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 06/02/2023]
Abstract
Since its inception two years ago, the international, multicenter Pancreatic Cancer Early Detection (PRECEDE) Consortium has enrolled high-risk individuals (HRI) undergoing pancreatic ductal adenocarcinoma (PDAC) surveillance. Herein we aim to evaluate enrollment disparities in PRECEDE. Data on HRIs enrolled between May 2020 and March 2022 were collected, with HRIs defined as participants enrolled in PRECEDE meeting guideline-based criteria for PDAC surveillance. Of 1,273 HRIs enrolled, 1,113 were eligible for inclusion, with 47.2% meeting familial pancreatic cancer criteria without a known pathogenic variant (PV) and the remainder having a pathogenic variant in a PDAC-risk gene (CDKN2A, STK11, PRSS1, BRCA1, BRCA2, PALB2, ATM, MLH1, MSH2, MSH6, PMS2, or EPCAM). Study participants were predominantly from the United States (82.7%), the most common age range at enrollment was 60-69 years (37.4%), and a non-PDAC cancer was present in 32.4%. There were racial/ethnic- and sex-based disparities among enrolled subjects, as the majority of participants were female (65.9%) and self-reported white (87.7%), with only 2.9% having Hispanic ethnicity. While more than 97% of participants consented to utilize imaging data and biosamples for research, there was no difference in rate of consent based on race/ethnicity, sex, or age, thereby demonstrating uniform participation in research activities among all subgroups after enrollment. Ensuring that diversity of HRIs in PDAC surveillance programs mirrors the communities served by participating centers is important. Substantial racial/ethnic- and sex-based disparities persist among recently enrolled HRIs undergoing PDAC surveillance, and therefore reducing these disparities will be a major focus of the PRECEDE Consortium moving forward. PREVENTION RELEVANCE Pancreatic cancer surveillance is critical to decreasing pancreatic cancer mortality; therefore, it is important that pancreatic cancer surveillance studies enroll diverse patients. We demonstrate that substantial racial/ethnic- and sex-based disparities exist amongst enrollment in the international PRECEDE consortium, highlighting the dire need for future efforts to reduce these disparities. See related Spotlight, p. 305.
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Affiliation(s)
- Bryson W Katona
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kelsey Klute
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Randall E Brand
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - James J Farrell
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Vivek Kaul
- University of Rochester, Rochester, New York
| | - Sonia S Kupfer
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | | | | | - Aimee L Lucas
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Fay Kastrinos
- Division of Digestive and Liver Diseases and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center and the Vagelos College of Physicians and Surgeons, New York, New York
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Klute K, Lucas AL, Brand R, Everett JN, Farrell JJ, Hawthorne K, Kaul V, Kupfer SS, Paiella S, Simeone DM, Sussman DA, Zogopoulos G, Kastrinos F, Katona BW. Racial, ethnic, and sex-based disparities among high-risk individuals undergoing pancreatic cancer surveillance. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
687 Background: The international, multi-center Pancreatic Cancer Early Detection (PRECEDE) Consortium enrolls high-risk individuals (HRIs) undergoing pancreatic ductal adenocarcinoma (PDAC) surveillance. Enrollment began in 2020, and despite challenges related to the COVID-19 pandemic, the PRECEDE Consortium rapidly accrued a large cohort of HRIs. The purpose of this study is to describe the characteristics of this cohort and assess racial, ethnic, and sex-based disparities. Methods: The PRECEDE Consortium (NCT04970056) is a prospective, multicenter study focused on improving survival from PDAC through early detection. Data from all HRIs who met criteria for PDAC surveillance and enrolled between May 2020 - March 2022 were collected and included in the analysis. Results: During the study period, 1299 HRIs enrolled in PRECEDE at 32 centers. HRIs were excluded if enrollment data was incomplete or criteria for PDAC surveillance were not met. Of 1113 who were included, 47.2% met criteria for familial pancreatic cancer (FPC) and 45.4% had a family history of PDAC along with a PV in a PDAC-risk gene (BRCA1, BRCA2, PALB2, ATM, MLH1, MSH2, MSH6, PMS2, or EPCAM). The remainder had familial atypical mole melanoma syndrome (5.7%), Peutz-Jeghers syndrome (1.6%), or hereditary pancreatitis (0.2%). More females than males enrolled (65.9% vs. 33.5%). The distribution of HRIs by race and ethnicity is depicted; the majority identified as white (87.7%). Study participants were primarily from the US (82.7%), the median age was 61 (27-85) and 18.5% had Ashkenazi Jewish ancestry. Nearly all HRIs consented to allow access to imaging data (99.6%), collection of germline DNA (97.7%), and biosample collection (99.5%). There were no race, ethnicity, or sex-based differences in rates of consent for collection of imaging, DNA, or biosamples. Conclusions: Enrollment of HRIs in prospective studies of PDAC surveillance is essential for advancing early detection research in PDAC. A distinct advantage of the PRECEDE Consortium for examining enrollment disparities is that recruitment began in 2020, providing a unique and current snapshot of the international PDAC surveillance landscape. Despite the recent attention on addressing disparities in healthcare delivery, significant racial, ethnic, and sex-based disparities persisted in the cohort of HRIs enrolled in the PRECEDE Consortium. Ensuring that the diversity of participants in the PRECEDE Consortium mirrors the communities served by participating centers is crucial. Further examining and addressing the reasons for these disparities is a major focus of the PRECEDE Consortium moving forward. [Table: see text]
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Affiliation(s)
- Kelsey Klute
- University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | | | - Vivek Kaul
- Division of Gastroenterology, Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | | | - Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | | | | | | | | | - Bryson W Katona
- University of Pennsylvania Perelman School of Medicine (Philadelphia, PA), Philadelphia, PA
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Haimi I, Zogopoulos G, Dettwyler SA, Everett JN, Bi Y, Brand RE, Chung DC, Farrell JJ, Grossberg A, Kastrinos F, Katona BW, Klute K, Kupfer SS, Lucas AL, Paiella S, Parmigiani G, Permuth JB, Sears RC, Sussman DA, Simeone DM. Pancreatic imaging findings from the PRECEDE study: A large high-risk heritable cohort for pancreatic cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
689 Background: Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal cancer typically discovered at incurable stages. The PRECEDE Consortium was established to accelerate early detection by using a large-scale, collaborative, innovative model, predicated on standardized collection of demographic, clinical, and imaging data from high-risk individuals (HRI). Here we report the initial pancreas imaging findings in Cohort 1, representing HRI with familial pancreatic cancer (FPC) or pathogenic germline variants (PGV) in PDAC susceptibility genes with a 1st or 2nd degree relative with PDAC. Methods: The PRECEDE Consortium (NCT04970056) began enrollment in 5/2020. HRI enrolled prospectively at centers worldwide into one of 7 cohorts based on personal and/or family history of PDAC and PGV status. PRECEDE’s planned enrollment is 10,000 patients. Data sharing is required to join PRECEDE, facilitated by a standardized data collection system and central database (PRECEDELink). Imaging (MRI/MRCP and EUS) is performed using standardized image acquisition and reporting templates. Imaging and clinical sequencing data are stored and analyzed in the PRECEDE data cloud. Results: By 9/16/2022, 26 sites enrolled 3156 patients in 7 cohorts, with 1716 in Cohort 1. Cohort 1 was 60% female, 80% white; 48% met FPC criteria, and 52% were PGV carriers. Within Cohort 1, 658 FPC and 965 PGV (1353 total, 79%) underwent imaging (68% MRI; 32% EUS). Overall, 573/1353 (42%) had pancreas abnormalities: 320/573 (49%) FPC, and 253/573 (36%) PGV (OR [95% CI] 1.65 [1.32–2.06], P < 0.001). Cysts were the most common abnormality, present in 549/1353 (41%) and accounting for 310/320 (97%) FPC and 239/253 (94%) PGV HRI abnormalities. Of 549 HRI with cysts, 262 (48%) had 1 cyst, including 137/310 (44%) FPC and 125/239 (52%) PGV HRI (OR 1.43 [1.07–1.92], P = .012) The remaining 287/549 (52%) had ≥2 cysts, including 173/310 (56%) FPC and 114/239 (48%) PGV HRI (OR 1.98 [1.49–2.64], P < 0.001). Worrisome features occurred in 83/1353 (6.1%) including: 14 (1%) cyst > 2 cm, 7 (0.5%) cyst ≥3 cm, 35 (2.6%) main pancreatic duct (MPD) diameter ≥5 mm; 2 (0.15%) duct strictures; and 25 (1.8%) solid masses. Solid masses included 1 (0.07%) PDAC, 9 (0.7%) neuroendocrine tumors, and 15 (1.1%) benign lesions (e.g. lipoma, splenule). Conclusions: Pancreatic abnormalities are common in a cohort of 1353 HRI enrolled in PRECEDE; 6.1% of HRI had findings with worrisome features and clinical implications. Multiple cysts were significantly more common in FPC HRI (OR 1.98); worrisome findings did not differ between FPC and PGV groups. The longitudinal study of this growing HRI cohort with standardized imaging and matched comprehensive epidemiological, clinical, and laboratory data, along with germline testing, will provide critical information and understanding of PDAC risk, and augment existing clinical decision-making models governing surveillance and treatment.
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Affiliation(s)
- Ido Haimi
- NYU Langone Health- Department of Surgery, New York, NY
| | | | | | | | - Yan Bi
- Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | - Bryson W Katona
- University of Pennsylvania Perelman School of Medicine (Philadelphia, PA), Philadelphia, PA
| | - Kelsey Klute
- University of Nebraska Medical Center, Omaha, NE
| | | | | | - Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
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Everett JN, Dettwyler SA, Jing X, Stender C, Schmitter M, Baptiste A, Chun J, Kawaler EA, Khanna LG, Gross SA, Gonda TA, Beri N, Oberstein PE, Simeone DM. Impact of comprehensive family history and genetic analysis in the multidisciplinary pancreatic tumor clinic setting. Cancer Med 2022; 12:2345-2355. [PMID: 35906821 PMCID: PMC9939217 DOI: 10.1002/cam4.5059] [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: 01/25/2022] [Revised: 04/25/2022] [Accepted: 06/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Genetic testing is recommended for all pancreatic ductal adenocarcinoma (PDAC) patients. Prior research demonstrates that multidisciplinary pancreatic cancer clinics (MDPCs) improve treatment- and survival-related outcomes for PDAC patients. However, limited information exists regarding the utility of integrated genetics in the MDPC setting. We hypothesized that incorporating genetics in an MDPC serving both PDAC patients and high-risk individuals (HRI) could: (1) improve compliance with guideline-based genetic testing for PDAC patients, and (2) optimize HRI identification and PDAC surveillance participation to improve early detection and survival. METHODS Demographics, genetic testing results, and pedigrees were reviewed for PDAC patients and HRI at one institution over 45 months. Genetic testing analyzed 16 PDAC-associated genes at minimum. RESULTS Overall, 969 MDPC subjects were evaluated during the study period; another 56 PDAC patients were seen outside the MDPC. Among 425 MDPC PDAC patients, 333 (78.4%) completed genetic testing; 29 (8.7%) carried a PDAC-related pathogenic germline variant (PGV). Additionally, 32 (9.6%) met familial pancreatic cancer (FPC) criteria. These PDAC patients had 191 relatives eligible for surveillance or genetic testing. Only 2/56 (3.6%) non-MDPC PDAC patients completed genetic testing (p < 0.01). Among 544 HRI, 253 (46.5%) had a known PGV or a designation of FPC, and were eligible for surveillance at baseline; of the remainder, 15/291 (5.2%) were eligible following genetic testing and PGV identification. CONCLUSION Integrating genetics into the multidisciplinary setting significantly improved genetic testing compliance by reducing logistical barriers for PDAC patients, and clarified cancer risks for their relatives while conserving clinical resources. Overall, we identified 206 individuals newly eligible for surveillance or genetic testing (191 relatives of MDPC PDAC patients, and 15 HRI from this cohort), enabling continuity of care for PDAC patients and at-risk relatives in one clinic.
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Affiliation(s)
- Jessica N. Everett
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA,Department of SurgeryNew York University Langone HealthNew York CityNew YorkUSA,Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Shenin A. Dettwyler
- Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Xiaohong Jing
- Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Cody Stender
- Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Madeleine Schmitter
- Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Ariele Baptiste
- Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Jennifer Chun
- Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA
| | - Emily A. Kawaler
- Applied Bioinformatics LaboratoriesNew York University Langone HealthNew York CityNew YorkUSA
| | - Lauren G. Khanna
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA
| | - Seth A. Gross
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA
| | - Tamas A. Gonda
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA
| | - Nina Beri
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA,Department of SurgeryNew York University Langone HealthNew York CityNew YorkUSA
| | - Paul E. Oberstein
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA,Department of SurgeryNew York University Langone HealthNew York CityNew YorkUSA
| | - Diane M. Simeone
- Department of MedicineNew York University Langone HealthNew York CityNew YorkUSA,Perlmutter Cancer CenterNew York University Langone HealthNew York CityNew YorkUSA,Department of PathologyNew York University Langone HealthNew York CityNew YorkUSA
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Gonda TA, Everett JN, Wallace M, Simeone DM. Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium. Gastroenterology 2021; 161:1751-1757. [PMID: 34454916 DOI: 10.1053/j.gastro.2021.08.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/06/2021] [Accepted: 08/19/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Tamas A Gonda
- Department of Medicine, Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Jessica N Everett
- Department of Medicine, Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | - Michael Wallace
- Mayo Clinic, Jacksonville, Florida; Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates
| | - Diane M Simeone
- Perlmutter Cancer Center, Departments of Surgery and Pathology, NYU Langone Health, New York, New York
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Wang A, Everett JN, Chun J, Cen C, Simeone DM, Schnabel F. Impact of changing guidelines on genetic testing and surveillance recommendations in a contemporary cohort of breast cancer survivors with family history of pancreatic cancer. Sci Rep 2021; 11:12491. [PMID: 34127761 PMCID: PMC8203798 DOI: 10.1038/s41598-021-91971-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/27/2021] [Indexed: 01/06/2023] Open
Abstract
Changing practice guidelines and recommendations have important implications for cancer survivors. This study investigated genetic testing patterns and outcomes and reported family history of pancreatic cancer (FHPC) in a large registry population of breast cancer (BC) patients. Variables including clinical and demographic characteristics, FHPC in a first or second-degree relative, and genetic testing outcomes were analyzed for BC patients diagnosed between 2010 and 2018 in the NYU Langone Health Breast Cancer Database. Among 3334 BC patients, 232 (7%) had a positive FHPC. BC patients with FHPC were 1.68 times more likely to have undergone genetic testing (p < 0.001), but 33% had testing for BRCA1/2 only and 44% had no genetic testing. Pathogenic germline variants (PGV) were identified in 15/129 (11.6%) BC patients with FHPC, and in 145/1315 (11.0%) BC patients without FHPC. Across both groups, updates in genetic testing criteria and recommendations could impact up to 80% of this cohort. Within a contemporary cohort of BC patients, 7% had a positive FHPC. The majority of these patients (56%) had no genetic testing, or incomplete testing by current standards, suggesting under-diagnosis of PC risk. This study supports recommendations for survivorship care that incorporate ongoing genetic risk assessment and counseling.
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Affiliation(s)
- Annie Wang
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Jessica N Everett
- Department of Medicine, New York University Langone Health, New York, NY, USA
- Perlmutter Cancer Center, New York University Langone Health, 160 East 34th St., New York, NY, 10016, USA
| | - Jennifer Chun
- Perlmutter Cancer Center, New York University Langone Health, 160 East 34th St., New York, NY, 10016, USA
| | - Cindy Cen
- Department of Surgery, New York University Langone Health, New York, NY, USA
| | - Diane M Simeone
- Department of Surgery, New York University Langone Health, New York, NY, USA.
- Department of Pathology, New York University Langone Health, New York, NY, USA.
- Perlmutter Cancer Center, New York University Langone Health, 160 East 34th St., New York, NY, 10016, USA.
| | - Freya Schnabel
- Department of Surgery, New York University Langone Health, New York, NY, USA.
- Perlmutter Cancer Center, New York University Langone Health, 160 East 34th St., New York, NY, 10016, USA.
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Kaphingst KA, Kohlmann W, Chambers RL, Goodman MS, Bradshaw R, Chan PA, Chavez-Yenter D, Colonna SV, Espinel WF, Everett JN, Gammon A, Goldberg ER, Gonzalez J, Hagerty KJ, Hess R, Kehoe K, Kessler C, Kimball KE, Loomis S, Martinez TR, Monahan R, Schiffman JD, Temares D, Tobik K, Wetter DW, Mann DM, Kawamoto K, Del Fiol G, Buys SS, Ginsburg O. Comparing models of delivery for cancer genetics services among patients receiving primary care who meet criteria for genetic evaluation in two healthcare systems: BRIDGE randomized controlled trial. BMC Health Serv Res 2021; 21:542. [PMID: 34078380 PMCID: PMC8170651 DOI: 10.1186/s12913-021-06489-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/06/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Advances in genetics and sequencing technologies are enabling the identification of more individuals with inherited cancer susceptibility who could benefit from tailored screening and prevention recommendations. While cancer family history information is used in primary care settings to identify unaffected patients who could benefit from a cancer genetics evaluation, this information is underutilized. System-level population health management strategies are needed to assist health care systems in identifying patients who may benefit from genetic services. In addition, because of the limited number of trained genetics specialists and increasing patient volume, the development of innovative and sustainable approaches to delivering cancer genetic services is essential. METHODS We are conducting a randomized controlled trial, entitled Broadening the Reach, Impact, and Delivery of Genetic Services (BRIDGE), to address these needs. The trial is comparing uptake of genetic counseling, uptake of genetic testing, and patient adherence to management recommendations for automated, patient-directed versus enhanced standard of care cancer genetics services delivery models. An algorithm-based system that utilizes structured cancer family history data available in the electronic health record (EHR) is used to identify unaffected patients who receive primary care at the study sites and meet current guidelines for cancer genetic testing. We are enrolling eligible patients at two healthcare systems (University of Utah Health and New York University Langone Health) through outreach to a randomly selected sample of 2780 eligible patients in the two sites, with 1:1 randomization to the genetic services delivery arms within sites. Study outcomes are assessed through genetics clinic records, EHR, and two follow-up questionnaires at 4 weeks and 12 months after last genetic counseling contactpre-test genetic counseling. DISCUSSION BRIDGE is being conducted in two healthcare systems with different clinical structures and patient populations. Innovative aspects of the trial include a randomized comparison of a chatbot-based genetic services delivery model to standard of care, as well as identification of at-risk individuals through a sustainable EHR-based system. The findings from the BRIDGE trial will advance the state of the science in identification of unaffected patients with inherited cancer susceptibility and delivery of genetic services to those patients. TRIAL REGISTRATION BRIDGE is registered as NCT03985852 . The trial was registered on June 6, 2019 at clinicaltrials.gov .
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Affiliation(s)
- Kimberly A Kaphingst
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
- Department of Communication, University of Utah, 255 S. Central Campus Drive, Salt Lake City, UT, 84112, USA.
| | - Wendy Kohlmann
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | | | - Melody S Goodman
- School of Global Public Health, New York University, 726 Broadway, New York, NY, 10012, USA
| | - Richard Bradshaw
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA
| | - Priscilla A Chan
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
| | - Daniel Chavez-Yenter
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Communication, University of Utah, 255 S. Central Campus Drive, Salt Lake City, UT, 84112, USA
| | - Sarah V Colonna
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Veterans Administration Medical Center, 500 S. Foothill Boulevard, Salt Lake City, UT, 84149, USA
| | - Whitney F Espinel
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Jessica N Everett
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Amanda Gammon
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Eric R Goldberg
- Department of Medicine, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Javier Gonzalez
- Medical Center Information Technology, NYU Langone Health, 360 Park Avenue South, New York, NY, 10010, USA
| | - Kelsi J Hagerty
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Kelsey Kehoe
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Cecilia Kessler
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Kadyn E Kimball
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Shane Loomis
- NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
- Boost Services, Epic Systems Corporation, 1979 Milky Way, Verona, WI, 53593, USA
| | - Tiffany R Martinez
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Rachel Monahan
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Joshua D Schiffman
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Dani Temares
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
| | - Katie Tobik
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - David W Wetter
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Devin M Mann
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA
| | - Saundra S Buys
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Ophira Ginsburg
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
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9
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Everett JN, Burgos G, Chun J, Baptiste A, Khanna LG, Oberstein PE, Simeone DM. Cancer surveillance awareness and practice among families at increased risk for pancreatic adenocarcinoma. Cancer 2021; 127:2271-2278. [PMID: 33721345 DOI: 10.1002/cncr.33500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/26/2020] [Revised: 01/08/2021] [Accepted: 01/27/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Early detection of pancreatic ductal adenocarcinoma (PDAC) is an important goal for improving survival. Individuals who meet published guidelines for surveillance may be underidentified, and family communication about risk represents a pathway to increasing participation in surveillance. We investigated the uptake of and barriers to surveillance in at-risk relatives of clinic patients. METHODS We conducted a retrospective record review of patients with personal or family history of PDAC evaluated over 12 months. The first relative presenting to clinic (proband) reported surveillance status and reasons for nonparticipation for at-risk relatives. Descriptive analyses and Fisher's exact tests were conducted to evaluate differences in surveillance participation. RESULTS Among 193 at-risk relatives, 21% were in surveillance. The primary reasons for nonparticipation were lack of awareness (36%) and lack of interest (24%). Neither the sex nor the cancer status of probands impacted surveillance. At-risk relatives with familial pancreatic cancer (FPC) who also carried relevant pathogenic germline variants (PGVs) were more likely to undergo surveillance than those with FPC or PGVs alone (P = .003). Among families with PGVs, 59% of relatives potentially eligible for surveillance had not completed genetic testing. CONCLUSION PDAC surveillance is underutilized in high-risk families. Communication interventions to address informational needs and decisional support could improve outcomes.
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Affiliation(s)
- Jessica N Everett
- Department of Medicine, New York University Langone Health, New York, New York.,Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Gabriela Burgos
- Department of Surgery, New York University Langone Health, New York, New York.,Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Jennifer Chun
- Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Ariele Baptiste
- Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Lauren G Khanna
- Department of Medicine, New York University Langone Health, New York, New York
| | - Paul E Oberstein
- Department of Medicine, New York University Langone Health, New York, New York.,Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Diane M Simeone
- Department of Surgery, New York University Langone Health, New York, New York.,Department of Pathology, New York University Langone Health, New York, New York.,Perlmutter Cancer Center, New York University Langone Health, New York, New York
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10
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Hart MR, Biesecker BB, Blout CL, Christensen KD, Amendola LM, Bergstrom KL, Biswas S, Bowling KM, Brothers KB, Conlin LK, Cooper GM, Dulik MC, East KM, Everett JN, Finnila CR, Ghazani AA, Gilmore MJ, Goddard KAB, Jarvik GP, Johnston JJ, Kauffman TL, Kelley WV, Krier JB, Lewis KL, McGuire AL, McMullen C, Ou J, Plon SE, Rehm HL, Richards CS, Romasko EJ, Sagardia AM, Spinner NB, Thompson ML, Turbitt E, Vassy JL, Wilfond BS, Veenstra DL, Berg JS, Green RC, Biesecker LG, Hindorff LA. Correction: Secondary findings from clinical genomic sequencing: prevalence, patient perspectives, family history assessment, and health-care costs from a multisite study. Genet Med 2019; 21:1261-1262. [PMID: 30670880 DOI: 10.1038/s41436-019-0440-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The originally published version of this Article contained errors in Fig. 2. The numbers below the black arrowheads were incorrect; please see incorrect Figure in associated Correction. These errors have now been corrected in the PDF and HTML versions of the Article.
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Affiliation(s)
- M Ragan Hart
- Department of Medicine (Medical Genetics), University of Washington, Seattle, WA, USA. .,Clinical Sequencing Exploratory Research Coordinating Center, University of Washington, Seattle, WA, USA.
| | - Barbara B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Carrie L Blout
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kurt D Christensen
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Laura M Amendola
- Department of Medicine (Medical Genetics), University of Washington, Seattle, WA, USA.,Clinical Sequencing Exploratory Research Coordinating Center, University of Washington, Seattle, WA, USA
| | - Katie L Bergstrom
- Department of Pediatrics, Oncology Section, Baylor College of Medicine, Houston, TX, USA
| | - Sawona Biswas
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kevin M Bowling
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | - Kyle B Brothers
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
| | - Laura K Conlin
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Greg M Cooper
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | - Matthew C Dulik
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly M East
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | - Jessica N Everett
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | | | - Arezou A Ghazani
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Marian J Gilmore
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, OR, USA
| | | | - Gail P Jarvik
- Department of Medicine (Medical Genetics), University of Washington, Seattle, WA, USA.,Clinical Sequencing Exploratory Research Coordinating Center, University of Washington, Seattle, WA, USA
| | - Jennifer J Johnston
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | - Joel B Krier
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Katie L Lewis
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Carmit McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Jeffrey Ou
- Clinical Sequencing Exploratory Research Coordinating Center, University of Washington, Seattle, WA, USA
| | - Sharon E Plon
- Department of Pediatrics, Oncology Section, Baylor College of Medicine, Houston, TX, USA
| | - Heidi L Rehm
- Harvard Medical School, Boston, MA, USA.,Laboratory for Molecular Medicine, Partners HealthCare, Cambridge, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - C Sue Richards
- Knight Diagnostic Laboratories, Oregon Health Science University, Portland, OR, USA
| | - Edward J Romasko
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital, Philadelphia, PA, USA
| | - Ane Miren Sagardia
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nancy B Spinner
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital, Philadelphia, PA, USA
| | | | - Erin Turbitt
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason L Vassy
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA
| | - Benjamin S Wilfond
- Department of Pediatrics and Seattle Children's Research Institute, University of Washington, Seattle, WA, USA
| | - David L Veenstra
- Clinical Sequencing Exploratory Research Coordinating Center, University of Washington, Seattle, WA, USA.,Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Jonathan S Berg
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Partners Personalized Medicine, Boston, MA, USA
| | - Leslie G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lucia A Hindorff
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
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11
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Weipert CM, Ryan KA, Everett JN, Yashar BM, Chinnaiyan AM, Scott Roberts J, De Vries R, Zikmund-Fisher BJ, Raymond VM. Physician Experiences and Understanding of Genomic Sequencing in Oncology. J Genet Couns 2017; 27:187-196. [PMID: 28840409 DOI: 10.1007/s10897-017-0134-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 07/18/2017] [Indexed: 01/14/2023]
Abstract
The amount of information produced by genomic sequencing is vast, technically complicated, and can be difficult to interpret. Appropriately tailoring genomic information for non-geneticists is an essential next step in the clinical use of genomic sequencing. To initiate development of a framework for genomic results communication, we conducted eighteen qualitative interviews with oncologists who had referred adult cancer patients to a matched tumor-normal tissue genomic sequencing study. In our qualitative analysis, we found varied levels of clinician knowledge relating to sequencing technology, the scope of the tumor genomic sequencing study, and incidental germline findings. Clinicians expressed a perceived need for more genetics education. Additionally, they had a variety of suggestions for improving results reports and possible resources to aid in results interpretation. Most clinicians felt genetic counselors were needed when incidental germline findings were identified. Our research suggests that more consistent genetics education is imperative in ensuring the proper utilization of genomic sequencing in cancer care. Clinician suggestions for results interpretation resources and results report modifications could be used to improve communication. Clinicians' perceived need to involve genetic counselors when incidental germline findings were found suggests genetic specialists could play a critical role in ensuring patients receive appropriate follow-up.
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Affiliation(s)
- Caroline M Weipert
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Kerry A Ryan
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jessica N Everett
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109-5419, USA
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Arul M Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J Scott Roberts
- Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Brian J Zikmund-Fisher
- Center for Bioethics and Social Sciences in Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Victoria M Raymond
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109-5419, USA.
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12
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Everett JN, Mody RJ, Stoffel EM, Chinnaiyan AM. Incorporating genetic counseling into clinical care for children and adolescents with cancer. Future Oncol 2016; 12:883-6. [PMID: 26888175 DOI: 10.2217/fon-2015-0022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Jessica N Everett
- University of Michigan Departments of Internal Medicine, MI, USA.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Rajen J Mody
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,University of Michigan Departments of Pediatrics, MI, USA
| | - Elena M Stoffel
- University of Michigan Departments of Internal Medicine, MI, USA
| | - Arul M Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,University of Michigan Departments of Pathology, MI, USA.,University of Michigan Departments of Urology, Ann Arbor, MI, USA.,Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI, USA
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13
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Everett JN, Raymond VM, Dandapani M, Marvin M, Kohlmann W, Chittenden A, Koeppe E, Gustafson SL, Else T, Fullen DR, Johnson TM, Syngal S, Gruber SB, Stoffel EM. Screening for germline mismatch repair mutations following diagnosis of sebaceous neoplasm. JAMA Dermatol 2015; 150:1315-21. [PMID: 25006859 DOI: 10.1001/jamadermatol.2014.1217] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Sebaceous neoplasms (SNs) define the Muir-Torre syndrome variant of Lynch syndrome (LS), which is associated with increased risk for colon and other cancers necessitating earlier and more frequent screening to reduce morbidity and mortality.Immunohistochemical (IHC) staining for mismatch repair (MMR) proteins in SNs can be used to screen for LS, but data on subsequent germline genetic testing to confirm LS diagnosis are limited.OBJECTIVE To characterize the utility of IHC screening of SNs in identification of germline MMR mutations confirming LS.DESIGN, SETTING, AND PARTICIPANTS Retrospective study at 2 academic cancer centers of 86 adult patients referred for clinical genetics evaluation after diagnosis of SN.MAIN OUTCOMES AND MEASURES Results of tumor IHC testing and germline genetic testing were reviewed to determine positive predictive value and sensitivity of IHC testing in diagnosis of LS. Clinical variables, including age at diagnosis of SN, clinical diagnostic criteria for LS and Muir-Torre syndrome, and family history characteristics were compared between mutation carriers and noncarriers.RESULTS Of 86 patients with SNs, 25 (29%) had germline MMR mutations confirming LS.Among 77 patients with IHC testing on SNs, 38 (49%) had loss of staining of 1 or more MMR proteins and 14 had germline MMR mutations. Immunohistochemical analysis correctly identified 13 of 16 MMR mutation carriers, corresponding to 81% sensitivity. Ten of 12 patients(83%) with more than 1 SN had MMR mutations. Fifty-two percent of MMR mutation carriers did not meet clinical diagnostic criteria for LS, and 11 of 25 (44%) did not meet the clinical definition of Muir-Torre syndrome. CONCLUSIONS AND RELEVANCE Immunohistochemical screening of SNs is effective in identifying patients with germline MMR mutations and can be used as a first-line test when LSis suspected. Abnormal IHC results, including absence of MSH2, are not diagnostic of LS and should be interpreted cautiously in conjunction with family history and germline genetic testing. Use of family history to select patients for IHC screening has substantial limitations,suggesting that universal IHC screening of SNs merits further study. Clinical genetics evaluation is warranted for patients with abnormal IHC test results, normal IHC test results with personal or family history of other LS-associated neoplasms, and/or multiple SNs.
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14
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Gustafson SL, Raymond VM, Marvin ML, Else T, Koeppe E, Stoffel EM, Everett JN. Outcomes of genetic evaluation for hereditary cancer syndromes in unaffected individuals. Fam Cancer 2014; 14:167-74. [DOI: 10.1007/s10689-014-9756-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Else T, Marvin ML, Everett JN, Gruber SB, Arts HA, Stoffel EM, Auchus RJ, Raymond VM. The clinical phenotype of SDHC-associated hereditary paraganglioma syndrome (PGL3). J Clin Endocrinol Metab 2014; 99:E1482-6. [PMID: 24758179 PMCID: PMC4121019 DOI: 10.1210/jc.2013-3853] [Citation(s) in RCA: 33] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Mutations in the genes encoding subunits of the succinate dehydrogenase complex cause hereditary paraganglioma syndromes. Although the phenotypes associated with the more commonly mutated genes, SDHB and SDHD, are well described, less is known about SDHC-associated paragangliomas. OBJECTIVE To describe functionality, penetrance, number of primary tumors, biological behavior, and location of paragangliomas associated with SDHC mutations. DESIGN Families with an SDHC mutation were identified through a large cancer genetics registry. A retrospective chart review was conducted with a focus on patient and tumor characteristics. In addition, clinical reports on SDHC-related paragangliomas were identified in the medical literature to further define the phenotype and compare findings. SETTING A cancer genetics clinic and registry at a tertiary referral center. PATIENTS Eight index patients with SDHC-related paraganglioma were identified. RESULTS Three of the eight index patients had mediastinal paraganglioma and four of the eight patients had more than one paraganglioma. Interestingly, the index patients were the only affected individuals in all families. When combining these index cases with reported cases in the medical literature, the mediastinum is the second most common location for SDHC-related paraganglioma (10% of all tumors), occurring in up to 13% of patients. CONCLUSIONS Our findings suggest that thoracic paragangliomas are common in patients with SDHC mutations, and imaging of this area should be included in surveillance of mutation carriers. In addition, the absence of paragangliomas among at-risk relatives of SDHC mutation carriers suggests a less penetrant phenotype as compared to SDHB and SDHD mutations.
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Affiliation(s)
- Tobias Else
- Department of Internal Medicine, Divisions of Metabolism Endocrinology and Diabetes (T.E., R.J.A.), Molecular Medicine and Genetics (J.N.E., V.M.R.), and Gastroenterology (E.M.S.), Department of Human Genetics (M.L.M.), and Department of Otolaryngology-Head and Neck Surgery (H.A.A.) at the University of Michigan Hospital and Health Systems, Ann Arbor, Michigan 48109; and Norris Cancer Center (S.B.G.), University of Southern California, Los Angeles, California 90033
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16
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Raymond VM, Long JM, Everett JN, Caoili EM, Gruber SB, Stoffel EM, Giordano TJ, Hammer GD, Else T. An oncocytic adrenal tumour in a patient with Birt-Hogg-Dubé syndrome. Clin Endocrinol (Oxf) 2014; 80:925-7. [PMID: 23848572 PMCID: PMC3893308 DOI: 10.1111/cen.12292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Victoria M. Raymond
- Division of Molecular Medicine and Genetics, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jessica M. Long
- Division of Molecular Medicine and Genetics, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jessica N. Everett
- Division of Molecular Medicine and Genetics, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elaine M. Caoili
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Stephen B. Gruber
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Elena M. Stoffel
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Gary D. Hammer
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tobias Else
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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17
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Everett JN, Gustafson SL, Raymond VM. Traditional roles in a non-traditional setting: genetic counseling in precision oncology. J Genet Couns 2014; 23:655-60. [PMID: 24578120 DOI: 10.1007/s10897-014-9698-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 01/31/2014] [Indexed: 02/06/2023]
Abstract
Next generation sequencing technology is increasingly utilized in oncology with the goal of targeting therapeutics to improve response and reduce side effects. Interpretation of tumor mutations requires sequencing of paired germline DNA, raising questions about incidental germline findings. We describe our experiences as part of a research team implementing a protocol for whole genome sequencing (WGS) of tumors and paired germline DNA known as the Michigan Oncology Sequencing project (MI-ONCOSEQ) that includes options for receiving incidental germline findings. Genetic counselors (GCs) discuss options for return of results with patients during the informed consent process and document family histories. GCs also review germline findings and actively participate in the multi-disciplinary Precision Medicine Tumor Board (PMTB), providing clinical context for interpretation of germline results and making recommendations about disclosure of germline findings. GCs have encountered ethical and counseling challenges with participants, described here. Although GCs have not been traditionally involved in molecular testing of tumors, our experiences with MI-ONCOSEQ demonstrate that GCs have important applicable skills to contribute to multi-disciplinary care teams implementing precision oncology. Broader use of WGS in oncology treatment decision making and American College of Medical Genetics and Genomics (ACMG) recommendations for active interrogation of germline tissue in tumor-normal dyads suggests that GCs will have future opportunities in this area outside of research settings.
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Affiliation(s)
- Jessica N Everett
- Department of Internal Medicine, University of Michigan, 300 North Ingalls, NI3A16, Ann Arbor, MI, 48109, USA,
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18
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Raymond VM, Everett JN, Furtado LV, Gustafson SL, Jungbluth CR, Gruber SB, Hammer GD, Stoffel EM, Greenson JK, Giordano TJ, Else T. Adrenocortical carcinoma is a lynch syndrome-associated cancer. J Clin Oncol 2013; 31:3012-8. [PMID: 23752102 DOI: 10.1200/jco.2012.48.0988] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Adrenocortical carcinoma (ACC) is an endocrine malignancy with a poor prognosis. The association of adult-onset ACC with inherited cancer predisposition syndromes is poorly understood. Our study sought to define the prevalence of Lynch syndrome (LS) among patients with ACC. PATIENTS AND METHODS One hundred fourteen patients with ACC were evaluated in a specialized endocrine oncology clinic and were prospectively offered genetic counseling and clinical genetics risk assessment (group 1). In addition, families with known mismatch repair (MMR) gene mutations that were recorded in the University of Michigan Cancer Genetics Registry were retrospectively reviewed for the presence of ACC (group 2). ACC tumors from patients with LS were tested for microsatellite instability and immunohistochemistry (IHC) to evaluate for MMR deficiency. RESULTS Ninety-four (82.5%) of 114 patients with ACC underwent genetic counseling (group 1). Three individuals (3.2%) had family histories suggestive of LS. All three families were found to have MMR gene mutations. Retrospective review of an additional 135 MMR gene-positive probands identified two with ACC (group 2). Four ACC tumors were available (group 1, 3; group 2, 1). All four tumors were microsatellite stable; three had IHC staining patterns consistent with germline mutation status. CONCLUSION The prevalence of LS among patients with ACC is 3.2%, which is comparable to the prevalence of LS in colorectal and endometrial cancer. Patients with ACC and a personal or family history of LS tumors should be strongly considered for genetic risk assessment. IHC screening of all ACC tumors may be an effective strategy for identifying patients with LS.
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Raymond VM, Else T, Everett JN, Long JM, Gruber SB, Hammer GD. Prevalence of germline TP53 mutations in a prospective series of unselected patients with adrenocortical carcinoma. J Clin Endocrinol Metab 2013; 98:E119-25. [PMID: 23175693 PMCID: PMC3537086 DOI: 10.1210/jc.2012-2198] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Adrenocortical carcinoma (ACC) is a hallmark cancer in families with Li Fraumeni syndrome (LFS) caused by mutations in the TP53 gene. The prevalence of germline TP53 mutations in children diagnosed with ACC ranges from 50-97%. Although existing criteria advocate for TP53 testing in all patients with ACC regardless of age at diagnosis, the overall prevalence of germline mutations in patients diagnosed with ACC has not been well studied. PATIENTS AND METHODS A total of 114 patients with confirmed ACC evaluated in the University of Michigan Endocrine Oncology Clinic were prospectively offered genetic counseling and TP53 genetic testing, regardless of age at diagnosis or family history. Ninety-four of the 114 patients met with a genetic counselor (82.5%), with 53 of 94 (56.4%) completing TP53 testing; 9.6% (nine of 94) declined testing. The remainder (32 of 94; 34%) expressed interest in testing but did not pursue it for various reasons. RESULTS Four of 53 patients in this prospective, unselected series were found to have a TP53 mutation (7.5%). The prevalence of mutations in those diagnosed over age 18 was 5.8% (three of 52). There were insufficient data to estimate the prevalence in those diagnosed under age 18. None of these patients met clinical diagnostic criteria for classic LFS. Three of the families met criteria for Li Fraumeni-like syndrome; one patient met no existing clinical criteria for LFS or Li Fraumeni-like syndrome. Three of the four patients with mutations were diagnosed with ACC after age 45. CONCLUSIONS Genetic counseling and germline testing for TP53 should be offered to all patients with ACC. Restriction on age at diagnosis or strength of the family history would fail to identify mutation carriers.
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Affiliation(s)
- Victoria M Raymond
- Division of Molecular Medicine and Genetics, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109-5419, USA.
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Christensen KD, Roberts JS, Shalowitz DI, Everett JN, Kim SYH, Raskin L, Gruber SB. Disclosing individual CDKN2A research results to melanoma survivors: interest, impact, and demands on researchers. Cancer Epidemiol Biomarkers Prev 2011; 20:522-9. [PMID: 21307304 DOI: 10.1158/1055-9965.epi-10-1045] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Whether to return individual research results from cancer genetics studies is widely debated, but little is known about how participants respond to results disclosure or about its time and cost burdens on investigators. METHODS We recontacted participants at one site of a multicenter genetic epidemiologic study regarding their CDKN2A gene test results and implications for melanoma risk. Interested participants were disclosed their results by telephone and followed for 3 months. RESULTS Among 39 patients approached, 27 were successfully contacted, and 19 (70% uptake) sought results, including three with mutations. Prior to disclosure, participants endorsed numerous benefits of receiving results (mean=7.7 of 9 posed), including gaining information relevant to their children's disease risk. Mean psychological well-being scores did not change from baseline, and no decreases to melanoma prevention behaviors were noted. Fifty-nine percent of participants reported that disclosure made participation in future research more likely. Preparation for disclosure required 40 minutes and $611 per recontact attempt. An additional 78 minutes and $68 was needed to disclose results. CONCLUSION Cancer epidemiology research participants who received their individual genetic research results showed no evidence of psychological harm or false reassurance from disclosure and expressed strong trust in the accuracy of results. Burdens to our investigators were high, but protocols may differ in their demands and disclosure may increase participants' willingness to enroll in future studies. IMPACT Providing individual study results to cancer genetics research participants poses potential challenges for investigators, but many participants desire and respond positively to this information.
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Affiliation(s)
- Kurt D Christensen
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
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Everett JN, Raymond VM, Gornick M, Mangrulkar RS, Blanco I, Gruber SB. Estimating probability of germline mismatch repair mutations in colorectal cancer patients with microsatellite stable tumors. Hered Cancer Clin Pract 2011. [PMCID: PMC3288906 DOI: 10.1186/1897-4287-9-s1-p12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Roberts JS, Shalowitz DI, Christensen KD, Everett JN, Kim SYH, Raskin L, Gruber SB. Returning individual research results: development of a cancer genetics education and risk communication protocol. J Empir Res Hum Res Ethics 2010; 5:17-30. [PMID: 20831418 PMCID: PMC3159194 DOI: 10.1525/jer.2010.5.3.17] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The obligations of researchers to disclose clinically and/or personally significant individual research results are highly debated, but few empirical studies have addressed this topic. We describe the development of a protocol for returning research results to participants at one site of a multicenter study of the genetic epidemiology of melanoma. Protocol development involved numerous challenges: (1) deciding whether genotype results merited disclosure; (2) achieving an appropriate format for communicating results; (3) developing education materials; (4) deciding whether to retest samples for additional laboratory validation; (5) identifying and notifying selected participants; and (6) assessing the impact of disclosure. Our experience suggests potential obstacles depending on researcher resources and the design of the parent study, but offers a process by which researchers can responsibly return individual study results and evaluate the impact of disclosure.
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Affiliation(s)
- J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
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Abstract
Up to 10% of cancers are caused by inherited mutations in single genes. The process of genetic counselling and genetic testing allows for identification of these high-risk individuals and their at risk family members and enrolment into appropriate screening protocols. The medical impact of genetic testing is evidenced by reduced morbidity and mortality, however, the impact on a personal or psychosocial level has been more difficult to evaluate. We present a review of the current literature regarding the role of genetic counselling and testing in the setting of gastrointestinal cancers and explore several related issues including risk perception and risk communication, family communication, psychosocial factors and decision making, and family planning. We also provide guidelines for referral to cancer genetics clinics and for promoting discussions about genetic counselling and genetic testing.
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Affiliation(s)
- Victoria M Raymond
- Department of Internal Medicine, University of Michigan, 300 North Ingalls, Ann Arbor, MI 48109-0419, USA.
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Koil CE, Everett JN, Hoechstetter L, Ricer RE, Huelsman KM. Differences in physician referral practices and attitudes regarding hereditary breast cancer by clinical practice location. Genet Med 2003; 5:364-9. [PMID: 14501831 DOI: 10.1097/01.gim.0000086477.00766.c9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To compare physician referral practices and attitudes regarding hereditary breast cancer by clinical practice location. METHODS A self-administered survey of 214 physicians in Ohio's tri-state region. RESULTS Rural-practice physicians were less likely to have ever referred for an indication of hereditary breast cancer than urban- and suburban-practice physicians combined. Rural-practice physicians reported stronger barriers to referral, including distance, lack of awareness, lack of effective cancer risk reduction, and lack of patient interest. CONCLUSION These findings demonstrate a need for increased clinical genetics outreach, physician education, and public awareness of genetic services for hereditary breast cancer in rural areas.
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Affiliation(s)
- Christine E Koil
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Howell KA, Huelsman KM, Everett JN, Hopkin RJ. Breast cancer genetics education for college women: an evaluation of approaches. J Cancer Educ 2002; 17:74-77. [PMID: 12092856 DOI: 10.1080/08858190209528802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND A strong family history of breast cancer may greatly increase the chances for young women to develop the disease. Breast cancer genetics education for college-age women would increase awareness, but an effective method remains elusive. METHODS Thirty-five college women viewed four education tools (CD-ROM, video, brochure, and lecture) and discussed topic importance, tool preference, and distribution ideas in focus groups. RESULTS The participants considered breast cancer genetics important; however, the information must be made relevant to their peers to be accepted. CONCLUSION An ideal education method would focus on general breast health, mentioning family history as an important risk factor.
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Affiliation(s)
- Kerry A Howell
- University of Cincinnati, and Cincinnati Children's Hospital Medical Center, Ohio 45229-3039, USA
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