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Robson ME, Gaissert P, Salo-Mullen EE, Amoroso K, Sheehan M, Berliner JL, Trottier M, Arnold AG, Sekhri N, Marcell V, Siegel B, Harlan Fleischut M, Hay JL, Walsh MF, Kauff ND, Stadler ZK, Offit K, Hamilton JG. Abstract P2-09-24: Information preferences and short-term psychological responses to multiplex genetic testing among individuals at risk for hereditary breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-09-24] [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: 11/16/2022]
Abstract
Abstract
Background: Multiplex genetic testing involves the simultaneous analysis of a panel of known cancer susceptibility genes. Although efficient and cost-effective, multiplex testing presents several challenges for patients and clinicians: these tests provide information about high and moderate penetrance genes of varying clinical utility, patients cannot choose which specific genes are tested, and multiple variants of uncertain significance can be identified at once. Multiplex testing is being increasingly integrated into clinical care, yet little is known about patients' preferences, uptake, or psychological responses to these tests.
Methods: To address this gap, we examined two data sources: Sample A) a cross-sectional clinical ascertainment of 189 patients evaluated for hereditary breast and other cancer syndromes (89% female), and Sample B) an ongoing prospective research study of multiplex testing among 194 breast cancer patients and survivors who previously received uninformative BRCA1/2 results (99% female, 84% white, ages 27-76, 60% had BRCA1/2 testing in the past year).
Results: In Sample A, 32% declined clinical multiplex testing in favor of more targeted testing. Female patients were more likely than males to decline (p=0.004). Self-reported reasons for declining included: concerns about uncertain clinical utility of moderate penetrance genes (51% of patients) and variants of uncertain significance (38%), feeling emotionally overwhelmed (23%), and not seeing the value of multiplex testing (20%). In Sample B, participants were allowed to select which information to receive from a multiplex test; 16% chose to learn less than all of the information available (e.g., not genes unrelated to breast/ovarian cancer, not genes without established clinical utility, not CDH1 or TP53). Information preferences were unrelated to demographic (age, race, time since cancer diagnosis and BRCA1/2 testing) and self-reported psychological factors (baseline genetic testing-related distress, uncertainty, and positive experiences; anxiety; depression). Participants who chose to learn all possible information reported greater concerns about their children's cancer risk than did those who chose to learn less information (p=0.01). Participants reported a small increase in both genetic testing-related distress and positive experiences from before testing to 1 week after receiving results (p<0.001). In multivariable analyses controlling for baseline psychological functioning, only non-white race was consistently associated with significantly increased post-result anxiety, depression, and genetic testing-related distress and uncertainty. Participants who had BRCA1/2 testing one or more years ago also reported fewer positive experiences 1 week after receiving results.
Conclusions: Together, these findings demonstrate that a sizable minority of patients have important concerns regarding multiplex tests that may limit their uptake of this novel testing, and suggest that some patients may prefer to customize the specific risk information provided. Results also highlight characteristics of those at risk for poorer emotional outcomes following testing; these individuals may benefit from additional support in this context.
Citation Format: Robson ME, Gaissert P, Salo-Mullen EE, Amoroso K, Sheehan M, Berliner JL, Trottier M, Arnold AG, Sekhri N, Marcell V, Siegel B, Harlan Fleischut M, Hay JL, Walsh MF, Kauff ND, Stadler ZK, Offit K, Hamilton JG. Information preferences and short-term psychological responses to multiplex genetic testing among individuals at risk for hereditary breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-24.
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Affiliation(s)
- ME Robson
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - P Gaissert
- Memorial Sloan Kettering Cancer Center, NY, NY
| | | | - K Amoroso
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - M Sheehan
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - JL Berliner
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - M Trottier
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - AG Arnold
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - N Sekhri
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - V Marcell
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - B Siegel
- Memorial Sloan Kettering Cancer Center, NY, NY
| | | | - JL Hay
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - MF Walsh
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - ND Kauff
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - ZK Stadler
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - K Offit
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - JG Hamilton
- Memorial Sloan Kettering Cancer Center, NY, NY
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Meisel JL, Hyman DM, Garg K, Zhou Q, Dao F, Bisogna M, Gao J, Schultz ND, Grisham RN, Phillips M, Iasonos A, Kauff ND, Levine DA, Soslow RA, Spriggs DR. The performance of BRCA1 immunohistochemistry for detecting germline, somatic, and epigenetic BRCA1 loss in high-grade serous ovarian cancer. Ann Oncol 2014; 25:2372-2378. [PMID: 25281711 DOI: 10.1093/annonc/mdu461] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND BRCA1 expression can be lost by a variety of mechanisms including germline or somatic mutation and promotor hypermethylation. Given the potential importance of BRCA1 loss as a predictive and prognostic biomarker in high-grade serous ovarian cancer, we sought to evaluate the utility of BRCA1 immunohistochemistry (IHC) in screening for BRCA1 loss by germline, somatic, and epigenetic mechanisms. PATIENTS AND METHODS Patients with advanced high-grade serous ovarian cancer who had previously undergone germline BRCA1 testing were identified. Samples from each tumor were stained for BRCA1 and reviewed independently by two pathologists blinded to BRCA status. Tumors with abnormal BRCA1 IHC and wild-type germline testing underwent further evaluation for somatic BRCA1 mutations and promoter hypermethylation. McNemar's test was used to determine the association of BRCA1 IHC with germline BRCA1 mutations and BRCA1 loss through any mechanism. Kaplan-Meier methods were used to estimate overall survival (OS), and the log-rank test was used to assess differences between groups. RESULTS Inter-rater reliability between the two pathologists on BRCA IHC interpretation was very good (kappa coefficient 0.865, P = 0.16; McNemar's test). BRCA1 IHC was abnormal in 36% (48/135) of cases. When compared with germline BRCA1 status, BRCA1 IHC had a high negative predictive value (95.4%) but a low positive predictive value (PPV, 52.1%). When accounting for promoter hypermethylation and somatic mutations as alternative methods of BRCA1 loss, the PPV rose to 87.5%. Five-year OS rate was 49.6% [95% confidence interval (CI) 26.3% to 69.3%] for patients with germline BRCA1 mutations, 50.4% (95% CI 27.5% to 69.5%) for germline wild-type BRCA1 and abnormal IHC, and 52.1% (95% CI 38.4% to 64.2%) for germline wild-type BRCA1 and normal IHC (P = 0.92). CONCLUSIONS BRCA1 IHC interpretation was a highly reproducible and accurate modality for detecting germline, somatic, or epigenetic mechanisms of BRCA1 loss. These results support further development of BRCA1 IHC as a potential biomarker for BRCA1 loss in high-grade serous ovarian cancer.
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Affiliation(s)
| | - D M Hyman
- Gynecologic Medical Oncology Service; Developmental Therapeutics, Department of Medicine; Weill Cornell Medical College, New York, USA.
| | | | - Q Zhou
- Department of Epidemiology and Biostatistics
| | - F Dao
- Gynecology Service, Department of Surgery
| | - M Bisogna
- Gynecology Service, Department of Surgery
| | - J Gao
- Computational Biology Program
| | | | - R N Grisham
- Gynecologic Medical Oncology Service; Weill Cornell Medical College, New York, USA
| | - M Phillips
- Gynecology Service, Department of Surgery
| | - A Iasonos
- Department of Epidemiology and Biostatistics
| | - N D Kauff
- Gynecologic Medical Oncology Service; Gynecology Service, Department of Surgery; Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Weill Cornell Medical College, New York, USA
| | - D A Levine
- Gynecology Service, Department of Surgery; Weill Cornell Medical College, New York, USA
| | - R A Soslow
- Department of Pathology; Weill Cornell Medical College, New York, USA
| | - D R Spriggs
- Gynecologic Medical Oncology Service; Developmental Therapeutics, Department of Medicine; Weill Cornell Medical College, New York, USA
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Zhang L, Fleischut MH, Kohut K, Spencer S, Wong K, Stadler ZK, Kauff ND, Offit K, Robson ME. Assessment of the prevalence of de novo mutations in the BRCA1 and BRCA2 genes. Clin Genet 2011; 80:97-8. [DOI: 10.1111/j.1399-0004.2011.01691.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jhaveri KL, Patil S, Khasraw M, Bhatia J, Stadler ZK, Kauff ND, Hudis C, Offit K, Robson ME. Risk of breast cancer (BC) after BRCA-mutation associated ovarian cancer (BRCA-OC): Memorial Sloan-Kettering Cancer Center (MSKCC) experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Arnold AG, Bhatia J, Phillips MF, Gardner GJ, Bell-McGuinn KM, Aghajanian C, Barakat RR, Offit K, Kauff ND. Feasibility and yield of offering genetic counseling to all patients with newly diagnosed high-grade epithelial ovarian cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hyman DM, Zhou Q, Arnold AG, Grisham RN, Bhatia J, Aghajanian C, Iasonos A, Spriggs DR, Kauff ND. Topoisomerase I inhibition in BRCA+ and BRCA- ovarian cancer (OC): A single-institution experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gallagher DJ, Konner JA, Bell-McGuinn KM, Bhatia J, Sabbatini P, Aghajanian CA, Offit K, Barakat RR, Spriggs DR, Kauff ND. Survival in epithelial ovarian cancer: a multivariate analysis incorporating BRCA mutation status and platinum sensitivity. Ann Oncol 2010; 22:1127-1132. [PMID: 21084428 DOI: 10.1093/annonc/mdq577] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Patients with BRCA-associated ovarian cancer (OC) have a survival advantage over those with sporadic OC. To further explore this, we examined the impact of prognostic factors on disease-free survival (DFS) and overall survival (OS) in patients with known BRCA mutation status. PATIENTS AND METHODS We reviewed stage III-IV OC patients treated at our institution between 1 December 1996 and 30 September 2006 and also tested on protocol for BRCA mutations. Impact on DFS and OS was determined by Kaplan-Meier analysis and a Cox proportional hazards model. RESULTS Of the 110 patients, 36 had deleterious BRCA mutations [BRCA (+)] and 74 were BRCA wild type [BRCA(-)]. Thirty-one of 36 (86%) BRCA (+) and 60 of 74 (81%) BRCA (-) patients were platinum sensitive (P = 0.60). Median OS was longer for BRCA (+) patients (not reached versus 67.8 months; P = 0.02), but DFS was similar (26.9 versus 24.0, P = 0.3). On multivariate analysis, OS correlated with primary platinum sensitivity [HR = 0.15; 95% CI (confidence interval) 0.06-0.34] and BRCA (+) mutation status (HR = 0.33; 95% CI 0.12-0.86). CONCLUSIONS BRCA mutation status predicted OS independent of primary platinum sensitivity, suggesting that underlying tumor biology contributes to disease outcome and may be worthy of consideration in future clinical trial design.
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Affiliation(s)
- D J Gallagher
- Gynecologic Medical Oncology Service, Division of Solid Tumor Oncology, Department of Medicine; Clinical Genetics Service, Division of Solid Tumor Oncology, Department of Medicine
| | - J A Konner
- Gynecologic Medical Oncology Service, Division of Solid Tumor Oncology, Department of Medicine
| | - K M Bell-McGuinn
- Gynecologic Medical Oncology Service, Division of Solid Tumor Oncology, Department of Medicine
| | - J Bhatia
- Clinical Genetics Service, Division of Solid Tumor Oncology, Department of Medicine
| | - P Sabbatini
- Gynecologic Medical Oncology Service, Division of Solid Tumor Oncology, Department of Medicine
| | - C A Aghajanian
- Gynecologic Medical Oncology Service, Division of Solid Tumor Oncology, Department of Medicine
| | - K Offit
- Clinical Genetics Service, Division of Solid Tumor Oncology, Department of Medicine
| | - R R Barakat
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - D R Spriggs
- Gynecologic Medical Oncology Service, Division of Solid Tumor Oncology, Department of Medicine
| | - N D Kauff
- Clinical Genetics Service, Division of Solid Tumor Oncology, Department of Medicine; Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA.
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Konner JA, Iasonos A, Sabbatini P, Tew WP, Hensley ML, Aghajanian C, Kauff ND, Moss RA. Self-identification by Jewish religion: Lack of association with overall survival in ovarian cancer at Memorial Sloan-Kettering Cancer Center from 1998 to 2006. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Dao F, Han G, Park KJ, Gardner GJ, Kauff ND, Barakat RR, Soslow RA, Levine DA. Primary fallopian tube lesions in BRCA mutation carriers undergoing risk-reducing surgery. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zivanovic O, Carter J, Kauff ND, Barakat RR. A review of the challenges faced in the conservative treatment of young women with endometrial carcinoma and risk of ovarian cancer. Gynecol Oncol 2009; 115:504-9. [PMID: 19758691 DOI: 10.1016/j.ygyno.2009.08.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 08/12/2009] [Accepted: 08/17/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The standard management for women diagnosed with endometrial carcinoma (EC) is hysterectomy with salpingo-oophorectomy. However, more conservative treatment approaches, including uterine and ovarian preservation, may be used for women who have a strong desire to maintain fertility in spite of potential oncologic risks. METHODS We reviewed the literature regarding fertility-preserving treatment for EC. We also conducted medical chart reviews for two young patients diagnosed with EC whose treatment deviated from the standard approach in order to preserve fertility. These patients were subsequently diagnosed with ovarian cancer. Our review summarizes the literature regarding the clinical and emotional implications of fertility preservation in young women. CASES Two young nulliparous women (29 and 23 years, respectively) with grade 1 endometrioid adenocarcinoma were initially treated with conservative fertility-sparing endocrine therapy. Upon failure of endocrine treatment both women underwent hysterectomy and staging with ovarian preservation. During surveillance, both women were subsequently diagnosed with ovarian carcinoma and underwent bilateral salpingo-oophorectomy (BSO) and comprehensive staging. CONCLUSION The management of young women with endometrial cancer can be complex and challenging. Patients and physicians are confronted with the dilemma of following standard surgical guidelines versus the desire to maintain fertility and avoid surgical menopause. Careful oncologic, psychotherapeutic, genetic and reproductive counseling is advised before offering a non-standard treatment strategy to young endometrial cancer patients.
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Affiliation(s)
- O Zivanovic
- Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Konner JA, Gallagher DJ, Bell-McGuinn KM, Hansen J, Kosarin K, Aghajanian CA, Offit K, Barakat RR, Spriggs DR, Kauff ND. Survival benefit for BRCA-associated epithelial ovarian cancer (OC) is not explained by primary platinum sensitivity alone. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Lewin SN, Kemel Y, Kosarin K, Hansen J, Robson ME, Offit K, Barakat RR, Kauff ND. Utility of ovarian cancer screening in women with BRCA mutations. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.5531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Kauff ND, Domchek SM, Friebel TM, Lee JB, Roth R, Robson ME, Barakat RR, Norton L, Offit K, Rebbeck TR. Multi-center prospective analysis of risk-reducing salpingo-oophorectomy to prevent BRCA-associated breast and ovarian cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.1003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1003 Background: Our groups previously reported on the efficacy of risk-reducing salpingo-oophorectomy (RRSO) for the prevention of BRCA-associated breast and ovarian cancer. (Kauff ND, et al. NEJM 2002; Rebbeck TR, et al. NEJM 2002) Limitations of those reports included relatively short prospective follow-up and lack of power to analyze the protection of RRSO when participants were stratified by BRCA1 vs. BRCA2. To address these limitations, we have pooled our updated datasets to provide robust estimates of the efficacy of RRSO. Methods: 886 women ≥ 30 years of age, with a deleterious mutation in BRCA1 or BRCA2 and ovaries in-situ at time of genetic test results, were enrolled on prospective follow-up studies at one of eleven centers from 11/1/1994 - 12/1/2004. Women chose to participate in either ovarian surveillance or undergo RRSO. Follow-up information was collected by questionnaire and medical record review. Follow-up time was counted from time of RRSO or from time of genetic test results for women who did not undergo RRSO. After excluding cancers diagnosed within the first 6 months of follow-up, the effect of RRSO on time to diagnosis of breast or BRCA-associated gynecologic cancer was analyzed using a Cox proportional-hazards model. Results: 559 (63%) participants underwent RRSO a median of 5 months after genetic test results. 12 occult ovarian or fallopian tube cancers were diagnosed at time of RRSO. During a mean 40 months follow-up, RRSO was associated with a 52% reduction in breast cancer risk and a 91% reduction in ovarian cancer risk (see Table ). When the cohort was stratified by mutation status, RRSO was associated with a reduced risk of BRCA1-associated ovarian cancer and BRCA2-associated breast cancer. Conclusions: The results confirm that RRSO is highly protective against BRCA-associated breast and ovarian cancer. These results also generate the hypothesis that the protection conferred by RRSO against specific cancers may differ between carriers of BRCA1 and BRCA2 mutations. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- N. D. Kauff
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - S. M. Domchek
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - T. M. Friebel
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - J. B. Lee
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - R. Roth
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - M. E. Robson
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - R. R. Barakat
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - L. Norton
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - K. Offit
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - T. R. Rebbeck
- Memorial Sloan-Kettering Cancer Center, New York, NY; University of Pennsylvania School of Medicine, Philadelphia, PA
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Adank MA, Brogi E, Bogomolniy F, Wadsworth EA, Lafaro KJ, Yee CJ, Kirchhoff T, Meijers-Heijboer EJ, Kauff ND, Boyd J, Offit K. Accuracy of BRCA1 and BRCA2 founder mutation analysis in formalin-fixed and paraffin-embedded (FFPE) tissue. Fam Cancer 2006; 5:337-42. [PMID: 16724247 DOI: 10.1007/s10689-006-0003-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Accepted: 04/03/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND A major limitation in counseling unaffected women from families with inherited breast and ovarian cancer is that a "true-negative" interpretation of wild type BRCA analysis of the proband cannot be inferred in the absence of demonstration of a BRCA mutation segregating in the kindred. Documentation of familial BRCA mutations from paraffin-derived DNA of deceased patients has been limited due to reports of technical complications leading to lack of reproducibility of BRCA testing of archival material. METHODS DNA was extracted from formalin-fixed paraffin-embedded (FFPE) morphologically normal tissue of 161 blinded, coded samples from women previously genotyped for the three Ashkenazi Jewish BRCA founder mutations from lymphocyte-derived DNA. Multiplex PCR followed by denaturing polyacrylamide gel electrophoresis was performed for the three founder mutations to determine if analysis on FFPE tissue could produce results concordant with those of the lymphocyte-derived DNA. RESULTS After disclosure of the sample codes, the results were compared with the original lymphocyte-derived DNA genotypes. Excluding one sample unevaluable due to PCR failure, there was 100% concordance of 160 genotypes (120 mutation samples) derived from DNA from archival FFPE tissue compared to peripheral lymphocytes. CONCLUSIONS The method described reliably detected BRCA founder mutations in archival DNA derived from FFPE tissue. These results suggests that this technique may be useful in clinical settings to inform wild type BRCA results of unaffected probands, leading to avoidance of unnecessary intensified surveillance or risk-reducing surgery. With further validation this approach can also be applied to other populations where founder mutations are observed.
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Affiliation(s)
- M A Adank
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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Goldfrank DJ, Lee J, Kauff ND, Hurley KE, Balistreri LM, Hellawell J, Borgen PI, Hudis CA, Offit K, Robson ME. Adherence to mammogram (MMG) screening guidelines in BRCA1/2 mutation carriers. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D. J. Goldfrank
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; Weill Medcl Coll of Cornell Univ, New York, NY
| | - J. Lee
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; Weill Medcl Coll of Cornell Univ, New York, NY
| | - N. D. Kauff
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; Weill Medcl Coll of Cornell Univ, New York, NY
| | - K. E. Hurley
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; Weill Medcl Coll of Cornell Univ, New York, NY
| | - L. M. Balistreri
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; Weill Medcl Coll of Cornell Univ, New York, NY
| | - J. Hellawell
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; Weill Medcl Coll of Cornell Univ, New York, NY
| | - P. I. Borgen
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; Weill Medcl Coll of Cornell Univ, New York, NY
| | - C. A. Hudis
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; Weill Medcl Coll of Cornell Univ, New York, NY
| | - K. Offit
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; Weill Medcl Coll of Cornell Univ, New York, NY
| | - M. E. Robson
- Memorial Sloan-Kettering Cancer Ctr, New York, NY; Weill Medcl Coll of Cornell Univ, New York, NY
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Kemel Y, Kauff ND, Robson ME, Goldfrank DJ, Wadsworth E, Diiorio T, Boyd J, Hudis CA, Barakat RR, Offit K. Four-year follow-up of outcomes following risk-reducing salpingo-oophorectomy in BRCA mutation carriers. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.1013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Y. Kemel
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - N. D. Kauff
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - M. E. Robson
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | | | - E. Wadsworth
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - T. Diiorio
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - J. Boyd
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - C. A. Hudis
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | | | - K. Offit
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
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Kauff ND, Wadsworth E, Goldfrank DJ, Robson ME, Lee J, Lafaro K, Aaron S, Norton L, Barakat RR, Offit K. Association of personal and family history with decision to undergo risk-reducing salpingo-oophorectomy in BRCA mutation carriers. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.9560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- N. D. Kauff
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - E. Wadsworth
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | | | - M. E. Robson
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - J. Lee
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - K. Lafaro
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - S. Aaron
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - L. Norton
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | | | - K. Offit
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
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Kauff ND, Perez-Segura P, Robson ME, Scheuer L, Siegel B, Schluger A, Rapaport B, Frank TS, Nafa K, Ellis NA, Parmigiani G, Offit K. Incidence of non-founder BRCA1 and BRCA2 mutations in high risk Ashkenazi breast and ovarian cancer families. J Med Genet 2002; 39:611-4. [PMID: 12161607 PMCID: PMC1735198 DOI: 10.1136/jmg.39.8.611] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kauff ND, Scheuer L, Robson ME, Glogowski E, Kelly B, Barakat R, Heerdt A, Borgen PI, Davis JG, Offit K. Insurance reimbursement for risk-reducing mastectomy and oophorectomy in women with BRCA1 or BRCA2 mutations. Genet Med 2001; 3:422-5. [PMID: 11715007 DOI: 10.1097/00125817-200111000-00008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 11/26/2022] Open
Abstract
PURPOSE Risk-reducing surgery is an important option for women with BRCA1 and BRCA2 mutations. There are reports in the literature that insurance reimbursement for these procedures varies greatly. Because health insurance coverage significantly affects medical decision-making, current information regarding reimbursement practices of third-party payers is needed. METHODS Retrospective study of hospital billing records of 38 women with documented BRCA1 or BRCA2 mutations who underwent either a risk-reducing mastectomy or a risk-reducing oophorectomy between March 1, 1997, and July 30, 2000. RESULTS Complete billing and reimbursement information was available for 35 women undergoing a total of 39 risk-reducing surgeries. A total of 38 of 39 (97%) risk-reducing surgeries were covered in full, less applicable coinsurance and deductibles. The rate of insurance reimbursement did not vary with type of insurance, personal history of cancer, or type of procedure. CONCLUSION Insurance carriers reimbursed the vast majority of BRCA mutation carriers undergoing risk-reducing surgery.
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Affiliation(s)
- N D Kauff
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Khalbuss WE, Rudomina D, Kauff ND, Chuang L, Melamed MR. SpinThin, a simple, inexpensive technique for preparation of thin-layer cervical cytology from liquid-based specimens: data on 791 cases. Cancer 2000; 90:135-42. [PMID: 10896326] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Acceptance of liquid-based fixatives for cervical cytology has been limited by the more complex slide-preparation procedures, increased cost, and reports that increased sensitivity has been based largely on comparison with conventional cytology without histologic correlation. Here the authors describe and evaluate a technically simple and relatively inexpensive method (which they call SpinThin) for preparing Cytospin (Shandon Inc., Pittsburgh, PA) cervical cytology slides from samples in liquid fixative using a modified electric toothbrush holder to put the cells in suspension. Results are compared with conventional cytology and histologic biopsy. METHODS A total of 791 cervical cytology specimens from 2 patient groups at high risk of uterine cervical neoplasia were entered into this study, and a spatula and cytobrush (174 specimens) or cytobroom (617 specimens) were used to collect conventional smears. The collection device with remaining cellular sample was placed in an alcohol-based fixative solution; the cells were put into suspension by a brief burst of vibration using a modified electric toothbrush holder, then cytocentrifuged on a slide and stained with the Papanicolaou technique. RESULTS Specimen adequacy in SpinThin slides was better than that of conventional cytology smears. However, the prevalence of dysplasia, including atypical squamous cells of undetermined significance (ASCUS-D), in conventional smears and SpinThin slides was the same--27% and 25%, respectively--and excluding ASCUS-D, it was 20% in both. The prevalence of neoplasia (low or high grade squamous intraepithelial lesion, or carcinoma) histologically was 31% in the 647 cases biopsied, and agreement with histology was similar for SpinThin and conventional smears. CONCLUSIONS Using a simple and relatively inexpensive new technique (Spin-Thin), slides prepared from fluid-based cervical cytology specimens obtained with the cytobrush or cytobroom correlated very well with the corresponding conventional smears within major diagnostic categories, and both correlated well with histology.
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Affiliation(s)
- W E Khalbuss
- Department of Pathology, New York Medical College and Westchester Medical Center, Valhalla, New York 10595, USA
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Abstract
Hemorrhage is one of the most frequent complications after dilation and evacuation. A small fraction of patients with hemorrhage will not respond to standard therapies. We discuss a case where both reaspiration and standard pharmacologic therapy failed to control hemorrhage and where hemorrhage was ultimately controlled by tamponade with two Foley catheters. We propose this method as an additional alternative for controlling hemorrhage after dilation and evacuation before resorting to angiographic embolization or surgery.
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Affiliation(s)
- N D Kauff
- Department of Obstetrics and Gynecology, Tufts University Medical School, Boston, MA, USA
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