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Huang T, Bedford HM, Rashid S, Rasasakaram E, Priston M, Mak-Tam E, Gibbons C, Meschino WS, Cuckle H, Mei-Dan E. Modified multiple marker aneuploidy screening as a primary screening test for preeclampsia. BMC Pregnancy Childbirth 2022; 22:190. [PMID: 35260099 PMCID: PMC8903171 DOI: 10.1186/s12884-022-04514-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 02/16/2022] [Indexed: 11/11/2022] Open
Abstract
Background Abnormal levels of maternal biochemical markers used in multiple marker aneuploidy screening have been associated with adverse pregnancy outcomes. This study aims to assess if a combination of maternal characteristics and biochemical markers in the first and second trimesters can be used to screen for preeclampsia (PE). The secondary aim was to assess this combination in identifying pregnancies at risk for gestational hypertension and preterm birth. Methods This case-control study used information on maternal characteristics and residual blood samples from pregnant women who have undergone multiple marker aneuploidy screening. The median multiple of the median (MoM) of first and second trimester biochemical markers in cases (women with PE, gestational hypertension and preterm birth) and controls were compared. Biochemical markers included pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PlGF), human chorionic gonadotropin (hCG), alpha feto-protein (AFP), unconjugated estriol (uE3) and Inhibin A. Logistic regression analysis was used to estimate screening performance using different marker combinations. Screening performance was defined as detection rate (DR) and false positive rate (FPR). Preterm and early-onset preeclampsia PE were defined as women with PE who delivered at < 37 and < 34 weeks of gestation, respectively. Results There were 147 pregnancies with PE (81 term, 49 preterm and 17 early-onset), 295 with gestational hypertension, and 166 preterm birth. Compared to controls, PE cases had significantly lower median MoM of PAPP-A (0.77 vs 1.10, p < 0.0001), PlGF (0.76 vs 1.01, p < 0.0001) and free-β hCG (0.81 vs. 0.98, p < 0.001) in the first trimester along with PAPP-A (0.82 vs 0.99, p < 0.01) and PlGF (0.75 vs 1.02, p < 0.0001) in the second trimester. The lowest first trimester PAPP-A, PlGF and free β-hCG were seen in those with preterm and early-onset PE. At a 20% FPR, 67% of preterm and 76% of early-onset PE cases can be predicted using a combination of maternal characteristics with PAPP-A and PlGF in the first trimester. The corresponding DR was 58% for gestational hypertension and 36% for preterm birth cases. Conclusions Maternal characteristics with first trimester PAPP-A and PlGF measured for aneuploidy screening provided reasonable accuracy in identifying women at risk of developing early onset PE, allowing triage of high-risk women for further investigation and risk-reducing therapy. This combination was less accurate in predicting women who have gestational hypertension or preterm birth.
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Affiliation(s)
- Tianhua Huang
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, ON, M2K 1E1, Canada. .,Prenatal Screening Ontario, Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON, Canada. .,Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.
| | - H Melanie Bedford
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, ON, M2K 1E1, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Shamim Rashid
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, ON, M2K 1E1, Canada
| | - Evasha Rasasakaram
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, ON, M2K 1E1, Canada
| | - Megan Priston
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, ON, M2K 1E1, Canada
| | - Ellen Mak-Tam
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, ON, M2K 1E1, Canada
| | - Clare Gibbons
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, ON, M2K 1E1, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Wendy S Meschino
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, ON, M2K 1E1, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Howard Cuckle
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Mei-Dan
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.,Maternal and Newborn Program, North York General Hospital, Toronto, ON, Canada
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Dossa F, Metcalfe K, Sutradhar R, Little T, Eisen A, Chun K, Meschino WS, Velsher L, Ellis JL, Baxter NN. Building the What Comes Next Cohort for BRCA1 and BRCA2 testing: a descriptive analysis. CMAJ Open 2021; 9:E874-E885. [PMID: 34870614 PMCID: PMC8741196 DOI: 10.9778/cmajo.20200228] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Our understanding of how testing for and mutations of the BRCA1 and BRCA2 genes affect cancer risk and the use of risk-reduction strategies comes largely from studies of women recruited from specialized genetics clinics. Our aim was to assemble a generalizable cohort of women who underwent BRCA1/BRCA2 testing (the What Comes Next Cohort), irrespective of test result, to enable study of health care utilization and outcomes after testing. METHODS This descriptive study included adult women (≥ 18 yr) who met at least 1 of 13 provincial criteria for BRCA1/BRCA2 testing and who underwent genetic testing at sites in Ontario, Canada, from 2007 to 2016. Most of the women were tested at 1 of 2 main sites, which together capture about 70% of all BRCA1/BRCA2 testing in the province. We collected detailed demographic, genetic testing and family history data through chart review for linkage with data from administrative health databases providing information on cancer history before and after testing. We followed all women to September 2019, evaluating the demographic characteristics of the cohort, indications for testing and test results. RESULTS We identified 15 986 women (mean age 52.5 [standard deviation 13.9] yr) who underwent BRCA1/BRCA2 testing. Of these, 2033 women had positive results, 1175 women had variants of uncertain significance, and 12 778 women had negative results. Positive yields were 41.0% (955/2329) for predictive testing (for familial variants), 10.4% (216/2072) for Ashkenazi Jewish founder testing and 7.4% (862/11 585) for complete gene analysis. Six of the 13 provincial testing criteria had less than 10% positive yield. Among 403 women who tested negative for Ashkenazi Jewish founder mutations and subsequently underwent complete gene analysis, 12 (3.0%) tested positive for alternate pathogenic or likely pathogenic variants in the BRCA1 or BRCA2 gene. INTERPRETATION Several provincial eligibility criteria for BRCA1/BRCA2 testing led to positive results in less than 10% of cases. How testing influences women's health care behaviours, particularly those with negative results and those found to carry variants of uncertain significance, is unknown; the What Comes Next Cohort will be instrumental in the study of long-term implications of BRCA1/BRCA2 testing.
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Affiliation(s)
- Fahima Dossa
- Division of General Surgery, Department of Surgery (Dossa), Institute of Health Policy, Management and Evaluation (Dossa, Sutradhar, Baxter), Lawrence S. Bloomberg Faculty of Nursing ( Metcalfe) Division of Biostatistics, Dalla Lana School of Public Health (Sutradhar), Department of Pediatrics (Meschino) and Department of Laboratory Medicine and Pathobiology (Lerner Ellis), University of Toronto; ICES Central (Sutradhar); Department of Surgery (Little), St. Michael's Hospital; Odette Cancer Centre (Eisen), Sunnybrook Health Sciences Centre; Department of Paediatric Laboratory Medicine (Chun), The Hospital for Sick Children; Genetics Program (Meschino, Velsher), North York General Hospital; Lunenfeld-Tanenbaum Research Institute (Lerner Ellis) and Pathology and Laboratory Medicine (Lerner Ellis), Mount Sinai Hospital, Sinai Health System, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly Metcalfe
- Division of General Surgery, Department of Surgery (Dossa), Institute of Health Policy, Management and Evaluation (Dossa, Sutradhar, Baxter), Lawrence S. Bloomberg Faculty of Nursing ( Metcalfe) Division of Biostatistics, Dalla Lana School of Public Health (Sutradhar), Department of Pediatrics (Meschino) and Department of Laboratory Medicine and Pathobiology (Lerner Ellis), University of Toronto; ICES Central (Sutradhar); Department of Surgery (Little), St. Michael's Hospital; Odette Cancer Centre (Eisen), Sunnybrook Health Sciences Centre; Department of Paediatric Laboratory Medicine (Chun), The Hospital for Sick Children; Genetics Program (Meschino, Velsher), North York General Hospital; Lunenfeld-Tanenbaum Research Institute (Lerner Ellis) and Pathology and Laboratory Medicine (Lerner Ellis), Mount Sinai Hospital, Sinai Health System, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Victoria, Australia
| | - Rinku Sutradhar
- Division of General Surgery, Department of Surgery (Dossa), Institute of Health Policy, Management and Evaluation (Dossa, Sutradhar, Baxter), Lawrence S. Bloomberg Faculty of Nursing ( Metcalfe) Division of Biostatistics, Dalla Lana School of Public Health (Sutradhar), Department of Pediatrics (Meschino) and Department of Laboratory Medicine and Pathobiology (Lerner Ellis), University of Toronto; ICES Central (Sutradhar); Department of Surgery (Little), St. Michael's Hospital; Odette Cancer Centre (Eisen), Sunnybrook Health Sciences Centre; Department of Paediatric Laboratory Medicine (Chun), The Hospital for Sick Children; Genetics Program (Meschino, Velsher), North York General Hospital; Lunenfeld-Tanenbaum Research Institute (Lerner Ellis) and Pathology and Laboratory Medicine (Lerner Ellis), Mount Sinai Hospital, Sinai Health System, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Victoria, Australia
| | - Tari Little
- Division of General Surgery, Department of Surgery (Dossa), Institute of Health Policy, Management and Evaluation (Dossa, Sutradhar, Baxter), Lawrence S. Bloomberg Faculty of Nursing ( Metcalfe) Division of Biostatistics, Dalla Lana School of Public Health (Sutradhar), Department of Pediatrics (Meschino) and Department of Laboratory Medicine and Pathobiology (Lerner Ellis), University of Toronto; ICES Central (Sutradhar); Department of Surgery (Little), St. Michael's Hospital; Odette Cancer Centre (Eisen), Sunnybrook Health Sciences Centre; Department of Paediatric Laboratory Medicine (Chun), The Hospital for Sick Children; Genetics Program (Meschino, Velsher), North York General Hospital; Lunenfeld-Tanenbaum Research Institute (Lerner Ellis) and Pathology and Laboratory Medicine (Lerner Ellis), Mount Sinai Hospital, Sinai Health System, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea Eisen
- Division of General Surgery, Department of Surgery (Dossa), Institute of Health Policy, Management and Evaluation (Dossa, Sutradhar, Baxter), Lawrence S. Bloomberg Faculty of Nursing ( Metcalfe) Division of Biostatistics, Dalla Lana School of Public Health (Sutradhar), Department of Pediatrics (Meschino) and Department of Laboratory Medicine and Pathobiology (Lerner Ellis), University of Toronto; ICES Central (Sutradhar); Department of Surgery (Little), St. Michael's Hospital; Odette Cancer Centre (Eisen), Sunnybrook Health Sciences Centre; Department of Paediatric Laboratory Medicine (Chun), The Hospital for Sick Children; Genetics Program (Meschino, Velsher), North York General Hospital; Lunenfeld-Tanenbaum Research Institute (Lerner Ellis) and Pathology and Laboratory Medicine (Lerner Ellis), Mount Sinai Hospital, Sinai Health System, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Victoria, Australia
| | - Kathy Chun
- Division of General Surgery, Department of Surgery (Dossa), Institute of Health Policy, Management and Evaluation (Dossa, Sutradhar, Baxter), Lawrence S. Bloomberg Faculty of Nursing ( Metcalfe) Division of Biostatistics, Dalla Lana School of Public Health (Sutradhar), Department of Pediatrics (Meschino) and Department of Laboratory Medicine and Pathobiology (Lerner Ellis), University of Toronto; ICES Central (Sutradhar); Department of Surgery (Little), St. Michael's Hospital; Odette Cancer Centre (Eisen), Sunnybrook Health Sciences Centre; Department of Paediatric Laboratory Medicine (Chun), The Hospital for Sick Children; Genetics Program (Meschino, Velsher), North York General Hospital; Lunenfeld-Tanenbaum Research Institute (Lerner Ellis) and Pathology and Laboratory Medicine (Lerner Ellis), Mount Sinai Hospital, Sinai Health System, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Victoria, Australia
| | - Wendy S Meschino
- Division of General Surgery, Department of Surgery (Dossa), Institute of Health Policy, Management and Evaluation (Dossa, Sutradhar, Baxter), Lawrence S. Bloomberg Faculty of Nursing ( Metcalfe) Division of Biostatistics, Dalla Lana School of Public Health (Sutradhar), Department of Pediatrics (Meschino) and Department of Laboratory Medicine and Pathobiology (Lerner Ellis), University of Toronto; ICES Central (Sutradhar); Department of Surgery (Little), St. Michael's Hospital; Odette Cancer Centre (Eisen), Sunnybrook Health Sciences Centre; Department of Paediatric Laboratory Medicine (Chun), The Hospital for Sick Children; Genetics Program (Meschino, Velsher), North York General Hospital; Lunenfeld-Tanenbaum Research Institute (Lerner Ellis) and Pathology and Laboratory Medicine (Lerner Ellis), Mount Sinai Hospital, Sinai Health System, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Victoria, Australia
| | - Lea Velsher
- Division of General Surgery, Department of Surgery (Dossa), Institute of Health Policy, Management and Evaluation (Dossa, Sutradhar, Baxter), Lawrence S. Bloomberg Faculty of Nursing ( Metcalfe) Division of Biostatistics, Dalla Lana School of Public Health (Sutradhar), Department of Pediatrics (Meschino) and Department of Laboratory Medicine and Pathobiology (Lerner Ellis), University of Toronto; ICES Central (Sutradhar); Department of Surgery (Little), St. Michael's Hospital; Odette Cancer Centre (Eisen), Sunnybrook Health Sciences Centre; Department of Paediatric Laboratory Medicine (Chun), The Hospital for Sick Children; Genetics Program (Meschino, Velsher), North York General Hospital; Lunenfeld-Tanenbaum Research Institute (Lerner Ellis) and Pathology and Laboratory Medicine (Lerner Ellis), Mount Sinai Hospital, Sinai Health System, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Victoria, Australia
| | - Jordan Lerner Ellis
- Division of General Surgery, Department of Surgery (Dossa), Institute of Health Policy, Management and Evaluation (Dossa, Sutradhar, Baxter), Lawrence S. Bloomberg Faculty of Nursing ( Metcalfe) Division of Biostatistics, Dalla Lana School of Public Health (Sutradhar), Department of Pediatrics (Meschino) and Department of Laboratory Medicine and Pathobiology (Lerner Ellis), University of Toronto; ICES Central (Sutradhar); Department of Surgery (Little), St. Michael's Hospital; Odette Cancer Centre (Eisen), Sunnybrook Health Sciences Centre; Department of Paediatric Laboratory Medicine (Chun), The Hospital for Sick Children; Genetics Program (Meschino, Velsher), North York General Hospital; Lunenfeld-Tanenbaum Research Institute (Lerner Ellis) and Pathology and Laboratory Medicine (Lerner Ellis), Mount Sinai Hospital, Sinai Health System, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Victoria, Australia
| | - Nancy N Baxter
- Division of General Surgery, Department of Surgery (Dossa), Institute of Health Policy, Management and Evaluation (Dossa, Sutradhar, Baxter), Lawrence S. Bloomberg Faculty of Nursing ( Metcalfe) Division of Biostatistics, Dalla Lana School of Public Health (Sutradhar), Department of Pediatrics (Meschino) and Department of Laboratory Medicine and Pathobiology (Lerner Ellis), University of Toronto; ICES Central (Sutradhar); Department of Surgery (Little), St. Michael's Hospital; Odette Cancer Centre (Eisen), Sunnybrook Health Sciences Centre; Department of Paediatric Laboratory Medicine (Chun), The Hospital for Sick Children; Genetics Program (Meschino, Velsher), North York General Hospital; Lunenfeld-Tanenbaum Research Institute (Lerner Ellis) and Pathology and Laboratory Medicine (Lerner Ellis), Mount Sinai Hospital, Sinai Health System, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Victoria, Australia
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Lentz EJM, Park AL, Langlois AWR, Huang T, Meschino WS, Ray JG. Risk of Severe Maternal Morbidity or Death in Relation to Prenatal Biochemical Screening: Population-Based Cohort Study. Am J Perinatol 2021; 38:44-59. [PMID: 31412403 DOI: 10.1055/s-0039-1694731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to examine whether prenatal biochemical screening analytes are associated with an increased risk of severe maternal morbidity (SMM) or maternal mortality. STUDY DESIGN This population-based cohort study includes all women in Ontario, Canada, who underwent prenatal screening from 2001 to 2011. Increasing fifth percentiles of the multiple of the median (MoM) for alphafetoprotein (AFP), total human chorionic gonadotropin, unconjugated estriol (uE3), dimeric inhibin-A (DIA), and pregnancy-associated plasma protein A were evaluated. An abnormally high concentration (>95th percentile MoM) for each analyte, individually and combined, was also evaluated. The main outcome assessed was the adjusted relative risk (aRR) of SMM or maternal mortality from 20 weeks' gestation up to 26 weeks thereafter. RESULTS Among 748,972 pregnancies, 11,177 resulted in SMM or maternal mortality (1.5%). Except for uE3, the aRR of SMM or maternal mortality increased in association with increasing fifth percentiles of the MoM for all analytes. AFP (aRR: 2.10; 95% confidence interval [CI]: 1.97-2.25) and DIA (aRR: 2.33; 95% CI: 1.98-2.74) > 95th versus ≤ 5th percentile of the MoM were especially associated with SMM or death. CONCLUSION Women with abnormally high concentrations of certain prenatal biochemical analytes may be at a higher risk of SMM or death in pregnancy or postpartum.
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Affiliation(s)
- Eric J M Lentz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alison L Park
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alec W R Langlois
- Faculty of Arts and Science, Queen's University, Kingston, Ontario, Canada
| | - Tianhua Huang
- Genetics Program, North York General Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Wendy S Meschino
- Genetics Program, North York General Hospital, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Joel G Ray
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Health Policy Management and Evaluation, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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4
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Huang T, Gibbons C, Rashid S, Priston MK, Bedford HM, Mak-Tam E, Meschino WS. Prenatal screening for trisomy 21: a comparative performance and cost analysis of different screening strategies. BMC Pregnancy Childbirth 2020; 20:713. [PMID: 33228595 PMCID: PMC7686697 DOI: 10.1186/s12884-020-03394-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/04/2020] [Indexed: 12/14/2022] Open
Abstract
Background Prenatal screening for chromosome aneuploidies have constantly been evolving, especially with the introduction of cell-free fetal DNA (cfDNA) screening in the most recent years. This study compares the performance, costs and timing of test results of three cfDNA screening implementation strategies: contingent, reflex and primary. Methods We modelled enhanced first trimester screening (eFTS) as the first-tier test in contingent or reflex strategies. cfDNA test was performed contingent on or reflex from eFTS results. A comparison was made between cfDNA screening using sequencing technology and Rolling Circle Amplification (RCA)/imaging solution. All model assumptions were based on results from previous publications or information from the Ontario prenatal screening population. Results At an eFTS risk cut-off of ≥1/1000, contingent and reflex cfDNA screening have the same detection rate (DR) (94%) for trisomy 21. Reflex cfDNA screening using RCA/Imaging solution provided the lowest false positive rate and cost. The number of women requiring genetic counselling and diagnostic testing was significantly reduced and women received their cfDNA screening result 9 days sooner compared with the contingent model. While primary cfDNA screening improved the trisomy 21 DR by 3–5%, it was more costly and more women required diagnostic testing. Conclusion Reflex cfDNA screening is the most cost-effective prenatal screening strategy. It can improve the efficiency of prenatal aneuploidy screening by reducing the number of patient visits and providing more timely results.
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Affiliation(s)
- Tianhua Huang
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada. .,Prenatal Screening Ontario, Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada. .,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
| | - Clare Gibbons
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Shamim Rashid
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada
| | - Megan K Priston
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada
| | - H Melanie Bedford
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ellen Mak-Tam
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada
| | - Wendy S Meschino
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Aronson M, Swallow C, Govindarajan A, Semotiuk K, Cohen Z, Kaurah P, Velsher L, Ambus I, Buckley K, Forster-Gibson C, Meschino WS, Blumenthal A, Kim RH, Brar S. Germline variants and phenotypic spectrum in a Canadian cohort of individuals with diffuse gastric cancer. Curr Oncol 2020; 27:e182-e190. [PMID: 32489267 PMCID: PMC7253747 DOI: 10.3747/co.27.5663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background CDH1 pathogenic variants (pvs) cause most cases of inherited diffuse gastric cancer (dgc), but have low detection rates and vary geographically. In the present study, we examined hereditary causes of dgc in patients in Ontario. Methods CDH1 testing through single-site or multi-gene panels was conducted for patients with dgc meeting the 2015 International Gastric Cancer Linkage Consortium (igclc) criteria, or with isolated dgc at less than 50 years of age, or with a strong family history of cancer identified at the Zane Cohen Centre (zcc). All CDH1-positive patients at zcc, regardless of cancer history, were summarized. Results In 15 of 85 patients with dgc (17.6%), a pv or likely pv was identified through CDH1 single-site (n = 43) or multi-gene panel (n = 42) testing. The detection rate was 9.4% overall (8 of 85) and 11% using igclc criteria (7 of 65). No CDH1 pvs were identified in patients with isolated dgc at less than 40 years of age, but 1 pv was identified in a patient with isolated dgc at less than 50 years of age. Multi-gene panels identified 9 pvs (21.4%), including CDH1, STK11, ATM, BRCA2, MLH1, and MSH2. Review of 81 CDH1 carriers identified 10% with dgc (median age: 48 years; range: 38-59 years); 41% were unaffected (median age: 53 years; range: 26-89 years). Observed malignancies other than dgc or lobular breast cancer (lbc) included colorectal, gynecologic, kidney or bladder, prostate, testicular, and ductal breast cancers. Lobular-breast cancer was seen only in 3 families. Conclusions In Ontario, the detection rate of CDH1 pvs in patients with dgc was low: no pvs were identified in patients with isolated dgc at less than 40 years of age, and 1 was identified in a patient with isolated dgc at less than 50 years of age. Isolated lbc with no dgc was observed in CDH1-positive families, as were pathology-confirmed nondgc or non-lbc malignancies, which had not previously been reported. Given a phenotype that overlaps with other hereditary conditions, multi-gene panels are recommended for all patients with dgc at less than 50 years of age and for those meeting igclc criteria.
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Affiliation(s)
- M Aronson
- Sinai Health System, Zane Cohen Centre for Digestive Diseases, University of Toronto, Toronto, ON
| | - C Swallow
- Sinai Health System, Department of Surgery, University of Toronto, Toronto, ON
| | - A Govindarajan
- Sinai Health System, Department of Surgery, University of Toronto, Toronto, ON
| | - K Semotiuk
- Sinai Health System, Zane Cohen Centre for Digestive Diseases, University of Toronto, Toronto, ON
| | - Z Cohen
- Sinai Health System, Zane Cohen Centre for Digestive Diseases, University of Toronto, Toronto, ON
| | | | - L Velsher
- North York General Hospital, Toronto, ON
| | - I Ambus
- North York General Hospital, Toronto, ON
| | | | | | | | | | - R H Kim
- Sinai Health System, Department of Medicine, Division of Medical Oncology, University of Toronto, Toronto, ON
| | - S Brar
- Sinai Health System, Department of Surgery, University of Toronto, Toronto, ON
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Park AL, Huang T, Meschino WS, Iqbal J, Ray JG. Prenatal Biochemical Screening and a Woman’s Long-Term Risk of Cancer: A Population-Based Cohort Study. JNCI Cancer Spectr 2020; 4:pkz077. [PMID: 32110774 PMCID: PMC7027569 DOI: 10.1093/jncics/pkz077] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 11/25/2022] Open
Abstract
Background Some hormones measured in pregnancy are linked to certain hormone-sensitive cancers. We investigated whether routine serum screening in pregnancy is associated with a woman’s subsequent risk of hormone-sensitive cancer. Methods This population-based cohort study included women aged 12–55 years who underwent prenatal screening between 11 weeks + 0 days of gestation to 20 weeks + 6 days of gestation in Ontario, Canada, 1993–2011, where universal health care is available. The hazard ratio of newly diagnosed breast, ovarian, endometrial, and thyroid cancer—arising at 21 weeks + 0 days of gestation or thereafter—was estimated in association with an abnormally low (≤5th) or high (>95th) percentile multiple of the median (MoM) for alpha-fetoprotein (AFP), total human chorionic gonadotropin (hCG), unconjugated estriol, pregnancy-associated plasma protein A, and dimeric inhibin A. Results Among 677 247 pregnant women followed for a median of 11.0 years (interquartile range = 7.5–16.1), 7231 (1.07%) developed breast cancer, 515 (0.08%) ovarian cancer, 508 (0.08%) endometrial cancer, and 4105 (0.61%) thyroid cancer. In multivariable adjusted models, abnormally high hCG greater than the 95th percentile MoM was associated with a doubling in the risk of endometrial cancer (adjusted hazard ratio [aHR] = 1.98, 95% confidence interval [CI] = 1.33 to 2.95), and abnormally low AFP at the fifth percentile or less MoM conferred a moderately greater risk of thyroid cancer (aHR = 1.21, 95% CI = 1.07 to 1.38). Abnormally low pregnancy-associated plasma protein A at the fifth percentile or less MoM was not statistically significantly associated with breast cancer after multivariable adjustment (aHR = 1.19, 95% CI = 0.98 to 1.36). Conclusions Women with abnormally high levels of serum hCG or low AFP in early pregnancy may be at a greater future risk of certain types of hormone-sensitive cancers.
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Affiliation(s)
| | - Tianhua Huang
- Genetics Program, North York General Hospital, Toronto, ON, Canada
- Better Outcomes Registry & Network (BORN), Ottawa, ON, Canada
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Wendy S Meschino
- Genetics Program, North York General Hospital, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Joel G Ray
- ICES, Toronto, ON, Canada
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Obstetrics & Gynecology, St. Michael’s Hospital, Toronto, ON, Canada
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Metcalfe K, Eisen A, Senter L, Armel S, Bordeleau L, Meschino WS, Pal T, Lynch HT, Tung NM, Kwong A, Ainsworth P, Karlan B, Moller P, Eng C, Weitzel JN, Sun P, Lubinski J, Narod SA. International trends in the uptake of cancer risk reduction strategies in women with a BRCA1 or BRCA2 mutation. Br J Cancer 2019; 121:15-21. [PMID: 30971774 PMCID: PMC6738089 DOI: 10.1038/s41416-019-0446-1] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Women with a BRCA1 or BRCA2 mutation face high risks of breast and ovarian cancer. In the current study, we report on uptake of cancer screening and risk-reduction options in a cohort of BRCA mutation carriers from ten countries over two time periods (1995 to 2008 and 2009 to 2017). METHODS Eligible subjects were identified from an international database of female BRCA mutation carriers and included women from 59 centres from ten countries. Subjects completed a questionnaire at the time of genetic testing, which included past use of cancer prevention options and screening tests. Biennial follow-up questionnaires were administered. RESULTS Six-thousand two-hundred and twenty-three women were followed for a mean of 7.5 years. The mean age at last follow-up was 52.1 years (27-96 years) and 42.3% of the women had a prior diagnosis of breast cancer. In all, 27.8% had a prophylactic bilateral mastectomy and 64.7% had a BSO. Screening with breast MRI increased from 70% before 2009 to 81% at or after 2009. There were significant differences in uptake of all options by country. CONCLUSION For women who received genetic testing more recently, uptake of prophylactic mastectomy and breast MRI is significantly higher than those who received genetic testing more than 10 years ago. However, uptake of both BSO and breast MRI is not optimal, and interventions to increase uptake are needed.
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Affiliation(s)
- Kelly Metcalfe
- Women's College Research Institute, Toronto, ON, Canada.,Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Andrea Eisen
- Toronto-Sunnybrook Regional Cancer Center, Toronto, ON, Canada
| | - Leigha Senter
- Division of Human Genetics, The Ohio State University Medical Center, Comprehensive Cancer Center, Columbus, OH, USA
| | - Susan Armel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | | | | | - Tuya Pal
- Vanderbilt-Ingram Cancer Center/Vanderbilt University Medical Center, Nashville, TN, USA
| | - Henry T Lynch
- Hereditary Cancer Center, Creighton University School of Medicine, Omaha, NE, USA
| | - Nadine M Tung
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ava Kwong
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR.,Department of Surgery, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR.,Hong Kong Hereditary Breast Cancer Family Registry, Happy Valley, Hong Kong SAR
| | - Peter Ainsworth
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Beth Karlan
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | - Pal Moller
- Research Group Inherited Cancer, Department of Medical, Genetics, Oslo University Hospital, Oslo, Norway.,Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, part of Oslo University Hospital, Oslo, Norway.,Center for Hereditary Tumors, HELIOS-Klinikum Wuppertal, University of Witten-Herdecke, Wuppertal, Germany
| | - Charis Eng
- Genomic Medicine Institute, Center for Personalised Genetic Healthcare, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ping Sun
- Women's College Research Institute, Toronto, ON, Canada
| | - Jan Lubinski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Steven A Narod
- Women's College Research Institute, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Aref-Eshghi E, Bend EG, Hood RL, Schenkel LC, Carere DA, Chakrabarti R, Nagamani SCS, Cheung SW, Campeau PM, Prasad C, Siu VM, Brady L, Tarnopolsky MA, Callen DJ, Innes AM, White SM, Meschino WS, Shuen AY, Paré G, Bulman DE, Ainsworth PJ, Lin H, Rodenhiser DI, Hennekam RC, Boycott KM, Schwartz CE, Sadikovic B. BAFopathies' DNA methylation epi-signatures demonstrate diagnostic utility and functional continuum of Coffin-Siris and Nicolaides-Baraitser syndromes. Nat Commun 2018; 9:4885. [PMID: 30459321 PMCID: PMC6244416 DOI: 10.1038/s41467-018-07193-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/18/2018] [Indexed: 01/16/2023] Open
Abstract
Coffin–Siris and Nicolaides–Baraitser syndromes (CSS and NCBRS) are Mendelian disorders caused by mutations in subunits of the BAF chromatin remodeling complex. We report overlapping peripheral blood DNA methylation epi-signatures in individuals with various subtypes of CSS (ARID1B, SMARCB1, and SMARCA4) and NCBRS (SMARCA2). We demonstrate that the degree of similarity in the epi-signatures of some CSS subtypes and NCBRS can be greater than that within CSS, indicating a link in the functional basis of the two syndromes. We show that chromosome 6q25 microdeletion syndrome, harboring ARID1B deletions, exhibits a similar CSS/NCBRS methylation profile. Specificity of this epi-signature was confirmed across a wide range of neurodevelopmental conditions including other chromatin remodeling and epigenetic machinery disorders. We demonstrate that a machine-learning model trained on this DNA methylation profile can resolve ambiguous clinical cases, reclassify those with variants of unknown significance, and identify previously undiagnosed subjects through targeted population screening. Mutations in genes encoding subunits of the BAF complex can cause Coffin–Siris and Nicolaides–Baraitser syndromes. Here the authors identify overlapping DNA methylation signatures in individuals with subtypes of these two syndromes that suggest a functional link and can be used to diagnose subjects with unclear clinical presentations.
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Affiliation(s)
- Erfan Aref-Eshghi
- Department of Pathology and Laboratory Medicine, Western University, London, N6A 5W9, ON, Canada.,Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, N6A 5W9, ON, Canada
| | - Eric G Bend
- Prevention Genetics, Marshfield, 54449, WI, USA
| | - Rebecca L Hood
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, K1H 8L1, ON, Canada
| | - Laila C Schenkel
- Department of Pathology and Laboratory Medicine, Western University, London, N6A 5W9, ON, Canada.,Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, N6A 5W9, ON, Canada
| | - Deanna Alexis Carere
- Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, N6A 5W9, ON, Canada
| | - Rana Chakrabarti
- Children's Health Research Institute, London, N6A 5W9, ON, Canada
| | - Sandesh C S Nagamani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, 77030, TX, USA
| | - Sau Wai Cheung
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, 77030, TX, USA
| | - Philippe M Campeau
- Department of Pediatrics, University of Montreal, Montreal, H3C 3J7, QC, Canada
| | - Chitra Prasad
- Children's Health Research Institute, London, N6A 5W9, ON, Canada
| | - Victoria Mok Siu
- Children's Health Research Institute, London, N6A 5W9, ON, Canada
| | - Lauren Brady
- Department of Pediatrics, McMaster University, Hamilton, L8P 1A2, ON, Canada
| | - Mark A Tarnopolsky
- Department of Pediatrics, McMaster University, Hamilton, L8P 1A2, ON, Canada
| | - David J Callen
- Department of Pediatrics, McMaster University, Hamilton, L8P 1A2, ON, Canada
| | - A Micheil Innes
- Department of Medical Genetics, Alberta Children's Hospital Research Institute for Child and Maternal Health, University of Calgary, Calgary, T3B 6A8, AB, Canada
| | - Susan M White
- Department of Paediatrics, University of Melbourne, Melbourne, 3052, VIC, Australia
| | - Wendy S Meschino
- Genetics Program, North York General Hospital, Toronto, M2K 1E1, ON, Canada
| | - Andrew Y Shuen
- Children's Health Research Institute, London, N6A 5W9, ON, Canada
| | - Guillaume Paré
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, L8P 1A2, ON, Canada
| | - Dennis E Bulman
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, K1H 8L1, ON, Canada
| | - Peter J Ainsworth
- Department of Pathology and Laboratory Medicine, Western University, London, N6A 5W9, ON, Canada.,Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, N6A 5W9, ON, Canada
| | - Hanxin Lin
- Department of Pathology and Laboratory Medicine, Western University, London, N6A 5W9, ON, Canada.,Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, N6A 5W9, ON, Canada
| | - David I Rodenhiser
- Children's Health Research Institute, London, N6A 5W9, ON, Canada.,Department of Pediatrics, Biochemistry and Oncology, Western University, London, N6A 5W9, ON, Canada
| | - Raoul C Hennekam
- Department of Pediatrics, Academic Medical Center, University of Amsterdam, Amsterdam, 1012 WX, The Netherlands
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, K1H 8L1, ON, Canada
| | | | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Western University, London, N6A 5W9, ON, Canada. .,Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, N6A 5W9, ON, Canada.
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9
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Iqbal J, Kahane A, Park AL, Huang T, Meschino WS, Ray JG. Hormone Levels in Pregnancy and Subsequent Risk of Maternal Breast and Ovarian Cancer: A Systematic Review. J Obstet Gynaecol Can 2018; 41:217-222. [PMID: 30528445 DOI: 10.1016/j.jogc.2018.03.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/22/2018] [Accepted: 03/27/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Some maternal hormone levels in pregnancy are associated with a higher risk of breast and ovarian cancer. This study systematically assessed the association between blood hormone levels measured in pregnancy and future risk of these cancers. METHODS Two reviewers independently conducted a literature search of MEDLINE and EMBASE databases from January 1970 to August 2017. Studies were included that measured one or more serum hormone levels in pregnancy and later assessed for cancer. Cancer outcomes were considered by cancer type, each in relation to a specific maternal hormone. RESULTS Eleven studies were included, comprising a total of 57 967 women. The interval between pregnancy and cancer onset varied from 4.1 to 20.5 years. Elevated serum chorionic gonadotropin (two of four studies) and alpha fetoprotein (two of three studies) were each associated with a lower risk of maternal breast cancer, whereas elevated estrone levels suggested a higher risk (one of three studies). Elevated testosterone (one of one study) and androstenedione (one of one study) were each associated with a significantly greater risk of sex-cord stromal ovarian tumours. Higher serum 17-hydroxyprogesterone was associated with an increased risk of sex-cord stromal (one of one study) and epithelial (one of one study) ovarian cancer. CONCLUSION Observational studies suggest some degree of association between serum hormones measured in pregnancy and a woman's future risk of breast and ovarian cancer. More data are needed to determine sufficiently whether certain blood hormone levels measured in pregnancy are predictive of future cancer risk.
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Affiliation(s)
- Javaid Iqbal
- Institute of Medical Science, University of Toronto, Toronto, ON
| | - Alyssa Kahane
- Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Alison L Park
- St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Tianhua Huang
- Genetics Program, North York General Hospital, Toronto, ON; The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Wendy S Meschino
- Genetics Program, North York General Hospital, Toronto, ON; Department of Paediatrics, University of Toronto, Toronto, ON
| | - Joel G Ray
- St. Michael's Hospital, University of Toronto, Toronto, ON.
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10
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Dossa F, Cusimano MC, Sutradhar R, Metcalfe K, Little T, Lerner-Ellis J, Eisen A, Meschino WS, Baxter NN. Real-world health services utilisation and outcomes after BRCA1 and BRCA2 testing in Ontario, Canada: the What Comes Next Cohort Study protocol. BMJ Open 2018; 8:e025317. [PMID: 30181190 PMCID: PMC6129086 DOI: 10.1136/bmjopen-2018-025317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Women who have pathogenic mutations in the BRCA1 and BRCA2 genes are at greatly increased risks for breast and ovarian cancers. Although risk-reduction strategies can be undertaken by these women, knowledge regarding the uptake of these strategies is limited. Additionally, the healthcare behaviours of women who receive inconclusive test results are not known. This study protocol describes the creation of a retrospective cohort of women who have undergone genetic testing for BRCA1 and BRCA2, linking genetic test results with administrative data to quantify the uptake of risk-reduction strategies and to assess long-term cancer and non-cancer outcomes after genetic testing. METHODS AND ANALYSIS Approximately two-thirds of BRCA1 and BRCA2 testing in Ontario, Canada is performed at North York General Hospital (NYGH) and Mount Sinai Hospital (MSH), Toronto. We will use registries at these sites to assemble a cohort of approximately 17 000 adult women who underwent BRCA1 and BRCA2 testing from January 2007 to April 2016. Trained chart abstractors will obtain detailed information for all women tested over this period, including demographics, personal and family cancer histories and genetic test results. We will link these data to provincial administrative databases, enabling assessment of healthcare utilisation and long-term outcomes after testing. Study outcomes will include the uptake of breast cancer screening and prophylactic breast and ovarian surgery, cancer incidence and mortality and incidence of non-cancer health outcomes, including cardiovascular, osteoporotic and neurodegenerative disease. ETHICS AND DISSEMINATION This study has been approved by the Research Ethics Boards at NYGH (no 16-0035), MSH (no 13-0124) and Sunnybrook Health Sciences Centre (no 275-2016). We plan to disseminate research findings through peer-reviewed publications and presentations at national and international meetings.
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Affiliation(s)
- Fahima Dossa
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Maria C Cusimano
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Kelly Metcalfe
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Tari Little
- Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jordan Lerner-Ellis
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Andrea Eisen
- Sunnybrook Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Wendy S Meschino
- Department of Molecular Genetics, North York General Hospital, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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11
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McCuaig JM, Stockley TL, Shaw P, Fung-Kee-Fung M, Altman AD, Bentley J, Bernardini MQ, Cormier B, Hirte H, Kieser K, MacMillan A, Meschino WS, Panabaker K, Perrier R, Provencher D, Schrader KA, Serfas K, Tomiak E, Wong N, Young SS, Gotlieb WH, Hoskins P, Kim RH. Evolution of genetic assessment for BRCA-associated gynaecologic malignancies: a Canadian multisociety roadmap. J Med Genet 2018; 55:571-577. [PMID: 30042185 PMCID: PMC6119348 DOI: 10.1136/jmedgenet-2018-105472] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/18/2018] [Accepted: 07/02/2018] [Indexed: 01/21/2023]
Abstract
The landscape of genetic testing in ovarian cancer patients has changed dramatically in recent years. The therapeutic benefits of poly ADP-ribose polymerase (PARP) inhibitors in treatment of BRCA1/2-related ovarian cancers has resulted in an increased demand and urgency for genetic testing results, while technological developments have led to widespread use of multi-gene cancer panels and development of tumour testing protocols. Traditional genetic counselling models are no longer sustainable and must evolve to match the rapid evolution of genetic testing technologies and developments in personalized medicine. Recently, representatives from oncology, clinical genetics, molecular genetics, pathology, and patient advocacy came together to create a national multi-disciplinary Canadian consortium. By aligning stakeholder interests, the BRCA Testing to Treatment (BRCA TtoT) Community of Practice aims to develop a national strategy for tumour and germline BRCA1/2 testing and genetic counselling in women with ovarian cancer. This article serves to provide an overview of the recent evolution of genetic assessment for BRCA1/2-associated gynecologic malignancies and outline a Canadian roadmap to facilitate change, improve genetic testing rates, and ultimately improve outcomes for hereditary ovarian cancer patients and their families.
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Affiliation(s)
- Jeanna M McCuaig
- Familial Breast & Ovarian Cancer Clinic, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Tracy L Stockley
- Division of Clinical Laboratory Genetics and Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Shaw
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Michael Fung-Kee-Fung
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alon D Altman
- Department of Gynecologic Oncology, University of Manitoba, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - James Bentley
- Department of Obstetrics and Gynecology, Nova Scotia Health Authority, Halifix, Nova Scotia, Canada
| | - Marcus Q Bernardini
- Department of Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Beatrice Cormier
- Department of Obstetrics and Gynecology, Université de Montreal, Montreal, Quebec, Canada
| | - Hal Hirte
- Department of Gynecologic Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Katharina Kieser
- Department of Gynecologic Oncology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Andree MacMillan
- Provincial Medical Genetics Program, Eastern Health, St John's, Newfoundland and Labrador, Canada
| | - Wendy S Meschino
- Department of Genetics, North York General Hospital, Toronto, Ontario, Canada
| | - Karen Panabaker
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Renee Perrier
- Department of Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Diane Provencher
- Department of Obstetrics and Gynecology, Université de Montreal, Montreal, Quebec, Canada
| | - Kasmintan A Schrader
- Hereditary Cancer Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Kimberly Serfas
- Department of Genetics and Metabolism, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Eva Tomiak
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nora Wong
- Department of Medical Genetics, CIUSSS West-Central Montreal Jewish General Hospital, Montreal, Canada
| | - Sean S Young
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Walter Henri Gotlieb
- Department of Gynecologic Oncology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Paul Hoskins
- Department of Gynecologic Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Raymond H Kim
- Familial Breast & Ovarian Cancer Clinic, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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12
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Huang T, Meschino WS, Rashid S, Dennis A, Mak-Tam E, Cuckle H. Enhanced First Trimester Aneuploidy Screening with Placental Growth Factor and Alpha Feto-Protein: Detection of Trisomies 18 and 13. J Obstet Gynaecol Can 2018; 40:1295-1301. [PMID: 30025867 DOI: 10.1016/j.jogc.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To assess the performance of first trimester combined screening (FTS) when enhanced with placental growth factor and alpha feto-protein in the detection of trisomies 18 and 13. METHODS A retrospective case-control study. Marker parameters were derived using frozen serum samples. Multivariate Gaussian modelling predicted the detection rate (DR) and false-positive rate (FPR) for trisomies 18 and 13 with FTS and enhanced first trimester screening (eFTS) using the risk of trisomy 21 alone and an additional risk cut-off for trisomy 18, or trisomies 18 or 13. RESULTS There were 83 trisomy 18, 22 trisomy 13, and 588 controls. The median placental growth factor levels in trisomies 18 and 13 were 0.75 and 0.65 multiple of the median of controls, respectively (both P < 0.0001). There were no statistically significant differences in alpha feto-protein levels. Modelling predicts that using a trisomy 21 risk cut-off alone, at FPR of 3%, eFTS increases the DR for trisomies 18 and 13 by 0.6-0.8% compared with FTS. Additionally using a trisomy 18 risk cut-off, at an extra FPR of 0.2%, eFTS increased the DR by 0.6-0.9% over FTS; using a trisomy 18 or 13 risk cut-off did not further increase detection for FTS or eFTS. The increase in DR was greater at higher FPR. CONCLUSION eFTS increases the detection of trisomies 18 and 13 to a small extent.
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Affiliation(s)
- Tianhua Huang
- Genetics Program, North York General Hospital, Toronto, ON; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON; The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON.
| | - Wendy S Meschino
- Genetics Program, North York General Hospital, Toronto, ON; Department of Paediatrics, University of Toronto, Toronto, ON
| | - Shamim Rashid
- Genetics Program, North York General Hospital, Toronto, ON
| | - Alan Dennis
- Genetics Program, North York General Hospital, Toronto, ON
| | - Ellen Mak-Tam
- Genetics Program, North York General Hospital, Toronto, ON
| | - Howard Cuckle
- Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
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13
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Abstract
OBJECTIVE To examine whether abnormal prenatal biochemical screening results are associated with an increased risk of premature cardiovascular disease after pregnancy. DESIGN Population based cohort study. SETTING The entire province of Ontario, Canada, where healthcare is universally available. PARTICIPANTS Women aged 12-55 years, without pre-existing cardiovascular disease, who underwent prenatal screening between 1993 and 2011. One pregnancy per woman was randomly selected. EXPOSURES Low (≤5th centile multiple of the median) serum total chorionic gonadotropin, unconjugated estriol, and pregnancy associated plasma protein A and high (≥95th centile multiple of the median) alphafetoprotein and dimeric inhibin-A. MAIN OUTCOME MEASURES Composite of hospital admission or revascularisation for coronary artery, cerebrovascular, or peripheral arterial disease or hospital admission for heart failure or dysrhythmia at least 365 days after pregnancy. RESULTS Among 855 536 pregnancies, and after a median of 11.4 (interquartile range 6.8-17.5) years of follow-up, 6209 women developed the main cardiovascular disease outcome. Abnormal results for each of the five prenatal biochemical screening analytes, especially dimeric inhibin-A, were associated with a higher risk of cardiovascular disease. Women with an abnormally high dimeric inhibin-A (≥95th centile) had the highest rate of cardiovascular disease (30 events or 8.3 per 10 000 person years versus 251 events or 3.8 per 10 000 person years for those <95th centile; multivariable adjusted hazard ratio 2.0, 95% confidence interval 1.4 to 3.0). Compared with women without any abnormal biochemical measure, the hazard ratio for the cardiovascular disease composite outcome was 1.2-1.3 times higher with one abnormal analyte and 1.5-2.0 times higher with two or more abnormal analytes. CONCLUSIONS Women with abnormal prenatal biochemical screening results, especially for dimeric inhibin-A, may be at higher risk of cardiovascular disease. If these findings are replicated elsewhere, a massive amount of data exists that could aid in identifying women at higher risk of premature cardiovascular disease and that could be conveyed to them or their healthcare providers.
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Affiliation(s)
- Joel G Ray
- Departments of Medicine, Health Policy Management and Evaluation, and Obstetrics and Gynecology, St Michael's Hospital, Toronto, ON, Canada, M5B 1W8
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada
| | - Tianhua Huang
- Genetics Program, North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Wendy S Meschino
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Alison L Park
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada
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14
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Eisen A, Blackmore KM, Meschino WS, Muradali D, Carroll JC, Majpruz V, Warner E, Rabeneck L, Chiarelli AM. Genetic assessment wait time indicators in the High Risk Ontario Breast Screening Program. Mol Genet Genomic Med 2018; 6:213-223. [PMID: 29368425 PMCID: PMC5902387 DOI: 10.1002/mgg3.359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 12/13/2022] Open
Abstract
Background The Ontario Breast Screening Program (OBSP) expanded in July 2011 to screen high‐risk women aged 30–69 with annual MRI and mammography. This study evaluated wait time (WT) indicators along the genetic assessment (GA) pathway for women referred to the High Risk OBSP. Methods Information was collected for 27,170 women referred to the High Risk OBSP from July 2011 to June 2015 and followed for GA until June 2016. Median duration (days), interquartile range (IQR) were measured for each WT indicator by program year, age, prior breast cancer, and risk criteria. Results Among 24,811 women who completed GA, 16,367 (66.0%) had genetic counseling only, 8,444 (34.0%) had counseling and testing and 8,027 (32.4%) met the high risk criteria. Median WT from physician visit to first screen was longer for women having genetic counseling only compared to those having counseling and testing (244 vs. 197 days). Women having counseling only also experienced the longest WT from physician visit to genetic counseling (88 days; IQR = 10–174), which increased by year from 71 to 100 days (p < .0001). Among women having counseling and testing, WT from physician visit to counseling was shortest for mutation carriers (39 days; IQR = 4–100). Median WT from testing to laboratory report issue was 41 days (IQR = 22–70) and 17 days to disclosure of test results (IQR = 7–33). Both WTs decreased with year and were shorter for mutation carriers (33 days, IQR = 19–58; 15 days, IQR = 7–28, respectively). Conclusions After implementation of the High Risk OBSP, women received timely genetic counseling, in particular those having counseling and testing. Effective triage models for physicians could reduce WT to GA after physician referral.
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Affiliation(s)
- Andrea Eisen
- Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | - Derek Muradali
- Ontario Breast Screening Program, Cancer Care Ontario, Toronto, ON, Canada
| | - June C Carroll
- Department of Family Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Vicky Majpruz
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Ellen Warner
- Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Linda Rabeneck
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anna M Chiarelli
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada.,Ontario Breast Screening Program, Cancer Care Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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15
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Huang T, Meschino WS, Teitelbaum M, Dougan S, Okun N. Enhanced First Trimester Screening for Trisomy 21 with Contingent Cell-Free Fetal DNA: A Comparative Performance and Cost Analysis. Journal of Obstetrics and Gynaecology Canada 2017. [DOI: 10.1016/j.jogc.2017.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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16
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Noor A, Bogatan S, Watkins N, Meschino WS, Stavropoulos DJ. Disruption of YWHAE gene at 17p13.3 causes learning disabilities and brain abnormalities. Clin Genet 2017; 93:365-367. [PMID: 28542865 DOI: 10.1111/cge.13056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 03/24/2017] [Revised: 05/15/2017] [Accepted: 05/17/2017] [Indexed: 11/30/2022]
Abstract
There is a broad phenotypic spectrum of patients with 17p13.3 deletions. One of the most prominent feature is lissencephaly caused by haploinsufficiency of the gene PAFAH1B1. The deletion of this gene and those distal to it, results in Miller-Dieker syndrome, however there have been many reports of patients with haploinsufficiency of the distal genes alone. The deletions of these genes including YWHAE CRK and TUSC5 have been studied extensively and YWHAE has been postulated to be the cause of neurological abnormalities. The patients with deletions of the Miller-Dieker syndrome distal region present with variable clinical features including brain abnormalities, growth retardation, developmental delay, facial dysmorphisms and seizures. While there have been many patients reported to have deletions involving the YWHAE gene along with other genes, here we present the first detailed clinical description of a patient with deletion of YWHAE alone, allowing a more accurate characterization of the pathogenicity of YWHAE haploinsufficiency. The patient reported here demonstrated brain abnormalities, learning disabilities, and seizures supporting the role of YWHAE in these features. We review the literature and use this case report to better characterize and further confirm the genotype-phenotype relationship of the genes within the critical region of Miller-Dieker Syndrome.
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Affiliation(s)
- A Noor
- Department of Pathology and Laboratory Medicine, Division of Diagnostic Medical Genetics, Mount Sinai Hospital, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - S Bogatan
- Department of Pathology and Laboratory Medicine, Division of Diagnostic Medical Genetics, Mount Sinai Hospital, Toronto, Canada
| | - N Watkins
- Department of Pathology and Laboratory Medicine, Division of Diagnostic Medical Genetics, Mount Sinai Hospital, Toronto, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - W S Meschino
- Genetics Program, North York General Hospital, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - D J Stavropoulos
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Genome Diagnostics, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
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Gibbons CA, Sadeghi M, Barlow-Krelina E, Shaikh KT, Alan Fung WL, Meschino WS, Till C. M15 Computerised cognitive training for individuals with early stage huntington’s disease. J Neurol Psychiatry 2016. [DOI: 10.1136/jnnp-2016-314597.300] [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: 11/03/2022]
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18
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Gibbons CA, Medved W, Meschino WS, Lefebvre A, Alan Fung WL, Semotok J. J6 Parents’ perspective on the challenges of disclosing huntington’s disease information to their at risk children. J Neurol Neurosurg Psychiatry 2016. [DOI: 10.1136/jnnp-2016-314597.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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19
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Meschino WS, Miller K, Bedford HM. Incidental detection of familialAPPduplication: an unusual reason for a false positive NIPT result of trisomy 21. Prenat Diagn 2016; 36:382-4. [DOI: 10.1002/pd.4783] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/17/2015] [Accepted: 01/28/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Wendy S. Meschino
- Genetics Program; North York General Hospital; Toronto ON Canada
- Department of Paediatrics; University of Toronto; Toronto ON Canada
| | - Kristen Miller
- Genetics Program; North York General Hospital; Toronto ON Canada
| | - H. Melanie Bedford
- Genetics Program; North York General Hospital; Toronto ON Canada
- Department of Paediatrics; University of Toronto; Toronto ON Canada
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20
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Huang T, Dennis A, Meschino WS, Rashid S, Mak-Tam E, Cuckle H. First trimester screening for Down syndrome using nuchal translucency, maternal serum pregnancy-associated plasma protein A, free-β human chorionic gonadotrophin, placental growth factor, and α-fetoprotein. Prenat Diagn 2015; 35:709-16. [DOI: 10.1002/pd.4597] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/25/2015] [Accepted: 03/26/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Tianhua Huang
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Alan Dennis
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Wendy S. Meschino
- Genetics Program; North York General Hospital; Toronto Ontario Canada
- Department of Paediatrics; University of Toronto; Toronto Ontario Canada
| | - Shamim Rashid
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Ellen Mak-Tam
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Howard Cuckle
- Department of Obstetrics and Gynecology; Columbia University Medical Center; New York NY USA
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21
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Maheu C, Meschino WS, Hu W, Honeyford J, Ambus I, Kidd M, Benea A, Gao X, Azadbakhsh M, Rochefort C, Esplen MJ. Pilot Testing of a Psycho-educational Telephone Intervention for Women Receiving Uninformative BRCA1/2 Genetic Test Results. Can J Nurs Res 2015; 47:53-71. [PMID: 29509450 DOI: 10.1177/084456211504700105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/17/2022] Open
Abstract
Evidence suggests that women who receive uninformative results for breast and ovarian cancer (BRCA1/2) gene mutations may experience as much distress as women whose results indicate the presence of a gene mutation. No intervention to reduce distress after receipt of uninformative results has yet been tested. The purpose of this study was to test the feasibility and preliminary effects of a psycho-educational telephone (PET) intervention to reduce distress in women who receive uninformative BRCA1/2 results. A single group with repeated measures was used to assess the impact of the intervention on 72 such women. After receiving the results, most of the women continued to feel uncertain about their carrier genetic status. However, their distress significantly decreased between receipt of uninformative results and 3 months post-intervention (p = 0.01). The preliminary findings suggest that a PET uncertainty intervention is clinically feasible and may reduce the distress of receiving uninformative results.
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Affiliation(s)
- Christine Maheu
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada, and Clinical Scientist Butterfield/Drew Fellow, ELLICSR: Health, Wellness and Cancer Survivorship Centre, University Health Network, University of Toronto, Ontario, Canada
| | - Wendy S Meschino
- Genetics Program, North York General Hospital, Toronto, and Assistant Professor, Department of Paediatrics, University of Toronto
| | - Weiming Hu
- Department of Mathematics and Statistics, York University, Toronto
| | | | | | | | - Aronela Benea
- Advanced Practice Nurse, ACTT at Women's College Hospital, Toronto
| | - Xin Gao
- Department of Mathematics and Statistics, York University
| | | | - Christian Rochefort
- Ingram School of Nursing, McGill University, and FRQ-S Junior 1 Investigator
| | - Mary Jane Esplen
- de Souza Institute, Toronto, and Clinician-Scientist and Professor, Department of Psychiatry, University of Toronto/University Health Network
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22
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Huang T, Boucher K, Aul R, Rashid S, Meschino WS. First and second trimester maternal serum markers in pregnancies with a vanishing twin. Prenat Diagn 2014; 35:90-6. [DOI: 10.1002/pd.4492] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/25/2014] [Accepted: 09/01/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Tianhua Huang
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Karen Boucher
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Ritu Aul
- Genetics Program; North York General Hospital; Toronto Ontario Canada
- Department of Paediatrics; University of Toronto; Toronto Ontario Canada
| | - Shamim Rashid
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Wendy S. Meschino
- Genetics Program; North York General Hospital; Toronto Ontario Canada
- Department of Paediatrics; University of Toronto; Toronto Ontario Canada
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23
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Chiarelli AM, Prummel MV, Muradali D, Majpruz V, Horgan M, Carroll JC, Eisen A, Meschino WS, Shumak RS, Warner E, Rabeneck L. Effectiveness of Screening With Annual Magnetic Resonance Imaging and Mammography: Results of the Initial Screen From the Ontario High Risk Breast Screening Program. J Clin Oncol 2014; 32:2224-30. [DOI: 10.1200/jco.2013.52.8331] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The Ontario Breast Screening Program expanded in July 2011 to screen women age 30 to 69 years at high risk for breast cancer with annual magnetic resonance imaging (MRI) and digital mammography. To the best of our knowledge, this is the first organized screening program for women at high risk for breast cancer. Patients and Methods Performance measures after assessment were compared with screening results for 2,207 women with initial screening examinations. The following criteria were used to determine eligibility: known mutation in BRCA1, BRCA2, or other gene predisposing to a markedly increased risk of breast cancer, untested first-degree relative of a gene mutation carrier, family history consistent with hereditary breast cancer syndrome and estimated personal lifetime breast cancer risk ≥ 25%, or radiation therapy to the chest (before age 30 years and at least 8 years previously). Results The recall rate was significantly higher among women who had abnormal MRI alone (15.1%; 95% CI, 13.8% to 16.4%) compared with mammogram alone (6.4%; 95% CI, 5.5% to 7.3%). Of the 35 breast cancers detected (16.3 per 1,000; 95% CI, 11.2 to 22.2), none were detected by mammogram alone, 23 (65.7%) were detected by MRI alone (10.7 per 1,000; 95% CI, 6.7 to 15.8), and 25 (71%) were detected among women who were known gene mutation carriers (30.8 per 1,000, 95% CI, 19.4 to 43.7). The positive predictive value was highest for detection based on mammogram and MRI (12.4%; 95% CI, 7.3% to 19.3%). Conclusion Screening with annual MRI combined with mammography has the potential to be effectively implemented into an organized breast screening program for women at high risk for breast cancer. This could be considered an important management option for known BRCA gene mutation carriers.
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Affiliation(s)
- Anna M. Chiarelli
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Maegan V. Prummel
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Derek Muradali
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Vicky Majpruz
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Meaghan Horgan
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - June C. Carroll
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Andrea Eisen
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Wendy S. Meschino
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Rene S. Shumak
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Ellen Warner
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Anna M. Chiarelli, Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Meaghan Horgan, Rene S. Shumak, and Linda Rabeneck, Cancer Care Ontario; Anna M. Chiarelli, Derek Muradali, June C. Carroll, Andrea Eisen, Ellen Warner, and Linda Rabeneck, University of Toronto; June C. Carroll, Mount Sinai Hospital; Andrea Eisen and Ellen Warner, Sunnybrook Health Sciences Centre; and Wendy S. Meschino, North York General Hospital, Toronto, Ontario, Canada
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Costain G, Esplen MJ, Toner B, Scherer SW, Meschino WS, Hodgkinson KA, Bassett AS. Evaluating genetic counseling for individuals with schizophrenia in the molecular age. Schizophr Bull 2014; 40:78-87. [PMID: 23236078 PMCID: PMC3885288 DOI: 10.1093/schbul/sbs138] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recent advances in schizophrenia genetics are shedding new light on etiopathogenesis, but issues germane to translation of findings into clinical practice are relatively understudied. We assessed the need for, and efficacy of, a contemporary genetic counseling protocol for individuals with schizophrenia. METHODS After characterizing rare copy number variation in a cohort of adults with schizophrenia, we recruited subjects from the majority of individuals who had no clinically relevant structural genetic variant. We used a pre-post study design with longitudinal follow-up to assess both the profile of need and the impact of general genetic counseling on key knowledge-based and psychological factors. RESULTS Thirty-nine (60.0%) of 65 patients approached actively expressed an interest in the study. At baseline, participants (n = 25) tended to overestimate the risk of familial recurrence of schizophrenia, express considerable concern related to this perceived risk, endorse myths about schizophrenia etiology, and blame themselves for their illness. Postcounseling, there was a significant improvement in understanding of the empiric recurrence risk (P = .0090), accompanied by a decrease in associated concern (P = .0020). There were also significant gains in subjective (P = .0007) and objective (P = .0103) knowledge, and reductions in internalized stigma (P = .0111) and self-blame (P = .0401). Satisfaction with genetic counseling, including endorsement of the need for such counseling (86.4%), was high. CONCLUSIONS These results provide initial evidence of need for, and efficacy of, genetic counseling for individuals with schizophrenia. The findings may help facilitate development of a contemporary genetic counseling process that could optimize outcomes in the nascent field of evidence-based psychiatric genetic counseling.
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Affiliation(s)
- Gregory Costain
- To whom correspondence should be addressed; 33 Russell Street, Room 1100, Toronto, Ontario, Canada M5S 2S1; tel: (416) 535-8501 x2731, fax: (416) 535-7199, e-mail:
| | - Mary Jane Esplen
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada;,Behavioural Sciences and Health Research Division, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Brenda Toner
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada;,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada;,Social Equity and Health Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Stephen W. Scherer
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada;,Department of Molecular Genetics and the McLaughlin Centre, University of Toronto, Toronto, Ontario, Canada
| | - Wendy S. Meschino
- Department of Genetics, North York General Hospital, North York, Ontario, Canada
| | - Kathleen A. Hodgkinson
- Clinical Epidemiology and Genetics, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St John’s, Newfoundland, Canada
| | - Anne S. Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada;,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada;,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada;,Department of Psychiatry and Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada,To whom correspondence should be addressed; 33 Russell Street, Room 1100, Toronto, Ontario, Canada M5S 2S1; tel: (416) 535–8501 x2731, fax: (416) 535–7199, e-mail:
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Carroll JC, Rideout A, Wilson BJ, Allanson J, Blaine S, Esplen MJ, Farrell S, Graham GE, MacKenzie J, Meschino WS, Prakash P, Shuman C, Taylor S, Tobin S. Maternal age-based prenatal screening for chromosomal disorders: attitudes of women and health care providers toward changes. Can Fam Physician 2013; 59:e39-e47. [PMID: 23341678 PMCID: PMC3555677] [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: 06/01/2023]
Abstract
OBJECTIVE To explore views of women and health care providers (HCPs) about the changing recommendations regarding maternal age-based prenatal screening. DESIGN Mixed-methods design. SETTING Ontario. PARTICIPANTS A sample of women who had given birth within the previous 2 years and who had attended a family medicine centre, midwifery practice, or baby and mother wellness program (n = 42); and a random sample of family physicians (n = 1600), and all Ontario obstetricians (n = 694) and midwives (n = 334) who provided prenatal care. METHODS We used focus groups (FGs) to explore women's views. Content analysis was used to uncover themes and delineate meaning. To explore HCPs' views, we conducted a cross-sectional self-completion survey. MAIN FINDINGS All FG participants (42 women in 6 FGs) expressed the importance of individual choice of prenatal screening modality, regardless of age. They described their perception that society considers women older than 35 to be at high obstetric risk and raised concerns that change in the maternal age-related screening policy would require education. The HCP survey response rate was 40%. Results showed 24% of HCPs agreed that women of any age should be eligible for invasive diagnostic testing regardless of prenatal screening results; 15% agreed that the age for diagnostic testing should be increased to 40 years, 14% agreed that diagnostic testing should be reserved for women with positive prenatal screening results, and 45% agreed that prenatal screening should remain unchanged. CONCLUSION Maternity care organizations have recommended that maternal age-based prenatal screening is no longer appropriate. Informed choice is of paramount importance to women and should be part of any change. Health care providers need to be engaged in and educated about any change to screening guidelines to offer women informed choices.
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Affiliation(s)
- June C Carroll
- Granovsky Gluskin Family Medicine Centre, 60 Murray St, 4th Floor, Box 25, Toronto, ON M5T 3L9.
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Abstract
OBJECTIVE To describe an approach to history, physical examination and investigation for the developmentally delayed child. METHODS A review of electronic databases from 1997 to 2001 was done searching for articles relating to the approach to or investigations of children with developmental delay. Five studies, including a review of a consensus conference on evaluation of mental retardation, were chosen because of their general approaches to developmental delay and/or mental retardation, or specific evaluations of a particular laboratory investigation. CONCLUSIONS A diagnosis or cause of mental retardation can be identified in 20% to 60% of cases. Evaluation of the developmentally delayed child should include a detailed history and physical examination, taking special care to record a three-generation pedigree, as well as to look for dysmorphic features. If no other cause is apparent, routine investigations should include a chromosome study and fragile X studies. Further investigations are warranted depending on the clinical features.
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Affiliation(s)
- Wendy S Meschino
- Department of Genetics, North York General Hospital, Toronto, Ontario.
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27
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Girirajan S, Rosenfeld JA, Coe BP, Parikh S, Friedman N, Goldstein A, Filipink RA, McConnell JS, Angle B, Meschino WS, Nezarati MM, Asamoah A, Jackson KE, Gowans GC, Martin JA, Carmany EP, Stockton DW, Schnur RE, Penney LS, Martin DM, Raskin S, Leppig K, Thiese H, Smith R, Aberg E, Niyazov DM, Escobar LF, El-Khechen D, Johnson KD, Lebel RR, Siefkas K, Ball S, Shur N, McGuire M, Brasington CK, Spence JE, Martin LS, Clericuzio C, Ballif BC, Shaffer LG, Eichler EE. Phenotypic heterogeneity of genomic disorders and rare copy-number variants. N Engl J Med 2012; 367:1321-31. [PMID: 22970919 PMCID: PMC3494411 DOI: 10.1056/nejmoa1200395] [Citation(s) in RCA: 412] [Impact Index Per Article: 34.3] [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: 12/30/2022]
Abstract
BACKGROUND Some copy-number variants are associated with genomic disorders with extreme phenotypic heterogeneity. The cause of this variation is unknown, which presents challenges in genetic diagnosis, counseling, and management. METHODS We analyzed the genomes of 2312 children known to carry a copy-number variant associated with intellectual disability and congenital abnormalities, using array comparative genomic hybridization. RESULTS Among the affected children, 10.1% carried a second large copy-number variant in addition to the primary genetic lesion. We identified seven genomic disorders, each defined by a specific copy-number variant, in which the affected children were more likely to carry multiple copy-number variants than were controls. We found that syndromic disorders could be distinguished from those with extreme phenotypic heterogeneity on the basis of the total number of copy-number variants and whether the variants are inherited or de novo. Children who carried two large copy-number variants of unknown clinical significance were eight times as likely to have developmental delay as were controls (odds ratio, 8.16; 95% confidence interval, 5.33 to 13.07; P=2.11×10(-38)). Among affected children, inherited copy-number variants tended to co-occur with a second-site large copy-number variant (Spearman correlation coefficient, 0.66; P<0.001). Boys were more likely than girls to have disorders of phenotypic heterogeneity (P<0.001), and mothers were more likely than fathers to transmit second-site copy-number variants to their offspring (P=0.02). CONCLUSIONS Multiple, large copy-number variants, including those of unknown pathogenic significance, compound to result in a severe clinical presentation, and secondary copy-number variants are preferentially transmitted from maternal carriers. (Funded by the Simons Foundation Autism Research Initiative and the National Institutes of Health.).
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Affiliation(s)
- Santhosh Girirajan
- Department of Genome Sciences, University of Washington, Seattle, Washington 98195, USA
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Carroll JC, Wilson BJ, Allanson J, Grimshaw J, Blaine SM, Meschino WS, Permaul JA, Graham ID. GenetiKit: a randomized controlled trial to enhance delivery of genetics services by family physicians. Fam Pract 2011; 28:615-23. [PMID: 21746696 DOI: 10.1093/fampra/cmr040] [Citation(s) in RCA: 31] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients look to their family physicians (FPs) for credible information and guidance in making informed choices about genetic testing. FPs are challenged by lack of knowledge and the rapid pace of genetic discovery. There is an urgent need for effective interventions to facilitate integration of genetics into family medicine. OBJECTIVE To determine if a multi-faceted knowledge translation intervention would improve skills, including referral decisions, confidence in core genetics competencies and knowledge. METHODS Randomized controlled trial involving FPs in four communities in Ontario, Canada (two urban and two rural). The intervention consisted of an interactive educational workshop, portfolio of practical clinical genetics tools and knowledge service called Gene Messenger. Outcome measures included appropriate genetics referral decisions in response to 10 breast cancer scenarios, decisional difficulty, self-reported confidence in 11 genetics core competencies, 3 knowledge questions and evaluation of intervention components 6 months afterwards. RESULTS Among the one hundred and twenty-five FPs randomized, 80 (64%) completed the study (33 control, 47 intervention). Intervention FPs had significantly higher appropriate referral decision scores [6.4/10 [95% confidence interval (CI) 5.8-6.9] control, 7.8/10 (95% CI 7.4-8.2) intervention] and overall self-reported confidence on core genetics competencies [37.9/55 (95% CI 35.1-40.7) control, 47.0/55 (95% CI 44.9-49.2) intervention]. Over 90% of FPs wanted to continue receiving Gene Messengers and would recommend them to colleagues. No significant differences were found in decisional difficulty or knowledge. CONCLUSIONS This study demonstrated that a complex educational intervention was able to significantly improve practice intent for clinical genetics scenarios found in primary care, as well as confidence in genetics skills.
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Affiliation(s)
- June C Carroll
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Toronto, Canada.
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Milunsky JM, Maher TM, Zhao G, Wang Z, Mulliken JB, Chitayat D, Clemens M, Stalker HJ, Bauer M, Burch M, Chénier S, Cunningham ML, Drack AV, Janssens S, Karlea A, Klatt R, Kini U, Klein O, Lachmeijer AM, Megarbane A, Mendelsohn NJ, Meschino WS, Mortier GR, Parkash S, Ray CR, Roberts A, Roberts A, Reardon W, Schnur RE, Smith R, Splitt M, Tezcan K, Whiteford ML, Wong DA, Zori R, Lin AE. Genotype-phenotype analysis of the branchio-oculo-facial syndrome. Am J Med Genet A 2010; 155A:22-32. [DOI: 10.1002/ajmg.a.33783] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Cremin C, Carroll JC, Allanson J, Blaine SM, Dorman H, Gibbons CA, Honeywell C, Meschino WS, Permaul J, Wilson BJ. Genetics: factor V Leiden. Can Fam Physician 2010; 56:353. [PMID: 20393096 PMCID: PMC2860828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Chang KTE, Taylor GP, Meschino WS, Kantor PF, Cutz E. Mitogenic cardiomyopathy: a lethal neonatal familial dilated cardiomyopathy characterized by myocyte hyperplasia and proliferation. Hum Pathol 2010; 41:1002-8. [PMID: 20303141 DOI: 10.1016/j.humpath.2009.12.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Revised: 12/13/2009] [Accepted: 12/18/2009] [Indexed: 11/15/2022]
Abstract
Pediatric cardiomyopathies are a heterogenous group of conditions of which dilated cardiomyopathies are the most common clinicomorphologic subtype. However, the etiology and pathogenesis of many cases of dilated cardiomyopathies remain unknown. We describe a series of 5 cases of a rare but clinically and histologically distinctive dilated cardiomyopathy that was uniformly lethal in early infancy. The 5 cases include 2 pairs of siblings. There was parental consanguinity in 1 of the 2 pairs of siblings. Death occurred in early infancy (range, 22-67 days; mean, 42 days) after a short history of general lethargy, decreased feeding, respiratory distress, or cyanosis. There was no specific birth or early neonatal problems. Autopsy revealed congestive cardiac failure and enlarged, dilated hearts with ventricular dilatation more pronounced than atrial dilatation, and endocardial fibroelastosis. Histology showed prominent hypertrophic nuclear changes of cardiac myofibers and markedly increased myocyte mitotic activity including occasional atypical mitoses. Immunohistochemical staining for Mib1 showed a markedly increased proliferative index of 10% to 20%. Ancillary investigations, including molecular studies, did not reveal a primary cause for the cardiomyopathies. This distinctive dilated cardiomyopathy characterized by unusual histologic features of myocyte nuclear hypertrophy and marked mitotic activity is lethal in early infancy. Its occurrence in 2 pairs of siblings suggests familial inheritance. Although the underlying molecular pathogenesis remains to be elucidated, it is important to recognize this distinctive entity for purposes of genetic counseling.
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Affiliation(s)
- Kenneth T E Chang
- Division of Pathology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
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Gibbons CA, Allanson J, Blaine SM, Cremin C, Dorman H, Honeywell C, Meschino WS, Permaul J, Carroll JC. Genetics: Preimplantation genetic diagnosis. Can Fam Physician 2010; 56:247. [PMID: 20228309 PMCID: PMC2837689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Cremin C, Blaine SM, Allanson J, Dorman H, Gibbons CA, Honeywell C, Meschino WS, Permaul J, Carroll JC. Genetics: familial melanoma. Can Fam Physician 2010; 56:31. [PMID: 20090079 PMCID: PMC2809172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Rideout AL, Carroll JC, Blaine SM, Cremin C, Dorman H, Gibbons CA, Honeywell C, Meschino WS, Permaul J, Allanson J. Genetics: schizophrenia. Can Fam Physician 2009; 55:1207. [PMID: 20008600 PMCID: PMC2793225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Honeywell C, Meschino WS, Allanson J, Blaine SM, Cremin C, Dorman H, Gibbons CA, Permaul J, Carroll JC. Genetics: Hypertrophic cardiomyopathy. Can Fam Physician 2009; 55:1095. [PMID: 19910596 PMCID: PMC2776798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Meschino WS, Gibbons CA, Allanson J, Blaine SM, Cremin C, Dorman H, Honeywell C, Permaul J, Wilson BJ, Carroll JC. Genetics: Newborn screening for sickle cell anemia. Can Fam Physician 2009; 55:1001. [PMID: 19826159 PMCID: PMC2762301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Dorman H, Meschino WS, Allanson J, Blaine SM, Cremin C, Gibbons CA, Honeywell C, Permaul J, Carroll JC. Genetics: type 2 diabetes. Can Fam Physician 2009; 55:893. [PMID: 19752257 PMCID: PMC2743584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Meschino WS, Farrell SA, Allanson J. Dr. Anne M. Summers MD, FRCPC, FCCMG: October 16, 1954-March 14, 2009. Clin Genet 2009. [DOI: 10.1111/j.1399-0004.2009.01268.x] [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: 11/29/2022]
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Blaine SM, Honeywell C, Allanson J, Cremin C, Dorman H, Gibbons CA, Meschino WS, Permaul J, Carroll JC. Genetics: prostate cancer. Can Fam Physician 2009; 55:710. [PMID: 19602656 PMCID: PMC2718597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Dorman H, Meschino WS, Allanson J, Blaine SM, Cremin C, Gibbons CA, Honeywell C, Permaul J, Carroll JC. Genetics: Alzheimer disease. Can Fam Physician 2009; 55:603. [PMID: 19509202 PMCID: PMC2694081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Aviezer H, Bentin S, Hassin RR, Meschino WS, Kennedy J, Grewal S, Esmail S, Cohen S, Moscovitch M. Not on the face alone: perception of contextualized face expressions in Huntington's disease. Brain 2009; 132:1633-44. [PMID: 19451178 DOI: 10.1093/brain/awp067] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Numerous studies have demonstrated that Huntington's disease mutation-carriers have deficient explicit recognition of isolated facial expressions. There are no studies, however, which have investigated the recognition of facial expressions embedded within an emotional body and scene context. Real life facial expressions are typically embedded in contexts which may dramatically change the emotion recognized in the face. Moreover, a recent study showed that the magnitude of the contextual bias is modulated by the similarity between the actual expression of the presented face and the facial expression that would typically fit the context, e.g. disgust faces are more similar to anger than to sadness faces and, consequently, are more strongly influenced by contexts expressing anger than by contexts expressing sadness. Since context effects on facial expression perception are not explicitly controlled, their pattern serves as an implicit measure of the processing of facial expressions. In this study we took advantage of the face-in-context design to compare explicit recognition of face-expressions by Huntington's disease mutation-carriers, with evidence for processing the expressions deriving from implicit measures. In an initial experiment we presented a group of 21 Huntington's disease mutation-carriers with standard tests of face-expression recognition. Relative to controls, they displayed deficits in recognizing disgust and anger faces despite intact recognition of these emotions from non-facial images. In a subsequent experiment, we embedded the disgust faces on images of people conveying sadness and anger as expressed by body language and additional paraphernalia. In addition, sadness and anger faces were embedded on context images conveying disgust. In both cases participants were instructed to categorize the facial expressions, ignoring the context. Despite the deficient explicit recognition of isolated disgust and anger faces, the perception of the emotions expressed by the faces was affected by context in Huntington's disease mutation-carriers in a similar manner as in control participants. Specifically, they displayed the same sensitivity to face-context pairings. These findings suggest that, despite their impaired explicit recognition of facial expressions, Huntington's disease mutation-carriers display relatively preserved processing of the same facial configurations when embedded in context. The results also show intact utilization of the information elicited by contextual cues about faces expressing disgust even when the actually presented face expresses a different emotion. Overall, our findings shed light on the nature of the deficit in facial expression recognition in Huntington's disease mutation-carriers as well as underscore the importance of context in emotion perception.
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Affiliation(s)
- Hillel Aviezer
- Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel.
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Carroll JC, Gibbons CA, Blaine SM, Cremin C, Dorman H, Honeywell C, Meschino WS, Permaul J, Allanson J. Genetics: newborn screening for MCAD deficiency. Can Fam Physician 2009; 55:487. [PMID: 19439701 PMCID: PMC2682303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Gibbons CA, Blaine SM, Allanson J, Cremin C, Dorman H, Honeywell C, Meschino WS, Permaul J, Carroll JC. Genetics: Codeine metabolism. Can Fam Physician 2009; 55:164. [PMID: 19221076 PMCID: PMC2642483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Allanson J, Honeywell C, Blaine SM, Cremin C, Dorman H, Gibbons CA, Grimshaw J, Meschino WS, Permaul J, Wilson BJ, Carroll JC. Genetics: hereditary hemochromatosis. Can Fam Physician 2009; 55:53. [PMID: 19155369 PMCID: PMC2628833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Carroll JC, Cremin C, Allanson J, Blaine SM, Dorman H, Gibbons CA, Grimshaw J, Honeywell C, Meschino WS, Permaul J, Wilson BJ. Hereditary breast and ovarian cancers. Can Fam Physician 2008; 54:1691-1692. [PMID: 19074707 PMCID: PMC2602616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- June C Carroll
- Family Medicine, Mount Sinai Hospital, Toronto, ON, Canada
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Horsman D, Wilson BJ, Avard D, Meschino WS, Kim Sing C, Plante M, Eisen A, Howley HE, Simard J. Clinical management recommendations for surveillance and risk-reduction strategies for hereditary breast and ovarian cancer among individuals carrying a deleterious BRCA1 or BRCA2 mutation. J Obstet Gynaecol Can 2007; 29:45-60. [PMID: 17346477 DOI: 10.1016/s1701-2163(16)32349-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In Canada, there are wide variations in services for patients at risk for hereditary breast and ovarian cancer (HBOC), and clinical interventions and recommendations differ between regions and/or provinces. National strategies for the clinical management of HBOC exist in the United Kingdom, France, and Australia, and clinical programs in Canada would benefit from similar national recommendations and a consistent approach to clinical management. The National Hereditary Cancer Task Force developed recommendations to address the clinical management of patients at high risk of HBOC and related cancers. These recommendations are based on current practice in high-risk cancer clinics that provide care for individuals with known BRCA1 or BRCA2 mutations. METHODS Canadian consensus recommendations were generated by the National Hereditary Cancer Task Force and compared mainly with two recently published guidance documents on the clinical management of women with increased risk of HBOC, one from the United Kingdom and the other from France. After review of these documents and the associated supporting scientific evidence, the Canadian consensus recommendations were modified and rated using predefined criteria. CONCLUSIONS These recommendations pertain to (1) surveillance options including breast self-examination, clinical breast examination, breast surveillance by imaging, ovarian cancer surveillance, and surveillance for men; (2) risk-reduction strategies including prophylactic mastectomy, prophylactic salpingo-oophorectomy, and pharmacoprevention; and (3) the use of exogenous hormones. Regular updates should occur as new evidence becomes available.
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Affiliation(s)
- Doug Horsman
- British Columbia Cancer Agency, Vancouver, BC, Canada
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Kotsopoulos J, Lubinski J, Lynch HT, Klijn J, Ghadirian P, Neuhausen SL, Kim-Sing C, Foulkes WD, Moller P, Isaacs C, Domchek S, Randall S, Offit K, Tung N, Ainsworth P, Gershoni-Baruch R, Eisen A, Daly M, Karlan B, Saal HM, Couch F, Pasini B, Wagner T, Friedman E, Rennert G, Eng C, Weitzel J, Sun P, Narod SA, Garber J, Osborne M, Fishman D, McLennan J, McKinnon W, Merajver S, Olsson H, Provencher D, Pasche B, Evans G, Meschino WS, Lemire E, Chudley A, Rayson D, Bellati C. Age at first birth and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. Breast Cancer Res Treat 2007; 105:221-8. [PMID: 17245541 DOI: 10.1007/s10549-006-9441-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Accepted: 10/24/2006] [Indexed: 10/23/2022]
Abstract
An early age at first full-term birth is associated with a reduction in the subsequent development of breast cancer among women in the general population. A similar effect has not yet been reported among women who carry an inherited BRCA1 or BRCA2 mutation. We conducted a matched case-control study on 1816 pairs of women with a BRCA1 (n = 1405) or BRCA2 (n = 411) mutation in an attempt to elucidate the relationship between age at first full-term pregnancy and the risk of developing breast cancer. Information about the age at first childbirth and other pregnancy-related variables was derived from a questionnaire administered to women during the course of genetic counselling. There was no difference in the mean age at first full-term birth in the cases and controls (24.9 years vs. 24.8 years; P = 0.81, respectively). Compared to women whose first child was born at or before 18 years of age, a later age at first full-term birth did not influence the risk of developing breast cancer (OR = 1.00 per year; 95% CI 0.98-1.03; P-trend = 0.67). Stratification by mutation status did not affect the results. These findings suggest that an early first full-term birth does not confer protection against breast cancer in BRCA mutation carriers. Nonetheless, BRCA mutation carriers opting for a prophylactic oophorectomy as a breast and/or ovarian cancer risk-reducing strategy should complete childbearing prior to age 40 when this prevention modality is most effective.
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Affiliation(s)
- Joanne Kotsopoulos
- Centre for Research in Women's Health, Women's College Hospital, University of Toronto, Room 750, 790 Bay Street, 7th Floor, Toronto, ON M5G 1N8, Canada
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Meschino WS. Genetics and life insurance: Medical underwriting and social policy. Edited by Mark A. Rothstein. The MIT Press, 2004, 293p. Am J Med Genet A 2006. [DOI: 10.1002/ajmg.a.31137] [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: 11/12/2022]
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Warner E, Plewes DB, Hill KA, Causer PA, Zubovits JT, Jong RA, Cutrara MR, DeBoer G, Yaffe MJ, Messner SJ, Meschino WS, Piron CA, Narod SA. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA 2004; 292:1317-25. [PMID: 15367553 DOI: 10.1001/jama.292.11.1317] [Citation(s) in RCA: 807] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Current recommendations for women who have a BRCA1 or BRCA2 mutation are to undergo breast surveillance from age 25 years onward with mammography annually and clinical breast examination (CBE) every 6 months; however, many tumors are detected at a relatively advanced stage. Magnetic resonance imaging (MRI) and ultrasound may improve the ability to detect breast cancer at an early stage. OBJECTIVE To compare the sensitivity and specificity of 4 methods of breast cancer surveillance (mammography, ultrasound, MRI, and CBE) in women with hereditary susceptibility to breast cancer due to a BRCA1 or BRCA2 mutation. DESIGN, SETTING, AND PARTICIPANTS A surveillance study of 236 Canadian women aged 25 to 65 years with BRCA1 or BRCA2 mutations who underwent 1 to 3 annual screening examinations, consisting of MRI, mammography, and ultrasound at a single tertiary care teaching hospital between November 3, 1997, and March 31, 2003. On the day of imaging and at 6-month intervals, CBE was performed. MAIN OUTCOME MEASURES Sensitivity and specificity of each of the 4 surveillance modalities, and sensitivity of all 4 screening modalities vs mammography and CBE. RESULTS Each imaging modality was read independently by a radiologist and scored on a 5-point Breast Imaging Reporting and Data System scale. All lesions with a score of 4 or 5 (suspicious or highly suspicious for malignancy) were biopsied. There were 22 cancers detected (16 invasive and 6 ductal carcinoma in situ). Of these, 17 (77%) were detected by MRI vs 8 (36%) by mammography, 7 (33%) by ultrasound, and 2 (9.1%) by CBE. The sensitivity and specificity (based on biopsy rates) were 77% and 95.4% for MRI, 36% and 99.8% for mammography, 33% and 96% for ultrasound, and 9.1% and 99.3% for CBE, respectively. There was 1 interval cancer. All 4 screening modalities combined had a sensitivity of 95% vs 45% for mammography and CBE combined. CONCLUSIONS In BRCA1 and BRCA2 mutation carriers, MRI is more sensitive for detecting breast cancers than mammography, ultrasound, or CBE alone. Whether surveillance regimens that include MRI will reduce mortality from breast cancer in high-risk women requires further investigation.
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Affiliation(s)
- Ellen Warner
- Division of Medical Oncology, Department of Medicine, Sunnybrook and Women's College Health Sciences Centre and University of Toronto, Ontario, Canada.
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