BRCA awareness and testing experience in the UK Jewish population: a qualitative study

BACKGROUND

1 in 40 UK Jewish individuals carry a pathogenic variant in BRCA1/BRCA2. Traditional testing criteria miss half of carriers, and so population genetic testing is being piloted for Jewish people in England. There has been no qualitative research into the factors influencing BRCA awareness and testing experience in this group. This study aimed to explore these and inform improvements for the implementation of population genetic testing.

METHODS

Qualitative study of UK Jewish adults who have undergone BRCA testing. We conducted one-to-one semistructured interviews via telephone or video call using a predefined topic guide, until sufficient information power was reached. Interviews were audio-recorded, transcribed verbatim and interpreted using applied thematic analysis.

RESULTS

32 individuals were interviewed (28 carriers, 4 non-carriers). We interpreted five themes intersecting across six time points of the testing pathway: (1) individual differences regarding personal/family history of cancer, demographics and personal attitudes/approach; (2) healthcare professionals' support; (3) pathway access and integration; (4) nature of family/partner relationships; and (5) Jewish community factors. Testing was largely triggered by connecting information to a personal/family history of cancer. No participants reported decision regret, although there was huge variation in satisfaction. Suggestions were given around increasing UK Jewish community awareness, making information and support services personally relevant and proactive case management of carriers.

CONCLUSIONS

There is a need to improve UK Jewish community BRCA awareness and to highlight personal relevance of testing for individuals without a personal/family history of cancer. Traditional testing criteria caused multiple issues regarding test access and experience. Carriers want information and support services tailored to their individual circumstances.

Does oseltamivir prevent hospitalisation in people with influenza?

Overview of: Hanula R, Bortolussi-Courval É, Mendel A, et al. Evaluation of oseltamivir used to prevent hospitalization in outpatients with influenza: a systematic review and meta-analysis. JAMA Internal Medicine 2024;184:18-27.

Use of oral penicillin challenge in low-risk penicillin allergy

Overview of: Copaescu AM, Vogrin S, James F, et al. Efficacy of a clinical decision rule to enable direct oral challenge in patients with low-risk penicillin allergy: The PALACE randomized clinical trial. JAMA Intern Med 2023;183:944-52.

Safety update: valproate safety and educational materials

Overview of: Medicines and Healthcare products Regulatory Agency. Valproate (Belvo, Convulex, Depakote, Dyzantil, Epilim, Epilim Chrono or Chronosphere, Episenta, Epival and Syonell▼): new safety and educational materials to support regulatory measures in men and women under 55 years of age. Drug Safety Update 2024;17:1.

Effect of topical testosterone on pre-diabetes and diabetes

Overview of: Bhasin S, Lincoff AM, Nissen SE, et al. Effect of testosterone on progression from prediabetes to diabetes in men with hypogonadism: a substudy of the TRAVERSE randomized clinical trial. JAMA Intern Med. 2024. doi: 10.1001/jamainternmed.2023.7862. [Epub ahead of print 5 February 2024].

Recent updates from the BNF (BNF 87)

The BNF is jointly published by the Royal Pharmaceutical Society and BMJ. BNF is published in print twice a year and interim updates are issued and published monthly in the digital versions. The following summary provides a brief description of some recent key changes that have been made to BNF content.

Distribution of case volumes in surgery: an analysis of the British Spine Registry

Objectives

To characterize the distribution of case volumes within a surgical field.

Design

An analysis of British Spine Registry.

Setting

295 centers in England that conducted at least one spinal operation either within the NHS or private settings between 1 May 2016 and 27 February 2021.

Participants

644 surgeons.

Main outcome measures

Mathematical descriptions of distributions of cases among surgeons and the extent of workforce-level case-volume concentration as a surrogate marker.

Results

There were wide variations in monthly caseloads between surgeons, ranging from 0 to average monthly high of 81.8 cases. The curves showed that 37.7% of surgeons were required to perform 80% of all spinal operations, which is substantially less than in fields outside of healthcare.With the COVID-19 pandemic, the case volumes of surgeons with the highest volumes dropped dramatically, whereas those with the lowest case numbers remained nearly unchanged. This, along with the relatively low level of case-volume concentration within spinal surgery, may indicate an inevitability of at least some level of surgical care being provided by the relatively lower volume surgeons.

Conclusions

While there is a reasonable degree of workforce-level case volume concentration within spinal surgery, with high volume spinal surgeons providing a large proportion of care, it is not clear whether a further concentration of case volumes into those few hands is possible or desirable.

Do COX-inhibitors improve emergency contraception efficacy?

Overview of: Li RHW, Lo SST, Gemzell-Danielsson K, et al. Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial [correction appears in Lancet 2023;402:850]. Lancet 2023;402:851-8.

Tramadol-warfarin interaction

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Effect of semaglutide on major cardiovascular events

Overview of: Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med 2023;389:2221-32.

Safety update: omega-3-acid ethyl esters and atrial fibrillation

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Low-dose aspirin and anaemia in older people

Overview of: McQuilten ZK, Thao LTP, Pasricha SR, et al. Effect of low-dose aspirin versus placebo on incidence of anemia in the elderly: a secondary analysis of the aspirin in reducing events in the elderly trial. Ann Intern Med. 2023;176:913-21.

MHRA issues two updates on fluoroquinolone safety

Overview of: Medicines and Healthcare products Regulatory Agency. Fluoroquinolone antibiotics: reminder of the risk of disabling and potentially long-lasting or irreversible side effects. Drug Safety Update 2023;17:1. Medicines and Healthcare products Regulatory Agency. Fluoroquinolone antibiotics: suicidal thoughts and behaviour. Drug Safety Update 2023;17:2.

Risk of recurrence after first unprovoked seizure

Overview of: Neligan A, Adan G, Nevitt SJ, et al. Prognosis of adults and children following a first unprovoked seizure. Cochrane Database Syst Rev. 2023:10.1002/14651858.CD013847.pub2.

Can antidepressants worsen COPD?

Overview of: Siraj RA, Bolton CE, McKeever TM. Association between antidepressants with pneumonia and exacerbation in patients with COPD: a self-controlled case series (SCCS). Thorax. 2023. doi:10.1136/thorax-2022-219736 [Epub ahead of print 19 June 2023].

Changes in primary endpoints in cancer trials

Overview of: Florez MA, Jaoude JA, Patel RR, et al. Incidence of primary end point changes among active cancer phase 3 randomized clinical trials.JAMA Netw Open2023;6:e2313819.

Hydrocortisone for severe community acquired pneumonia in ICU

Overview of:Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in severe community-acquired pneumonia. N Engl J Med 2023;388:1931-41.

Safety update: statins and myasthenia gravis

Overview of: Medicines and Healthcare products Regulatory Agency. Statins: very infrequent reports of myasthenia gravis.Drug Safety Update 2023;17(2):1.

Bempedoic acid and cardiovascular outcomes

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Safety update: methotrexate and photosensitivity reactions

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Missing information in US accelerated approval drug labels

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No benefit of vitamin D on cognition in older adults

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Coroners' reports, medicines and preventable deaths

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Recent updates from the BNF (BNF 86)

The BNF is jointly published by the Royal Pharmaceutical Society and BMJ. BNF is published in print twice a year and interim updates are issued and published monthly in the digital versions. The following summary provides a brief description of some of the key changes that have been made to BNF content.

FDA-approved drugs not meeting primary endpoints

Overview of: Johnston JL, Ross JS, Ramachandran R. US Food and Drug Administration approval of drugs not meeting pivotal trial primary end points, 2018-2021. JAMA Intern Med 2023;183:376-80.

Is alternate day dosing of oral iron an effective option for iron-deficiency anaemia?

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Hydroxychloroquine and retinopathy risk

Overview of: Melles RB, Jorge AM, Marmor MF, et al. Hydroxychloroquine dose and risk for incident retinopathy: a cohort study. Ann Intern Med 2023;176:166-73.

Antibiotic-associated Stevens-Johnson syndrome

Overview of: Lee EY, Knox C, Phillips EJ. Worldwide prevalence of antibiotic-associated Stevens-Johnson syndrome and toxic epidermal necrolysis: a systematic review and meta-analysis. JAMA Dermatol 2023;159:384-392.

Safety update: NSAIDs in pregnancy

Overview of: Medicines and Healthcare products Regulatory Agency. Non-steroidal anti-inflammatory drugs (NSAIDs): potential risks following prolonged use after 20 weeks of pregnancy. Drug Safety Update 2023;16:2.

Spironolactone for acne in women

Overview of: Santer M, Lawrence M, Renz S, et al. Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial. BMJ. 2023;381:e074349.

Safety update: hyoscine hydrobromide patches and serious anticholinergic adverse effects

Overview of: Medicines and Healthcare products Regulatory Agency. Hyoscine hydrobromide patches (Scopoderm 1.5mg Patch or Scopoderm TTS Patch): risk of anticholinergic side effects, including hyperthermia. Drug Safety Update 2023;16:1.

The 2020 US cancer screening deficit and the timing of adults' most recent screen: a population-based cross-sectional study

OBJECTIVE

In 2020, cancer screenings declined, resulting in a cancer screening deficit. The significance of this deficit, however, has yet to be quantified from a population health perspective. Our study addresses this evidence gap by examining how the pandemic changed the timing of American adults' most recent cancer screen.

METHODOLOGY

We obtained population-based, cancer screening data from the Behavioural Risk Factor Surveillance System (BRFSS) (2010, 2012, 2014, 2016, 2018, 2020). Mammograms, pap smears and colonoscopies were each specified as a variable of mutually exclusive categories to indicate the timing since the most recent screening (never, 0-1 years, 1-2 years, 3+ years). Our cross-sectional, quasi-experimental design restricts the sample to adults surveyed in January, February or March. We then leverage a quirk in the BRFSS implementation and consider adults surveyed in the second year of the 2020 survey wave as exposed to the COVID-19 pandemic. Respondents surveyed in January 2020-March 2020 were considered unexposed. To estimate the impact of exposure to the COVID-19 pandemic on the timing of recent cancer screenings, we constructed linear and logistic regression models which control for sociodemographic characteristics associated with screening patterns, and state fixed effects and temporal trend fixed effects to control for confounding.

RESULTS

In 2020, the cancer screening deficit was largely due to a 1 year delay among adults who receive annual screening, as the proportion of adults reporting a cancer screen in the past year declined by a nearly identical proportion of adults reporting their most recent cancer screen 1-2 years ago (3%-4% points). However, the relative change was higher for mammograms and pap smears (17%) than colonoscopies (4%). We also found some evidence that the proportion of women reporting never having completed a mammogram declined in 2020, but the mechanisms for this finding should be further explored with the release of future data.

CONCLUSION

Our estimates for the pandemic's effect on cancer screening rates are smaller than prior studies. Because we account for temporal trends, we believe prior studies overestimated the effect of the pandemic and underestimated the overall downward trend in cancer screenings across the country leading up to 2020.