Honoramos A Todas Nuestras Madres Con El Don Del Conocimiento: A Conference To Learn the Needs of Latina Patients and Families Seen for Breast Cancer Risk Assessment

Background: Long-term follow-up surveys of Spanish-speaking Latina patients at increased risk for hereditary breast cancer who completed genetic cancer risk assessment (GCRA) in our underserved clinics revealed a need for ongoing education and support. Consequently, we invited patients back for a half-day educational conference, employing mixed methods research to better understand their medical and social/cultural issues and needs.Aims: The conference aims were to: 1) share medical advances in GCRA and cancer screening and prevention recommendations and resources and 2) explore GCRA-related experiences and needs, and access to risk-appropriate care.Methods: Invitees were Latina patients with personal and/or family history of breast cancer who completed GCRA between 2001-2009 and their family members. The conference, conducted entirely in Spanish, was held at the regional county medical facility where our underserved clinic is conducted. Educational information was delivered by podium-presentations, expert and patient panel discussions and interactive sessions and community resource booth exhibits. Mixed methods research (surveys and Audio Response System [ARS] mediated interaction and discussion) was used to explore GRCA experiences and access to care.Results: The 71 primarily Spanish speaking (96%) participants ranged in age from 18 to 71 years (mean age, 44), were female (93%), had children (78%), and had at least completed high school (71%). Of the 41 patient-participant, 78% were accompanied by at least one family member and/or friend. Thirty (73%) had a personal history of breast cancer; 4 also had ovarian cancer. Of the 35 tested, 20 (57%) were BRCA positive. Nearly all participants (96%) completed the voluntary survey and post-conference evaluation. On average, 87% responded to eight ARS questions related to the GCRA process and access to care. The majority of patient-participant (71%) understood why they were referred for GCRA, 15% did not, and 13% were uncertain. Eighty percent understood their cancer risk; however 20% expressed a need for more risk information. Although 83% understood cancer screening recommendations, 17% were unsure and requested more information. Interestingly, only 5% reported lack of access to care. More than 75% found the GCRA process stressful and desired more support and preparedness for sharing information with relatives. All responders (96%) reported that the conference met their expectations, valued the resources provided, and suggested allocating more time for questions in a future conference.Conclusion: The interactive conference format was highly rated and effective in providing Latina breast cancer patients and family members with ongoing education and support following GCRA, and provided important information to guide improvement in the risk assessment process.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3073.

Magnetic Resonance Imaging quantification of breast density in BRCA carriers following gonadotropin releasing hormone agonist (GnRHA)-based hormonal chemoprevention

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Background: Breast tissue density limits the usefulness of mammography as a surveillance tool in young women. Breast Magnetic Resonance Imaging (MRI) provides high tissue contrast and three-dimensional structural information not impaired by high breast density. We developed a volumetric “MR density” measure of breast structural composition that may be complementary to mammographic breast density. We tested this MR density measure in unaffected women with known high risk of breast cancer due to a BRCA gene mutation (or empiric risk > 30% lifetime), who were recruited in a phase II trial to study the effects of a hormonal chemoprevention regimen. Methods: Nine premenopausal high-risk women age 21 to 48 were treated with intranasal GnRHA (deslorelin), low-dose estradiol, and testosterone daily for 10 months. All patients underwent one contrast-enhanced breast MRI exam before and after treatment. We measured MR density as the ratio of fibroglandular tissue volume to total volume of the breast, at both time points. Our technique involved the semi-automated delineation of the breast and the automated segmentation of fibroglandular from adipose tissue. An “MR index” was also defined to quantify partial voluming effects due to the presence of adipose/fibroglandular edges in the MR data. Results: Eight out of nine patients showed a reduction in MR density (p = 0.026) with treatment. Three patients had less than 5% MR density at baseline, making it difficult to quantitate a change with treatment. All of the remaining six patients had reduced MR density after treatment (mean reduction 35.5%; p = 0.035). Conclusions: We have demonstrated the use of breast MR density as a robust volumetric quantitative measure of breast tissue composition. Our findings suggest that MR could be used to measure hormonal chemoprevention effects in BRCA carriers.

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Characterization of a novel founder rearrangement mutation of BRCA1 in high-risk Hispanic families

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Background: Large rearrangements are estimated to account for 5–10% of all mutations in BRCA1 and BRCA2. Prevalent founder rearrangement mutations have been described in European populations. We sought to identify rearrangements in the BRCA genes in a cohort of Hispanic patients. Methods: We identified 34 deleterious BRCA mutations via full sequence analysis among 110 unrelated high-risk Hispanic families enrolled in an IRB approved registry who underwent cancer risk assessment (CEBP 2005;14:1–6). DNA from 67 of 76 patients without an identifiable mutation was subjected to multiplexed quantitative differential PCR (MQDP, per B. Erickson and T. Scholl, Myriad Genetics Laboratory) for detection of large rearrangements. An apparent deletion of BRCA1 exons 9–12, indicated by a 50% loss of signal was identified by MQDP in 3 unrelated families (ASHG, 2005). Long range PCR resulted in the generation of a 2.7kb product in these samples, consistent with a deletion event of 15.1kb. This putative mutation was further characterized by cloning and sequencing the breakpoint in all 3 families. RNA splicing was evaluated by sequencing RT-PCR products from lymphoblastoid cell line RNA for each family. Results: Sequence analysis identified the breakpoint within Alu elements in introns 8 and 12, and all 3 unrelated families shared the same breakpoint. Analysis of cDNA demonstrated direct splicing of exons 8–13 predicting a frameshift mutation and premature truncation of the BRCA1 protein, thus confirming the deleterious nature of this mutation. Conclusion: We identified the same novel large deletion in three unrelated families of Mexican ancestry, suggesting potential founder effect. The frequency was 2.7% of the 110 high-risk Hispanic families screened for BRCA mutations, bringing the overall prevalence of deleterious mutations to 33.6%(37/110) in this cohort. This BRCA1 rearrangement may account for a substantial proportion of high-risk Hispanic families, and should be included in all subsequent studies of this ethnic group.

No significant financial relationships to disclose.