1
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Brock P, Liynarachchi S, Nieminen TT, Chan C, Kohlmann W, Stout LA, Yao S, La Greca A, Jensen KE, Kolesar JM, Salhia B, Gulhati P, Hicks JK, Ringel MD. CHEK2 Founder Variants and Thyroid Cancer Risk. Thyroid 2024; 34:477-483. [PMID: 38279823 PMCID: PMC10998703 DOI: 10.1089/thy.2023.0529] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Background: Germline pathogenic variants in CHEK2 are associated with a moderate increase in the lifetime risk for breast cancer. Increased risk for other cancers, including non-medullary thyroid cancer (NMTC), has also been suggested. To date, data implicating CHEK2 variants in NMTC predisposition primarily derive from studies within Poland, driven by a splice site variant (c.444 + 1G>A) that is uncommon in other populations. In contrast, the predominant CHEK2 variants in non-Polish populations are c.1100del and c.470T>C/p.I157T, representing 61.1% and 63.8%, respectively, of all CHEK2 pathogenic variants in two large U.S.-based commercial laboratory datasets. To further delineate the impact of common CHEK2 variants on thyroid cancer, we aimed to investigate the association of three CHEK2 founder variants (c.444 + 1G>A, c.1100del, and c.470T>C/p.Ile157Thr) on NMTC susceptibility in three groups of unselected NMTC patients. Methods: The presence of three CHEK2 founder variants was assessed within three groups: (1) 1544 NMTC patients (and 1593 controls) from previously published genome-wide association study (GWAS) analyses, (2) 789 NMTC patients with germline exome sequencing (Oncology Research Information Exchange Network [ORIEN] Avatar), and (3) 499 NMTC patients with germline sequence data available in The Cancer Genome Atlas (TCGA). A case-control study design was utilized with odds ratios (ORs) calculated by comparison of all three groups with the Ohio State University GWAS control group. Results: The predominant Polish variant (c.444 + 1G>A) was present in only one case. The proportion of patients with c.1100del was 0.92% in the GWAS group, 1.65% in the ORIEN Avatar group, and 0.80% in the TCGA group. The ORs (with 95% confidence intervals [CIs]) for NMTC associated with c.1100del were 1.71 (0.73-4.29), 2.64 (0.95-7.63), and 2.5 (0.63-8.46), respectively. The proportion of patients with c.470T>C/p.I157T was 0.91% in the GWAS group, 0.76% in the ORIEN Avatar group, and 0.80% in the TCGA group, respectively. The ORs (with CIs) for NMTC associated with c.470T>C/p.I157T were 1.75 (0.74-4.39), 1.52 (0.42-4.96), and 2.31 (0.58-7.90), respectively. Conclusions: Our analyses of unselected patients with NMTC suggest that CHEK2 variants c.1100del and c.470T>C/p.I157T have only a modest impact on thyroid cancer risk. These results provide important information for providers regarding the relatively low magnitude of thyroid cancer risk associated with these CHEK2 variants.
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Affiliation(s)
- Pamela Brock
- Division of Human Genetics, The Ohio State University College of Medicine, Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Sandya Liynarachchi
- Department of Molecular Medicine and Therapeutics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Taina T. Nieminen
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Carlos Chan
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Wendy Kohlmann
- University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Leigh Anne Stout
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Song Yao
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Amanda La Greca
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Kirk E. Jensen
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jill M. Kolesar
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Bodour Salhia
- Department of Translational Genomics, Norris Comprehensive Cancer Center, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Pat Gulhati
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - J. Kevin Hicks
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Matthew D. Ringel
- Department of Molecular Medicine and Therapeutics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
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2
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Fortuno C, Feng BJ, Carroll C, Innella G, Kohlmann W, Lázaro C, Brunet J, Feliubadaló L, Iglesias S, Menéndez M, Teulé A, Ballinger ML, Thomas DM, Campbell A, Field M, Harris M, Kirk J, Pachter N, Poplawski N, Susman R, Tucker K, Wallis M, Williams R, Cops E, Goldgar D, James PA, Spurdle AB. Cancer Risks Associated With TP53 Pathogenic Variants: Maximum Likelihood Analysis of Extended Pedigrees for Diagnosis of First Cancers Beyond the Li-Fraumeni Syndrome Spectrum. JCO Precis Oncol 2024; 8:e2300453. [PMID: 38412388 PMCID: PMC10914239 DOI: 10.1200/po.23.00453] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/23/2023] [Accepted: 12/21/2023] [Indexed: 02/29/2024] Open
Abstract
PURPOSE Establishing accurate age-related penetrance figures for the broad range of cancer types that occur in individuals harboring a pathogenic germline variant in the TP53 gene is essential to determine the most effective clinical management strategies. These figures also permit optimal use of cosegregation data for classification of TP53 variants of unknown significance. Penetrance estimation can easily be affected by bias from ascertainment criteria, an issue not commonly addressed by previous studies. MATERIALS AND METHODS We performed a maximum likelihood penetrance estimation using full pedigree data from a multicenter study of 146 TP53-positive families, incorporating adjustment for the effect of ascertainment and population-specific background cancer risks. The analysis included pedigrees from Australia, Spain, and United States, with phenotypic information for 4,028 individuals. RESULTS Core Li-Fraumeni syndrome (LFS) cancers (breast cancer, adrenocortical carcinoma, brain cancer, osteosarcoma, and soft tissue sarcoma) had the highest hazard ratios of all cancers analyzed in this study. The analysis also detected a significantly increased lifetime risk for a range of cancers not previously formally associated with TP53 pathogenic variant status, including colorectal, gastric, lung, pancreatic, and ovarian cancers. The cumulative risk of any cancer type by age 50 years was 92.4% (95% CI, 82.2 to 98.3) for females and 59.7% (95% CI, 39.9 to 81.3) for males. Females had a 63.3% (95% CI, 35.6 to 90.1) cumulative risk of developing breast cancer by age 50 years. CONCLUSION The results from maximum likelihood analysis confirm the known high lifetime risk for the core LFS-associated cancer types providing new risk estimates and indicate significantly increased lifetime risks for several additional cancer types. Accurate cancer risk estimates will help refine clinical recommendations for TP53 pathogenic variant carriers and improve TP53 variant classification.
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Affiliation(s)
- Cristina Fortuno
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Bing-Jian Feng
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Courtney Carroll
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Giovanni Innella
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Conxi Lázaro
- Hereditary Cancer Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer Program, ONCOBELL, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, Madrid, Spain
| | - Joan Brunet
- Hereditary Cancer Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer Program, ONCOBELL, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, Madrid, Spain
- Precision Oncology in Girona, IDIBGI, Girona, Spain
| | - Lidia Feliubadaló
- Hereditary Cancer Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer Program, ONCOBELL, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, Madrid, Spain
| | - Silvia Iglesias
- Hereditary Cancer Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mireia Menéndez
- Hereditary Cancer Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alex Teulé
- Hereditary Cancer Program, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer Program, ONCOBELL, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mandy L. Ballinger
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, New South Wales, Australia
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - David M. Thomas
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- Centre for Molecular Oncology, Faculty of Medicine, University of New South Wales, New South Wales, Australia
| | - Ainsley Campbell
- Department of Clinical Genetics, Austin Health, Melbourne, Victoria, Australia
| | - Mike Field
- Familial Cancer Service, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Marion Harris
- Monash Health Familial Cancer Service, Melbourne, Victoria, Australia
| | - Judy Kirk
- Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Nicholas Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Nicola Poplawski
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel Susman
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Kathy Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Mathew Wallis
- Tasmanian Clinical Genetics Service, Tasmanian Health Service, Royal Hobart Hospital, Hobart, Tasmania, Australia
- School of Medicine and Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Rachel Williams
- Prince of Wales Clinical School, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Prince of Wales Hereditary Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Elisa Cops
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Goldgar
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - kConFab Investigators
- kConFab, Research Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul A. James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Amanda B. Spurdle
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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3
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Mooney R, Wu YP, Kehoe K, Volkmar M, Kohlmann W, Koptiuch C, Kaphingst KA. Experiences of patients and family members with follow-up care, information needs and provider support after identification of Lynch Syndrome. Hered Cancer Clin Pract 2023; 21:28. [PMID: 38115072 PMCID: PMC10731879 DOI: 10.1186/s13053-023-00273-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Lynch Syndrome is among the most common hereditary cancer syndromes and requires ongoing cancer surveillance, repeated screenings and potential risk-reducing surgeries. Despite the importance of continued surveillance, there is limited understanding of patient experiences after initial testing and counseling, the barriers or facilitators they experience adhering to recommendations, and how they want to receive information over time. METHODS A cross-sectional, observational study was conducted among 127 probands and family members who had received genetic testing for Lynch Syndrome. We conducted semi-structured interviews to determine proband and family member experiences after receiving genetic testing results including their surveillance and screening practices, information needs, and interactions with health care providers. Both closed-ended and open-ended data were collected and analyzed. RESULTS Both probands (96.9%) and family members (76.8%) received recommendations for follow-up screening and all probands (100%) and most family members (98.2%) who tested positive had completed at least one screening. Facilitators to screening included receiving screening procedure reminders and the ease of making screening and surveillance appointments. Insurance coverage to pay for screenings was a frequent concern especially for those under 50 years of age. Participants commented that their primary care providers were often not knowledgeable about Lynch Syndrome and surveillance recommendations; this presented a hardship in navigating ongoing surveillance and updated information. Participants preferred information from a knowledgeable health care provider or a trusted internet source over social media or support groups. CONCLUSIONS Probands and family members receiving genetic testing for Lynch Syndrome generally adhered to initial screening and surveillance recommendations. However, factors such as insurance coverage and difficulty finding a knowledgeable healthcare provider presented barriers to receiving recommended follow-up care. There is an opportunity to improve care through better transitions in care, procedures to keep primary care providers informed of surveillance guidelines, and practices so that patients receive reminders and facilitated appointment setting for ongoing screening and surveillance at the time they are due.
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Affiliation(s)
- Ryan Mooney
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Yelena P Wu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Kelsey Kehoe
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Molly Volkmar
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Cathryn Koptiuch
- VA Medical Center, National TeleOncology Service, Durham, NC, USA
| | - Kimberly A Kaphingst
- Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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4
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Daly MB, Pal T, Maxwell KN, Churpek J, Kohlmann W, AlHilli Z, Arun B, Buys SS, Cheng H, Domchek SM, Friedman S, Giri V, Goggins M, Hagemann A, Hendrix A, Hutton ML, Karlan BY, Kassem N, Khan S, Khoury K, Kurian AW, Laronga C, Mak JS, Mansour J, McDonnell K, Menendez CS, Merajver SD, Norquist BS, Offit K, Rash D, Reiser G, Senter-Jamieson L, Shannon KM, Visvanathan K, Welborn J, Wick MJ, Wood M, Yurgelun MB, Dwyer MA, Darlow SD. NCCN Guidelines® Insights: Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 2.2024. J Natl Compr Canc Netw 2023; 21:1000-1010. [PMID: 37856201 DOI: 10.6004/jnccn.2023.0051] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 10/20/2023]
Abstract
The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic focus primarily on assessment of pathogenic/likely pathogenic (P/LP) variants associated with increased risk of breast, ovarian, pancreatic, and prostate cancer, including BRCA1, BRCA2, CDH1, PALB2, PTEN, and TP53, and recommended approaches to genetic counseling/testing and care strategies in individuals with these P/LP variants. These NCCN Guidelines Insights summarize important updates regarding: (1) a new section for transgender, nonbinary and gender diverse people who have a hereditary predisposition to cancer focused on risk reduction strategies for ovarian cancer, uterine cancer, prostate cancer, and breast cancer; and (2) testing criteria and management associated with TP53 P/LP variants and Li-Fraumeni syndrome.
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Affiliation(s)
| | - Tuya Pal
- 2Vanderbilt-Ingram Cancer Center
| | - Kara N Maxwell
- 3Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Zahraa AlHilli
- 6Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Banu Arun
- 7The University of Texas MD Anderson Cancer Center
| | | | | | | | | | - Veda Giri
- 10Yale Cancer Center/Smilow Cancer Hospital
| | - Michael Goggins
- 11The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Andrea Hagemann
- 12Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Ashley Hendrix
- 13St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Nawal Kassem
- 16Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | - Seema Khan
- 17Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Julie S Mak
- 21UCSF Helen Diller Family Comprehensive Cancer Center
| | - John Mansour
- 22UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | | | | | | | | | - Leigha Senter-Jamieson
- 29The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Kala Visvanathan
- 11The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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5
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Wu YP, Hamilton JG, Kaphingst KA, Jensen JD, Kohlmann W, Parsons BG, Lillie HM, Wang X, Haaland B, Wankier AP, Grossman D, Hay JL. Increasing Skin Cancer Prevention in Young Adults: the Cumulative Impact of Personalized UV Photography and MC1R Genetic Testing. J Cancer Educ 2023; 38:1059-1065. [PMID: 36306029 PMCID: PMC10502947 DOI: 10.1007/s13187-022-02232-1] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 06/02/2023]
Abstract
Skin cancer has become increasingly common among young adults; however, this population does not consistently adhere to recommended methods for preventing the disease. Interventions in college settings have relied on appearance-focused appeals and have not been able to examine the cumulative effect of multiple behavior change and skin cancer risk communication strategies. The goal of the current study was to examine the unique and combined impacts of personalized ultraviolet (UV) radiation photographs, genetic testing for skin cancer risk, and general skin cancer prevention education. Participants were randomly assigned to one of four conditions: (1) skin cancer prevention education, (2) education + UV photo, (3) education + genetic testing, and (4) education + UV photo + genetic testing. Self-reported sun protection, tanning, and sunburn were assessed at baseline, immediately post-intervention, and 1 month post-intervention. The findings indicated benefits of the interventions to skin cancer prevention behaviors in the overall sample; however, the combined (UV photo + genetic testing) intervention had the most consistent positive effects on behaviors. Intervention effects were distinct across seasons. These results suggest that interventions containing multiple skin cancer risk communication strategies hold promise in benefitting health-promoting behavior changes in an at-risk, young adult population.Trial Registration Number: NCT03979872; Registered 6/5/2019.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah Health Sciences Center, 30 North 1900 East, 4A330-Salt Lake City, UT, 84132, USA.
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Rm LL376, Salt Lake City, UT, 84112, USA.
| | - Jada G Hamilton
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Rm LL376, Salt Lake City, UT, 84112, USA
- Department of Communication, University of Utah, 255 Central Campus Drive, Salt Lake City, UT, 84112, USA
| | - Jakob D Jensen
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Rm LL376, Salt Lake City, UT, 84112, USA
- Department of Communication, University of Utah, 255 Central Campus Drive, Salt Lake City, UT, 84112, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Rm LL376, Salt Lake City, UT, 84112, USA
| | - Bridget G Parsons
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Rm LL376, Salt Lake City, UT, 84112, USA
| | - Helen M Lillie
- Department of Communication, University of Utah, 255 Central Campus Drive, Salt Lake City, UT, 84112, USA
| | - Xuechen Wang
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Rm LL376, Salt Lake City, UT, 84112, USA
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Williams Building Room 1N410, Salt Lake City, UT, 84108, USA
| | - Benjamin Haaland
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Rm LL376, Salt Lake City, UT, 84112, USA
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Williams Building Room 1N410, Salt Lake City, UT, 84108, USA
| | - Ali P Wankier
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Rm LL376, Salt Lake City, UT, 84112, USA
| | - Douglas Grossman
- Department of Dermatology, University of Utah Health Sciences Center, 30 North 1900 East, 4A330-Salt Lake City, UT, 84132, USA
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Rm LL376, Salt Lake City, UT, 84112, USA
| | - Jennifer L Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
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6
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Subasri V, Light N, Kanwar N, Brzezinski J, Luo P, Hansford JR, Cairney E, Portwine C, Elser C, Finlay JL, Nichols KE, Alon N, Brunga L, Anson J, Kohlmann W, de Andrade KC, Khincha PP, Savage SA, Schiffman JD, Weksberg R, Pugh TJ, Villani A, Shlien A, Goldenberg A, Malkin D. Multiple Germline Events Contribute to Cancer Development in Patients with Li-Fraumeni Syndrome. Cancer Res Commun 2023; 3:738-754. [PMID: 37377903 PMCID: PMC10150777 DOI: 10.1158/2767-9764.crc-22-0402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/19/2023] [Accepted: 03/29/2023] [Indexed: 06/29/2023]
Abstract
Li-Fraumeni syndrome (LFS) is an autosomal dominant cancer-predisposition disorder. Approximately 70% of individuals who fit the clinical definition of LFS harbor a pathogenic germline variant in the TP53 tumor suppressor gene. However, the remaining 30% of patients lack a TP53 variant and even among variant TP53 carriers, approximately 20% remain cancer-free. Understanding the variable cancer penetrance and phenotypic variability in LFS is critical to developing rational approaches to accurate, early tumor detection and risk-reduction strategies. We leveraged family-based whole-genome sequencing and DNA methylation to evaluate the germline genomes of a large, multi-institutional cohort of patients with LFS (n = 396) with variant (n = 374) or wildtype TP53 (n = 22). We identified alternative cancer-associated genetic aberrations in 8/14 wildtype TP53 carriers who developed cancer. Among variant TP53 carriers, 19/49 who developed cancer harbored a pathogenic variant in another cancer gene. Modifier variants in the WNT signaling pathway were associated with decreased cancer incidence. Furthermore, we leveraged the noncoding genome and methylome to identify inherited epimutations in genes including ASXL1, ETV6, and LEF1 that confer increased cancer risk. Using these epimutations, we built a machine learning model that can predict cancer risk in patients with LFS with an area under the receiver operator characteristic curve (AUROC) of 0.725 (0.633-0.810). Significance Our study clarifies the genomic basis for the phenotypic variability in LFS and highlights the immense benefits of expanding genetic and epigenetic testing of patients with LFS beyond TP53. More broadly, it necessitates the dissociation of hereditary cancer syndromes as single gene disorders and emphasizes the importance of understanding these diseases in a holistic manner as opposed to through the lens of a single gene.
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Affiliation(s)
- Vallijah Subasri
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
| | - Nicholas Light
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nisha Kanwar
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jack Brzezinski
- Division of Haematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ping Luo
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Jordan R. Hansford
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
- Michael Rice Cancer Centre, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- South Australia Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia
| | - Elizabeth Cairney
- Department of Paediatrics, London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Carol Portwine
- Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Christine Elser
- Department of Medical Oncology, Princess Margaret Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan L. Finlay
- Neuro-Oncology Program, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Kim E. Nichols
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Noa Alon
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ledia Brunga
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jo Anson
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Kelvin C. de Andrade
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Payal P. Khincha
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Sharon A. Savage
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, NCI, Bethesda, Maryland
| | - Joshua D. Schiffman
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
- PEEL Therapeutics, Inc., Salt Lake City, Utah
| | - Rosanna Weksberg
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Trevor J. Pugh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Anita Villani
- Division of Haematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Adam Shlien
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anna Goldenberg
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
- CIFAR: Child and Brain Development, Toronto, Ontario, Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - David Malkin
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Feng BJ, Kohlmann W, Nix DA, Atkinson A, Boucher KM, Carroll C, Kolesar J, Singer EA, Edge SB, Sahu K, Sanchez A, Larson M, Churchman ML, Graham L, Carpten JD, Zakharia Y, Byrne L, Jain RK, Nepple KG, Shabsigh A, Chahoud J, Gupta S. Abstract 6074: Germline and somatic genomic profiling of urothelial carcinoma. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-6074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Urothelial carcinoma (UC) presents most frequently as bladder cancer and is the most common cancer of the urinary system in the United States. UC relapse and progression are common and impose a significant negative impact on the lives of patients and healthcare resources. To elucidate the biological mechanisms of UC and find novel biomarkers, we analyzed the clinical and genomic data in the Oncology Research Information Exchange Network (ORIEN). We conducted gene-based and gene-set based association tests on rare germline variants comparing the exome sequencing of 336 UC patients and genome sequencing of 366 healthy controls (42 unrelated individuals from the Centre d'Etudes du Polymorphisme Humain [CEPH] families and 324 from the University of Utah Heritage 1000 [H1K] Projects). The analysis of loss-of-function (LoF) variants revealed that the forkhead box (FOX) J2 gene set was significantly associated with UC at the genome-wide level (Bonferroni-corrected p-value=0.01). Genes in this gene set contain a motif that matches the FOXJ2 transcription factor binding site. Firth-penalized Cox proportional hazard regression on overall survival identified LoF variants in genes down-regulated in naive CD8 T cells to be associated with worse prognosis (Bonferroni-corrected p-value=0.032, hazard ratio=28.2, and 95% confidence interval 6.66 to 119.0). In exome sequencing of tumor tissues, we searched for driver genes and pathways by testing for higher variant allelic fractions than the genome average. The tests yielded eleven genes with genome-wide significance (Table 1). By gene set analysis using the MSigDB Hallmark database, significant pathways included the P53 pathway (p<2 × 10−16), Wnt beta-catenin signaling (p<2 × 10−16), E2F targets (p=8 × 10−13), PI3K/AKT/mTOR signaling (4 × 10−7), and apoptosis (p=9 × 10−7). These results reveal the germline predisposition variants and somatic oncogenic drivers in UC and suggest immune evasion as a contributing factor for poor clinical outcomes in UC patients.
Table 1. Genes with high allelic fractions Gene P-value Number of Variants TP53 <2 × 10−16 203 RB1 2.42 × 10−16 67 ELF3 2.06 × 10−7 38 TSC1 4.05 × 10−7 32 KMT2D 7.59 × 10−7 91 ZFP36L1 8.80 × 10−7 33 CDKN1A 2.47 × 10−6 40 FGFR3 1.11 × 10−5 37 ARID1A 1.28 × 10−5 62 SMARCA4 1.53 × 10−5 17 PIK3CA 2.00 × 10−5 53
Citation Format: Bing-Jian Feng, Wendy Kohlmann, David A. Nix, Aaron Atkinson, Kenneth M. Boucher, Courtney Carroll, Jill Kolesar, Eric A. Singer, Stephen B. Edge, Kamal Sahu, Alejandro Sanchez, Mikaela Larson, Michelle L. Churchman, Laura Graham, John D. Carpten, Yousef Zakharia, Lindsey Byrne, Rohit K. Jain, Kenneth G. Nepple, Ahmad Shabsigh, Jad Chahoud, Sumati Gupta. Germline and somatic genomic profiling of urothelial carcinoma. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6074.
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Affiliation(s)
| | | | | | | | | | | | | | - Eric A. Singer
- 4Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Kamal Sahu
- 2Huntsman Cancer Institute, Salt Lake City, UT
| | | | | | | | | | | | | | - Lindsey Byrne
- 10Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Ahmad Shabsigh
- 10Ohio State University Comprehensive Cancer Center, Columbus, OH
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8
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Foley M, Sharma A, Garfield K, Maese L, Buchmann L, Boyle J, Kohlmann W, Jeter J, Greenberg S. A need to tailor surveillance based on family history: describing a highly penetrant familial paraganglioma kindred with an SDHD pathogenic variant. Fam Cancer 2023; 22:217-224. [PMID: 36223042 DOI: 10.1007/s10689-022-00318-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/05/2022] [Indexed: 11/29/2022]
Abstract
Pathogenic variants (PVs) in the SDHD gene increase risk for paragangliomas (PGL)/pheochromocytomas, renal cell carcinomas, and gastrointestinal stromal tumors. Penetrance in individuals with SDHD PVs varies in reported research from 40-70%, and there is limited evidence of specific genotype risks. This study aims to characterize a multi-generational family with SDHD p.Trp43* PVs and potential genotype-phenotype considerations for surveillance. Individuals with a paternally inherited SDHD p.Trp43*(c.129G > A) PV were identified. Genetic, medical and family histories were abstracted, including clinical characteristics, tumor histories, and treatment approaches. Eleven individuals with the SDHD PV in the same kindred were diagnosed with 41 SDHx-related tumors across all family members. Eight individuals developed 27 head and neck PGL of varying origins, and seven individuals developed tumors outside of the head and neck region. Many individuals had multiple tumors, and age of first tumor diagnosis ranged from age 10 to age 45 years old. Individuals with SDHD p.Trp43* variants may have higher risks for SDHx related tumors than other SDHD variants. Prioritizing identification of at-risk individuals and initiating surveillance tailored to family history is recommended given the rate of multiple tumors found in one familial branch of individuals under 18 years old. Individuals with strong family histories of PGL at young ages with this PV will benefit from tailored surveillance recommendations.
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Affiliation(s)
- Madeline Foley
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Anu Sharma
- Department of Endocrinology, University of Utah, Salt Lake City, UT, USA
| | - Kinley Garfield
- Genetic Counseling Shared Resource, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Luke Maese
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Luke Buchmann
- Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA
| | - Julie Boyle
- Huntsman Cancer Institute, Bioinformatic Analysis Shared Resource, Salt Lake City, UT, USA
| | - Wendy Kohlmann
- Genetic Counseling Shared Resource, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Joanne Jeter
- Division of Oncology, University of Utah, Salt Lake City, UT, USA
| | - Samantha Greenberg
- Genetic Counseling Shared Resource, Huntsman Cancer Institute, Salt Lake City, UT, USA.
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9
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Winskill C, Goodman MS, Daly BM, Elrick A, Mooney R, Espinel W, Kohlmann W, Kaphingst KA. Predictors of Women's Intentions to Communicate Updated Genetic Test Results to Immediate and Extended Family Members. Public Health Genomics 2023; 26:24-34. [PMID: 36642066 PMCID: PMC10015742 DOI: 10.1159/000528522] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/28/2022] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Many individuals who previously received negative genetic test results are eligible for updated testing. This study examined intention to communicate updated genetic test results to relatives in participants who previously received negative genetic test results. METHODS Women with a personal or family history of breast or ovarian cancer who tested negative for BRCA1/2 before 2013 were enrolled between April 2018 and October 2019. Proportions were calculated to assess intention to communicate updated genetic test results to living immediate family, extended family, and all family. Potential predictors of intentions from the theory of planned behavior (attitudes, subjective norms, perceived behavioral control) were assessed. The three outcomes were analyzed using generalized linear models with a quasi-binomial probability distribution. RESULTS 110 women completed the baseline assessment prior to updated testing. Participants intended to communicate genetic test results to 90% of immediate family, 51% of extended family, and 66% of all living relatives. Participants with higher subjective norms (aOR = 1.93, 95% CI: 1.08-3.57) had higher intentions to communicate genetic test results to extended family, while participants with more positive attitudes (aOR = 1.27, 95% CI: 1.01-1.60) had higher intentions to communicate to all family. Placing higher importance on genetic information was associated with higher intentions to communicate to immediate family (aOR = 1.40, 95% CI: 1.06-1.83). Lower subjective numeracy was associated with higher intentions to communicate to extended family (aOR = 0.50, 95% CI: 0.32-0.76). CONCLUSION Attitudes and subjective norms were predictors of intention to communicate updated genetic information to at-risk biological relatives, and predictors may vary by degree of relationship.
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Affiliation(s)
- Carolyn Winskill
- New York University School of Global Public Health, New York, New York, USA
| | - Melody S. Goodman
- New York University School of Global Public Health, New York, New York, USA
| | - Brianne M. Daly
- Huntsman Cancer Institute, University of UT, Salt Lake City, Utah, USA
| | - Ashley Elrick
- Department of Communications, Huntsman Cancer Institute, University of UT, Salt Lake City, Utah, USA
| | - Ryan Mooney
- Huntsman Cancer Institute, University of UT, Salt Lake City, Utah, USA
| | - Whitney Espinel
- Huntsman Cancer Institute, University of UT, Salt Lake City, Utah, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of UT, Salt Lake City, Utah, USA
| | - Kimberly A. Kaphingst
- Department of Communications, Huntsman Cancer Institute, University of UT, Salt Lake City, Utah, USA
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10
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Liebermann E, Taber P, Vega AS, Daly BM, Goodman MS, Bradshaw R, Chan PA, Chavez-Yenter D, Hess R, Kessler C, Kohlmann W, Low S, Monahan R, Kawamoto K, Del Fiol G, Buys SS, Sigireddi M, Ginsburg O, Kaphingst KA. Barriers to family history collection among Spanish-speaking primary care patients: a BRIDGE qualitative study. PEC Innovation 2022; 1:100087. [PMID: 36532299 PMCID: PMC9757734 DOI: 10.1016/j.pecinn.2022.100087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives Family history is an important tool for assessing disease risk, and tailoring recommendations for screening and genetic services referral. This study explored barriers to family history collection with Spanish-speaking patients. Methods This qualitative study was conducted in two US healthcare systems. We conducted semi-structured interviews with medical assistants, physicians, and interpreters with experience collecting family history for Spanish-speaking patients. Results The most common patient-level barrier was the perception that some Spanish-speaking patients had limited knowledge of family history. Interpersonal communication barriers related to dialectical differences and decisions about using formal interpreters vs. Spanish-speaking staff. Organizational barriers included time pressures related to using interpreters, and ad hoc workflow adaptations for Spanish-speaking patients that might leave gaps in family history collection. Conclusions This study identified multi-level barriers to family history collection with Spanish-speaking patients in primary care. Findings suggest that a key priority to enhance communication would be to standardize processes for working with interpreters. Innovation To improve communication with and care provided to Spanish-speaking patients, there is a need to increase healthcare provider awareness about implicit bias, to address ad hoc workflow adjustments within practice settings, to evaluate the need for professional interpreter services, and to improve digital tools to facilitate family history collection.
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Affiliation(s)
- Erica Liebermann
- College of Nursing, University of Rhode Island, RINEC, 350 Eddy Street, Providence, RI 02903, USA
| | - Peter Taber
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT 84108, USA
| | - Alexis S Vega
- Department of Communication, University of Utah, 255 S. Central Campus Drive, Salt Lake City, UT 84112, USA
| | - Brianne M Daly
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Melody S Goodman
- School of Global Public Health, New York University, 726 Broadway, New York, NY 10012, USA
| | - Richard Bradshaw
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT 84108, USA
| | - Priscilla A Chan
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY 10016, USA
| | - Daniel Chavez-Yenter
- Department of Communication, University of Utah, 255 S. Central Campus Drive, Salt Lake City, UT 84112, USA
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Cecilia Kessler
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Sara Low
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Rachel Monahan
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY 10016, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT 84108, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT 84108, USA
| | - Saundra S Buys
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132, USA
| | - Meenakshi Sigireddi
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY 10016, USA
| | - Ophira Ginsburg
- Center for Global Health, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20892-9760, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, 255 S. Central Campus Drive, Salt Lake City, UT 84112, USA
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
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11
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Brady HL, Hamilton JG, Kaphingst KA, Jensen JD, Kohlmann W, Parsons BG, Lillie HM, Wankier AP, Smith HJ, Grossman D, Hay JL, Wu YP. 'I had a bigger cancer risk than I thought…': The experience of receiving personalized risk information as part of a skin cancer prevention intervention in the college setting. Health Expect 2022; 25:2937-2949. [PMID: 36225123 PMCID: PMC9700178 DOI: 10.1111/hex.13601] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/25/2022] [Accepted: 08/25/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Diagnoses of both melanoma and nonmelanoma skin cancers are becoming increasingly common among young adults. Interventions in this population are a priority because they do not consistently follow skin cancer prevention recommendations. OBJECTIVES The goal of the current study was to examine college students' perspectives on and experience with receiving a skin cancer prevention intervention that provided personalized skin cancer risk feedback in the form of an ultraviolet (UV) photograph, the results of genetic testing for common skin cancer risk variants, and/or general skin cancer prevention education. METHODS Qualitative interviews were conducted with 38 college students who received a skin cancer prevention intervention. The interview covered students' feelings about their personal skin cancer risk information, the impact of the intervention on their skin cancer risk perceptions, actions or intentions to act with regard to their sun protection practices and feedback for improvement of the intervention content or delivery. RESULTS Participants reported that different intervention components contributed to increased awareness of their sun protection behaviours, shifts in cognitions about and motivation to implement sun protection strategies and reported changes to their skin cancer prevention strategies. CONCLUSION Our findings indicate that college students are interested in and responsive to these types of multicomponent skin cancer preventive interventions. Further, students demonstrate some motivation and intentionality toward changing their skin cancer risk behaviour in the short term. PATIENT OR PUBLIC CONTRIBUTION Participants involved in this study were members of the public (undergraduate students) who were involved in a skin cancer prevention intervention, then participated in semistructured interviews, which provided the data analysed for this study.
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Affiliation(s)
- Hannah L. Brady
- Cancer Control and Population Sciences Division, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Jada G. Hamilton
- Department of Psychiatry & Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA,Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Kimberly A. Kaphingst
- Cancer Control and Population Sciences Division, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA,Department of CommunicationUniversity of UtahSalt Lake CityUtahUSA
| | - Jakob D. Jensen
- Department of CommunicationUniversity of UtahSalt Lake CityUtahUSA,Department of DermatologyUniversity of Utah Health Sciences CenterSalt Lake CityUtahUSA
| | - Wendy Kohlmann
- Cancer Control and Population Sciences Division, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Bridget G. Parsons
- Cancer Control and Population Sciences Division, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Helen M. Lillie
- Department of CommunicationUniversity of UtahSalt Lake CityUtahUSA
| | - Ali P. Wankier
- Cancer Control and Population Sciences Division, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Heather J. Smith
- Cancer Control and Population Sciences Division, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Douglas Grossman
- Cancer Control and Population Sciences Division, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA,Department of DermatologyUniversity of Utah Health Sciences CenterSalt Lake CityUtahUSA
| | - Jennifer L. Hay
- Department of Psychiatry & Behavioral SciencesMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Yelena P. Wu
- Cancer Control and Population Sciences Division, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA,Department of DermatologyUniversity of Utah Health Sciences CenterSalt Lake CityUtahUSA
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12
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Steinberg B, Kohlmann W, Fair D, Kirchhoff A, Trabert B, Welt CK, Letourneau JM. CANCER PREDISPOSITION GENE MUTATIONS AND ONCOFERTILITY: PREVALENCE IN REPRODUCTIVE AGE CANCER PATIENTS AND EFFECTS ON OVARIAN RESERVE. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.674] [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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13
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Shi J, Morgan KL, Bradshaw RL, Jung SH, Kohlmann W, Kaphingst KA, Kawamoto K, Fiol GD. Correction: Identifying Patients Who Meet Criteria for Genetic Testing of Hereditary Cancers Based on Structured and Unstructured Family Health History Data in the Electronic Health Record: Natural Language Processing Approach. JMIR Med Inform 2022; 10:e42533. [PMID: 36099593 PMCID: PMC9516360 DOI: 10.2196/42533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jianlin Shi
- Veterans Affairs Informatics and Computing Infrastructure, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States.,Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Keaton L Morgan
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States.,Department of Emergency Medicine, University of Utah, Salt Lake City, UT, United States
| | - Richard L Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Se-Hee Jung
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States.,College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Wendy Kohlmann
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States.,Department of Communication, University of Utah, Salt Lake City, UT, United States
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
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14
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Shi J, Morgan KL, Bradshaw RL, Jung SH, Kohlmann W, Kaphingst KA, Kawamoto K, Fiol GD. Identifying Patients Who Meet Criteria for Genetic Testing of Hereditary Cancers Based on Structured and Unstructured Family Health History Data in the Electronic Health Record: Natural Language Processing Approach. JMIR Med Inform 2022; 10:e37842. [PMID: 35969459 PMCID: PMC9412758 DOI: 10.2196/37842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family health history has been recognized as an essential factor for cancer risk assessment and is an integral part of many cancer screening guidelines, including genetic testing for personalized clinical management strategies. However, manually identifying eligible candidates for genetic testing is labor intensive. OBJECTIVE The aim of this study was to develop a natural language processing (NLP) pipeline and assess its contribution to identifying patients who meet genetic testing criteria for hereditary cancers based on family health history data in the electronic health record (EHR). We compared an algorithm that uses structured data alone with structured data augmented using NLP. METHODS Algorithms were developed based on the National Comprehensive Cancer Network (NCCN) guidelines for genetic testing for hereditary breast, ovarian, pancreatic, and colorectal cancers. The NLP-augmented algorithm uses both structured family health history data and the associated unstructured free-text comments. The algorithms were compared with a reference standard of 100 patients with a family health history in the EHR. RESULTS Regarding identifying the reference standard patients meeting the NCCN criteria, the NLP-augmented algorithm compared with the structured data algorithm yielded a significantly higher recall of 0.95 (95% CI 0.9-0.99) versus 0.29 (95% CI 0.19-0.40) and a precision of 0.99 (95% CI 0.96-1.00) versus 0.81 (95% CI 0.65-0.95). On the whole data set, the NLP-augmented algorithm extracted 33.6% more entities, resulting in 53.8% more patients meeting the NCCN criteria. CONCLUSIONS Compared with the structured data algorithm, the NLP-augmented algorithm based on both structured and unstructured family health history data in the EHR increased the number of patients identified as meeting the NCCN criteria for genetic testing for hereditary breast or ovarian and colorectal cancers.
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Affiliation(s)
- Jianlin Shi
- Veterans Affairs Informatics and Computing Infrastructure, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Keaton L Morgan
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
- Department of Emergency Medicine, University of Utah, Salt Lake City, UT, United States
| | - Richard L Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Se-Hee Jung
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Wendy Kohlmann
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
- Department of Communication, University of Utah, Salt Lake City, UT, United States
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
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15
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Pauley K, Koptiuch C, Greenberg S, Kohlmann W, Jeter J, Colonna S, Werner T, Kinsey C, Gilcrease G, Weis J, Whisenant J, Florou V, Garrido-Laguna I. Discrepancies between tumor genomic profiling and germline genetic testing. ESMO Open 2022; 7:100526. [PMID: 35780590 PMCID: PMC9511791 DOI: 10.1016/j.esmoop.2022.100526] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/06/2021] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Tumor genomic profiling (TGP) often incidentally identifies germline pathogenic variants (PVs) associated with cancer predisposition syndromes. Methods used by somatic testing laboratories, including germline analysis, differ from designated germline laboratories that have optimized the identification of germline PVs. This study evaluated discrepancies between somatic and germline testing results, and their impact on patients. PATIENTS AND METHODS Chart reviews were carried out at a single institution for patients who had both somatic and designated germline genetic testing. Cases with discrepant results in which germline PVs were not detected by the somatic laboratory or in which variant classification differed are summarized. RESULTS TGP was carried out on 2811 cancer patients, 600 of whom also underwent designated germline genetic testing. Germline PVs were identified for 109 individuals. Discrepancies between germline genetic testing and tumor profiling reports were identified in 20 cases, including 14 PVs identified by designated germline genetic testing laboratories that were not reported by somatic testing laboratories and six variants with discrepant classifications between the designated germline and somatic testing laboratories. Three PVs identified by designated germline laboratories are targets for poly adenosine diphosphate-ribose polymerase (PARP) inhibitors and resulted in different treatment options. Of the PVs identified by designated germline laboratories, 60% (n = 12) were in genes with established associations to the patients' cancer, and 40% of the PVs were incidental. The majority (90%) of all discrepant findings, both contributory and incidental, changed management recommendations for these patients, highlighting the importance of comprehensive germline assessment. CONCLUSIONS Methods used by somatic laboratories, regardless of the inclusion of germline analysis, differ from those of designated germline laboratories for identifying germline PVs. Unrecognized germline PVs may harm patients by missing hereditary syndromes and targeted therapy opportunities (e.g. anti-programmed cell death protein 1 immunotherapy, PARP inhibitors). Clinicians should refer patients who meet the criteria for genetic evaluation regardless of somatic testing outcomes.
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Affiliation(s)
- K Pauley
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, USA.
| | - C Koptiuch
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, USA
| | - S Greenberg
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, USA
| | - W Kohlmann
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, USA
| | - J Jeter
- Department of Internal Medicine, Huntsman Cancer Institute, Salt Lake City, USA
| | - S Colonna
- Department of Internal Medicine, Huntsman Cancer Institute, Salt Lake City, USA
| | - T Werner
- Department of Internal Medicine, Huntsman Cancer Institute, Salt Lake City, USA
| | - C Kinsey
- Department of Internal Medicine, Huntsman Cancer Institute, Salt Lake City, USA
| | - G Gilcrease
- Department of Internal Medicine, Huntsman Cancer Institute, Salt Lake City, USA
| | - J Weis
- Department of Internal Medicine, Huntsman Cancer Institute, Salt Lake City, USA
| | - J Whisenant
- Department of Medical Oncology and Hematology, Utah Cancer Specialists, Salt Lake City, USA
| | - V Florou
- Department of Internal Medicine, Huntsman Cancer Institute, Salt Lake City, USA
| | - I Garrido-Laguna
- Department of Internal Medicine, Huntsman Cancer Institute, Salt Lake City, USA
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16
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Subasri V, Brew B, Erdman L, Guha T, Hansford JR, Cairney E, Portwine C, Elser C, Finlay JL, Nichols KE, Kohlmann W, Alon N, Novokmet A, Brunga L, Villani A, de Andrade KC, Khincha PP, Savage SA, Schiffman JD, Malkin D, Goldenberg A. Abstract 1428: DNA methylation predicts early onset of primary tumor in patients with Li-Fraumeni syndrome. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Li-Fraumeni syndrome (LFS) is an autosomal dominant cancer predisposition syndrome. Approximately 80% of individuals with LFS harbor a germline TP53 pathogenic variant rendering them susceptible to a wide spectrum of early-onset malignancies. A comprehensive surveillance regimen termed the ‘Toronto Protocol’, has recently been adopted for early tumor detection, demonstrating significant improvement in survival among TP53 pathogenic variant carriers. However, the protocol’s “one-size-fits-all” approach fails to consider an individual patient's risk of cancer. We built a machine learning model that predicts early-onset of primary tumors in LFS by estimating the probability of cancer onset before the age of six years, leveraging patient peripheral blood leukocyte methylation profiles.
Methods: We built a gradient-boosted tree model to predict the probability of cancer onset before the age of six using methylation data from 288 TP53 pathogenic variant carriers. An external test set of 82 TP53 pathogenic variant carriers was used to validate our model. To increase the signal-to-noise ratio, methylation probes associated with TP53 status were retained and probes associated with aging were removed. In our study, we were primarily interested in minimizing the false negative rate (i.e. to reduce the number of patients who developed cancer before the age of six but were undetected by our algorithm.
Findings: We correctly predicted whether the first tumor will occur before the age of six with an accuracy of 79% in our external test set. Importantly, our model classified 90% of the patients that developed cancer prior to the age of six correctly. In addition, 81% of the individuals without cancer in the external test set were predicted correctly.
Interpretation: Our tool provides additional value to clinicians in stratifying patients into low- or high-risk groups of developing early-onset malignancies, and helps inform rational use of clinical surveillance tools for early cancer detection, with the ultimate aim to improve overall patient outcomes.
Citation Format: Vallijah Subasri, Benjamin Brew, Lauren Erdman, Tanya Guha, Jordan R. Hansford, Elizabeth Cairney, Carol Portwine, Christine Elser, Jonathan L. Finlay, Kim E. Nichols, Wendy Kohlmann, Noa Alon, Ana Novokmet, Ledia Brunga, Anita Villani, Kelvin C. de Andrade, Payal P. Khincha, Sharon A. Savage, Joshua D. Schiffman, David Malkin, Anna Goldenberg. DNA methylation predicts early onset of primary tumor in patients with Li-Fraumeni syndrome [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1428.
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Affiliation(s)
| | - Benjamin Brew
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lauren Erdman
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tanya Guha
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | - Noa Alon
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ana Novokmet
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ledia Brunga
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anita Villani
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - David Malkin
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
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17
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Greenberg S, Orlando E, Devlin M, Low S, Anson A, O Neil B, Kohlmann W, Wong B, Dechet CB, Sanchez A, Tward JD, Johnson SB, Agarwal N, Kohli M, Gupta S, Swami U, Maughan BL. Comparing pretest video genetic education for prostate cancer patients: Do patients need assistance? J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5061 Background: Expanded germline genetic testing recommendations for individuals with prostate cancer (PCa) have resulted in increased demand for pre-test genetic education. As a result, alternative service delivery models in genetic counseling (GC) have been suggested. Previous research has shown no difference in genetic testing uptake when video genetic education (VGE) is used rather than face-to-face counseling. However, data is limited when evaluating how VGE is delivered to patients. This study aimed to evaluate the impact of pre-test VGE on genetic testing uptake when facilitated by a GC assistant or self-completed by the patient. Methods: PCa patients referred for GC were contacted for pre-test VGE. Patients were randomized to undergo VGE with a GC assistant via Zoom (assistant-led) or perform VGE on their own via email instructions (patient-led). Assistant-led VGE was scheduled via standard of care, and patient-led VGE involved electronic and phone contact. In both arms, pre-test VGE included administrating family history collection via electronic software and viewing of informational genetics video. VGE completion and genetic testing uptake was the primary outcome measured for all participants. Initial pilot data was presented previously. This analysis represents the entire study period outcome. Data analysis used t-test, Fisher’s exact and chi square. Results: From 10/1/2020-12/31/2021, 266 PCa patients were referred. In total, 254 were randomized, with 130 in the assistant-led intervention and 124 randomized to the patient-led arm. Technological limitations, loss to follow up, and procedural withdrawals resulted in 41 (31.5%) patients in the assistant-led arm and 65 (52.4%) in the self-led arm. The primary reason for discontinuing the process was lack of patient response to contact to schedule their genetics visit (n = 109, 35 patient-led, 74 assistant-led). There was significantly more loss to follow up in the assistant-led arm versus the self-led arm (p < 0.001). Of those who completed VGE, the median age was 66 years, with no difference between the two arms (p = 0.66). Participants primary identified as white (n = 96, 91%) and non-Hispanic (n = 100, 94%). There was no difference in uptake of genetic testing (p = 0.09) between patient and assistant led VGE. Conclusions: A randomized intervention suggests no difference in genetic testing uptake when pre-test VGE occurs with an assistant or is patient-led. Analyses of satisfaction, decision conflict, and knowledge are needed to evaluate if patient-led VGE is a suitable alternative to GC. Loss to follow up given standard of care scheduling approaches for assistant-led VGE suggests pre-test VGE may be better delivered during oncology visits. Additional evaluation of the facilitators and barriers, in addition to larger multi-center studies, are required to consider patient-led pre-test VGE as a primary method of pre-testing genetic education.
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Affiliation(s)
| | | | | | - Sara Low
- Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Brock O Neil
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Bob Wong
- University of Utah, Salt Lake City, UT
| | | | | | | | - Skyler B Johnson
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Sumati Gupta
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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18
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Greenberg S, Yozamp N, Anson A, Brand S, Buchmann L, Kohlmann W, Low S, Wong B, Else T, Vaidya A, Fishbein L. Impact of COVID-19 on individuals with paraganglioma/pheochromocytoma history and/or hereditary risk. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10613 Background: Patients with paraganglioma/pheochromocytoma (PPGL) or hereditary predisposition to PPGL often need screening with biochemical labs, imaging and physical exam. Given the rarity of PPGL and hereditary PPGL, care is often provided through specialty centers. Subsequently, patients may have experienced restrictions on travel and delayed scheduling of non-elective procedures due to COVID-19. This study aimed to analyze the impact of COVID-19 on seeking PPGL management. Methods: Patients with a personal history of PPGL or hereditary PPGL risk from the University of Michigan, Brigham Women’s Hospital, and Huntsman Cancer Institute were sent a survey in 2021. The survey included questions regarding tumor history (Y/N), gene status, demographics, and experience with COVID. The survey assessed whether they missed any exams related to PPGL diagnosis or screening. Comparative analyses utilized regression and chi-square tests. Patient factors measured in analyses evaluated COVID surveillance (labs, imaging, doctor visit) as the primary outcome and age, institution, gene status, sex, and PPGL history as predicting variables. Results: In total, 241 respondents across three institutions completed the survey. The cohort was primarily female (n = 158, 65.6%). A majority of the cohort identified as White (n = 222, 92%) and non-Hispanic (n = 226, 93.8%). PPGL history was reported in 158 patients (65.6%), 43 of which were pheochromocytoma and 113 were paraganglioma, primarily in the head and neck (n = 78). At time of survey completion, 209 (87%) respondents answered COVID-related questions. Thirty-nine respondents (19.2%) reported missing doctor visits, while 31 (15.3%) report missing HPPGL imaging and 33 (16.3%) report missing lab tests. There were no differences by institution (p > 0.05) on patient reported missed visits. Logistic regression analysis showed no difference in missing visits based on having a hereditary PPGL predisposition gene or sex of respondent (all p-values > 0.05). There was no difference based on PPGL history, though it is unknown if patients missed PGL follow-up or screening. Individuals who missed imaging (Y/N) were more likely to report missing their lab tests (OR = 1.8, p < 0.01) and doctor visit (OR = 1.25, p < 0.01). Age was a significant predictor for missing doctor visits (p = 0.02) with an odds ratio of 1.002 per 1 year increase in age. Conclusions: Though institutions had different COVID-19 restrictions and guidelines by state, there was no difference on missing surveillance or screening. Over 15% of respondents reported missing at least one aspect of PPGL care, indicating a need to re-engage those with PPGL and hereditary PPGL to return to typical screening and surveillance. Patients who miss one aspect of surveillance are likely to have missed other aspects of surveillance and will require evaluation of all aspects of screening to return up to date on needed visits and procedures.
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Affiliation(s)
| | | | | | | | | | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Sara Low
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Bob Wong
- University of Utah, Salt Lake City, UT
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19
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Vagher J, Gammon A, Kohlmann W, Jeter J. Non-Melanoma Skin Cancers and Other Cutaneous Manifestations in Bone Marrow Failure Syndromes and Rare DNA Repair Disorders. Front Oncol 2022; 12:837059. [PMID: 35359366 PMCID: PMC8960432 DOI: 10.3389/fonc.2022.837059] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/17/2022] [Indexed: 11/17/2022] Open
Abstract
Although most non-melanoma skin cancers are felt to be sporadic in origin, these tumors do play a role in several cancer predisposition syndromes. The manifestations of skin cancers in these hereditary populations can include diagnosis at extremely early ages and/or multiple primary cancers, as well as tumors at less common sites. Awareness of baseline skin cancer risks for these individuals is important, particularly in the setting of treatments that may compromise the immune system and further increase risk of cutaneous malignancies. Additionally, diagnosis of these disorders and management of non-cutaneous manifestations of these diseases have profound implications for both the patient and their family. This review highlights the current literature on the diagnosis, features, and non-melanoma skin cancer risks associated with lesser-known cancer predisposition syndromes, including bone marrow failure disorders, genomic instability disorders, and base excision repair disorders.
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Affiliation(s)
- Jennie Vagher
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Amanda Gammon
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Wendy Kohlmann
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Joanne Jeter
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
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20
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Pauley K, Khan A, Kohlmann W, Jeter J. Considerations for Germline Testing in Melanoma: Updates in Behavioral Change and Pancreatic Surveillance for Carriers of CDKN2A Pathogenic Variants. Front Oncol 2022; 12:837057. [PMID: 35372037 PMCID: PMC8967159 DOI: 10.3389/fonc.2022.837057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/23/2022] [Indexed: 01/13/2023] Open
Abstract
The largest proportion of hereditary melanoma cases are due to pathogenic variants (PVs) in the CDKN2A/p16 gene, which account for 20%-40% of familial melanomas and confer up to a 30%-70% lifetime risk for melanoma in individuals with these variants. In addition, PVs in the CDKN2A gene also increase risk for pancreatic cancer (~5-24% lifetime risk). Individuals with PVs in the CDKN2A gene also tend to have an earlier onset of cancer. Despite these known risks, uptake of germline testing has been limited in the past, largely due to perceptions of limited benefit for patients. Prevention recommendations have been developed for individuals with CDKN2A PVs as well the providers who care for them. On the patient level, behavioral modifications regarding melanoma prevention such as wearing sunscreen, limiting prolonged sun exposure and practicing general sun safety can help reduce risks. Germline testing can provide motivation for some individuals to adhere to these lifestyle changes. On the provider level, pancreatic cancer surveillance for individuals with CDKN2A PVs has been increasingly endorsed by expert consensus, although the efficacy of these surveillance methods remains under study. This review summarizes the updated surveillance guidelines for individuals with CDKN2A PVs and explores the impact of genetic counseling and testing in influencing behavioral changes in these individuals.
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Affiliation(s)
- Kristen Pauley
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Ambreen Khan
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Wendy Kohlmann
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Joanne Jeter
- Department of Internal Medicine, Huntsman Cancer Institute, Salt Lake City, UT, United States
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21
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Maxwell KN, Cheng HH, Powers J, Gulati R, Ledet EM, Morrison C, Le A, Hausler R, Stopfer J, Hyman S, Kohlmann W, Naumer A, Vagher J, Greenberg S, Naylor L, Laurino M, Konnick EQ, Shirts BH, Al-Dubayan SH, Van Allen EM, Nguyen B, Vijai J, Abida W, Carlo M, Dubard-Gault M, Lee DJ, Maese LD, Mandelker D, Montgomery B, Morris MJ, Nicolosi P, Nussbaum RL, Schwartz LE, Stadler Z, Garber JE, Offit K, Schiffman JD, Nelson PS, Sartor O, Walsh MF, Pritchard CC. Inherited TP53 Variants and Risk of Prostate Cancer. Eur Urol 2022; 81:243-250. [PMID: 34863587 PMCID: PMC8891030 DOI: 10.1016/j.eururo.2021.10.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [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: 05/09/2021] [Revised: 09/22/2021] [Accepted: 10/28/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inherited germline TP53 pathogenic and likely pathogenic variants (gTP53) cause autosomal dominant multicancer predisposition including Li-Fraumeni syndrome (LFS). However, there is no known association of prostate cancer with gTP53. OBJECTIVE To determine whether gTP53 predisposes to prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This multi-institutional retrospective study characterizes prostate cancer incidence in a cohort of LFS males and gTP53 prevalence in a prostate cancer cohort. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We evaluated the spectrum of gTP53 variants and clinical features associated with prostate cancer. RESULTS AND LIMITATIONS We identified 31 prostate cancer cases among 163 adult LFS males, including 26 of 54 aged ≥50 yr. Among 117 LFS males without prostate cancer at the time of genetic testing, six were diagnosed with prostate cancer over a median (interquartile range [IQR]) of 3.0 (1.3-7.2) yr of follow-up, a 25-fold increased risk (95% confidence interval [CI] 9.2-55; p < 0.0001). We identified gTP53 in 38 of 6850 males (0.6%) in the prostate cancer cohort, a relative risk 9.1-fold higher than that of population controls (95% CI 6.2-14; p < 0.0001; gnomAD). We observed hotspots at the sites of attenuated variants not associated with classic LFS. Two-thirds of available gTP53 prostate tumors had somatic inactivation of the second TP53 allele. Among gTP53 prostate cancer cases in this study, the median age at diagnosis was 56 (IQR: 51-62) yr, 44% had Gleason ≥8 tumors, and 29% had advanced disease at diagnosis. CONCLUSIONS Complementary analyses of prostate cancer incidence in LFS males and gTP53 prevalence in prostate cancer cohorts suggest that gTP53 predisposes to aggressive prostate cancer. Prostate cancer should be considered as part of LFS screening protocols and TP53 considered in germline prostate cancer susceptibility testing. PATIENT SUMMARY Inherited pathogenic variants in the TP53 gene are likely to predispose men to aggressive prostate cancer.
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Affiliation(s)
- Kara N. Maxwell
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Heather H. Cheng
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jacquelyn Powers
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Roman Gulati
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Elisa M. Ledet
- Tulane Cancer Center, Tulane Medical School, New Orleans, LA, USA
| | - Casey Morrison
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anh Le
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Hausler
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jill Stopfer
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sophie Hyman
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Anne Naumer
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jennie Vagher
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Eric Q. Konnick
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Brian H. Shirts
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Saud H. Al-Dubayan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA,Cancer Program, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Eliezer M. Van Allen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA,Cancer Program, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Bastien Nguyen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph Vijai
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wassim Abida
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Carlo
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Daniel J. Lee
- Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Luke D. Maese
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA,Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Diana Mandelker
- Diagnostic Molecular Genetics Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bruce Montgomery
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Michael J. Morris
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Lauren E. Schwartz
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Zsofia Stadler
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Judy E. Garber
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kenneth Offit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joshua D. Schiffman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA,Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA,PEEL Therapeutics, Inc., Salt Lake City, UT, USA
| | - Peter S. Nelson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA,Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Oliver Sartor
- Tulane Cancer Center, Tulane Medical School, New Orleans, LA, USA
| | - Michael F. Walsh
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colin C. Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA,Brotman Baty Institute for Precision Medicine, Seattle, WA, USA,Corresponding author. Department of Laboratory Medicine and Pathology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA. Tel. +1 (206) 598-6131; Fax: 1 (206) 543-3644. (C.C. Pritchard)
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22
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Greenberg S, Woelmer E, Devlin M, Low S, Anson A, Kohlmann W, Wong B, O Neil B, Dechet CB, Sanchez A, Tward JD, Johnson SB, Agarwal N, Kohli M, Gupta S, Swami U, Maughan BL. Impact of pretest video genetic education in prostate cancer patients: Do patients need us? J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
68 Background: Germline genetic testing criteria for individuals with prostate cancer (PCa) are expanding. Alternative genetic service models are needed to meet increased need for genetic testing. Studies have shown no difference in genetic testing uptake, satisfaction, or knowledge when patients undergo face-to-face genetic counseling compared to pre-test video genetic education (VGE). Data is limited comparing options for how video genetic education is delivered. This study evaluated the impact of pre-test VGE when facilitated by a genetic counseling assistant (assistant-led) or self-completed by the patient (patient-led). Methods: Individuals with PCa referred for genetic counseling received pre-test VGE. Patients were randomized so that this process involved meeting with a genetic counseling assistant or completed at the patient’s convenience via email instructions. Pre-test VGE included family history completion via electronic software and viewing of informational video. VGE completion and genetic testing uptake were measured for all participants. Questionnaires regarding satisfaction, and knowledge were optional for participants after VGE completion. Data was analyzed using t-test and Fisher’s exact. Results: Eighty-one individuals referred for genetic counseling from October 2020-March 2021, and 78 individuals were randomized (1:1) to assistant-led or patient-led VGE, with 39 individuals in each arm. After removing patients for technological limitations, loss to follow up, and procedural withdrawals, there were 18 patients in the assistant-led arm, and 16 patients in the patient-led arm. The primary reason for discontinuing the process was lack of response to phone and electronic contacts to schedule their genetics visit (n = 22). The median age was 64.5 years, with no difference between the two arms (p = 0.698). Participants identified primarily as white/Caucasian (n = 32, 94%). In the assistant-led group, all participants elected to undergo germline genetic testing and 13 (81%) opted for genetic testing in the patient-led group. There was no difference in genetic testing uptake between the two arms (p = 0.094). Nine patients in the patient-led group and eight patients in the assistant-led group completed the questionnaires. There was no difference in satisfaction with their VGE experience (p = 0.815) or knowledge using the KnowGene scale (p = 0.120). Conclusions: Preliminary data suggests there is no difference in genetic testing uptake when pre-test VGE is facilitated by a genetic counseling assistant or self-led by the patient. Given no preliminary differences in satisfaction and knowledge, patient-led pre-test VGE may serve as a viable option prior to germline testing in PCa patients. Additional research is needed with larger sample size. Furthermore, evaluation of the facilitators and barriers of VGE is needed as there was significant drop off in completion of video pre-test VGE.
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Affiliation(s)
| | | | | | - Sara Low
- Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Bob Wong
- University of Utah, Salt Lake City, UT
| | - Brock O Neil
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | | | - Skyler B Johnson
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Sumati Gupta
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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23
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Kohlmann W, Nix D, Atkinson A, Boucher KM, Kolesar J, Singer EA, Edge SB, Quintana B, Churchman ML, Feng B, Graham L, Carpten JD, Sanchez A, Zakharia Y, Byrne L, Jain RK, Nepple KG, Shabsigh A, Chahoud J, Gupta S. Inherited germline variants in urothelial cancer: A multicenter whole-exome sequencing analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
451 Background: Outside of Lynch syndrome, few genetic factors have been associated with urothelial cancer (UC). This project seeks to describe the frequency of germline variants in a multi-center UC cohort. Methods: Patients diagnosed with UC from 1980 to 2019 and consented to the Total Cancer Care protocol by members of the Oncology Research Information Exchange Network (ORIEN) were included in the study. The ORIEN program includes a convenience sample of cases with both germline and tumor samples available, though this analysis was germline only. Whole exome sequencing data were analyzed using a GATK best practices for germline variant analysis. A series of quality control (allele frequency > = 0.3, read depth > = 20, genotype quality > = 20), annotation, functional impact (loss of function/splicing), and region (cancer predisposition genes/pathways) filters were applied to identify variants of significant consequence. Results: 348 exomes were evaluated. This identified 60 variants classified as pathogenic/likely pathogenic (P/LP) and 17 novel, high impact variants in genes associated with high, moderate, or recessively inherited cancer risk in 77 individuals (22.1%). 15 (4.5%) had P/LP variants in genes associated with a high or moderate cancer risk, and 10 (3%) of these variants were considered to be clinically actionable with associated with cancer screening, risk reduction or treatment recommendations. The high/moderate risk genes with P/LP variants included CHEK2 (n = 5), FANCM (n = 4), MSH6 (n = 2) and single cases of MSH2, BRCA2, ERCC3, and BRIP1. The average age of diagnosis in those with and without a high/moderate risk P/LP variant was 67.6 (57-80 yrs) and 68.9 (45-91 yrs). Family history of cancer was reported for 73% of those with a germline LP/PV and 60% of those without, but this trend was not significant (p =.44). Conclusions: Individuals with UC have a high frequency of germline variants that warrant further study for association with cancer risk. A smaller, but significant portion also carry germline variants that may be clinically relevant to them and/or family members. Currently UC is not included in genetic testing criteria. This study adds to the growing body of research indicating that diverse types of cancer patients harbor germline variants. Strategies for expanding testing should be considered.
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Affiliation(s)
- Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - David Nix
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Aaron Atkinson
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | - Eric A. Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Branda Quintana
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Bingjian Feng
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Laura Graham
- Division of Medical Oncology, University of Colorado, Aurora, CO
| | | | | | | | | | | | | | | | | | - Sumati Gupta
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Chavez-Yenter D, Kimball KE, Kohlmann W, Lorenz Chambers R, Bradshaw RL, Espinel WF, Flynn M, Gammon A, Goldberg E, Hagerty KJ, Hess R, Kessler C, Monahan R, Temares D, Tobik K, Mann DM, Kawamoto K, Del Fiol G, Buys SS, Ginsburg O, Kaphingst KA. Patient Interactions With an Automated Conversational Agent Delivering Pretest Genetics Education: Descriptive Study. J Med Internet Res 2021; 23:e29447. [PMID: 34792472 PMCID: PMC8663668 DOI: 10.2196/29447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/22/2021] [Accepted: 09/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cancer genetic testing to assess an individual’s cancer risk and to enable genomics-informed cancer treatment has grown exponentially in the past decade. Because of this continued growth and a shortage of health care workers, there is a need for automated strategies that provide high-quality genetics services to patients to reduce the clinical demand for genetics providers. Conversational agents have shown promise in managing mental health, pain, and other chronic conditions and are increasingly being used in cancer genetic services. However, research on how patients interact with these agents to satisfy their information needs is limited. Objective Our primary aim is to assess user interactions with a conversational agent for pretest genetics education. Methods We conducted a feasibility study of user interactions with a conversational agent who delivers pretest genetics education to primary care patients without cancer who are eligible for cancer genetic evaluation. The conversational agent provided scripted content similar to that delivered in a pretest genetic counseling visit for cancer genetic testing. Outside of a core set of information delivered to all patients, users were able to navigate within the chat to request additional content in their areas of interest. An artificial intelligence–based preprogrammed library was also established to allow users to ask open-ended questions to the conversational agent. Transcripts of the interactions were recorded. Here, we describe the information selected, time spent to complete the chat, and use of the open-ended question feature. Descriptive statistics were used for quantitative measures, and thematic analyses were used for qualitative responses. Results We invited 103 patients to participate, of which 88.3% (91/103) were offered access to the conversational agent, 39% (36/91) started the chat, and 32% (30/91) completed the chat. Most users who completed the chat indicated that they wanted to continue with genetic testing (21/30, 70%), few were unsure (9/30, 30%), and no patient declined to move forward with testing. Those who decided to test spent an average of 10 (SD 2.57) minutes on the chat, selected an average of 1.87 (SD 1.2) additional pieces of information, and generally did not ask open-ended questions. Those who were unsure spent 4 more minutes on average (mean 14.1, SD 7.41; P=.03) on the chat, selected an average of 3.67 (SD 2.9) additional pieces of information, and asked at least one open-ended question. Conclusions The pretest chat provided enough information for most patients to decide on cancer genetic testing, as indicated by the small number of open-ended questions. A subset of participants were still unsure about receiving genetic testing and may require additional education or interpersonal support before making a testing decision. Conversational agents have the potential to become a scalable alternative for pretest genetics education, reducing the clinical demand on genetics providers.
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Affiliation(s)
- Daniel Chavez-Yenter
- Department of Communication, University of Utah, Salt Lake City, UT, United States.,Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Kadyn E Kimball
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | | | - Richard L Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Whitney F Espinel
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Michael Flynn
- University of Utah Health, Salt Lake City, UT, United States
| | - Amanda Gammon
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Eric Goldberg
- Department of Medicine, New York University Grossman School of Medicine, New York University, New York, NY, United States
| | - Kelsi J Hagerty
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Cecilia Kessler
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Rachel Monahan
- Perlmutter Cancer Center, New York University Langone Health, New York, NY, United States.,Department of Population Health, New York University Grossman School of Medicine, New York University, New York, NY, United States
| | - Danielle Temares
- Perlmutter Cancer Center, New York University Langone Health, New York, NY, United States
| | - Katie Tobik
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Devin M Mann
- Department of Population Health, New York University Grossman School of Medicine, New York University, New York, NY, United States
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Saundra S Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States.,Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Ophira Ginsburg
- Perlmutter Cancer Center, New York University Langone Health, New York, NY, United States.,Department of Population Health, New York University Grossman School of Medicine, New York University, New York, NY, United States
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, United States.,Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, United States
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Taber P, Ghani P, Schiffman JD, Kohlmann W, Hess R, Chidambaram V, Kawamoto K, Waller RG, Borbolla D, Del Fiol G, Weir C. Physicians' strategies for using family history data: having the data is not the same as using the data. JAMIA Open 2021; 3:378-385. [PMID: 34632321 PMCID: PMC7660959 DOI: 10.1093/jamiaopen/ooaa035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/02/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To identify needs in a clinical decision support tool development by exploring how primary care providers currently collect and use family health history (FHH). Design Survey questionnaires and semi-structured interviews were administered to a mix of primary and specialty care clinicians within the University of Utah Health system (40 surveys, 12 interviews). Results Three key themes emerged regarding providers' collection and use of FHH: (1) Strategies for collecting FHH vary by level of effort; (2) Documentation practices extend beyond the electronic health record's dedicated FHH module; and (3) Providers desire feedback from genetic services consultation and are uncertain how to refer patients to genetic services. Conclusion Study findings highlight the varying degrees of engagement that providers have with collecting FHH. Improving the integration of FHH into workflow, and providing decision support, as well as links and tools to help providers better utilize genetic counseling may improve patient care.
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Affiliation(s)
- Peter Taber
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), Salt Lake City, Utah, USA
| | - Parveen Ghani
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Joshua D Schiffman
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Family Cancer Assessment Clinic, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Wendy Kohlmann
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Valli Chidambaram
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Rosalie G Waller
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Damian Borbolla
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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26
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Mooney R, Espinel W, Elrick A, Kehoe K, Kohlmann W, Kaphingst KA. Uptake of genetic counseling and multi-gene panel testing among women in the Intermountain West with previous negative BRCA1 and BRCA2 results contacted for updated testing. J Genet Couns 2021; 31:470-478. [PMID: 34570943 PMCID: PMC9206233 DOI: 10.1002/jgc4.1513] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Women with a personal history of breast or ovarian cancer who previously had BRCA1/2 testing now have the opportunity for additional genetic risk information through multi-gene panel testing. However, little is known about women's receptivity to further contact and uptake of genetic counseling and updated genetic testing. Utilizing a clinic database to identify potential participants, we prospectively contacted women in the United States with a personal and/or family history of breast or ovarian cancer who had negative BRCA1/2 testing, which was performed primarily between 2011 and 2018. Eligible and interested participants were scheduled for a genetic counseling appointment to discuss updated genetic testing using a multi-gene panel. We attempted to contact 455 participants, screened 203 (45%), and 103 (23%) completed a pre-test genetic counseling visit to discuss updated testing. Of these, 88 participants had updated multi-gene panel testing. Participants had an average age of 59 years, and most (78%) had breast cancer with an average age of 45 at diagnosis. The majority (97%) of participants were white. Of participants who underwent panel testing, 13% (n = 11) had at least one pathogenic variant identified. Most participants (86%) had an out-of-pocket cost of $100 or less for their panel. There is a sizable population of women with a personal and/or family history of breast or ovarian cancer and negative BRCA1/2 test results who would qualify for updated multi-gene panel testing. In our study, 59% of those reached who were eligible completed a pre-test genetic counseling visit. Clinics could consider an outreach program to offer genetic counseling and updated genetic testing. Supports for this type of effort may include coordinators and genetic counseling assistants and an available database with patients' contact information and prior genetic test results. Updated testing allows women more information about their risk and may expand the value of genetic counseling.
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Affiliation(s)
- Ryan Mooney
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Whitney Espinel
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Ashley Elrick
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Communication, University of Utah, Salt Lake City, Utah, USA
| | - Kelsey Kehoe
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Communication, University of Utah, Salt Lake City, Utah, USA
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27
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Greenberg SE, Holman R, Kohlmann W, Buchmann L, Naumer A. Paraganglioma and other tumour detection rates in individuals with SDHx pathogenic variants by age of diagnosis and after the age of 50. Clin Endocrinol (Oxf) 2021; 95:447-452. [PMID: 34255389 DOI: 10.1111/cen.14559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/07/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with SDHx germline mutations (SDHA, AF2, B, C, D) are at risk for paragangliomas (PGLs), renal cell carcinoma and gastrointestinal stromal tumours. The aim of this study was to evaluate the age of SDHx tumour diagnosis in those with pathogenic variants (PVs), notably tumour detection after the age of 50 years. STUDY DESIGN Longitudinal retrospective observational analysis. PATIENTS Individuals with SDHx PVs. MEASUREMENTS Demographic, clinical, genetic, screening and tumour detection and treatment data were abstracted from the electronic medical record. Descriptive analysis was utilised. RESULTS A total of 165 patients with SDHx PVs from 34 families were evaluated. Sixty-eight patients (41.2%) had at least one known SDHx-related tumour in their history, identified through symptoms, screening or incidentally. The average age of SDHx-related tumour diagnosis was 32.0 years. Age of diagnosis varied by the gene. Nine patients (n = 50; 18.0%) were identified with a tumour after the age of 50, identified via baseline screening after PV identification, or due to symptoms before molecular SDHx diagnosis. CONCLUSIONS Though tumours were identified in individuals above the age of 50; they were all identified on baseline screening or due to symptoms, confirming that baseline screening is essential. Given the slow-growing nature of PGLs, these tumours might have been discovered before age 50 if molecular diagnosis and baseline screening had occurred earlier. Considering discontinuing screening after age 50 may be warranted if baseline screen imaging is negative and the individual does not have a prior tumour history.
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Affiliation(s)
- Samantha E Greenberg
- Genetic Counseling Shared Resource, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Rachel Holman
- Maternal Fetal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Wendy Kohlmann
- Genetic Counseling Shared Resource, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Luke Buchmann
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Anne Naumer
- Genetic Counseling Shared Resource, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
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28
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Kaphingst KA, Kohlmann W, Chambers RL, Goodman MS, Bradshaw R, Chan PA, Chavez-Yenter D, Colonna SV, Espinel WF, Everett JN, Gammon A, Goldberg ER, Gonzalez J, Hagerty KJ, Hess R, Kehoe K, Kessler C, Kimball KE, Loomis S, Martinez TR, Monahan R, Schiffman JD, Temares D, Tobik K, Wetter DW, Mann DM, Kawamoto K, Del Fiol G, Buys SS, Ginsburg O. Comparing models of delivery for cancer genetics services among patients receiving primary care who meet criteria for genetic evaluation in two healthcare systems: BRIDGE randomized controlled trial. BMC Health Serv Res 2021; 21:542. [PMID: 34078380 PMCID: PMC8170651 DOI: 10.1186/s12913-021-06489-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/06/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Advances in genetics and sequencing technologies are enabling the identification of more individuals with inherited cancer susceptibility who could benefit from tailored screening and prevention recommendations. While cancer family history information is used in primary care settings to identify unaffected patients who could benefit from a cancer genetics evaluation, this information is underutilized. System-level population health management strategies are needed to assist health care systems in identifying patients who may benefit from genetic services. In addition, because of the limited number of trained genetics specialists and increasing patient volume, the development of innovative and sustainable approaches to delivering cancer genetic services is essential. METHODS We are conducting a randomized controlled trial, entitled Broadening the Reach, Impact, and Delivery of Genetic Services (BRIDGE), to address these needs. The trial is comparing uptake of genetic counseling, uptake of genetic testing, and patient adherence to management recommendations for automated, patient-directed versus enhanced standard of care cancer genetics services delivery models. An algorithm-based system that utilizes structured cancer family history data available in the electronic health record (EHR) is used to identify unaffected patients who receive primary care at the study sites and meet current guidelines for cancer genetic testing. We are enrolling eligible patients at two healthcare systems (University of Utah Health and New York University Langone Health) through outreach to a randomly selected sample of 2780 eligible patients in the two sites, with 1:1 randomization to the genetic services delivery arms within sites. Study outcomes are assessed through genetics clinic records, EHR, and two follow-up questionnaires at 4 weeks and 12 months after last genetic counseling contactpre-test genetic counseling. DISCUSSION BRIDGE is being conducted in two healthcare systems with different clinical structures and patient populations. Innovative aspects of the trial include a randomized comparison of a chatbot-based genetic services delivery model to standard of care, as well as identification of at-risk individuals through a sustainable EHR-based system. The findings from the BRIDGE trial will advance the state of the science in identification of unaffected patients with inherited cancer susceptibility and delivery of genetic services to those patients. TRIAL REGISTRATION BRIDGE is registered as NCT03985852 . The trial was registered on June 6, 2019 at clinicaltrials.gov .
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Affiliation(s)
- Kimberly A Kaphingst
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
- Department of Communication, University of Utah, 255 S. Central Campus Drive, Salt Lake City, UT, 84112, USA.
| | - Wendy Kohlmann
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | | | - Melody S Goodman
- School of Global Public Health, New York University, 726 Broadway, New York, NY, 10012, USA
| | - Richard Bradshaw
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA
| | - Priscilla A Chan
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
| | - Daniel Chavez-Yenter
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Communication, University of Utah, 255 S. Central Campus Drive, Salt Lake City, UT, 84112, USA
| | - Sarah V Colonna
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Veterans Administration Medical Center, 500 S. Foothill Boulevard, Salt Lake City, UT, 84149, USA
| | - Whitney F Espinel
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Jessica N Everett
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Amanda Gammon
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Eric R Goldberg
- Department of Medicine, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Javier Gonzalez
- Medical Center Information Technology, NYU Langone Health, 360 Park Avenue South, New York, NY, 10010, USA
| | - Kelsi J Hagerty
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Kelsey Kehoe
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Cecilia Kessler
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Kadyn E Kimball
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Shane Loomis
- NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA
- Boost Services, Epic Systems Corporation, 1979 Milky Way, Verona, WI, 53593, USA
| | - Tiffany R Martinez
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Rachel Monahan
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Joshua D Schiffman
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Dani Temares
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
| | - Katie Tobik
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - David W Wetter
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Devin M Mann
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA
| | - Saundra S Buys
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Ophira Ginsburg
- Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
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Whipple N, Kohlmann W, Cheshier S, Yu Z, Curtin K, Schiffman J. RARE-24. IDENTIFYING INDIVIDUALS WITH PRIMARY CENTRAL NERVOUS SYSTEM TUMORS AT RISK FOR HEREDITARY CANCER SYNDROMES USING THE UTAH POPULATION DATABASE. Neuro Oncol 2021. [PMCID: PMC8168178 DOI: 10.1093/neuonc/noab090.185] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background CNS tumors are the most common solid tumors and the deadliest cancers in children. Approximately 10% of children with a CNS tumor harbor a hereditary cancer syndrome (HCS), but many will not be tested for a HCS. The Utah Population Database (UPDB) contains comprehensive cancer registry data for Utah families and can determine multigenerational cancer pedigrees across an archive of 5.8 million individuals. We hypothesize that the UPDB can identify children and families with HCSs not previously identified. Methods We queried the UPDB for individuals ages 0–39 diagnosed with a primary CNS tumor (malignant and benign) between 1966–2017 and generated cancer pedigrees of 3 generations or more for probands, extending to at least third-degree relatives. Specialized software calculated a familial standardized incidence ratio (FSIR) to determine families with excess clustering of CNS tumors. Clinical cancer genetics experts reviewed pedigrees to confirm patterns of HCS. Results We identified 4,634 CNS tumors in 4,550 individuals, of whom 2,233 (49%) reside in high-quality pedigrees containing ≥2 grandparents, at least 1 from both maternal and paternal sides. To identify families with excess clustering of CNS tumors, we selected pedigrees with an FSIR P<0.05 and ≥2 affected patients, resulting in 161 high-risk families with a mean of 170 (median 96) relatives per pedigree of 3–6 generations. Among these 161 families, there were 2,017 unique relatives (first-third degree) of CNS probands with 2,355 tumors (any site), for a per pedigree average of 14.7 tumors in 12.5 relatives. Review of the 10 highest risk pedigrees indicated that 4 meet HCS criteria, including Li-Fraumeni (n=2), von Hippel-Lindau (n=1), and rhabdoid tumor predisposition (n=1). Conclusion The UPDB can produce multigenerational cancer pedigrees that identify individuals and families at risk of harboring a HCS who warrant germline testing. These findings should encourage clinicians to perform thorough family history screening.
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Affiliation(s)
- Nicholas Whipple
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- University of Utah, Salt Lake City, UT, USA
| | - Samuel Cheshier
- Primary Children’s Hospital, Salt Lake City, UT, USA
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Zhe Yu
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Karen Curtin
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Joshua Schiffman
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Kohlmann W, Sutherland N, Pappas LM, Ma D, Berry T, Sama N, Kinnear S, Fraser AM, Colonna SV, Jeter JM. Use of the Utah population database to evaluate statewide use of genetic testing for hereditary breast/ovarian cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e22529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22529 Background: Genetic testing for hereditary breast/ovarian cancer (HBOC) continues to be underutilized, and options for population-based assessment of testing barriers and outcomes are lacking. This project uses linkages between statewide data sources available through the Utah Population Database (UPDB) to establish an infrastructure for studying the use of HBOC cancer genetic testing across a state. Methods: Clinical HBOC testing data from 1994-2018 was obtained for the University of Utah Huntsman Cancer Institute, Intermountain Healthcare, Utah Cancer Specialists, and the Salt Lake Veterans administration via electronic imports of tests attributed to these healthcare systems from three commercial laboratories. Genetic testing was linked to external data through the UPDB to determine demographic and urban/rural designation. Cancer diagnoses were obtained from the Utah Cancer Registry, and genealogies from the Utah Resource for Genetic and Epidemiology Research. These variables were matched to data available for the individual at the date of testing. For individuals with multiple genetic tests, the date for the first test was used. Results: Testing data was available for 12983 individuals who linked to additional records within the UPDB. Tested individuals were 86% White, 9% Hispanic, and 16% lived in rural/frontier areas. 75% of tests were performed between 2011-2018. 1575 (12%) had >1 pathogenic variant (PVs) identified in an HBOC gene, with the majority of PVs being in BRCA1/2 (89%), and TP53, CHEK2, and ATM each accounting for 2% of PVs. 7178 cancers were diagnosed in 5980 individuals (46%, avg. 1.2 cancer/person). Cancer cases were evaluated to determine if National Comprehensive Cancer Network (HBOC 2018) criteria were met. Cancer cases who have a relative with BC < 50 years of age or a relative with ovarian cancer (OC) were more likely to have a have BRCA1/2 PV than cases not meeting those criteria (17.5% vs 6.1% and 22.3% vs. 6.3% respectively). Cancer cases meeting criteria due to family history of pancreatic cancer also had a higher rate of PVs (13.1% vs. 8.4%) predominately due to additional PVs in BRCA2. Conclusions: This project begins to address the challenge of population assessment of HBOC genetic testing. We established a regulatory infrastructure to share testing data between multiple healthcare systems. In collaboration with commercial laboratories, genetic testing data was obtained in a consistent, discrete format even though it is stored differently within each health care system. The majority (54%) of HBOC testing in Utah is happening in people who did not have cancer at the time of their test, and focusing on assessing testing of cancer patients will not provide comprehensive information on testing done in the state. Among individuals with cancer, access to family history information is crucial for assessing the rate of PVs and utility of testing criteria.
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Affiliation(s)
- Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Lisa M. Pappas
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Debra Ma
- University of Utah, Salt Lake City, UT
| | | | | | | | - Alison M Fraser
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
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Whipple NS, Kohlmann W, Cheshier S, Yu Z, Curtin K, Schiffman JD. Identifying individuals with primary central nervous system tumors at risk for hereditary cancer syndromes using the Utah Population Database. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10532 Background: CNS tumors are the most common solid tumors and the deadliest cancers in children. Approximately 10% of children with a CNS tumor harbor a hereditary cancer syndrome (HCS), but many will not be tested for a HCS. The Utah Population Database (UPDB) contains comprehensive cancer registry data for Utah families and can determine multigenerational cancer pedigrees across an archive of 5.8 million individuals. Early identification of HCSs results in improved cancer surveillance and outcomes, reducing the impact of CNS tumors in children. We hypothesize that the UPDB can identify children and families with HCSs not previously identified. Methods: We queried the UPDB for individuals ages 0-39 diagnosed with a primary CNS tumor (malignant and benign) between 1966-2017 and generated cancer pedigrees of 3 generations or more for probands, extending to at least third-degree relatives. Specialized software calculated a familial standardized incidence ratio (FSIR) to determine families with excess clustering of CNS tumors. Clinical cancer genetics experts reviewed pedigrees to confirm patterns of HCS. Results: We identified 4,634 CNS tumors in 4,550 individuals, of whom 2,233 (49%) reside in high-quality pedigrees containing ≥2 grandparents, at least 1 from both maternal and paternal sides. To identify families with excess clustering of CNS tumors, we selected pedigrees with an FSIR P< 0.05 and ≥2 affected patients, resulting in 161 high-risk families with a mean of 170 (median 96) relatives per pedigree of 3-6 generations. Among these 161 families, there were 2,017 unique relatives (first-third degree) of CNS probands with 2,355 tumors (any site), for a per pedigree average of 14.7 tumors in 12.5 relatives. Review of the 10 highest risk pedigrees indicated that 4 meet HCS criteria, including Li-Fraumeni (n = 2), von Hippel-Lindau (n = 1), and rhabdoid tumor predisposition (n = 1). Conclusions: The UPDB can produce multigenerational cancer pedigrees that identify individuals and families at risk of harboring a HCS who warrant germline testing. These findings should encourage clinicians to perform thorough family history screening and to always consider workup for associated HCSs.
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Affiliation(s)
- Nicholas Shawn Whipple
- Division of Pediatric Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Samuel Cheshier
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, UT
| | - Zhe Yu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Karen Curtin
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Greenberg S, Luke B, Naumer A, Kohlmann W, Garfield K, Sharma A. Description of a SDHD c.129G>A (p.W43X) Mutation With Variable Presentation in Multiple Family Members. J Endocr Soc 2021. [PMCID: PMC8089188 DOI: 10.1210/jendso/bvab048.2036] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Approximately 40% of paragangliomas and pheochromocytomas are attributed to hereditary mutations. SDHD mutations account for 7% of inherited mutations (PGL1 syndrome), is maternally imprinted and has variable penetrance. SDHD pathogenic variants (PV) have been previously described extensively in Dutch pedigrees, with a varying lifetime risk for tumor development. Here we report a large family (Fig 1) displaying a SDHD c.129G>A (p.W43X) variation in 12 family members, 10 of whom had screening or tumor history available. The presentation and age of diagnosis in family members showed variable penetrance. Age at first diagnosis of a pheochromocytoma/paraganglioma ranged from 10 - 45 years. Family members displayed bilateral pheochromocytomas, bilateral carotid body tumors, and paragangliomas of the head, neck and trunk with variable recurrence rates (none to multiple). No malignant lesions were detected to date. Pheochromocytomas were norepinephrine producing. Paragangliomas ranged from non-functional to dopamine and norepinephrine producing. Compared to previous reports of other SDHD mutations, the SDHD c.129G>A (p.W43X) variation displayed an earlier age at first diagnosis with a highly variable phenotype ranging from one benign, non-secreting paraganglioma to bilateral pheochromocytomas and recurrent parganagliomas along the parasympathetic chain from head to abdomen. This report contributes to the evolving understanding of the phenotypic presentations of various genetic mutations. We propose that expert guidelines that suggest screening family members with the SDHD c.129G>A (p.W43X) variation at the age of 8 for early detection of pheochromocytomas and paragangliomas is beneficial.
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Affiliation(s)
| | | | - Anne Naumer
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | | | - Anu Sharma
- The University of Utah School of Medicine, Salt Lake City, UT, USA
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Kerrigan K, Chan J, Vagher J, Kohlmann W, Naumer A, Anson J, Low S, Schiffman J, Maese L. Lung Cancer in Li-Fraumeni Syndrome. JCO Precis Oncol 2021; 5:PO.20.00468. [PMID: 34250390 DOI: 10.1200/po.20.00468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kathleen Kerrigan
- Department of Internal Medicine, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Jessica Chan
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
| | - Jennie Vagher
- Department of Genetic Counseling, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Wendy Kohlmann
- Department of Genetic Counseling, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Anne Naumer
- Department of Genetic Counseling, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Jo Anson
- Department of Genetic Counseling, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Sara Low
- Department of Genetic Counseling, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Joshua Schiffman
- Department of Pediatrics, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Luke Maese
- Department of Pediatrics, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
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Taber JM, Aspinwall LG, Drummond DM, Stump TK, Kohlmann W, Champine M, Cassidy P, Leachman SA. Priority of Risk (But Not Perceived Magnitude of Risk) Predicts Improved Sun-Protection Behavior Following Genetic Counseling for Familial Melanoma. Ann Behav Med 2021; 55:24-40. [PMID: 32415830 PMCID: PMC7880221 DOI: 10.1093/abm/kaaa028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Understanding multiple components of risk perceptions is important because perceived risk predicts engagement in prevention behaviors. PURPOSE To examine how multiple components of risk perceptions (perceived magnitude of and worry about risk, prioritization of the management of one's risk) changed following genetic counseling with or without test reporting, and to examine which of these components prospectively predicted improvements in sun-protection behavior 1 year later. METHODS A prospective, nonrandomized study design was used. Participants were 114 unaffected members of melanoma-prone families who (i) underwent genetic testing for a CDKN2A/p16 mutation (n = 69) or (ii) were at comparably elevated risk based on family history and underwent genetic counseling but not testing (no-test controls, n = 45). Participants reported risk perception components and sun-protection behavior at baseline, immediately following counseling, and 1 month and 1 year after counseling. RESULTS Factor analysis indicated three risk components. Carriers reported increased perceived magnitude and priority of risk, but not cancer worry. No-test controls showed no changes in any risk perception. Among noncarriers, priority of risk remained high at all assessments, whereas magnitude of risk and cancer worry decreased. Of the three risk components, greater priority of risk uniquely predicted improved self-reported sun protection 1 year post-counseling. CONCLUSIONS Priority of risk (i) seems to be a component of risk perceptions distinguishable from magnitude of risk and cancer worry, (ii) may be an important predictor of daily prevention behavior, and (iii) remained elevated 1 year following genetic counseling only for participants who received a positive melanoma genetic test result.
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Affiliation(s)
- Jennifer M Taber
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, UT
| | | | - Tammy K Stump
- Department of Preventive Medicine, Northwestern University, Evanston, IL
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Marjan Champine
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Daly MB, Pal T, Berry MP, Buys SS, Dickson P, Domchek SM, Elkhanany A, Friedman S, Goggins M, Hutton ML, Karlan BY, Khan S, Klein C, Kohlmann W, Kurian AW, Laronga C, Litton JK, Mak JS, Menendez CS, Merajver SD, Norquist BS, Offit K, Pederson HJ, Reiser G, Senter-Jamieson L, Shannon KM, Shatsky R, Visvanathan K, Weitzel JN, Wick MJ, Wisinski KB, Yurgelun MB, Darlow SD, Dwyer MA. Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:77-102. [DOI: 10.6004/jnccn.2021.0001] [Citation(s) in RCA: 211] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic focus primarily on assessment of pathogenic or likely pathogenic variants associated with increased risk of breast, ovarian, and pancreatic cancer and recommended approaches to genetic testing/counseling and management strategies in individuals with these pathogenic or likely pathogenic variants. This manuscript focuses on cancer risk and risk management for BRCA-related breast/ovarian cancer syndrome and Li-Fraumeni syndrome. Carriers of a BRCA1/2 pathogenic or likely pathogenic variant have an excessive risk for both breast and ovarian cancer that warrants consideration of more intensive screening and preventive strategies. There is also evidence that risks of prostate cancer and pancreatic cancer are elevated in these carriers. Li-Fraumeni syndrome is a highly penetrant cancer syndrome associated with a high lifetime risk for cancer, including soft tissue sarcomas, osteosarcomas, premenopausal breast cancer, colon cancer, gastric cancer, adrenocortical carcinoma, and brain tumors.
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Affiliation(s)
| | - Tuya Pal
- 2Vanderbilt-Ingram Cancer Center
| | - Michael P. Berry
- 3St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | - Patricia Dickson
- 5Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Michael Goggins
- 9The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | - Seema Khan
- 12Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | | | | | - Holly J. Pederson
- 22Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Hendrickson PG, Luo Y, Kohlmann W, Schiffman J, Maese L, Bishop AJ, Lloyd S, Kokeny KE, Hitchcock YJ, Poppe MM, Gaffney DK, Tao R. Radiation therapy and secondary malignancy in Li-Fraumeni syndrome: A hereditary cancer registry study. Cancer Med 2020; 9:7954-7963. [PMID: 32931654 PMCID: PMC7643676 DOI: 10.1002/cam4.3427] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 01/02/2023] Open
Abstract
Background Li‐Fraumeni Syndrome (LFS) is a rare cancer‐predisposing condition caused by germline mutations in TP53. Conventional wisdom and prior work has implied an increased risk of secondary malignancy in LFS patients treated with radiation therapy (RT); however, this risk is not well‐characterized. Here we describe the risk of subsequent malignancy and cancer‐related death in LFS patients after undergoing RT for a first or second primary cancer. Methods We reviewed a multi‐institutional hereditary cancer registry of patients with germline TP53 mutations who were treated from 2004 to 2017. We assessed the rate of subsequent malignancy and death in the patients who received RT (RT group) as part of their cancer treatment compared to those who did not (non‐RT group). Results Forty patients with LFS were identified and 14 received RT with curative intent as part of their cancer treatment. The median time to follow‐up after RT was 4.5 years. Fifty percent (7/14) of patients in the curative‐intent group developed a subsequent malignancy (median time 3.5 years) compared to 46% of patients in the non‐RT group (median time 5.0 years). Four of seven subsequent malignancies occurred within a prior radiation field and all shared histology with the primary cancer suggesting recurrence rather than new malignancy. Conclusion We found that four of14 patients treated with RT developed in‐field malignancies. All had the same histology as the primary suggesting local recurrences rather than RT‐induced malignancies. We recommend that RT should be considered as part of the treatment algorithm when clinically indicated and after multidisciplinary discussion.
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Affiliation(s)
- Peter G Hendrickson
- Department of Radiation Oncology, University of Utah- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Yukun Luo
- Department of Radiation Oncology, University of Utah- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Wendy Kohlmann
- Department of Pediatric Hematology and Oncology, University of Utah- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Josh Schiffman
- Department of Pediatric Hematology and Oncology, University of Utah- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Luke Maese
- Department of Pediatric Hematology and Oncology, University of Utah- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Andrew J Bishop
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shane Lloyd
- Department of Radiation Oncology, University of Utah- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Kristine E Kokeny
- Department of Radiation Oncology, University of Utah- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Ying J Hitchcock
- Department of Radiation Oncology, University of Utah- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Matthew M Poppe
- Department of Radiation Oncology, University of Utah- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - David K Gaffney
- Department of Radiation Oncology, University of Utah- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Randa Tao
- Department of Radiation Oncology, University of Utah- Huntsman Cancer Institute, Salt Lake City, UT, USA
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Donovan LN, Kohlmann W, Snow AK, Neklason DW, Schiffman JD, Maese L. Germ Cell Mosaicism: A Rare Cause of Li-Fraumeni Recurrence Among Siblings. JCO Precis Oncol 2020; 4:PO.20.00064. [PMID: 32923893 PMCID: PMC7446446 DOI: 10.1200/po.20.00064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Wendy Kohlmann
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - Angela K. Snow
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | - Deborah W. Neklason
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Joshua D. Schiffman
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
- University of Utah Department of Pediatrics, Salt Lake City, UT
| | - Luke Maese
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
- University of Utah Department of Pediatrics, Salt Lake City, UT
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McCrary HC, Babajanian E, Calquin M, Carpenter P, Casazza G, Naumer A, Greenberg S, Kohlmann W, Cannon R, Monroe MM, Hunt JP, Buchmann L. Characterization of Malignant Head and Neck Paragangliomas at a Single Institution Across Multiple Decades. JAMA Otolaryngol Head Neck Surg 2020; 145:641-646. [PMID: 31194233 DOI: 10.1001/jamaoto.2019.1110] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Malignant head and neck paragangliomas (HNPGLs) are rare entities, and there are limited data regarding optimal treatment recommendations to improve clinical outcomes. Objective To classify succinate dehydrogenase (SDH) germline mutations associated with malignant HNPGLs, evaluate time from diagnosis to identification of malignant tumor, describe locations of metastases and the functional status of malignant HNPGLs, and determine the role of selective neck dissection at the time of initial surgical resection. Design, Setting, and Participants A retrospective cohort study was completed of patients diagnosed with paragangliomas on various sites on the body at an academic tertiary cancer hospital between the years 1963 and 2018. A subanalysis of HNPGLs was also completed. Data regarding diagnosis, gene and mutation, tumor characteristics and location, and treatments used were reviewed between February 2017 and March 2018. Main Outcomes and Measures Mutations of SDH genes associated with benign and malignant HNPGLs, treatments used, time to the discovery of malignancy, and location of metastasis. Results Of the 70 patients included in the study, 40 (57%) were male, and the mean (SD) age was 47 (21.1) years. Of patients with tumors isolated to the head and neck, 38 (54%) had benign HNPGLs, which were associated with mutations in the genes SDH subunit B (SDHB) (n = 18; 47%), SDH subunit C (n = 2; 5%), and SDH subunit D (n = 18; 47%). Among those with malignant HNPGLs, all but 1 patient had mutations in SDHB (n = 5; 83%); 1 patient had no mutation associated with their disease. The average age at diagnosis for malignant HNPGLs was 35 years, while benign tumors were diagnosed at an average age at 36 years. All patients with malignant disease underwent surgery. Four patients were found to have metastasis at the time of selective neck dissection. Among patients with malignant HNPGLs, 5 (83%) were treated with adjuvant radiation, and 1 (17%) was treated with adjuvant chemotherapy. Conclusions and Relevance Malignant HNPGLs are rare entities that are difficult to diagnose and are typically identified by the presence of regional or distant metastasis. The results of this study found the prevalence of malignant HNPGLs to be 9%. These data suggest that it is beneficial to perform a selective neck dissection at the time of tumor excision. All patients with malignant HNPGLs but 1 had SDHB mutations.
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Affiliation(s)
- Hilary C McCrary
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | - Eric Babajanian
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | | | - Patrick Carpenter
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | - Geoffrey Casazza
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | - Anne Naumer
- Genetic Counseling Shared Resource, Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Samantha Greenberg
- Genetic Counseling Shared Resource, Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Wendy Kohlmann
- Genetic Counseling Shared Resource, Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Richard Cannon
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | - Marcus M Monroe
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | - Jason P Hunt
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
| | - Luke Buchmann
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
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Greenberg S, Jacobs M, Wachtel H, Anson A, Buchmann L, Cohen D, Bonnani M, Bennett B, Naumer A, Schaefer A, Kohlmann W, Nathanson K, Else T, Fishbein L. Tumor detection rates in screening carriers with SDHx-related hereditary paraganglioma-pheochromocytoma syndrome based on prior tumor history. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1545 Background: Patients with germline pathogenic variants (PVs) in the SDHx genes have increased risk for paragangliomas/pheochromocytomas (PGL/PCC), renal cell carcinomas, and gastrointestinal stromal tumors. Expert recommendation suggests individuals with SDHx PVs undergo biennial whole-body imaging and annual biochemical testing. This study aimed to evaluate tumor detection rate using standard biochemical and imaging protocols for individuals with SDHx PVs, particularly in those with and without SDHx-related tumor history, and in those with biochemical testing data. Methods: A retrospective longitudinal observational study at the Universities of Michigan, Pennsylvania, and Utah Huntsman Cancer Institute was conducted from the start of each center’s screening program through March 1, 2018. Individuals with SDHx PVs had clinical imaging with whole body MRI/CT and biochemical testing per expert recommendation. SDHx-related tumors identified during clinical screening were measured. Results: A total of 263 individuals with SDHx PVs completed 491 screens. Individuals with SDHB PVs were the most prevalent (n = 188, 71.5%). The average number of screens per subject was 1.87 (range 1-7). A majority (n = 194, 73.7%) of individuals did not have a prior history of PGL/PCC. Overall, SDHx-related tumors were detected in 17.1% (n = 45) of the cohort. Of the 46 scans that identified an SDHx-related tumor, 85% of them (n = 39) were baseline scans. SDHx-related tumors were identified in 18.6% (n = 36/194) of individuals that did not have a prior history of PGL/PCC, whereas they were identified in 13.0% (n = 9/69) of individuals that did have a prior history of PGL/PCC (p = 0.39). Biochemical testing was available for 70% (n = 343) of imaging screens, of which 18% (n = 61) had positive biochemistry. Of those with positive biochemistry, 19 tumors were identified on imaging (6%). Sixteen tumors were identified on imaging with negative biochemistry (5%) with a sensitivity of 54% and a specificity of 94%. Utilizing a cut-off of two times the upper limit of normal, 9.91% (n = 34) biochemical tests were positive, and 15 (44.12%) had an SDHx-related tumor on corresponding imaging. Conclusions: Current SDHx screening protocols are effective at identifying SDHx-related tumors. Tumors were detected in subjects with a prior history of PGL/PCC and those with no prior history. This suggests life-long screening is important for all SDHx carriers. Imaging is a crucial piece of SDHx screening given biochemical testing’s sensitivity and specificity.
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Affiliation(s)
| | | | - Heather Wachtel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | | | | | | | | | - Anne Naumer
- Department of Pediatric Hematology/Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Daly MB, Pilarski R, Yurgelun MB, Berry MP, Buys SS, Dickson P, Domchek SM, Elkhanany A, Friedman S, Garber JE, Goggins M, Hutton ML, Khan S, Klein C, Kohlmann W, Kurian AW, Laronga C, Litton JK, Mak JS, Menendez CS, Merajver SD, Norquist BS, Offit K, Pal T, Pederson HJ, Reiser G, Shannon KM, Visvanathan K, Weitzel JN, Wick MJ, Wisinski KB, Dwyer MA, Darlow SD. NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 1.2020. J Natl Compr Canc Netw 2020; 18:380-391. [PMID: 32259785 DOI: 10.6004/jnccn.2020.0017] [Citation(s) in RCA: 246] [Impact Index Per Article: 61.5] [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: 12/15/2022]
Abstract
The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic provide recommendations for genetic testing and counseling for hereditary cancer syndromes, and risk management recommendations for patients who are diagnosed with syndromes associated with an increased risk of these cancers. The NCCN panel meets at least annually to review comments, examine relevant new data, and reevaluate and update recommendations. These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding criteria for high-penetrance genes associated with breast and ovarian cancer beyond BRCA1/2, pancreas screening and genes associated with pancreatic cancer, genetic testing for the purpose of systemic therapy decision-making, and testing for people with Ashkenazi Jewish ancestry.
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Affiliation(s)
| | - Robert Pilarski
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Michael P Berry
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Patricia Dickson
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Michael Goggins
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Seema Khan
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | - Julie S Mak
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | - Holly J Pederson
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Boyle JL, Hahn AW, Kapron AL, Kohlmann W, Greenberg SE, Parnell TJ, Teerlink CC, Maughan BL, Feng BJ, Cannon-Albright L, Agarwal N, Cooney KA. Pathogenic Germline DNA Repair Gene and HOXB13 Mutations in Men With Metastatic Prostate Cancer. JCO Precis Oncol 2020; 4:1900284. [PMID: 32923906 PMCID: PMC7446531 DOI: 10.1200/po.19.00284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Germline mutations in DNA repair (DR) genes and susceptibility genes CDKN2A and HOXB13 have previously been associated with prostate cancer (PC) incidence and/or progression. However, the role and prevalence of this class of mutations in metastatic PC (mPC) are not fully understood. PATIENTS AND METHODS To evaluate the frequency of pathogenic/likely pathogenic germline variants (PVs/LPVs) in men with mPC, this study sequenced 38 DR genes, CDKN2A, and HOXB13 in a predominantly white cohort of 317 patients with mPC. A PC registry at the University of Utah was used for patient sample acquisition and retrospective clinical data collection. Deep target sequencing allowed for germline and copy number variant analyses. Validated PVs/LPVs were integrated with clinical and demographic data for statistical correlation analyses. RESULTS All pathogenic variants were found in men self-reported as white, with a carrier frequency of 8.5% (DR genes, 7.3%; CDKN2A/HOXB13, 1.2%). Consistent with previous reports, mutations were most frequently identified in the breast cancer susceptibility gene BRCA2. It was also found that 50% of identified PVs/LPVs were categorized as founder mutations with European origins. Correlation analyses did not support a trend toward more advanced or earlier-onset disease in comparisons between carriers and noncarriers of deleterious DR or HOXB13 G84E mutations. CONCLUSION These findings demonstrate a lower prevalence of germline PVs/LPVs in an unselected, predominantly white mPC cohort than previously reported, which may have implications for the design of clinical trials testing targeted therapies. Larger studies in broad and diverse populations are needed to more accurately define the prevalence of germline mutations in men with mPC.
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Affiliation(s)
- Julie L Boyle
- Department of Internal Medicine, University of Utah, Salt Lake City, UT.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Andrew W Hahn
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Ashley L Kapron
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | - Craig C Teerlink
- Department of Internal Medicine, University of Utah, Salt Lake City, UT.,Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Benjamin L Maughan
- Department of Internal Medicine, University of Utah, Salt Lake City, UT.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Bing-Jian Feng
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.,Department of Dermatology, University of Utah, Salt Lake City, UT
| | - Lisa Cannon-Albright
- Department of Internal Medicine, University of Utah, Salt Lake City, UT.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.,George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT
| | - Neeraj Agarwal
- Department of Internal Medicine, University of Utah, Salt Lake City, UT.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Kathleen A Cooney
- Department of Medicine and the Duke Cancer Institute, Duke University School of Medicine, Durham, NC
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42
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Affiliation(s)
- Wendy Kohlmann
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
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43
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Pauley K, Koptiuch C, Greenberg S, Amanda G, Nevala-Plagemann C, Vagher J, Espinel W, Gilcrease GW, Kohlmann W, Garrido-Laguna I. Case series examining somatic test results for patients with hereditary cancer syndromes associated with gastrointestinal cancer risk. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
680 Background: Somatic tumor testing may identify germline pathogenic variants (PV) associated with cancer predisposition syndromes. Labs differ whether they offer somatic only or paired germline analysis. Methods used by somatic testing labs, even those that include germline analysis, differ from designated germline labs that have optimized the identification of germline PV. Methods: Chart reviews were performed for patients who had testing through both somatic and designated germline laboratories. Cases with discrepant results in which germline PV were not detected by the somatic laboratory are summarized. Results: Nine cases with discrepant results. Five had paired germline testing and 4 somatic testing only. All 9 patients met the criteria to undergo designated germline testing, either for Lynch syndrome (3) or BRCA1/2 testing (6), based on personal and/or family history. Designated germline testing identified 4 MLH1, 1 BRCA1, 2 ATM, 1 MUTYH and 1 RAD50 PV not reported by the somatic labs’ tumor or germline analysis; 2 MLH1 PV were called variants of uncertain significance by somatic testing but classified as PV by ClinVar and designated germline labs. Three PV identified by designated germline labs are targets for PARP inhibitors and resulted in different treatment options. Three of the MLH1 PV were identified in patients meeting Lynch Syndrome test criteria while 1 was identified in a patient meeting BRCA1/2 criteria. Among the 5 other patients meeting BRCA1/2 test criteria, 3 had PV in breast cancer genes (2 ATM, 1 BRCA1) and 2 had PV in other cancer genes ( MUTYH and RAD50) not reported by the somatic labs, highlighting the importance of panel testing. Conclusions: Methods used by somatic labs, regardless of inclusion of germline analysis, are not equivalent to those of designated germline labs. Overlooked germline PV may miss identification of hereditary syndromes and targeted therapy opportunities (e.g. Anti-PD1 immunotherapy, PARP inhibitors). Patients meeting criteria for genetic evaluation should be referred for designated germline testing regardless of somatic testing outcomes.
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Affiliation(s)
- Kristen Pauley
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Cathryn Koptiuch
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Gammon Amanda
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | | | | | - Wendy Kohlmann
- University of Utah and Huntsman Cancer Institute, Salt Lake City, UT
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Del Fiol G, Kohlmann W, Bradshaw RL, Weir CR, Flynn M, Hess R, Schiffman JD, Nanjo C, Kawamoto K. Standards-Based Clinical Decision Support Platform to Manage Patients Who Meet Guideline-Based Criteria for Genetic Evaluation of Familial Cancer. JCO Clin Cancer Inform 2020; 4:1-9. [PMID: 31951474 PMCID: PMC7000231 DOI: 10.1200/cci.19.00120] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The ubiquitous adoption of electronic health records (EHRs) with family health history (FHH) data provides opportunities for tailoring cancer screening strategies to individuals. We aimed to enable a standards-based clinical decision support (CDS) platform for identifying and managing patients who meet guidelines for genetic evaluation of hereditary cancer. METHODS The CDS platform (www.opencds.org) was used to implement algorithms based on the 2018 National Comprehensive Cancer Network guidelines for genetic evaluation of hereditary breast/ovarian and colorectal cancer. The platform was designed to be interfaced with different EHR systems via the Health Level Seven International Fast Healthcare Interoperability Resources standard. The platform was integrated with the Epic EHR and evaluated in a pilot study at an academic health care system. RESULTS The CDS platform was executed against a target population of 143,012 patients; 5,245 (3.7%) met criteria for genetic evaluation based on the FHH recorded in the EHR. In a clinical pilot study, genetic counselors attempted to reach out to 71 of the patients. Of those patients, 25 (35%) scheduled an appointment, 10 (14%) declined, 2 (3%) did not need genetic counseling, 7 (10%) said they would consider it in the future, and 27 (38%) were unreachable. To date, 13 (52%) of the scheduled patients completed visits, and 2 (15%) of those were found to have pathogenic variants in cancer predisposition genes. CONCLUSION A standards-based CDS platform integrated with EHR systems is a promising population-based approach to identify patients who are appropriate candidates for genetic evaluation of hereditary cancers.
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Affiliation(s)
- Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Richard L. Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Charlene R. Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Michael Flynn
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Rachel Hess
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Joshua D. Schiffman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Claude Nanjo
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
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45
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Wu YP, Boucher K, Hu N, Hay J, Kohlmann W, Aspinwall LG, Bowen DJ, Parsons BG, Nagelhout ES, Grossman D, Mooney K, Leachman SA, Tercyak KP. A pilot study of a telehealth family-focused melanoma preventive intervention for children with a family history of melanoma. Psychooncology 2020; 29:148-155. [PMID: 31520429 PMCID: PMC6980884 DOI: 10.1002/pon.5232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/23/2019] [Accepted: 09/11/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Melanoma preventive interventions for children with familial risk are critically needed because ultraviolet radiation (UVR) exposure and sunburn occurrence early in life are the primary modifiable risk factors for melanoma. The current study examined the feasibility and acceptability of a new, family-focused telehealth intervention for children with familial risk for melanoma and their parents. The study also explored changes in child sun protection and risk behaviors, sunburn occurrence, and objectively measured UVR exposure. METHODS This was a prospective study with a single-group design (n = 21 parent-child dyads, children ages 8-17). Dyads were asked to participate in three in-person assessments and three live video teleconference intervention sessions. RESULTS The intervention was feasibly delivered, and the intervention content was acceptable to parents and children. The intervention was associated with improvements in child use of certain sun protection strategies over time and declines in child UVR exposure. CONCLUSIONS A telehealth-delivered,family-focused melanoma preventive intervention was feasibly delivered and was acceptable to parent-child dyads. Future melanoma preventive interventions for this at-risk population could incorporate eHealth technologies to facilitate improvements in use of sun protection and monitoring of UVR exposure. This trial was registered with Clinicaltrials.gov, number NCT02846714.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kenneth Boucher
- Huntsman Cancer Institute, Salt Lake City, Utah
- Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Nan Hu
- Huntsman Cancer Institute, Salt Lake City, Utah
- Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jennifer Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, Utah
| | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | | | - Elizabeth S Nagelhout
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Douglas Grossman
- Department of Dermatology, University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kathi Mooney
- Huntsman Cancer Institute, Salt Lake City, Utah
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Sancy A Leachman
- Department of Dermatology & Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Kenneth P Tercyak
- Cancer Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C
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46
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Wu YP, Parsons BG, Mooney R, Aspinwall LG, Cloyes K, Hay JL, Kohlmann W, Grossman D, Leachman SA. Barriers and Facilitators to Melanoma Prevention and Control Behaviors Among At-Risk Children. J Community Health 2019; 43:993-1001. [PMID: 29623503 DOI: 10.1007/s10900-018-0516-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/24/2022]
Abstract
Melanoma prevention is essential for children who are at elevated risk for the disease due to family history. However, children who carry a familial risk for the disease do not optimally adhere to recommended melanoma preventive behaviors. The current study sought to identify perceived barriers to and facilitators of children's engagement in melanoma preventive behaviors among children at elevated risk for melanoma due to family history of the disease (i.e., having a parent with a history of melanoma) from both parents' and childrens' perspectives. Qualitative methods were employed and consisted of separate focus group discussions with children (ages 8-17 years, n = 37) and their parents (n = 39). Focus group transcripts were coded using content analysis. Parents and children reported a number of barriers and facilitators, including on the individual (e.g., knowledge and awareness, preferences), social (e.g., peer influences, family modeling and communication), and contextual (e.g., healthcare provider communication) levels. The identified categories of barriers and facilitators both confirm and extend the literature documenting the reasons children who are at elevated risk for melanoma do not engage in melanoma prevention and control behaviors. Programs aiming to decrease melanoma risk among children of melanoma survivors could help families address their barriers to preventive behavior implementation and build on facilitators. Melanoma survivors and their children could benefit from support on their interactions with healthcare providers, schools, peers, and other caregivers about melanoma prevention.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA. .,Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
| | - Bridget G Parsons
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Ryan Mooney
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Kristin Cloyes
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Douglas Grossman
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Sancy A Leachman
- Department of Dermatology & Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
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47
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Greenberg S, Buys SS, Edwards SL, Espinel W, Fraser A, Gammon A, Hafen B, Herget KA, Kohlmann W, Roundy C, Sweeney C. Population prevalence of individuals meeting criteria for hereditary breast and ovarian cancer testing. Cancer Med 2019; 8:6789-6798. [PMID: 31531966 PMCID: PMC6825998 DOI: 10.1002/cam4.2534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/11/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/21/2022] Open
Abstract
Background Personal cancer diagnosis and family cancer history factor into which individuals should undergo genetic testing for hereditary breast and ovarian cancer (HBOC) syndrome. Family history is often determined in the research setting through kindreds with disease clusters, or clinically from self‐report. The population prevalence of individuals with diagnostic characteristics and/or family cancer history meeting criteria for HBOC testing is unknown. Methods Utilizing Surveillance, Epidemiology, and End Results (SEER) cancer registry data and a research resource linking registry records to genealogies, the Utah Population Database, the population‐based prevalence of diagnostic and family history characteristics meeting National Comprehensive Cancer Network (NCCN) criteria for HBOC testing was objectively assessed. Results Among Utah residents with an incident breast cancer diagnosis 2010‐2015 and evaluable for family history, 21.6% met criteria for testing based on diagnostic characteristics, but the proportion increased to 62.9% when family history was evaluated. The proportion of cases meeting testing criteria at diagnosis was 94% for ovarian cancer, 23% for prostate cancer, and 51.1% for pancreatic cancer. Among an unaffected Utah population of approximately 1.7 million evaluable for family history, 197,601 or 11.6% met testing criteria based on family history. Conclusions This study quantifies the population‐based prevalence of HBOC criteria using objectively determined genealogy and cancer incidence data. Sporadic breast cancer likely represents a portion of the high prevalence of family cancer history seen in this study. These results underline the importance of establishing presence of a deleterious mutation in an affected family member, per NCCN guidelines, before testing unaffected relatives.
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Affiliation(s)
| | - Saundra S Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | | | - Whitney Espinel
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Alison Fraser
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Amanda Gammon
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Brent Hafen
- Intermountain Healthcare, Salt Lake City, Utah
| | | | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Carol Sweeney
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Utah Cancer Registry, University of Utah, Salt Lake City, Utah
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48
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Hendrickson P, Luo Y, Kohlmann W, Schiffman J, Lloyd S, Kokeny K, Hitchcock Y, Poppe M, Gaffney D, Tao R. No Significant Association between Radiation Therapy and Subsequent Malignancies in Patients with Li-Fraumeni Syndrome: A Multi-Institutional Hereditary Cancer Registry Study. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1183] [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: 11/13/2022]
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49
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Martin C, Leiser CL, O'Neil B, Gupta S, Lowrance WT, Kohlmann W, Greenberg S, Pathak P, Smith KR, Hanson HA. Familial Cancer Clustering in Urothelial Cancer: A Population-Based Case-Control Study. J Natl Cancer Inst 2019; 110:527-533. [PMID: 29228305 DOI: 10.1093/jnci/djx237] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/10/2017] [Indexed: 11/12/2022] Open
Abstract
Background Family history of bladder cancer confers an increased risk for concordant and discordant cancers in relatives. However, previous studies investigating this relationship lack any correction for smoking status of family members. We conducted a population-based study of cancer risks in relatives of bladder cancer patients and matched controls with exclusion of variant subtypes to improve the understanding of familial cancer clustering. Methods Case subjects with urothelial carcinoma were identified using the Utah Cancer Registry and matched 1:5 to cancer-free controls from the Utah Population Database. Cox regression was used to determine the risk of cancer in first-degree relatives, second-degree relatives, first cousins, and spouses. A total of 229 251 relatives of case subjects and 1 197 552 relatives of matched control subjects were analyzed. To correct for smoking status, we performed a secondary analysis excluding families with elevated rates of smoking-related cancers. All statistical tests were two-sided. Results First- and second-degree relatives of case subjects had an increased risk for any cancer diagnosis (hazard ratio [HR] = 1.06, 95% confidence interval [CI] = 1.03 to 1.09, P < .001; HR = 1.04, 95% CI = 1.02 to 1.07, P = .001) and urothelial cancer (HR = 1.73, 95% CI = 1.50 to 1.99, P < .001; HR = 1.35, 95% CI = 1.21 to 1.51, P < .001). Site-specific analysis found increased risk for bladder (HR = 1.69, 95% CI = 1.47 to 1.95, P < .001), kidney (HR = 1.30, 95% CI = 1.08 to 1.57, P = .006), cervical (HR = 1.25, 95% CI = 1.06 to 1.49, P = .01), and lung cancer (HR = 1.34, 95% CI = 1.19 to 1.51, P < .001) in first-degree relatives. Second-degree relatives had increased risk for bladder (HR = 1.35, 95% CI = 1.2 to 1.5, P < .001) and thyroid cancer (HR = 1.18, 95% CI = 1.03 to 1.35, P = .02). Spouses showed an increased risk for laryngeal (HR = 2.68, 95% CI = 1.02 to 7.05, P = .04) and cervical cancer (HR = 1.57, 95% CI = 1.13 to 2.17, P = .007). These results did not substantively change after correction for suspected smoking behaviors. Conclusion Our results suggest familial urothelial cancer clustering independent of smoking, with increased risk in relatives for both concordant and discordant cancers, suggesting shared genetic or environmental roots. Identifying families with statistically significant risks for non-smoking-related urothelial cancer would be extremely informative for genetic linkage studies.
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Affiliation(s)
- Christopher Martin
- Division of Urology, Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Claire L Leiser
- University of Utah, Salt Lake City, UT; Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Brock O'Neil
- Division of Urology, Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Sumati Gupta
- University of Utah, Salt Lake City, UT; Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - William T Lowrance
- Division of Urology, Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Wendy Kohlmann
- University of Utah, Salt Lake City, UT; Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Samantha Greenberg
- University of Utah, Salt Lake City, UT; Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT.,Division of Oncology, Department of Medicine, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Piyush Pathak
- Division of Urology, Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Ken R Smith
- Department of Family and Consumer Studies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT.,University of Utah, Salt Lake City, UT; Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Heidi A Hanson
- Division of Urology, Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT.,University of Utah, Salt Lake City, UT; Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
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50
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Michaeli O, Tabori U, Schiffman JD, Naumer A, Kohlmann W, Evans DG, Forde C, Hoffman LM, Rednam SP, Maxwell KN, Bornhorst M, O'Neill AF, Nichols K, Villani A, Slavin TP, Caspi S, Zelcer SM, Leary S, Stasi SM, Malkin D. Gliomas in the context of Li-Fraumeni syndrome: An international cohort. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1517 Background: Li-Fraumeni syndrome (LFS) is a cancer predisposition syndrome associated with germline mutation in the TP53 tumor suppressor gene. As a result of increased awareness and surveillance imaging, more asymptomatic low-grade brain lesions are being identified, raising important questions regarding the management of those patients. Sporadic low-grade gliomas (LGG) in the pediatric age rarely transform to malignant lesions, whereas the prognosis of high-grade gliomas (HGG) is grim in all age groups. Although HGG is a hallmark of LFS, little is known of the natural history of these lesions in this syndrome. Methods: For this multi-institutional retrospective study, anonymized clinicopathologic data from TP53 mutation carriers with gliomas were collected and analysed. Results: Our cohort included 61 patients, of whom 71% (n = 45) were children or young adults (age < 25 years). 39% of patients with known family history of cancer had a close relative with a brain tumor. Of 31 patients with low grade lesions at presentation, 83% (n = 26) were identified through surveillance. Five-year progression free survival (PFS) for these patients was 48%, though two patients progressed later. Furthermore, at 5 years 25% of these patients had biopsy proven malignant transformation to HGG. This “transformation free survival” rate did not plateau, as at 7 years 56% of patients transformed. When considering death from a brain tumor, the 5- and 10- year overall survival (OS) for the LGG group was 100% and 83%, respectively. Additional 3 patients succumbed to other LFS related malignancies. For the HGG group, consisting of 30 patients, the 5 year OS was 35% (median follow-up 19.5 months), comparing favorably with the sporadic HGG population as reported in the literature. Almost all of these patients presented with clinical symptoms. Notably, 12 (40%) of them had a prior malignancy. Conclusions: Our analysis suggests that the risk of transformation of LGG in the setting of LFS is high and warrants ongoing surveillance. Interestingly, there are a considerable number of long- term survivors in our HGG group, although the median follow up is still short. Further study to examine potential genotype- phenotype correlations in germline TP53 mutation carriers will inform strategies to identify those patients at highest risk of glioma progression.
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Affiliation(s)
| | - Uri Tabori
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Anne Naumer
- Department of Pediatric Hematology/Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | - Claire Forde
- Manchester Academic Health Sciences Centre, Central Manchester Universities Foundation Trust, St. Mary's Hospital, Manchester, United Kingdom
| | | | - Surya P Rednam
- Baylor College of Medicine, Texas Children's Cancer and Hematology Centers, Houston, TX
| | | | - Miriam Bornhorst
- Center for Genetic Medicine, Children's National Health System, Brain Tumor Institute, Children's National Health System, Washington, DC
| | | | - Kim Nichols
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Shani Caspi
- 11 Department of Pediatric Hematology-Oncology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | | | | | - Shannon M Stasi
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA
| | - David Malkin
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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