scholarly journals Systematic review of the empirical investigation of resources to support decision-making regarding BRCA1 and BRCA2 genetic testing in women with breast cancer

2018 ◽  
Vol 101 (5) ◽  
pp. 779-788 ◽  
Author(s):  
Chloe Grimmett ◽  
Karen Pickett ◽  
Jonathan Shepherd ◽  
Karen Welch ◽  
Alejandra Recio-Saucedo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Decision Making ◽  
Genetic Testing ◽  
Empirical Investigation ◽  
Brca1 And Brca2 ◽  
Support Decision Making

scholarly journals Personalized Decision Making on Genomic Testing in Early Breast Cancer: Expanding the MINDACT Trial with Decision-Analytic Modeling

2021 ◽  
pp. 0272989X2199117
Author(s):  
Ewout W. Steyerberg ◽  
Liesbeth C. de Wreede ◽  
David van Klaveren ◽  
Patrick M. M. Bossuyt
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Genetic Testing ◽  
Early Stage ◽  
Pragmatic Trial ◽  
Genomic Signature ◽  
Genomic Testing ◽  
Analytic Modeling ◽  
Clinical Risk ◽  
Genomic Test

Background Genomic tests may improve upon clinical risk estimation with traditional prognostic factors. We aimed to explore how evidence on the prognostic strength of a genomic signature (clinical validity) can contribute to individualized decision making on starting chemotherapy for women with breast cancer (clinical utility). Methods The MINDACT trial was a randomized trial that enrolled 6693 women with early-stage breast cancer. A 70-gene signature (Mammaprint) was used to estimate genomic risk, and clinical risk was estimated by a dichotomized version of the Adjuvant!Online risk calculator. Women with discordant risk results were randomized to the use of chemotherapy. We simulated the full risk distribution of these women and estimated individual benefit, assuming a constant relative effect of chemotherapy. Results The trial showed a prognostic effect of the genomic signature (adjusted hazard ratio 2.4). A decision-analytic modeling approach identified far fewer women as candidates for genetic testing (4% rather than 50%) and fewer benefiting from chemotherapy (3% rather than 27%) as compared with the MINDACT trial report. The selection of women benefitting from genetic testing and chemotherapy depended strongly on the required benefit from treatment and the assumed therapeutic effect of chemotherapy. Conclusions A high-quality pragmatic trial was insufficient to directly inform clinical practice on the utility of a genomic test for individual women. The indication for genomic testing may be far more limited than suggested by the MINDACT trial.

scholarly journals Cost of diseases in Brazil: breast cancer, enteritis, cardiac valve disease and bronchopneumonia

1995 ◽  
Vol 29 (5) ◽  
pp. 349-354 ◽  
Author(s):  
Armando Arredondo ◽  
Lejeune Y. Lockett ◽  
Esteban de Icaza
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cost Analysis ◽  
Economic Cost ◽  
Cardiac Valve ◽  
Valve Disease ◽  
Use Of Resources ◽  
Economic Cost Analysis ◽  
Cardiac Valve Disease ◽  
Support Decision Making

The results from the need to develop methodologies for performing cost analysis in developing countries, principally in the region of Latin America, were studied. It, furthermore, serves to generate knowledge from an economic evaluation in order to support decision-making related to the organization of health systems, particularly in the efficient use of resources which are allocated for the provision of medical services. Two chronic diseases (breast cancer and cardiac valve disease) and two infections (enteritis and bronchopneumonia) were selected for the study. The results recommend the use of a valid methodology for economic cost analysis of any disease to be studied and the use of this information in the decision-making process.

Facilitating decision-making in women undergoing genetic testing for hereditary breast cancer: BRECONDA randomized controlled trial results

The Breast ◽  
2017 ◽  
Vol 36 ◽  
pp. 79-85 ◽  
Author(s):  
Kerry A. Sherman ◽  
Christopher J. Kilby ◽  
Laura-Kate Shaw ◽  
Caleb Winch ◽  
Judy Kirk ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Randomized Controlled Trial ◽  
Genetic Testing ◽  
Hereditary Breast Cancer ◽  
Controlled Trial ◽  
Randomized Controlled

scholarly journals Clinical Decision Support Systems in Breast Cancer: A Systematic Review

Cancers ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 369 ◽  
Author(s):  
Claudia Mazo ◽  
Cathriona Kearns ◽  
Catherine Mooney ◽  
William M. Gallagher
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Decision Making ◽  
Decision Support ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Support Systems ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Major Advance

Breast cancer is the most frequently diagnosed cancer in women, with more than 2.1 million new diagnoses worldwide every year. Personalised treatment is critical to optimising outcomes for patients with breast cancer. A major advance in medical practice is the incorporation of Clinical Decision Support Systems (CDSSs) to assist and support healthcare staff in clinical decision-making, thus improving the quality of decisions and overall patient care whilst minimising costs. The usage and availability of CDSSs in breast cancer care in healthcare settings is increasing. However, there may be differences in how particular CDSSs are developed, the information they include, the decisions they recommend, and how they are used in practice. This systematic review examines various CDSSs to determine their availability, intended use, medical characteristics, and expected outputs concerning breast cancer therapeutic decisions, an area that is known to have varying degrees of subjectivity in clinical practice. Utilising the methodology of Kitchenham and Charter, a systematic search of the literature was performed in Springer, Science Direct, Google Scholar, PubMed, ACM, IEEE, and Scopus. An overview of CDSS which supports decision-making in breast cancer treatment is provided along with a critical appraisal of their benefits, limitations, and opportunities for improvement.

scholarly journals Immunohistochemistry for the detection of BRCA1 and BRCA2 proteins in patients with ovarian cancer: a systematic review

2019 ◽  
Vol 73 (4) ◽  
pp. 191-196 ◽  
Author(s):  
Lorena Alves Teixeira ◽  
Francisco Jose Candido dos Reis
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Ovarian Cancer ◽  
Cancer Type ◽  
Loss Of Function ◽  
Brca1 And Brca2 ◽  
Brca1 Protein ◽  
Current Usage ◽  
Breast Cancer Type

BackgroundLoss of function in either breast cancer type 1 susceptibility protein (BRCA1) or breast cancer type 2 susceptibility protein (BRCA2) is a major risk factor for epithelial ovarian cancer (EOC) development. BRCA1 or BRCA2 deficiencies are associated with short-term prognosis and might have importance for the treatment of women with the disease. However, the screening of all possible mechanisms of dysfunction is expensive, time-consuming and difficult to apply in clinical practice. On the other hand, immunohistochemistry (IHC) is a simple and reliable method to access the expression of several proteins in tumour tissues.Materials and methodsThis systematic review aims to evaluate the current usage of IHC to detect BRCA1 and BRCA2 deficiencies in EOC. We searched and evaluated all primary literature on the use of IHC for evaluating BRCA1 and BRCA2 proteins expression in EOC. The main concepts for the search were: ovarian neoplasms, IHC, BRCA1 and BRCA2.ResultsForty-four studies from 925 unique titles were included. A total of 4206 tumour samples were evaluated for BRCA1 and 1041 for BRCA2 expression. Twelve BRCA1 primary antibodies were used in 41 studies, and the most common was the MS110 clone (75.6%). Seven BRCA2 primary antibodies were used in ten studies. Using the cut-off of 10%, 47.0% of EOCs are associated with loss of BRCA1 and 34.5% with the loss of BRCA2 expression.ConclusionIHC was effective to detect loss of BRCA1 protein expression in EOC; however, data on BRCA2 expression were heterogeneous and difficult to interpret.

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