Clinical Management Recommendations for Surveillance and Risk-Reduction Strategies for Hereditary Breast and Ovarian Cancer Among Individuals Carrying a Deleterious BRCA1 or BRCA2 Mutation

2007 ◽  
Vol 29 (1) ◽  
pp. 45-60 ◽  
Author(s):  
Doug Horsman ◽  
Brenda J. Wilson ◽  
Denise Avard ◽  
Wendy S. Meschino ◽  
Charmaine Kim Sing ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Risk Reduction ◽  
Clinical Management ◽  
Brca2 Mutation ◽  
Breast And Ovarian Cancer ◽  
Reduction Strategies ◽  
Management Recommendations ◽  
Risk Reduction Strategies

scholarly journals Preferences for breast cancer prevention among women with a BRCA1 or BRCA2 mutation

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Carol A. Mansfield ◽  
◽  
Kelly A. Metcalfe ◽  
Carrie Snyder ◽  
Geoffrey J. Lindeman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Risk Reduction ◽  
Online Survey ◽  
Brca2 Mutation ◽  
Bilateral Mastectomy ◽  
Reduction Strategies ◽  
Risk Reduction Strategies ◽  
Cancer Risk Reduction

Abstract Background Women with a BRCA1 or BRCA2 mutation have high lifetime risks of developing breast and ovarian cancer. The decision to embark on risk reduction strategies is a difficult and personal one. We surveyed an international group of women with BRCA mutations and measured choices and sequence of breast cancer risk reduction strategies. Methods Women with a BRCA1/2 mutation and no previous cancer diagnosis were recruited from the US, Canada, the UK, Australia, and from a national advocacy group. Using an online survey, we asked about cancer-risk reduction preferences including for one of two hypothetical medicines, randomly assigned, and women’s recommendations for a hypothetical woman (Susan, either a 25- or 36-year-old). Sunburst diagrams were generated to illustrate hierarchy of choices. Results Among 598 respondents, mean age was 40.9 years (range 25–55 years). Timing of the survey was 4.8 years (mean) after learning their positive test result and 33% had risk-reducing bilateral salpingo-oophorectomy (RRBSO) and bilateral mastectomy (RRBM), while 19% had RRBSO only and 16% had RRBM only. Although 30% said they would take a hypothetical medicine, 6% reported taking a medicine resembling tamoxifen. Respondents were 1.5 times more likely to select a hypothetical medicine for risk reduction when Susan was 25 than when Susan was 36. Women assigned to 36-year-old Susan were more likely to choose a medicine if they had a family member diagnosed with breast cancer and personal experience taking tamoxifen. Conclusions Women revealed a willingness to undergo surgeries to achieve largest reduction in breast cancer risk, although this would not be recommended for a younger woman in her 20s. The goal of achieving the highest degree of cancer risk reduction is the primary driver for women with BRCA1 or BRCA2 mutations in selecting an intervention and a sequence of interventions, regardless of whether it is non-surgical or surgical.

Management of high, moderate, and low penetrance ovarian cancer susceptibility mutations: an assessment of current risk reduction practices

2020 ◽  
Vol 30 (10) ◽  
pp. 1583-1588
Author(s):  
Catherine H. Watson ◽  
Lindsay Soo ◽  
Brittany A. Davidson ◽  
Laura J. Havrilesky ◽  
Paula S. Lee ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Postmenopausal Woman ◽  
Risk Reduction ◽  
Premenopausal Woman ◽  
Cancer Susceptibility ◽  
Gynecologic Oncology ◽  
Reduction Strategies ◽  
Risk Reduction Strategies ◽  
Risk Reducing ◽  
Current Risk

ObjectiveLimited information exists regarding risk reduction strategies for women with moderate and low penetrance ovarian cancer susceptibility mutations. We sought to assess current risk reduction practice patterns for carriers of these mutations through a survey of members of the Society of Gynecologic Oncology.MethodsSociety of Gynecologic Oncology members were emailed a survey consisting of two vignettes: (1) a 35-year-old premenopausal woman; (2) a 55-year-old postmenopausal woman with comorbidities. Each vignette contained sub-scenarios in which the patient had either a BRCA1 (relative risk (RR)=30–60), RAD51C (RR=5.0), or ATM (RR=1.5–2.0) mutation. Respondents were queried about their preferred management approach. Summary statistics were performed to describe results of the survey. We used χ2 testing for statistical analyses, comparing results according to mutation type and demographic information.ResultsA total of 193 (15%) of 1284 Society of Gynecologic Oncology members responded. For the premenopausal woman, 99%, 80%, and 40% would perform a risk reducing salpingo-oophorectomy prior to menopause in the setting of a BRCA1, RAD51C, and ATM mutation, respectively. For the postmenopausal woman, 98%, 85%, and 42% would proceed with risk reducing salpingo-oophorectomy in the setting of a BRCA1, RAD51C, and ATM mutation, respectively. Response distribution for carriers of RAD51C and ATM mutations were different from BRCA1 in both vignettes (p<0.001).ConclusionsRespondents were more likely to perform risk reducing salpingo-oophorectomy, in the setting of a BRCA1, RAD51C, and ATM mutation, earlier and more frequently in the setting of a BRCA1 mutation. However, there was a lack of consensus about management of the moderate and low penetrance mutations, suggesting that more data regarding age specific risks and appropriate risk reduction strategies for these alterations are needed.

Management of high, moderate, and low penetrance ovarian cancer susceptibility gene mutations: An assessment of current practice patterns.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1536-1536
Author(s):  
Catherine H. Watson ◽  
Brittany Anne Davidson ◽  
Laura Jean Havrilesky ◽  
Paula S. Lee ◽  
Leah McNally ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Postmenopausal Woman ◽  
Risk Reduction ◽  
Premenopausal Woman ◽  
Current Practice ◽  
Practice Patterns ◽  
Management Approach ◽  
Limited Information ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

1536 Background: Limited information exists regarding appropriate risk-reduction strategies for women with moderate and low penetrance ovarian cancer (OVCA) susceptibility mutations. We sought to assess current practice patterns for women with these genetic changes through a survey of members of the Society of Gynecologic Oncology (SGO). Methods: All full SGO members were e-mailed a survey consisting of two vignettes: 1) a 35-year-old premenopausal woman who desires pregnancy; 2) a 55-year-old postmenopausal woman with multiple comorbidities. Each vignette contained sub-scenarios in which the patient had either a BRCA1 (RR = 30-60), RAD51C (RR = 5.0) or ATM (RR 1.5-2.0) OVCA susceptibility mutation. Respondents were queried about their preferred management approach. Chi-square test was used for statistical analysis. Results: 193 (15%) of 1284 SGO members responded. 58% were in academic practice. For the premenopausal woman, 52%, 13% and 6% would perform an RRSO prior to age 40 in the setting of a BRCA1, RAD51C and ATM mutation respectively. 47%, 68% and 9% would perform RRSO at 40-50; and 0%, 9% and 23% would perform RRSO at menopause, depending on the gene mutated. For the postmenopausal woman with comorbidities, 98%, 85% and 42% would proceed with RRSO in the setting of a BRCA1, RAD51C and ATM mutation respectively; 2%, 8% and 39% would observe (with/without screening); and 0%, 7% and 19% would do further research prior to proceeding. Distribution of responses for carriers of RAD51C and ATM mutations were different from BRCA1 in both vignettes [p < 0.001]. Conclusions: Respondents were more likely to perform RRSO earlier and more frequently in the setting of a BRCA1 mutation compared to either a RAD51C or ATM mutation. However, there was lack of consensus in management of the moderate and low penetrance OVCA susceptibility mutations. These patterns likely reflect the limited information available regarding the timing and magnitude of risk associated with these genes. Given the immediate and long-term morbidity of oophorectomy, more data regarding age-specific risks and appropriate risk-reduction strategies for moderate and low penetrance OVCA susceptibility mutations is needed.

scholarly journals Hazards of Risk: Identifying Plausible Community Wildfire Disasters in Low-Frequency Fire Regimes

Forests ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 934
Author(s):  
Andy McEvoy ◽  
Becky K. Kerns ◽  
John B. Kim
Keyword(s):  
Risk Reduction ◽  
Low Frequency ◽  
Fire Regimes ◽  
Cascade Range ◽  
Private Land ◽  
Wildfire Risk ◽  
Location Data ◽  
Reduction Strategies ◽  
Community Exposure ◽  
Risk Reduction Strategies

Optimized wildfire risk reduction strategies are generally not resilient in the event of unanticipated, or very rare events, presenting a hazard in risk assessments which otherwise rely on actuarial, mean-based statistics to characterize risk. This hazard of actuarial approaches to wildfire risk is perhaps particularly evident for infrequent fire regimes such as those in the temperate forests west of the Cascade Range crest in Oregon and Washington, USA (“Westside”), where fire return intervals often exceed 200 years but where fires can be extremely intense and devastating. In this study, we used wildfire simulations and building location data to evaluate community wildfire exposure and identify plausible disasters that are not based on typical mean-based statistical approaches. We compared the location and magnitude of simulated disasters to historical disasters (1984–2020) in order to characterize plausible surprises which could inform future wildfire risk reduction planning. Results indicate that nearly half of communities are vulnerable to a future disaster, that the magnitude of plausible disasters exceeds any recent historical events, and that ignitions on private land are most likely to result in very high community exposure. Our methods, in combination with more typical actuarial characterizations, provide a way to support investment in and communication with communities exposed to low-probability, high-consequence wildfires.

Prevention of Breast Cancer (Part II): Risk Reduction Strategies

2010 ◽  
Vol 28 (10) ◽  
pp. 1070-1077 ◽  
Author(s):  
Maria Tria Tirona ◽  
Rajesh Sehgal ◽  
Oscar Ballester
Keyword(s):  
Breast Cancer ◽  
Risk Reduction ◽  
Reduction Strategies ◽  
Risk Reduction Strategies ◽  
Prevention Of Breast Cancer

Impact of the New York State Prescription Drug Monitoring Program (IStop) on chronic pain management by primary care providers

2021 ◽  
Vol 17 (1) ◽  
pp. 39-54
Author(s):  
Josiah D. Strawser, MD ◽  
Lauren Block, MD, MPH
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Risk Reduction ◽  
New York State ◽  
Monitoring Program ◽  
Primary Care Providers ◽  
Care Providers ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Objective: To explore the impact of the New York State Prescription Drug Monitoring Program (IStop) on the self-reported management of patients with chronic pain by primary care providers.Design: Mixed-methods study with survey collection and semistructured interviews.Setting: Multiple academic hospitals in New York.Participants: One hundred and thirty-six primary care providers (residents, fellows, attendings, and nurse practitioners) for survey collection, and eight primary care clinicians (residents, attending, and pharmacist) for interviews. Interventions: Introduction of IStop.Main outcome measure(s): Change in usage of four risk reduction strategies (pain contracts, urine tests, monthly visits, and co-management) as reported by primary care providers for patients with chronic pain.Results: After the introduction of IStop, 25 percent (32/128) of providers increased usage of monthly visits, 28 percent (36/128) of providers increased usage of pain management co-management with other healthcare providers, and 46 percent (60/129) of providers increased usage of at least one of four risk reduction strategies. Residents indicated much higher rates of change in risk reduction strategies due to IStop usage; increasing in the use of monthly visits (32 vs. 13 percent, p = 0.02) and co-management (36 vs. 13 percent, p = 0.01) occurred at a much higher rate in residents than attending physicians. Interview themes revealed an emphasis on finding opioid alternatives when possible, the need for frequent patient visits in effective pain management, and the importance of communication between the patient and provider to protect the relationship in chronic pain management.Conclusions: After the introduction of IStop, primary care providers have increased usage of risk reduction strategies in the care of chronic pain patients.

scholarly journals Evaluation of flood risk reduction strategies through combinations of interventions

2018 ◽  
Vol 12 (S2) ◽  
Author(s):  
Erik C. Berchum ◽  
William Mobley ◽  
Sebastiaan N. Jonkman ◽  
Jos S. Timmermans ◽  
Jan H. Kwakkel ◽  
...  
Keyword(s):  
Risk Reduction ◽  
Flood Risk ◽  
Reduction Strategies ◽  
Flood Risk Reduction ◽  
Risk Reduction Strategies

scholarly journals Inadequate stakeholder management and its effect on a coherent sinkhole risk management strategy: The case of the Merafong Local Municipality, South Africa

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Tshepo Moshodi ◽  
Christo Coetzee ◽  
Kristel Fourie
Keyword(s):  
Risk Management ◽  
Risk Reduction ◽  
Community Involvement ◽  
Stakeholder Management ◽  
Current Status ◽  
Community Stakeholders ◽  
Management Processes ◽  
Reduction Strategies ◽  
Local Municipality ◽  
Risk Reduction Strategies

The Merafong Local Municipality (MLM) has historically suffered financial and human losses because of the presence of dolomite and the consequent formation of sinkholes. There is a great need for the MLM to address the risk posed by sinkholes to ensure the continued safety of communities. However, as the risk is so pervasive, the MLM needs to coordinate their risk reduction strategies with a wide array of stakeholders in the municipality. Efficient stakeholder management is thus crucial if the sinkhole risk is to be addressed appropriately. This article reviews the current status of stakeholder management in the MLM as it pertains to the formulation of a holistic sinkhole risk reduction strategy. Findings indicate that there are serious deficiencies in the MLM’s stakeholder management relating to key risk management processes such as community involvement in risk management structures, disaster risk assessment, training and awareness, and early warning and response. Improved stakeholder management could be characterised by the following factors: improved two-way communication between the municipality and community stakeholders, fostering a relationship based upon trust and equality amongst stakeholders, participation by a wide array of stakeholder groups affected by the sinkhole risk and a mutual commitment by all stakeholders to address the risk. These factors could contribute to enhancing current and future sinkhole risk reduction strategies.

Sign in / Sign up

Export Citation Format

Share Document