Preventive surgery after multiplex genetic panel testing (MGPT).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1525-1525 ◽  
Author(s):  
Gregory Idos ◽  
Allison W. Kurian ◽  
Charité Ricker ◽  
Duveen Sturgeon ◽  
Julie Culver ◽  
...  
Keyword(s):  
Pathogenic Variant ◽  
Personal History ◽  
Prophylactic Surgery ◽  
Cancer History ◽  
Variant Of Uncertain Significance ◽  
Negative Results ◽  
Panel Testing ◽  
Preventive Surgery ◽  
History Of ◽  
History Of Cancer

1525 Background: Guidelines recommend consideration of prophylactic surgery for patients with a germline pathogenic variant in some cancer predisposition genes. We assessed surgery utilization in a prospective, multi-institutional cohort study of MGPT. Methods: 2000 patients had MGPT and completed questionnaires at 3, 6, and 12 months. Patients reported surgical utilization and indication (treatment or prevention). Surgery utilization was assessed according to cancer history and MGPT test results: Positive, pathogenic variant; VUS, variant of uncertain significance; Negative, benign variants. Results: Overall, 12.9% (198/1537) of patients reported surgery after MGPT (median follow-up 13 months). Only 31.3% (62/198) of patients specified that their surgery was preventive. Preventive surgery utilization was significantly higher among patients who tested positive (n=30, 14.9%) compared to those testing negative (n=20, 2.3%, p<0.001) or VUS (n=12, 2.2%, p<0.001). Preventive surgery was very low among patients testing negative or VUS who had no personal history of cancer in the relevant organ (Table). For example, mastectomy was not reported among any patients testing negative or VUS who had no personal history of breast cancer (Table). Conclusions: More than one year after MGPT, prophylactic surgery use was low among patients with VUS or negative results, especially among those with no personal history of cancer at the relevant site. Surgery utilization. [Table: see text]

Follow-up decisions and care after BRCA testing.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 52-52
Author(s):  
Hadeel Assad ◽  
Maliha Naseer ◽  
Samira Ahsan
Keyword(s):  
Hormonal Therapy ◽  
Deleterious Mutation ◽  
Brca Mutation ◽  
Family Members ◽  
Personal History ◽  
Prophylactic Surgery ◽  
Brca Testing ◽  
History Of ◽  
Risk Reducing ◽  
History Of Cancer

52 Background: Women with a deleterious mutation in BRCA 1/2 genes have an increased lifetime risk of developing breast and ovarian cancer. A spectrum of risk reducing and early detection strategies exist including clinical and radiographic surveillance, hormonal therapy, and prophylactic surgery. Methods: We studied the pattern of clinicopreventive inclination among patients undergoing BRCA testing in our genetics center via a telephone based questionnaire. Differences in sociodemographic and clinical characteristics were identified using independent sample t-test and Fisher exact test. Results: A total of 320 individuals were seen at the genetics center between October 2007 and February 2013. Twenty-nine were eligible of which 25 agreed to participate; 20 were found to be BRCA positive and 5 were true negatives. Most participants (> 75%) informed family members they were undergoing BRCA testing and all women shared the result of their deleterious mutation. An average of 2.2 (SD: 1.28) subsequent family members were tested which led to the discovery of 1.33 (SD: 1.15) new deleterious BRCA mutation carriers. Of the 20 BRCA positive patients, 13 opted for prophylactic surgery of which 5 underwent prophylactic oophorectomy (PO), 4 had prophylactic mastectomy (PM), and another 4 combined PO with PM. The remaining chose increased surveillance. Hormonal therapy was used as a preventive program in 6 women, 4 combined it with prophylactic surgery. Data subanalysis revealed BRCA carriers who opted for prophylactic surgery were more likely to be white (> 75%), younger, multiparous, live in Detroit suburbs, and have a personal history of cancer (92% versus 83%, respectively). Screening and surveillance practices were variable in timing and modality. Conclusions: 65 % of women with deleterious BRCA mutation underwent prophylactic surgery as their cancer risk reducing method. Decisions regarding adopting least to most aggressive measures remain highly influenced by personal history of cancer as well as individual socioeconomic characteristics. Understanding factors that affect women’s decisions to adopt various risk reduction strategies will aid both mutation carriers and clinicians to decide on optimal management.

Uptake of oophorectomy in women with findings on multigene panel testing: Results from the Prospective Registry of Multiplex Testing (PROMPT).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1508-1508 ◽  
Author(s):  
Susan M. Domchek ◽  
Jamie Brower ◽  
Heather Symecko ◽  
Vanessa Marcell ◽  
Michael Francis Walsh ◽  
...  
Keyword(s):  
Cancer Susceptibility ◽  
Personal History ◽  
Variant Of Uncertain Significance ◽  
Panel Testing ◽  
Pathogenic Variants ◽  
Increased Risk ◽  
History Of ◽  
Multigene Panel Testing ◽  
Multiplex Testing ◽  
Multigene Panel

1508 Background: With the expansion of multigene panel testing for cancer susceptibility, increasing numbers of patients are identified with pathogenic/likely pathogenic variants (P/LP V) in genes which do not have a clearly actionable increased risk of ovarian cancer (OC) (lifetime risk of OC >5%). However, there is concern that patients and/or providers may ascribe OC risk to such genetic findings with the potential for unnecessary oophorectomy (ooph). Methods: The Prospective Registry of Multiplex Testing (PROMPT) is an online registry for individuals with a genetic alteration detected on multiplex panel testing for cancer susceptibility. Participants self-enroll and complete baseline and annual follow-up questionnaires. PROMPT has enrolled 7388 participants (6936; 93.9% women) since September 2014. Results: 1566 women in the PROMPT registry reported ooph, the indications for which were reported as either cancer treatment (n=481, 30.7%) or benign disease (n=432, 27.6%). An additional 186 (12.8%) reported PV in genes associated with lifetime OC risk >5% ( BRCA1, BRCA2, RAD51C, RAD51D, BRIP, or Lynch syndrome genes). The remaining 467 did not have guideline based indications for ooph due to OC risk and are described further here. 92 (19.7%) had a variant of uncertain significance (VUS) in genes associated with OC, 241 (51.6%) had a personal history of breast cancer (BC) and no VUS in OC genes, and 119 (25.5%) had no personal history of BC and no VUS in OC genes. The majority of women had no family history (FH) of OC in first or second degree relatives (Table). Most ooph occurred prior to age 50. Of the 405 women with CHEK2 P/LP, 11.4% reported ooph (59% under age 50 when age known), as did 13.2% (of 228) with CHEK2 VUS, 8.8% (of 261) with ATM P/LP (66.7% under age 50), and 8.3% (of 387) with ATM VUS. In addition, of the 184 women with PALB2 P/LP, 14.1% reported ooph (35.3% under age 50) as did 11.6% (of 198) with PALB2 VUS. Of those who reported provider discussions, 47.2% stated “my provider recommended this” (including >60% in the OC gene VUS group) and an additional 25.2% stated “my provider presented this as an option, but not a requirement”. In those with no FH of OC, 45.8% stated that their provider recommended ooph. Conclusions: 10-15% of women with PV/VUS in genes not associated with a high risk of OC reported ooph without a clear indication. [Table: see text]

Accuracy of Self-Reported Personal History of Cancer in an Outpatient Breast Center

2007 ◽  
Vol 16 (3) ◽  
pp. 341-345 ◽  
Author(s):  
Francisco J. Dominguez ◽  
Christine Lawrence ◽  
Elkan F. Halpern ◽  
Brian Drohan ◽  
Georges Grinstein ◽  
...  
Keyword(s):  
Personal History ◽  
Breast Center ◽  
History Of ◽  
History Of Cancer

scholarly journals COGNITIVE FUNCTIONING AMONG BREAST CANCER SURVIVORS AND NON-CANCER PARTICIPANTS: EVIDENCE FOR SIMILARITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S649-S650
Author(s):  
Giancarlo Pasquini ◽  
Brent J Small ◽  
Jacqueline Mogle ◽  
Martin Sliwinski ◽  
Stacey B Scott
Keyword(s):  
Breast Cancer ◽  
Working Memory ◽  
Executive Functioning ◽  
Cancer Survivors ◽  
Cognitive Functioning ◽  
Processing Speed ◽  
Breast Cancer Survivors ◽  
Cancer History ◽  
History Of ◽  
History Of Cancer

Abstract Breast cancer survivors may experience accelerated decline in cognitive functioning compared to same-aged peers with no cancer history (Small et al., 2015). Survivors may show important differences in mean-level performance or variability in cognitive functioning compared to those without a history of cancer (Yao et al., 2016). This study compared ambulatory cognitive functioning in a sample of breast cancer survivors and an age-matched community sample without a history of cancer (n_cancer=47, n_non-cancer=105, age range: 40-64 years, M=52.13 years). Participants completed three cognitive tasks measuring working memory, executive functioning, and processing speed up to five times per day for 14 days. Results indicated no mean-level differences in cognitive performance on the three tasks between cancer survivors and those without cancer history (p’s&gt;.05). Unexpectedly, women without cancer history showed more variability than survivors on working memory but not on the other two tasks. Across both groups, those without a college education performed worse on executive functioning (B=-0.05, SE=0.03, p&lt;.05) and working memory (B=0.94, SE=0.36, p&lt;.05) compared to those that completed college. Additionally, older age was associated with slower processing speed (B=31.67, SE=7.44, p&lt;.001). In sum, this study did not find mean-level group differences in cognitive functioning between cancer survivors and age-matched women without a history of cancer. Contrary to hypotheses, those without a history of cancer were more variable on working memory. Results suggested similarities in cognitive functioning in the two samples and that education and age are important predictors of cognitive functioning independent of cancer history.

scholarly journals Family history of cancer, personal history of medical conditions and risk of oral cavity cancer in France: the ICARE study

BMC Cancer ◽  
2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Loredana Radoï ◽  
Sophie Paget-Bailly ◽  
Florence Guida ◽  
Diane Cyr ◽  
Gwenn Menvielle ◽  
...  
Keyword(s):  
Family History ◽  
Oral Cavity ◽  
Oral Cavity Cancer ◽  
Personal History ◽  
Medical Conditions ◽  
Family History Of Cancer ◽  
History Of ◽  
History Of Cancer

Major Bleeding Events Among Cancer and Non-Cancer Patients Taking Rivaroxaban for Venous Thromboembolism Treatment in a Department of Defense Health System Cohort

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1447-1447 ◽  
Author(s):  
Alok A. Khorana ◽  
Frank Peacock ◽  
Sally G Tamayo ◽  
Zhong Yuan ◽  
Nicholas Sicignano ◽  
...  
Keyword(s):  
Research And Development ◽  
Cancer Patients ◽  
Department Of Defense ◽  
Research Funding ◽  
Cancer Site ◽  
United States Department ◽  
Cancer History ◽  
History Of ◽  
History Of Cancer ◽  
Active Cancer

Abstract Background: Cancer patients are at increased risk of both venous thromboembolism (VTE) and bleeding, but real world bleeding rates with contemporary anticoagulants are not known. Purpose: To describe the incidence of major bleeding (MB) in VTE patients treated with rivaroxaban, and to compare differences in MB incidence and characteristics among patients with active cancer, history of cancer, and no current or past cancer. Methods: We queried over 10 million electronic medical records (EMRs) from the United States Department of Defense healthcare system from November 2, 2012 to September 30, 2015 to identify MB events in VTE patients treated with rivaroxaban. The Cunningham algorithm was used for identifying MB, and VTE was determined by diagnosis codes. Presence of cancer was assessed from 5 years prior to index rivaroxaban exposure through end of study, and categorized by active cancer, history of cancer, and no cancer. Active cancer was defined by one of the following: 1) a metastatic diagnosis code within 6 months prior to or overlapping with rivaroxaban exposure, 2) chemotherapy and/or radiation codes within 6 months prior to rivaroxaban exposure, 3) cancer-related surgery overlapping with rivaroxaban exposure, or 4) leukemia and/or indolent lymphoma codes at any point within the entire assessment window. History of cancer was defined as the presence of any cancer diagnosis within the 5-year baseline period not meeting the definition of active cancer. Patients with active cancer or history of cancer were further categorized by cancer site/type. Incidence, outcomes, demographics, and bleeding risk scores were evaluated by cancer status. A Cox proportional hazard model was used to assess the association between cancer status and rate of MB adjusting for baseline characteristics. Results: The study population comprised 9,638 VTE patients on rivaroxaban, including 1,728 (17.9%) with active cancer, 1,548 (16.1%) with history of cancer and 6,362 (66.0%) with no cancer. Of these, 130 (1.3%) experienced MB. After stratifying by cancer status, MB occurred at a rate of 2.61 (95% CI 1.80-3.78) per 100 person-years in those with active cancer, 3.18 (95% CI 2.17-4.67) per 100 person-years in those with history of cancer, and 2.25 (95% CI 1.80-2.81) per 100 person-years in those with no cancer. No significant difference in the incidence of MB was found between those with cancer (active or history) and those without cancer (HR 1.01; 95% CI 0.70-1.47, p-value 0.94) after adjusting for age, sex, and baseline comorbidities. Neither history of cancer nor active cancer when independently compared to no cancer was significantly associated with MB after multivariate adjustment. MB rates varied notably by cancer site. Additional key findings are presented in Table 1. Conclusion: In this large United States Department of Defense cohort study of rivaroxaban users treated for VTE, incidence of MB is relatively low and not significantly different between cancer and non-cancer patients. Fatal outcomes associated with bleeding hospitalization were also uncommon across all the cancer groups. These data should provide assurance to oncology providers regarding the safety of rivaroxaban use in the real-world setting. Disclosures Khorana: Pfizer: Consultancy, Honoraria; Amgen: Consultancy, Honoraria, Research Funding; Leo: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria; Bayer: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Halozyme: Consultancy, Honoraria; Janssen Scientific Affairs, LLC: Consultancy, Honoraria, Research Funding. Peacock:Phillips: Consultancy; Comprehensive Research Associates LLC: Equity Ownership; Pfizer: Research Funding; Banyan: Research Funding; Cardiorentis: Consultancy, Research Funding; Portola: Consultancy, Research Funding; Abbott: Research Funding; Emergencies in Medicine LLC: Equity Ownership; Ischemia Care: Consultancy; Janssen: Consultancy, Research Funding; Alere: Consultancy, Research Funding; Roche: Research Funding; The Medicine's Company: Consultancy, Research Funding; ZS Pharma: Consultancy, Research Funding; Prevencio: Consultancy. Yuan:Janssen Research and Development: Employment; Johnson & Johnson: Other: Mr. Yuan owns stocks in Johnson & Johnson.. Sicignano:Janssen Research and Development: Other: NMS is an employee of Health ResearchTx LLC, which has a business relationship with Janssen.. Hopf:Janssen Research and Development: Other: KPH is an independent contractor for Health ResearchTx LLC, which has a business relationship with Janssen . Patel:National Heart Lung and Blood Institute: Research Funding; Janssen: Consultancy; Bayer: Consultancy; Otsuka: Consultancy; Johnson & Johnson: Consultancy; AstraZeneca: Consultancy, Research Funding; Heart Flow Technologies: Research Funding; Agency for Healthcare Research and Quality: Research Funding.

Job Discrimination Against People With A Cancer History

1995 ◽  
Vol 26 (2) ◽  
pp. 12-16 ◽  
Author(s):  
John V. Conti
Keyword(s):  
Cancer Survivors ◽  
Job Market ◽  
Skill Levels ◽  
Cancer History ◽  
Current Information ◽  
Job Discrimination ◽  
History Of ◽  
History Of Cancer

Job discrimination against persons with a history of cancer is common and is found at all skill levels and throughout all fields of employment. Irrational fears, lack of current information, and distortions in perception prevent counselors, and society in general, from viewing the work potential of persons with a cancer history objectively. Due to significant improvements in the treatment of some forms of cancer, there is a large new group of young cancer survivors in need of guidance and advocacy to enter or re-enter the job market. Legal protections are in place but largely unused by cancer survivors. Suggestions are offeredfor increasing individual and systemic advocacy for this population, and some recommendations for future effort are made.

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