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  • American Association for Cancer Research (AACR)  (4)
  • 1
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    Abstract P6-08-16: Evaluation of a decision aid on BRCA1/2 genetic testing in Orthodox Jewish women
    American Association for Cancer Research (AACR) ; 2020
    In:  Cancer Research Vol. 80, No. 4_Supplement ( 2020-02-15), p. P6-08-16-P6-08-16
    Details
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 80, No. 4_Supplement ( 2020-02-15), p. P6-08-16-P6-08-16
    Abstract: Background: Ashkenazi Jews have a 1 in 40 chance of carrying a BRCA1 or BRCA2 (BRCA1/2) pathogenic variant. Our prior research has shown that Orthodox Jewish women face unique social, cultural, and religious factors that may influence uptake of BRCA1/2 genetic testing. The aim of our study was to examine the impact of a web-based decision aid (DA) on BRCA1/2 genetic testing intention/uptake in Orthodox Jewish women. Methods: We conducted a pilot study among 50 Orthodox Jewish women in the New York/New Jersey area who were given access to the RealRisks DA and completed surveys at baseline prior to exposure to RealRisks and at 1 and 6 months after exposure to RealRisks. RealRisks is a patient-centered DA that includes family history intake, calculation of personalized breast cancer risk according to the BRCAPRO model, education about the pros and cons of genetic testing, and preference elicitation. The surveys collected information on participant demographics, health literacy, subjective numeracy, perceived breast cancer risk and BRCA1/2 mutation risk, breast cancer worry, stigma, hereditary breast and ovarian cancer (HBOC) genetic testing knowledge, autonomy, decision self-efficacy, decisional conflict, decision regret, and genetic testing intention/uptake. Descriptive statistics and paired t-tests and Chi-squared tests were conducted to assess changes in the study measures from baseline to follow-up. Results: Fifty women completed the baseline survey, 43 (86%) the 1-month survey, and 38 (74%) the 6-month survey. Mean age was 43.9 years (standard deviation [SD] 14.6); 94% had adequate health literacy and mean numeracy score was 4.25 (SD 0.83; range, 1-6). At baseline, 74% of women had adequate HBOC genetic testing knowledge and 52% thought it was likely that they carried an altered BRCA1/2 gene. Compared to baseline, there was a significant increase in HBOC genetic testing knowledge and decrease in decisional conflict at 1 month and 6 months. There was no significant change in decision self-efficacy, autonomy, stigma, or breast cancer worry after exposure to RealRisks at 1-month or 6-month follow-up. The percentage of women who intended to complete or already completed BRCA1/2 genetic testing decreased from 54% at baseline to 30% at 1 month. At 6 months, 21% reported they had completed or intended to complete BRCA1/2 genetic testing at that time. Conclusions: The RealRisks DA was effective at improving HBOC genetic testing knowledge and reducing decisional conflict about HBOC genetic testing; however, genetic testing intention decreased after exposure to the DA. An intervention that directly addresses the religious and cultural issues regarding genetic testing in the Orthodox Jewish community may improve BRCA1/2 genetic testing uptake and adoption of cancer prevention strategies in this population. Such an intervention will likely have to include religious, community, and medical leaders within the Orthodox Jewish community. Changes in study measures over 3 time pointsOutcome MeasuresBaseline Mean (SD)1 month Mean (SD)p-value compared to baseline6 months Mean (SD)p-value compared to baselineHBOC geneting testing knowledge [range, 0-11]6.60 (2.18)7.74 (1.94) & lt;0.0017.24 (2.07)0.050Decision self-efficacy [range, 0-100]56.26 (15.63)55.39 (16.91)0.869Not Assessed (NA)Decisional conflict [range, 0-100] 52.45 (28.43)33.93 (28.74) & lt;0.00128.29 (27.64) & lt;0.001Autonomy [range, 0-7]4.21 (1.43)4.36 (1.38)0.680NAStigma [range, 1-7] 3.51 (1.15)3.25 (0.98)0.477NABreast cancer worry [range, 1-7]2.23 (1.03)2.27 (0.98)0.7672.26 (1.00)0.889HBOC genetic testing completion or intention to complete (%)54%30%0.02021%0.002 Citation Format: Meghna S Trivedi, Haley Manley, Haeseung Yi, Thomas Silverman, Wendy K Chung, Paul S Appelbaum, Rebecca Starck, Isaac Schechter, Rita Kukafka, Katherine D Crew. Evaluation of a decision aid on BRCA1/2 genetic testing in Orthodox Jewish women [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-08-16.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
    URL: Article
    DOI: 10.1158/1538-7445.SABCS19-P6-08-16
    RVK:
    XA 36000
    RVK:
    XA 10000
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2020
    detail.hit.zdb_id: 2036785-5
    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 2
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    Abstract PS8-08: Impact of genetic testing for hereditary breast cancer on screening and risk-reducing surgeries among multi-ethnic breast cancer survivors
    American Association for Cancer Research (AACR) ; 2021
    In:  Cancer Research Vol. 81, No. 4_Supplement ( 2021-02-15), p. PS8-08-PS8-08
    Details
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 81, No. 4_Supplement ( 2021-02-15), p. PS8-08-PS8-08
    Abstract: Introduction Current guidelines for cancer risk management for hereditary breast cancer focus on individuals with pathogenic/likely pathogenic variants (P/LP) in high penetrance genes. There is little consensus on prophylactic mastectomy for low/moderate penetrance genes or variants of uncertain significance (VUS). Furthermore, many guidelines for enhanced breast cancer screening are targeted to unaffected carriers, but not breast cancer survivors. Given the increasing use of multigene panel testing, more patients are receiving results of P/LP in low/moderate penetrance genes or VUSs. We aimed to investigate how multigene panel results impacted surgical and screening decisions among breast cancer patients. Methods We conducted a retrospective analysis of women diagnosed with stage 0-III breast cancer at Columbia University Irving Medical Center in 2013 or later, who received germline genetic testing. Clinical data were extracted from the electronic health record (EHR), tumor registry, and genetic testing portals. Patients were excluded if they had stage IV disease at diagnosis, had bilateral mastectomy before 2013, or had missing genetic test results or surgical reports. For the screening analysis, patients were excluded if they had bilateral mastectomy or did not have breast imaging in the EHR. Surgery type was defined by the most advanced breast surgery received. Enhanced screening was defined as use of breast ultrasound or MRI in the absence of breast symptoms and in the setting of a normal mammogram. Univariable and multivariable analyses were performed to assess the association between clinical factors and receipt of bilateral mastectomy or enhanced screening. Results Among 715 evaluable women, about two-thirds were 50 years or younger, with 45% white, 12% black, 27% Hispanic, 11% Asian, and 4% other. Most patients (69.5%) had benign/likely benign (B/LB) genetic test results, while 91 (12.7%) had P/LP and 127 (17.8%) had VUS. VUS rates were higher among racial/ethnic minorities (27% Asian, 25% Hispanic, 19% black) compared to white women (10%). About 31% of women underwent bilateral mastectomy, 25% unilateral mastectomy, and 45% lumpectomy. Bilateral mastectomy rates among patients with P/LP variants were higher compared to those with VUS or B/LB results (66% vs. 27% vs. 26%), particularly P/LP in high-penetrance genes (76%) compared to other genes (45%). On multivariable analysis, compared to patients with B/LB genetic results, P/LP was significantly associated with bilateral mastectomy (odds ratio [OR] =5.72, 95% confidence interval [CI]=3.43-9.53). Younger age at diagnosis and family history of breast cancer were also associated with bilateral mastectomy. Among patients with breast cancer screening data, almost half (43%) received enhanced screening (59% ultrasound, 25% MRI, 16% both). On multivariable analysis, patients with P/LP variants and age of diagnosis under 50 were more likely to receive enhanced screening (OR=4.43, 95% CI=1.59-12.33 and OR=1.92, 95% CI=1.09-3.38, respectively). Hispanic women compared to non-Hispanic whites and those with Medicaid rather than private health insurance were less likely to undergo enhanced screening. Conclusions We demonstrated that detection of P/LP variants on multigene panel testing influences surgical and screening decisions among breast cancer patients. Patients with VUS, a group enriched for racial/ethnic minorities, appropriately have similar surgical and screening decisions as those with B/LB results. Our findings suggest adequate genetic counseling and communication of cancer risk to multi-ethnic breast cancer survivors. Citation Format: Vicky Ro, Tarsha Jones, Meghna S Trivedi, Julia E McGuinness, Thomas Silverman, Wendy K Chung, Rita Kukafka, Katherine D Crew. Impact of genetic testing for hereditary breast cancer on screening and risk-reducing surgeries among multi-ethnic breast cancer survivors [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-08.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
    URL: Article
    DOI: 10.1158/1538-7445.SABCS20-PS8-08
    RVK:
    XA 36000
    RVK:
    XA 10000
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2021
    detail.hit.zdb_id: 2036785-5
    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 3
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    Mendelian Randomization Analysis of n-6 Polyunsaturated Fatty Acid Levels and Pancreatic Cancer Risk
    American Association for Cancer Research (AACR) ; 2020
    In:  Cancer Epidemiology, Biomarkers & Prevention Vol. 29, No. 12 ( 2020-12-01), p. 2735-2739
    Details
    In: Cancer Epidemiology, Biomarkers & Prevention, American Association for Cancer Research (AACR), Vol. 29, No. 12 ( 2020-12-01), p. 2735-2739
    Abstract: Whether circulating polyunsaturated fatty acid (PUFA) levels are associated with pancreatic cancer risk is uncertain. Mendelian randomization (MR) represents a study design using genetic instruments to better characterize the relationship between exposure and outcome. Methods: We utilized data from genome-wide association studies within the Pancreatic Cancer Cohort Consortium and Pancreatic Cancer Case–Control Consortium, involving approximately 9,269 cases and 12,530 controls of European descent, to evaluate associations between pancreatic cancer risk and genetically predicted plasma n-6 PUFA levels. Conventional MR analyses were performed using individual-level and summary-level data. Results: Using genetic instruments, we did not find evidence of associations between genetically predicted plasma n-6 PUFA levels and pancreatic cancer risk [estimates per one SD increase in each PUFA-specific weighted genetic score using summary statistics: linoleic acid odds ratio (OR) = 1.00, 95% confidence interval (CI) = 0.98–1.02; arachidonic acid OR = 1.00, 95% CI = 0.99–1.01; and dihomo-gamma-linolenic acid OR = 0.95, 95% CI = 0.87–1.02]. The OR estimates remained virtually unchanged after adjustment for covariates, using individual-level data or summary statistics, or stratification by age and sex. Conclusions: Our results suggest that variations of genetically determined plasma n-6 PUFA levels are not associated with pancreatic cancer risk. Impact: These results suggest that modifying n-6 PUFA levels through food sources or supplementation may not influence risk of pancreatic cancer.
    Type of Medium: Online Resource
    ISSN: 1055-9965 , 1538-7755
    URL: Article
    DOI: 10.1158/1055-9965.EPI-20-0651
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2020
    detail.hit.zdb_id: 2036781-8
    detail.hit.zdb_id: 1153420-5
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  • 4
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    Impact of Risk-Stratified Therapy on Health Status in Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study
    American Association for Cancer Research (AACR) ; 2022
    In:  Cancer Epidemiology, Biomarkers & Prevention Vol. 31, No. 1 ( 2022-01-01), p. 150-160
    Details
    In: Cancer Epidemiology, Biomarkers & Prevention, American Association for Cancer Research (AACR), Vol. 31, No. 1 ( 2022-01-01), p. 150-160
    Abstract: Prior studies have identified that survivors of childhood acute lymphoblastic leukemia (ALL) report poor health status. It is unknown how risk-stratified therapy impacts the health status of ALL survivors. Methods: We estimated and compared the prevalence of self-reported poor health status among adult (≥18 years) survivors of childhood ALL diagnosed at age & lt;21 years from 1970 to 1999 and sibling controls, excluding proxy reports. Therapy combinations defined treatment groups representative of 1970s therapy (70s), standard- and high-risk 1980s and 1990s therapy (80sSR, 80sHR, 90sSR, 90sHR), and relapse/bone marrow transplant (R/BMT). Log-binomial models, adjusted for clinical and demographic factors, compared outcomes between groups using prevalence ratios (PR) with 95% confidence intervals (CI). Results: Among 5,119 survivors and 4,693 siblings, survivors were more likely to report poor health status in each domain including poor general health (13.5% vs. 7.4%; PR = 1.92; 95% CI, 1.69–2.19). Compared with 70s, 90sSR and 90sHR were less likely to report poor general health (90sSR: PR = 0.75; 95% CI, 0.57–0.98; 90sHR: PR = 0.58; 95% CI, 0.39–0.87), functional impairment (90sSR: PR = 0.56; 95% CI, 0.42–0.76; 90sHR: PR = 0.63; 95% CI, 0.42–0.95), and activity limitations (90sSR: 0.61; 95% CI, 0.45–0.83; 90sHR: PR = 0.59; 95% CI, 0.38–0.91). An added adjustment for chronic conditions in multivariable models partially attenuated 90sSR risk estimates. Conclusions: Risk-stratified ALL therapy has succeeded in reducing risk for poor general health, functional impairment, and activity limitations among more recent survivors of standard- and high-risk therapy. Impact: Future research into the relationship between risk-stratified therapy, health status, and late health outcomes may provide new opportunities to further improve late morbidity among survivors.
    Type of Medium: Online Resource
    ISSN: 1055-9965 , 1538-7755
    URL: Article
    DOI: 10.1158/1055-9965.EPI-21-0667
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2022
    detail.hit.zdb_id: 2036781-8
    detail.hit.zdb_id: 1153420-5
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