This document discusses genetic testing guidelines for breast and ovarian cancer. It provides an overview of current guidelines from organizations like USPSTF, NCCN, ACOG, and NICE. The USPSTF recommends testing only for those with a suggestive family history. NCCN guidelines provide more detailed criteria for testing breast cancer patients. Studies have found a high percentage (around 10%) of Ashkenazi Jewish women with breast cancer carry BRCA mutations, suggesting all such women should undergo genetic testing. Overall, the guidelines are evolving to expand testing to more patients as the therapeutic implications of mutations are better understood.
Cancer risk assessment is a multi-step process that involves taking a detailed family history, assessing individual risk levels, providing counseling and follow-up, and offering genetic testing when appropriate. Key factors that increase the likelihood of harmful BRCA1/2 mutations include early-onset breast or ovarian cancer, bilateral breast cancer, or a family history of both breast and ovarian cancer. For those found to carry a BRCA mutation, risk-reducing options like prophylactic surgeries, chemoprevention, and increased screening can help lower cancer risk. While genetic discrimination by life insurers has been a concern, recent studies found little evidence of this occurring after genetic counseling.
Breast cancer is the most common cancer among American women (American Cancer Society), but only 5-10 percent of breast cancer cases are hereditary. Of those cases, roughly 20-25 percent are linked to mutations in the BRCA1 and BRCA2 genes (BRCA stands for BReast CAncer susceptibility). View the infographic above for more on the genetics of breast cancer.
For more information on breast cancer, visit the website for Dana-Farber’s Susan F. Smith Center for Women’s Cancers Breast Oncology Program: http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Breast-Cancer.aspx
This document summarizes breast cancer risks from both personal and environmental factors. It discusses how genetics and the environment can contribute to increased breast cancer risk and identifies some preventive measures. The key points are:
1) Breast cancer risk is influenced by a combination of personal factors like family history, age of first period, and hormone exposure, as well as environmental exposures.
2) Inherited genetic mutations account for 5-10% of cases, while genes like BRCA1 and BRCA2 cause 2-5% of cases.
3) Environmental toxins can damage breast DNA over time and increase cancer risk, while a healthy lifestyle with exercise, diet, weight control, and limiting alcohol can help reduce
Eric Fowler, MS, CGC, Certified/Licensed Genetic Counselor, manager of Genetic Counseling at Cancer Treatment Centers of America(r) presents "Know Your Risk: Understanding Genetics and Breast Cancer." The webinar presentation addresses genetics and genetic counseling basics, factors that impact breast cancer risk, family history risk, hereditary breast cancer and the pros and cons of genetic testing.
Beyond BRCA Mutations: What's New in the World of Genetic Testing?bkling
Dr. Mark Robson, Clinic Director of the Clinical Genetics Service at Memorial Sloan Kettering Cancer Center, presents a medical update regarding the latest developments in genetic testing as it relates to breast and ovarian cancer. Topics include non-BRCA mutations, including both high-penetrance and so-called moderate penetrance mutations, and a framework for management of these.
Presented in collaboration with FORCE.
BRCA – Importance in Hereditary Breast & Ovarian CancerLifecare Centre
BRCA – Importance in Hereditary
Breast & Ovarian Cancer
DGF & WOW India
presentation was made by
Dr Sharda Jain
based on presentation made by
Dr Sunil Tadepalli
The document summarizes information about hereditary breast and ovarian cancer syndrome (HBOC). It finds that 10-25% of breast cancer and 5-10% of ovarian cancer is considered hereditary. The majority of HBOC cases, around 84%, are caused by mutations in the BRCA1 and BRCA2 genes. Carriers of BRCA1 and BRCA2 mutations have significantly increased lifetime risks of developing breast cancer (56-87% for both genes) and ovarian cancer (44% for BRCA1, 27% for BRCA2) compared to the general population. Genetic testing for BRCA1 and BRCA2 mutations is available to assess cancer risk and guide risk-reducing medical or
This document discusses genetic counseling for cancer risk assessment. It begins with an introduction to Sandra Brown and her role as manager of the Cancer Genetics Program. It then provides information on various genes associated with cancer risks and how damage to these genes can cause uncontrolled growth and malignant tumors. The rest of the document discusses the differences between sporadic, familial, and inherited cancers; the process of genetic counseling before and after genetic testing; recommendations for who should receive genetic counseling; challenges like interpreting results and informing family; and current issues and controversies in cancer genetics.
Cancer risk assessment is a multi-step process that involves taking a detailed family history, assessing individual risk levels, providing counseling and follow-up, and offering genetic testing when appropriate. Key factors that increase the likelihood of harmful BRCA1/2 mutations include early-onset breast or ovarian cancer, bilateral breast cancer, or a family history of both breast and ovarian cancer. For those found to carry a BRCA mutation, risk-reducing options like prophylactic surgeries, chemoprevention, and increased screening can help lower cancer risk. While genetic discrimination by life insurers has been a concern, recent studies found little evidence of this occurring after genetic counseling.
Breast cancer is the most common cancer among American women (American Cancer Society), but only 5-10 percent of breast cancer cases are hereditary. Of those cases, roughly 20-25 percent are linked to mutations in the BRCA1 and BRCA2 genes (BRCA stands for BReast CAncer susceptibility). View the infographic above for more on the genetics of breast cancer.
For more information on breast cancer, visit the website for Dana-Farber’s Susan F. Smith Center for Women’s Cancers Breast Oncology Program: http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Breast-Cancer.aspx
This document summarizes breast cancer risks from both personal and environmental factors. It discusses how genetics and the environment can contribute to increased breast cancer risk and identifies some preventive measures. The key points are:
1) Breast cancer risk is influenced by a combination of personal factors like family history, age of first period, and hormone exposure, as well as environmental exposures.
2) Inherited genetic mutations account for 5-10% of cases, while genes like BRCA1 and BRCA2 cause 2-5% of cases.
3) Environmental toxins can damage breast DNA over time and increase cancer risk, while a healthy lifestyle with exercise, diet, weight control, and limiting alcohol can help reduce
Eric Fowler, MS, CGC, Certified/Licensed Genetic Counselor, manager of Genetic Counseling at Cancer Treatment Centers of America(r) presents "Know Your Risk: Understanding Genetics and Breast Cancer." The webinar presentation addresses genetics and genetic counseling basics, factors that impact breast cancer risk, family history risk, hereditary breast cancer and the pros and cons of genetic testing.
Beyond BRCA Mutations: What's New in the World of Genetic Testing?bkling
Dr. Mark Robson, Clinic Director of the Clinical Genetics Service at Memorial Sloan Kettering Cancer Center, presents a medical update regarding the latest developments in genetic testing as it relates to breast and ovarian cancer. Topics include non-BRCA mutations, including both high-penetrance and so-called moderate penetrance mutations, and a framework for management of these.
Presented in collaboration with FORCE.
BRCA – Importance in Hereditary Breast & Ovarian CancerLifecare Centre
BRCA – Importance in Hereditary
Breast & Ovarian Cancer
DGF & WOW India
presentation was made by
Dr Sharda Jain
based on presentation made by
Dr Sunil Tadepalli
The document summarizes information about hereditary breast and ovarian cancer syndrome (HBOC). It finds that 10-25% of breast cancer and 5-10% of ovarian cancer is considered hereditary. The majority of HBOC cases, around 84%, are caused by mutations in the BRCA1 and BRCA2 genes. Carriers of BRCA1 and BRCA2 mutations have significantly increased lifetime risks of developing breast cancer (56-87% for both genes) and ovarian cancer (44% for BRCA1, 27% for BRCA2) compared to the general population. Genetic testing for BRCA1 and BRCA2 mutations is available to assess cancer risk and guide risk-reducing medical or
This document discusses genetic counseling for cancer risk assessment. It begins with an introduction to Sandra Brown and her role as manager of the Cancer Genetics Program. It then provides information on various genes associated with cancer risks and how damage to these genes can cause uncontrolled growth and malignant tumors. The rest of the document discusses the differences between sporadic, familial, and inherited cancers; the process of genetic counseling before and after genetic testing; recommendations for who should receive genetic counseling; challenges like interpreting results and informing family; and current issues and controversies in cancer genetics.
This document discusses hereditary breast and ovarian cancer syndrome, which is caused by mutations in the BRCA1 and BRCA2 genes. Carriers of these mutations have significantly increased risks of developing breast cancer and ovarian cancer. The document provides estimates of cancer risks associated with BRCA1 and BRCA2 mutations and discusses clinical management recommendations, including who should be referred for genetic counseling and testing. Genetic counseling is important to discuss test results, cancer risks, and risk reduction options like increased screening and preventative surgeries.
This document summarizes a study examining the expression of BRCA1 and BRCA2 genes in premenopausal Mexican women with breast cancer. The study analyzed 62 premenopausal women under age 45 with breast cancer to evaluate the clinical and immunohistochemical correlates of BRCA1 and BRCA2 mRNA expression. Low levels of BRCA1 expression were associated with younger patient age and more advanced clinical stage, but BRCA2 expression did not correlate with disease severity. Neither gene expression correlated with tumor characteristics like histology, differentiation, metastasis, or markers like p53 and HER-2.
Audio and slides for this presentation are also available on YouTube: http://youtu.be/ukXhuy5cXrE
Huma Q. Rana, MD, a cancer geneticist with Dana-Farber Cancer Institute, explains the cancer risk associated with BRCA1 and BRCA2 gene mutations. This presentation was originally given on July 23, 2013 as part of the "What Every Woman Should Know" event put on by Dana-Farber's Susan F. Smith Center for Women's Cancers.
This document discusses hereditary breast and ovarian cancer and the role of genetics in cancer risk. It provides an overview of BRCA1 and BRCA2 genes which are known to increase the risk of breast and ovarian cancers when mutated. Individuals with mutations in these genes have a high lifetime risk, up to 85%, of developing breast cancer and 16-44% risk for ovarian cancer. Referral to a cancer genetics clinic is recommended for those with a strong family history or personal history of related cancers to determine risk and recommend screening and management options.
Breast Cancer, Ovarian Cancer and Prostate CancerThet Su Win
This document discusses hereditary breast, ovarian, and prostate cancer. It provides information on BRCA1 and BRCA2 mutations which are responsible for a large portion of familial breast cancer cases. Other genes like PALB2 are also discussed. The document reports the results of a study that sequenced DNA from breast cancer patients and found PALB2 mutations in 1% of cases negative for BRCA1/2 mutations, suggesting PALB2 mutations also contribute to hereditary breast cancer risk.
This document summarizes genetics of hereditary breast cancer. About 5-10% of breast cancers are hereditary, with 40-50% caused by mutations in the BRCA1 and BRCA2 genes. Genetic testing is recommended for patients with a family history suggesting over 20-25% risk of a BRCA mutation. A positive test result increases cancer surveillance and treatment options like prophylactic surgeries, while laws protect against genetic discrimination in health insurance.
1) BRCA status is important for treatment planning in breast cancer patients. Those with BRCA1/2 mutations have increased risk of contralateral breast cancer and benefit more from risk-reducing bilateral mastectomies.
2) Patients with BRCA mutations, especially BRCA1, have better responses to platinum-based chemotherapy compared to non-carriers. Platinum drugs may be a better option for these patients.
3) Testing for a wide panel of hereditary cancer genes is now possible using new sequencing technologies, which may help guide more personalized treatment decisions.
This document provides a guide to understanding BRCA1 and BRCA2 genes and managing cancer risks for carriers. It discusses background on the genes and associated cancer risks, screening and risk reduction options for breast and ovarian cancer, sharing genetic information with family, and other topics like insurance and family planning considerations. The key points are that BRCA1/2 carriers have high lifetime risks of breast and ovarian cancer, and screening and risk-reducing surgeries are options to help manage those risks, though neither prevent cancer. Genetic testing of relatives is also recommended to identify others who may benefit from similar risk management strategies.
BRCA Testing is a gene test that uses DNA analyses.
This test is usually done to identify the harmful changes of the two breast cancer susceptibility genes.
1. Several molecular pathways are involved in breast cancer pathogenesis, including steroid hormone receptors, HER2/neu, cell cycle proteins, and growth factors.
2. Risk factors for breast cancer include increasing age, female gender, family history, genetic mutations, personal history of breast cancer or other breast diseases, reproductive factors, and hormone use.
3. High risk patients are identified using tools like the Gail model and managed through increased screening including breast self-exams, clinical exams, mammograms, and MRI. Preventive options include tamoxifen, raloxifen, and prophylactic surgeries.
Oct. 2013 Via Christi Women's Connection presentation on breast cancer genetic testing featuring Patty Tenofsky, MD, with Via Christi Clinic in Wichita, Kan.
BRCA – IMPORTANCE IN HEREDITARY BREAST & OVARIAN CANCER by Dr Sharda Jain Lifecare Centre
BRCA1 and BRCA2 gene mutations significantly increase the risks of breast and ovarian cancers. Screening for these mutations allows for increased surveillance and risk-reducing procedures that can improve health outcomes. Specifically:
- BRCA1/2 mutation carriers have a 40-80% risk of developing breast cancer and a 11-40% risk of ovarian cancer.
- Bilateral risk-reducing mastectomy can decrease breast cancer risk by at least 90% for carriers. Bilateral risk-reducing salpingo-oophorectomy can reduce ovarian and breast cancer risks by approximately 80% and 50% respectively.
- Genetic testing costs around 23k in India and allows high-risk families and individuals to
Prophylaxis and early diagnosis of breast cancerINVICTA GENETICS
The document discusses the BRCA1/2 genetic test, which analyzes genes associated with breast and ovarian cancer risk. It can detect mutations that increase cancer risk from 40-85%. The test uses next generation sequencing to fully analyze the BRCA1 and BRCA2 genes. A positive result provides information on cancer monitoring and prevention options and has implications for other family members' cancer risk. The document is from a Polish genetics laboratory that offers the BRCA1/2 test and genetic counseling.
Karen Fasciano, PSY.D., director of the Young Adult Program at Dana-Farber Cancer Institute, discusses the facts around young adults who are diagnosed with lymphoma, how the disease affects their life, and the resources available to young adults who are facing cancer. This presentation was originally given at the Lymphoma Research Foundation's 2013 North American Forum on Sept. 28, 2013. http://www.dana-farber.org | http://www.lymphoma.org
- Three major molecular assays have been developed for prognostic assessment of breast cancer: Oncotype DX, Mammaprint, and Prosigna.
- Oncotype DX uses a 21-gene signature to predict recurrence risk in ER+ breast cancer. Mammaprint uses a 70-gene signature and Prosigna uses the PAM50 intrinsic subtyping algorithm.
- Clinical trials have validated the use of these assays in lymph node positive and negative disease to predict chemotherapy benefit and guide treatment decisions. Ongoing research aims to further refine risk assessment and subclassify breast cancer.
Brca2 mutation and their influence to cancergalinayakubova
BRCA2 is a gene that helps repair damaged DNA. Certain mutations or variants in the BRCA2 gene increase cancer risk. The document discusses how BRCA2 mutations are inherited and their increased risks for breast cancer, ovarian cancer, prostate cancer, and pancreatic cancer. It provides information on BRCA2 testing, who should consider testing, screening recommendations based on BRCA2 status, and management options like increased screening, risk-reducing surgery, medications, and PARP inhibitors for those with BRCA2 mutations.
This document discusses personalized cancer therapy for ovarian cancer. It summarizes that high grade serous ovarian cancer (HGSOC) is the most common and aggressive form of ovarian cancer. HGSOC often has defects in the BRCA1/2 pathway involved in DNA repair. This makes HGSOC sensitive to PARP inhibitors, which have been FDA approved. The document also discusses developing biomarkers like the homologous recombination deficiency (HRD) score to predict which patients will respond to PARP inhibitors based on their tumor's DNA repair capabilities. Combination therapies targeting multiple pathways like the PI3K and PARP pathways are presented as a strategy to overcome resistance to targeted therapies.
This document discusses a proposed experiment to test the hypothesis that increased estrogen levels can activate mutated BRCA1 and BRCA2 genes, leading to breast cancer development. The experiment would involve genetically engineering mice to have these mutated genes. The mice would then be given periodic doses of estrogen over their lifetime to observe if and when their normal cell growth turns cancerous. If cancer develops, repeating the experiment multiple times could help determine if estrogen is sufficient to trigger tumor growth by activating the mutated genes. Positive results may inform future research developing anti-estrogen treatments to prevent cancer formation in high-risk individuals.
The document discusses recurrent ovarian cancer. It notes that the chances of recurrence vary based on initial stage, with stage III having the highest risk. Symptoms of recurrence can include abdominal bloating or pain. Recurrence is typically diagnosed through physical exam, rising CA125 levels, or imaging. Treatment depends on platinum sensitivity, and may include surgery, chemotherapy, targeted therapies, or clinical trials. One study found that initiating treatment based on rising CA125 levels alone improved progression-free and overall survival compared to waiting for symptoms.
A data driven nomogram for breast cancer survivalLisa Federer
This document describes the development of a nomogram to predict breast cancer survival using demographic, diagnostic, and treatment data from the SEER database. The authors selected 13 variables related to survival time, age, race, cancer stage and other factors. Different classification models were tested including logistic regression, naive bayes, decision trees, and random forests. Cox proportional hazards and Aalen's additive regression models were also used. The results were used to build a "calculator" or nomogram to estimate survival time for individuals based on their characteristics. Limitations include the nomogram not being a substitute for medical advice and potential missing or incomplete data in the SEER database.
This document discusses ovarian cancer, including its epidemiology, risk factors, pathology, diagnosis, screening, staging, and treatment. It notes that ovarian cancer is the 5th leading cause of cancer death in women in the US. The majority of cases are diagnosed at an advanced stage due to asymptomatic early disease. Epithelial ovarian cancer accounts for approximately 80% of cases and arises from the ovarian surface epithelium. Risk factors include family history, BRCA mutations, and factors that reduce ovulation. Prognosis is correlated with stage at diagnosis, with 5-year survival rates of 45% overall but only 10-28% for advanced stage disease.
This document discusses hereditary breast and ovarian cancer syndrome, which is caused by mutations in the BRCA1 and BRCA2 genes. Carriers of these mutations have significantly increased risks of developing breast cancer and ovarian cancer. The document provides estimates of cancer risks associated with BRCA1 and BRCA2 mutations and discusses clinical management recommendations, including who should be referred for genetic counseling and testing. Genetic counseling is important to discuss test results, cancer risks, and risk reduction options like increased screening and preventative surgeries.
This document summarizes a study examining the expression of BRCA1 and BRCA2 genes in premenopausal Mexican women with breast cancer. The study analyzed 62 premenopausal women under age 45 with breast cancer to evaluate the clinical and immunohistochemical correlates of BRCA1 and BRCA2 mRNA expression. Low levels of BRCA1 expression were associated with younger patient age and more advanced clinical stage, but BRCA2 expression did not correlate with disease severity. Neither gene expression correlated with tumor characteristics like histology, differentiation, metastasis, or markers like p53 and HER-2.
Audio and slides for this presentation are also available on YouTube: http://youtu.be/ukXhuy5cXrE
Huma Q. Rana, MD, a cancer geneticist with Dana-Farber Cancer Institute, explains the cancer risk associated with BRCA1 and BRCA2 gene mutations. This presentation was originally given on July 23, 2013 as part of the "What Every Woman Should Know" event put on by Dana-Farber's Susan F. Smith Center for Women's Cancers.
This document discusses hereditary breast and ovarian cancer and the role of genetics in cancer risk. It provides an overview of BRCA1 and BRCA2 genes which are known to increase the risk of breast and ovarian cancers when mutated. Individuals with mutations in these genes have a high lifetime risk, up to 85%, of developing breast cancer and 16-44% risk for ovarian cancer. Referral to a cancer genetics clinic is recommended for those with a strong family history or personal history of related cancers to determine risk and recommend screening and management options.
Breast Cancer, Ovarian Cancer and Prostate CancerThet Su Win
This document discusses hereditary breast, ovarian, and prostate cancer. It provides information on BRCA1 and BRCA2 mutations which are responsible for a large portion of familial breast cancer cases. Other genes like PALB2 are also discussed. The document reports the results of a study that sequenced DNA from breast cancer patients and found PALB2 mutations in 1% of cases negative for BRCA1/2 mutations, suggesting PALB2 mutations also contribute to hereditary breast cancer risk.
This document summarizes genetics of hereditary breast cancer. About 5-10% of breast cancers are hereditary, with 40-50% caused by mutations in the BRCA1 and BRCA2 genes. Genetic testing is recommended for patients with a family history suggesting over 20-25% risk of a BRCA mutation. A positive test result increases cancer surveillance and treatment options like prophylactic surgeries, while laws protect against genetic discrimination in health insurance.
1) BRCA status is important for treatment planning in breast cancer patients. Those with BRCA1/2 mutations have increased risk of contralateral breast cancer and benefit more from risk-reducing bilateral mastectomies.
2) Patients with BRCA mutations, especially BRCA1, have better responses to platinum-based chemotherapy compared to non-carriers. Platinum drugs may be a better option for these patients.
3) Testing for a wide panel of hereditary cancer genes is now possible using new sequencing technologies, which may help guide more personalized treatment decisions.
This document provides a guide to understanding BRCA1 and BRCA2 genes and managing cancer risks for carriers. It discusses background on the genes and associated cancer risks, screening and risk reduction options for breast and ovarian cancer, sharing genetic information with family, and other topics like insurance and family planning considerations. The key points are that BRCA1/2 carriers have high lifetime risks of breast and ovarian cancer, and screening and risk-reducing surgeries are options to help manage those risks, though neither prevent cancer. Genetic testing of relatives is also recommended to identify others who may benefit from similar risk management strategies.
BRCA Testing is a gene test that uses DNA analyses.
This test is usually done to identify the harmful changes of the two breast cancer susceptibility genes.
1. Several molecular pathways are involved in breast cancer pathogenesis, including steroid hormone receptors, HER2/neu, cell cycle proteins, and growth factors.
2. Risk factors for breast cancer include increasing age, female gender, family history, genetic mutations, personal history of breast cancer or other breast diseases, reproductive factors, and hormone use.
3. High risk patients are identified using tools like the Gail model and managed through increased screening including breast self-exams, clinical exams, mammograms, and MRI. Preventive options include tamoxifen, raloxifen, and prophylactic surgeries.
Oct. 2013 Via Christi Women's Connection presentation on breast cancer genetic testing featuring Patty Tenofsky, MD, with Via Christi Clinic in Wichita, Kan.
BRCA – IMPORTANCE IN HEREDITARY BREAST & OVARIAN CANCER by Dr Sharda Jain Lifecare Centre
BRCA1 and BRCA2 gene mutations significantly increase the risks of breast and ovarian cancers. Screening for these mutations allows for increased surveillance and risk-reducing procedures that can improve health outcomes. Specifically:
- BRCA1/2 mutation carriers have a 40-80% risk of developing breast cancer and a 11-40% risk of ovarian cancer.
- Bilateral risk-reducing mastectomy can decrease breast cancer risk by at least 90% for carriers. Bilateral risk-reducing salpingo-oophorectomy can reduce ovarian and breast cancer risks by approximately 80% and 50% respectively.
- Genetic testing costs around 23k in India and allows high-risk families and individuals to
Prophylaxis and early diagnosis of breast cancerINVICTA GENETICS
The document discusses the BRCA1/2 genetic test, which analyzes genes associated with breast and ovarian cancer risk. It can detect mutations that increase cancer risk from 40-85%. The test uses next generation sequencing to fully analyze the BRCA1 and BRCA2 genes. A positive result provides information on cancer monitoring and prevention options and has implications for other family members' cancer risk. The document is from a Polish genetics laboratory that offers the BRCA1/2 test and genetic counseling.
Karen Fasciano, PSY.D., director of the Young Adult Program at Dana-Farber Cancer Institute, discusses the facts around young adults who are diagnosed with lymphoma, how the disease affects their life, and the resources available to young adults who are facing cancer. This presentation was originally given at the Lymphoma Research Foundation's 2013 North American Forum on Sept. 28, 2013. http://www.dana-farber.org | http://www.lymphoma.org
- Three major molecular assays have been developed for prognostic assessment of breast cancer: Oncotype DX, Mammaprint, and Prosigna.
- Oncotype DX uses a 21-gene signature to predict recurrence risk in ER+ breast cancer. Mammaprint uses a 70-gene signature and Prosigna uses the PAM50 intrinsic subtyping algorithm.
- Clinical trials have validated the use of these assays in lymph node positive and negative disease to predict chemotherapy benefit and guide treatment decisions. Ongoing research aims to further refine risk assessment and subclassify breast cancer.
Brca2 mutation and their influence to cancergalinayakubova
BRCA2 is a gene that helps repair damaged DNA. Certain mutations or variants in the BRCA2 gene increase cancer risk. The document discusses how BRCA2 mutations are inherited and their increased risks for breast cancer, ovarian cancer, prostate cancer, and pancreatic cancer. It provides information on BRCA2 testing, who should consider testing, screening recommendations based on BRCA2 status, and management options like increased screening, risk-reducing surgery, medications, and PARP inhibitors for those with BRCA2 mutations.
This document discusses personalized cancer therapy for ovarian cancer. It summarizes that high grade serous ovarian cancer (HGSOC) is the most common and aggressive form of ovarian cancer. HGSOC often has defects in the BRCA1/2 pathway involved in DNA repair. This makes HGSOC sensitive to PARP inhibitors, which have been FDA approved. The document also discusses developing biomarkers like the homologous recombination deficiency (HRD) score to predict which patients will respond to PARP inhibitors based on their tumor's DNA repair capabilities. Combination therapies targeting multiple pathways like the PI3K and PARP pathways are presented as a strategy to overcome resistance to targeted therapies.
This document discusses a proposed experiment to test the hypothesis that increased estrogen levels can activate mutated BRCA1 and BRCA2 genes, leading to breast cancer development. The experiment would involve genetically engineering mice to have these mutated genes. The mice would then be given periodic doses of estrogen over their lifetime to observe if and when their normal cell growth turns cancerous. If cancer develops, repeating the experiment multiple times could help determine if estrogen is sufficient to trigger tumor growth by activating the mutated genes. Positive results may inform future research developing anti-estrogen treatments to prevent cancer formation in high-risk individuals.
The document discusses recurrent ovarian cancer. It notes that the chances of recurrence vary based on initial stage, with stage III having the highest risk. Symptoms of recurrence can include abdominal bloating or pain. Recurrence is typically diagnosed through physical exam, rising CA125 levels, or imaging. Treatment depends on platinum sensitivity, and may include surgery, chemotherapy, targeted therapies, or clinical trials. One study found that initiating treatment based on rising CA125 levels alone improved progression-free and overall survival compared to waiting for symptoms.
A data driven nomogram for breast cancer survivalLisa Federer
This document describes the development of a nomogram to predict breast cancer survival using demographic, diagnostic, and treatment data from the SEER database. The authors selected 13 variables related to survival time, age, race, cancer stage and other factors. Different classification models were tested including logistic regression, naive bayes, decision trees, and random forests. Cox proportional hazards and Aalen's additive regression models were also used. The results were used to build a "calculator" or nomogram to estimate survival time for individuals based on their characteristics. Limitations include the nomogram not being a substitute for medical advice and potential missing or incomplete data in the SEER database.
This document discusses ovarian cancer, including its epidemiology, risk factors, pathology, diagnosis, screening, staging, and treatment. It notes that ovarian cancer is the 5th leading cause of cancer death in women in the US. The majority of cases are diagnosed at an advanced stage due to asymptomatic early disease. Epithelial ovarian cancer accounts for approximately 80% of cases and arises from the ovarian surface epithelium. Risk factors include family history, BRCA mutations, and factors that reduce ovulation. Prognosis is correlated with stage at diagnosis, with 5-year survival rates of 45% overall but only 10-28% for advanced stage disease.
On September 3, 2015, Ovarian cancer survivors and FDA Patient Representatives Peg Ford, Susan Leighton and Annie Ellis were invited to provide the patient perspective at the recent Ovarian Cancer Endpoints Workshop hosted by the Food and Drug Administration (FDA). This meeting was co-sponsored by the Society of Gynecologic Oncology (SGO), the American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO). Many important topics to the ovarian cancer community were discussed, including novel clinical trial designs, biomarkers, and new classes of agents such as immunotherapies.
This document discusses a woman's experience dealing with her risk of breast cancer, from learning about her risk and planning for surgery, to undergoing multiple surgeries and recovering, finally completing her process to reduce her risk. It references her grandmother and family history, planning and undergoing surgery, recovering, and having a final surgery to complete her risk-reduction efforts.
Ovarian cancer has a poor prognosis because it is often diagnosed at an advanced stage. Screening average risk women is not recommended as randomized trials found no decrease in mortality. Screening high risk women with annual CA-125 and transvaginal ultrasound may detect some early stage cancers but also has many false positives. The UKCTOCS trial found the multimodal screening strategy of combining CA-125 interpreted through ROCA and ultrasound had higher sensitivity and positive predictive value than ultrasound alone. Final mortality data from this large trial is still pending in 2015.
HEREDITARY BREAST and OVARY CANCER [HBOC] SYNDROME, Dr BUI DAC CHI.hungnguyenthien
The BRCA genes normally help repair DNA damage but mutations increase cancer risk. Hereditary Breast and Ovarian Cancer (HBOC) Syndrome is caused by mutations in the BRCA1 and BRCA2 genes, increasing risks for early-onset breast, ovarian, pancreatic, and other cancers. Genetic testing can identify BRCA mutations to diagnose HBOC and determine risks for family members. Referral for genetic testing should be considered for those with personal or family histories of certain cancers.
The document discusses principles of cancer chemotherapy and summarizes various classes of chemotherapeutic agents. It describes how chemotherapy can be used at different stages of treatment and highlights common toxicities. It also reviews mechanisms of action and examples of classical anticancer agents like alkylating agents, antimetabolites, natural products and hormone therapies. Novel targeted agents are discussed such as tyrosine kinase inhibitors, PARP inhibitors, angiogenesis inhibitors, HSP90 inhibitors and others.
This document summarizes treatment options for ovarian cancer after diagnosis. It discusses that most cases are advanced at presentation and surgery is used to stage and debulk the cancer. Chemotherapy with a taxane and platinum agent is recommended for early and advanced stage disease. For advanced cancer, intraperitoneal chemotherapy may provide a survival benefit compared to intravenous treatment alone. Recurrent cancer can be treated with additional chemotherapy or surgery depending on factors like time since last treatment and extent of recurrence. Future research aims to improve treatment tolerability and identify new targeted therapies.
Molecular Subtyping of Breast Cancer and Somatic Mutation Discovery Using DNA...Setia Pramana
Molecular Subtyping of Breast Cancer and Somatic Mutation Discovery Using DNA and RNA sequence
Guess Lecture at Computer Science Department, IPB, Bogor
This document summarizes a case study about a 20-year-old college student named Abby who was diagnosed with ovarian cancer. It describes her symptoms, including abdominal pain, and the ultrasound that revealed a mass on her right ovary. It then discusses her diagnosis and treatment options, including surgery to remove her ovaries followed by chemotherapy and radiation. The document also covers topics like the genetics of ovarian cancer, cell cycle regulation, and metastasis. After two years of treatment, Abby graduated from college and has since married and started a family.
It describes the prevalence of Breast Cancer among BRCA 1/2 mutations with special consideration to biological background, detection and screening, actions taken upon discovering mutation carriers and whether we have a different therapeutic algorithm than sporadic cases. Special emphasis on the role of PARP inhibitors in the management of metastatic disease.
The document discusses ovarian cancer, including its incidence, risk factors, signs and symptoms, screening and diagnostic methods, staging, types, and treatment options. It notes that ovarian cancer is the fifth most common cancer in women in the US and the most lethal gynecological cancer. Risk factors include age, family history, genetics, reproductive history, and exposure to talcum powder. Screening methods have limitations. Treatment involves surgery, chemotherapy, and sometimes radiotherapy, with prognosis being poor if detected at late stages.
The document discusses molecular subtyping of breast cancer through gene expression profiling which has identified major subtypes including luminal A, luminal B, HER2-enriched, and basal-like. It describes the characteristic gene expressions and clinical features of each subtype. Molecular subtyping is shown to have prognostic and predictive relevance for breast cancer outcomes and treatment responses.
A pedigree is a chart that shows the genetic history of a family over multiple generations. It is constructed by a genetic counselor or scientist based on a family's medical history. Pedigrees use symbols to represent individuals and their relationships and health status. Interpreting a pedigree can determine if a condition is autosomal or X-linked based on if it mainly affects males, and if it is dominant or recessive based on whether both parents need to carry the gene. Pedigrees are an analysis tool used to assess disease risk within a family.
This document provides background information on ovarian cancer, including its pathophysiology, etiology, epidemiology, clinical presentation, diagnosis, and screening. It states that ovarian cancer typically spreads within the peritoneal cavity. Several risk factors are identified, including genetic and reproductive factors. Epithelial ovarian cancer represents the most common histology and has a poor prognosis when diagnosed at advanced stages, due to nonspecific symptoms. No approved screening methods exist for ovarian cancer detection.
a nice presentation about the Ovarian Cancer its include an introduction with brief notes about the epidemiology and risk factors then shift to pathology and pathogenesis and diagnosis with signs , symptoms and lab tests with imaging modules , screening , management
- Ovarian cancer is the 5th most common cancer in women and the most common cause of gynecologic mortality, with an estimated 21,650 new cases and 15,520 deaths in the US in 2008.
- Risk factors include advancing age, infertility, endometriosis, talcum powder use, and genetic susceptibility. Protective factors include oral contraceptive use, parity, and tubal sterilization.
- Screening with transvaginal ultrasound and CA125 is recommended for high-risk women like those with BRCA mutations, but routine screening is not recommended for the general population due to low sensitivity of tests for early detection.
This document provides an overview of ovarian cancer, including:
1. The different types of ovarian tumors that can develop from the epithelial, germ, and stromal cells in the ovaries.
2. The symptoms of ovarian cancer, which can include pelvic pain, back pain, indigestion, and frequent urination.
3. Causes of ovarian cancer such as family history, age, number of ovulations, and genetic syndromes.
4. Stages of ovarian cancer from Stage 1 through Stage 4.
Next Gen Sequencing (NGS) Technology OverviewDominic Suciu
Next generation sequencing (NGS) provides several new technologies for DNA sequencing that have significantly increased throughput and reduced costs compared to previous methods. NGS technologies include Roche/454, Illumina, ABI SOLiD, Ion Torrent, and PacBio. These technologies have various applications including whole genome sequencing, detection of genetic mutations associated with diseases, RNA sequencing to study gene expression, and ChIP sequencing to identify DNA-binding sites. NGS is revolutionizing genomic research by allowing comprehensive study of genomes, transcriptomes, and gene regulation.
Presentation from Peter Hulick, MD, MMSc, to help nurses and nurse practitioners:
1) Understand the genetic consultation process
2) Examine genetic contribution to breast cancer
3) Identify suggestive family history patterns and risk estimation
4) Influence of genetic testing on management
Taken from a CNE-granting presentation given on 2/17/12 in Highland Park, IL, put together by the Chicago Center for Jewish Genetic Disorders and NorthShore University HealthSystem.
genetic screening in cancer presentationvenkateshendr
Genetic testing can be useful for some people when certain types of cancer seem to run in their families. It can also be helpful for certain people with cancer who don’t have a family history of cancer. But genetic testing isn't recommended for everyone. Here we offer basic information to help you understand what genetic testing is and how it is used for people and families concerned about their cancer risk.
Testing, genetic counselling and its implications in Gynaecological CancersNamrata Das
Genetic counseling involves assessing a person's risk of hereditary cancers through their family history, medical history, and genetic testing. It determines who should be tested, how to test via methods like PCR, MLPA, or NGS, and implications of results. For ovarian cancer, individuals meeting criteria like breast cancer under 50 or multiple primaries are offered BRCA1/2 testing. A pathogenic BRCA result increases breast and ovarian cancer risk up to 80% and 40% respectively. Management includes increased screening and risk-reducing surgeries and drugs. Relatives are also at higher risk and should consider counseling.
Douglas Riegert-Johnson discusses screening and referral for genetic diseases. Primary care providers should obtain a detailed cancer family history including cancer types and ages of diagnosis. Patients meeting certain criteria like breast cancer under age 50 or multiple primaries should be referred for genetic counseling. All colon cancer patients should now undergo tumor testing for Lynch syndrome. Genetic counselors can be located through the National Society of Genetic Counselors website. While genetic testing is advancing, randomized controlled trials are needed to establish clinical utility.
As more women are concerned with their hereditary breast & Gyneacological cancer risk, the threshold for genetic testing is falling .
Patients and family members should be supported & given information about chemoprevention, surveillance & risk-reducing surgery .
The true challenge lies in translation of this knowledge into clinical practice, such that a definitive improvement in longevity and quality of life for patients and their families is realized.
This document discusses hereditary cancer predisposition. It notes that cancer arises from gene mutations, which can be either germline mutations present in eggs or sperm that are heritable, or somatic mutations in non-germline tissues that are not heritable. While all cancer has a genetic basis, not all cancer is inherited. It highlights BRCA1 and BRCA2 as genes commonly associated with hereditary breast and ovarian cancer risk, especially in Ashkenazi Jewish populations. Management options for related cancer risks include surveillance, chemoprevention, and prophylactic surgery. Genetic testing for predisposition involves multiple steps including counseling, consent, testing, and disclosure of results.
This document discusses hereditary cancer predisposition. It notes that cancer arises from gene mutations, which can be either germline mutations present in eggs or sperm that are heritable, or somatic mutations in non-germline tissues that are not heritable. While all cancer has a genetic basis, not all cancer is inherited. It highlights BRCA1 and BRCA2 as genes commonly associated with hereditary breast and ovarian cancer risk, especially in Ashkenazi Jewish populations. Management options for related cancer risks include surveillance, chemoprevention, and prophylactic surgery. Genetic testing for predisposition involves multiple steps including counseling, consent, testing, and disclosure of results.
This document summarizes a presentation on genetic testing for cancer risk. The presentation covered:
- The role of genetic cancer risk assessment in identifying inherited cancer risk.
- Common hereditary cancer syndromes like BRCA1/2 and Lynch syndrome and their associated cancer risks.
- Guidelines for cancer screening and management based on genetic test results.
- The benefits and limitations of multi-gene cancer panels.
- How to interpret genetic test results and provide appropriate risk management recommendations to patients.
This document summarizes a conference on cancer screening and genetics risk assessment programs at the Xanit Oncology Institute. It discusses how screening can help avoid cancer deaths by detecting cancers earlier when treatment is often less aggressive. It outlines features that suggest hereditary cancer risk and merits genetic counseling. The process of genetic counseling and testing is explained. Risk assessment considers personal and family history. While screening and counseling help manage risk, prophylactic procedures like mastectomy can prevent breast cancers.
This document summarizes a conference on cancer screening and genetics risk assessment programs at the Xanit Oncology Institute. It discusses how screening can help avoid cancer deaths by detecting cancers earlier when treatment is often less aggressive. It outlines features that suggest hereditary cancer risk and merits genetic counseling. The process of genetic counseling and testing is explained. Risk assessment considers personal and family history. Hereditary breast and ovarian cancer syndromes like BRCA1 and BRCA2 are addressed. Clinical management of patients who test positive for BRCA mutations is also summarized.
This document provides information on breast cancer screening and prevention. It discusses screening principles and guidelines for mammography, MRI, ultrasound and other screening techniques. It outlines high-risk factors for breast cancer and recommends annual screening starting at age 30-40 for high-risk individuals, including those with BRCA gene mutations or family history. Screening mammography every 1-2 years is recommended for average risk women starting at age 40. Chemoprevention with tamoxifen or raloxifene can lower breast cancer risk in high risk postmenopausal women. Genetic testing guidelines are also provided.
This document summarizes hereditary cancer syndromes and BRCA mutations. It discusses that most cancers are sporadic, but 5-10% are hereditary due to germline mutations passed down from relatives. Hereditary cancers often occur earlier and increase risk for multiple cancer types. Specific cancer susceptibility genes are discussed, including BRCA1 and BRCA2 mutations which increase lifetime risks of breast and ovarian cancers. Diagnostic testing and management strategies for individuals with BRCA mutations are outlined, including increased cancer screening, risk-reducing surgeries, and lifestyle modifications. Genetic counseling plays an important role in assessing cancer risks and managing hereditary cancer syndromes in families.
Hereditary Breast and Ovarian Cancer SyndromeAsha Reddy
This document provides clinical management guidelines for hereditary breast and ovarian cancer syndrome from the American College of Obstetricians and Gynecologists. It summarizes that BRCA1 and BRCA2 gene mutations account for the majority of hereditary breast and ovarian cancer cases. It provides criteria for determining which patients should be offered genetic risk assessment. It makes recommendations for genetic counseling, testing, and risk reduction strategies including screening, chemoprevention, and risk-reducing surgery.
Hereditary Genetics focusing on Prostate Cancerflasco_org
This document discusses genetic testing for prostate cancer and its implications. It summarizes that genetic testing can change screening recommendations, impact treatment of advanced disease, and be life-saving for family members. It provides examples of significant family histories and genetic syndromes that increase prostate cancer risk. Major findings are that 11.8% of men with metastatic prostate cancer had germline DNA repair gene mutations, and that BRCA2 and BRCA1 carriers have higher risks of positive biopsy and poorer prognosis prostate cancer. The document concludes that genetic testing is indicated for those meeting risk criteria to help guide screening and treatment.
All in the Family: Hereditary Risk for Gynecologic Cancerbkling
Knowing and understanding your inherited genetics is important for ovarian and uterine cancer patients. Dr. Melissa Frey, gynecologic oncologist at Weill Cornell Medicine, discusses how genetic factors affect women with ovarian and uterine cancer and influence treatment decisions, with a particular focus on BRCA1 & 2 and Lynch Syndrome.
This webinar was being put on in partnership with FORCE.
Cancer genetic counseling services provide important benefits for those with and without cancer. Genetic counselors educate patients about their cancer risks, help patients understand genetic testing results, and empower informed decision making. While genetic testing identifies only a small percentage of cancer cases, it allows for targeted treatment and screening that can prevent cancer in families. Expanding access to genetic risk assessment and counseling could help identify more high-risk individuals and families earlier to reduce cancer burden through prevention and early detection strategies.
This document discusses cancer genetics and genetic testing, including that most cancers are sporadic, around 5% are hereditary, the goals of genetic counseling, cancer susceptibility genes, hereditary cancer syndromes like BRCA and Lynch syndrome
This document provides an overview of cancer genetics and genetic counseling. It discusses that approximately 5% of cancers are hereditary. Genetic testing aims to identify families with increased cancer risks so they can pursue increased screening or prevention options. For example, BRCA1/2 testing allows some families to lower their breast and ovarian cancer risks through surgeries. The document outlines cancer risks, testing considerations, management options and referral guidelines for several common hereditary cancer syndromes.
This document provides an overview of cancer genetics, including:
- Around 85% of cancers are sporadic, 10% are familial, and 5% are hereditary.
- Genetic testing is offered to high-risk families with over a 20% chance of a genetic mutation. Mutations in genes like BRCA1 and BRCA2 increase risks for cancers like breast and ovarian cancer.
- While cancer genetics cannot predict risk with certainty, it helps identify individuals at higher risk so they can make informed medical choices to reduce risk. Taking a family history and contacting genetics services can help determine cancer risk patterns.
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Efrat Levy Lahad : Genetic testing for breast and ovarian cancer
1. Gene$c
tes$ng
for
breast
&
ovarian
cancer
Ephrat
Levy-‐Lahad,
MD
Shaare
Zedek
Medical
Center
Jerusalem,
Israel
Israeli-‐French
Breast
Cancer
Update,
Jerusalem
May
1,
2014
2. Disclosures
-‐
none
Our
research
is
supported
by
:
• The
Israel
Cancer
Associa:on
• The
Breast
Cancer
Research
Founda:on
(NY,
USA)
3. Gene$c
tes$ng
for
breast
and
ovarian
cancer:
Who
should
be
tested
and
for
what
genes?
4. Why
perform
gene$c
tes$ng?
Unaffected
women
–
defining
risk
• Prevent
breast
&
ovarian
cancer
(in
carriers)
• Avoid
unnecessary
preven:on/surveillance
measures
(in
non-‐carriers)
• Enable
tes:ng
in
rela:ves.
Affected
women
(breast
or
ovarian
cancer)
• Prevent
addi:onal
cancers
(ovarian,
contralateral
breast)
• Enable
tes:ng
in
rela:ves
•
Therapeu$c
implica$ons
–
chemotherapy,
radiotherapy,
targeted
therapy
(incl.
clinical
trials).
Therapeu$c
implica$ons
are
a
game
changer:
Timeline;
Scope
of
tes:ng:
pa:ents
&
genes
5. Who
to
test?
Current
guidelines
• This
recommenda$on
applies
to
asymptoma$c
women
who
have
not
been
diagnosed
with
BRCA-‐related
cancer.
• USPSTF
recognizes
the
poten$al
importance
of
further
evalua$ng
women
who
have
a
diagnosis
of
breast
or
ovarian
cancer.
Some
women
receive
gene:c
tes:ng
as
part
of
a
cancer
evalua:on
at
the
:me
of
diagnosis
of
breast
cancer.
• The
USPSTF
did
not
review
the
appropriate
use
of
BRCA
tes$ng
in
the
evalua$on
of
women
who
are
newly
diagnosed
with
breast
cancer.
That
assessment
is
part
of
disease
management
and
is
beyond
the
scope
of
this
recommenda$on.
6. USPSTF
–
Test
asymptoma$c
only
with
sugges$ve
family
history
Family
history
sugges:ve
of
BRCA
muta:ons
includes:
• Breast
cancer
diagnosis
at
age
<50
years,
• Bilateral
breast
cancer
• Individual
with
2
primary
tumors:
breast&
ovarian/
fallopian/peritoneal
cancer
• Male
breast
cancer
• Mul:ple
cases
of
breast
cancer
in
the
family,
Rela:ves
with
2
primary
BRCA-‐related
cancers
• Ashkenazi
Jewish
ethnicity.
7. Insufficient
evidence
to
support
a
specific
risk
threshold
for
referral
for
tes$ng,
or
a
specific
carrier
probability
model.
Recommend
tes$ng
women
with
sugges:ve
family
history
Recommend
against
tes:ng
women
without
family
history
USPSTF
–
Tes$ng
only
for
sugges$ve
family
history
8. Who
to
test?
Addi:onal
guidelines
• ACOG
(2009),
SGO
(2007)
20-‐25%
cancer
risk
threshold,
suggest
tes:ng
could
be
helpful
for
those
with
>
5-‐10%
chance
of
inherited
cancer
predisposi:on.
(prior
probability
approach)
• ASCO
(2010),
NSGC
(2013)–
no
threshold,
emphasize
counseling
and
impera:ve
that
test
results
affect
pa:ent
management.
• ESMO
(2011)
–
pretest
&
post-‐test
counseling,
informed
consent.
(emphasis
on
process
and
clinical
u$lity)
9. NCCN
Guidelines
-‐
2014
Affected
persons
–
detailed
criteria
for
breast
cancer
+
• All
breast
cancer
<
45
• Early
onset
(<50
yrs)
breast
cancer+
• Triple
nega:ve
breast
cancer
–
all
<
60,
over
60
if
+
• All
mul:ple
primaries
• All
ovarian
cancer
• All
male
breast
cancer
10. NICE
Guidelines
(UK)
June
2013
• Carrier
probability
at
which
gene$c
tes$ng
should
be
offered
• Breast/ovarian
cancer
cases
with
combined
BRCA1/BRCA2
muta-on
carrier
probability
of
>10%
(based
on
acceptable
methods)
• Person
with
no
personal
history
of
breast
or
ovarian
cancer:
1. If
they
have
a
combined
BRCA1/BRCA2
muta-on
carrier
probability
>
10%.
2. If
they
have
an
an
affected
rela-ve
with
carrier
probability
>
10%
who
is
available
for
tes-ng.
11. Should
all
women
with
breast
or
ovarian
cancer
undergo
germline
gene$c
tes$ng?
12. Ashkenazi
Women
with
Breast
Cancer
IBCS
(Israel
Breast
Cancer
Study)
–Results
NYBCS
(King
et
al.
Science
2003)
N=1008
42
25
37
104
4.2%
2.5%
3.7%
10.3%
BRCA1
BRCA1
BRCA2
Total
185delAG
5382insC
6174delT
44
20
48
112
4.2%
1.9%
4.5%
10.6%
N=1,046
consecu:ve,
Ashkenazi
Jewish
women
with
breast
cancer
13. 83
52 48Br 39
79
*
BRCA1
5382 insC
84 74
48Br 42
*
BRCA2
6174 ΔT
VN" VN"
VN" VN"NN" NN" NN"
NN" NN"
Small families"
Paternal inheritance"
Female relatives carry wildtype alleles by Mendelian chance"
50% of patients with BRCA1 or BRCA2 mutations"
No close family history of breast or ovarian cancer"
V – Variant
(mutation)
N- normal
Courtesy of MC King, UW
14. Carriers
Non-carrier
controls
Family History-
How suggestive?
77* (45%)119 (70%)Not
31 (18%)32 (19%)Low
34** (20%)15 (9%)Moderate
25 (15%)4 (2%)High
3 (2%)0 (0%)Lack of information
170 (100%)170 (100%)Total
Do carriers have family history?
Carriers vs. Non-carriers – p<.001
BRCA2 vs. BRCA1 p=0.015
Assessment of family history in BRCA1/2 and control families
*one double heterozygote
** two double heterozygotes
15. Should
all
women
with
ovarian
cancer
undergo
germline
gene$c
tes$ng?
16. Hirsch-Yecehzkel et al, Gyn Oncol 2003
BRCA1/BRCA2
muta$ons
in
ovarian
cancer
NISOC
study
–
all
ovarian
cancer
cases
in
Israel
3/1994-‐6/1999
–
779
invasive
epithelial
ovarian
cancers.
17. TP53
BRCA1
BRCA2
BRIP1
CHEK2
BARD1
MRE11
MSH6
NBN
PALB2
RAD51C
RAD50
40
23
1
4
5
1
2
1
2
1 2 3
Ovarian cancer:
BRCA1/BRCA2
mutations in 63/360
(18%) patients not
selected for family
history or age at
onset
Walsh, Swisher et al. PNAS 2011
BRCA1/BRCA2
muta$ons
in
ovarian
cancer
(UW,
Seaile,
USA)
Courtesy of MC King, UW
18. Should
all
women
with
breast
or
ovarian
cancer
undergo
germline
gene$c
tes$ng?
BRCA1/BRCA2
Ovarian
cancer
–
Yes
>
10%
probability
Breast
cancer–
Ashkenazi
Jews
–
Yes
~10%
probability
other
founder
popula$ons,
all?
(7-‐8%)
19. Advantages
and
disadvantages
of
general
tes$ng
in
affected
women
Advantages
• Management
–
planning
surgery
and
radia:on,
chemotherapy
choice
• Preven:on/early
detec:on
of
second
primary
• Clinical
trials
Disadvantages
• Variants
of
unknown
significance
10-‐15%
20. For
what
genes?
• BRCA1/BRCA2
• Syndrome
specific
–
PTEN
(Cowden/PTEN
hamartoma
synd.),
TP53,
CDH1
• Popula:on
specific
–
PALB2
in
Finland
Game
changer
–
mul$-‐gene
panels
Available
as
a
consequence
of
NGS
(next
genera:on
sequencing).
Most
now
include
BRCA1/BRCA2
25. Mul$-‐gene
panel
tes$ng
-‐
results
1.
Deleterious
muta$ons
in
high-‐risk
genes
2.
Deleterious
muta$ons
in
moderate-‐risk
genes?
• No
clinical
guidelines
for
management
of
moderate
penetrance
genes.
• Life:me
breast
cancer
risk
>
20%,
breast
MRI
• Risk
reducing
surgeries????
3.
Variants
of
unknown
signficance
(VOUS)
26. What
is
the
added
yield
of
mul$-‐gene
panels?
27. TP53
BRCA1
BRCA2
BRIP1
CHEK2
BARD1
MRE11
MSH6
NBN
PALB2
RAD51C
RAD50
40
23
1
4
5
1
2
1
2
1 2 3
Ovarian
cancer:
BRCA1/BRCA2
muta:ons
in
63/360
(18%)
pa:ents
not
selected
for
family
history
or
age
at
onset
Muta$ons
in
10
other
genes:
19/360
–
5%
Walsh,
Swisher
et
al.
PNAS
2011
BRCA1/BRCA2
muta$ons
in
ovarian
cancer
(UW,
Seaile,
USA)
Courtesy
of
MC
King,
UW
28. Patient’s genotype determines treatment
Implications for relatives
Almost all these cases are preventable
Patients w ovarian cancer
BRCA1/BRCA2
Other genes
Total with inherited risk
360
63
19
82
0.18
0.05
0.23
N Proportion
Walsh, Swisher et al. PNAS 2011
Ovarian cancer:
Inherited mutations in 12 genes in 23% of unselected patients
29. 18 genes with actionable mutations in 191 breast cancer families
25% of families negative by commercial BRCA1 and BRCA2 testing
Courtesy of MC King, UW
30. Families with negative results from commercial BRCA1 and BRCA2
testing – Sequencing 20 breast cancer genes
0
0.1
0.2
0.3
All
families
(N = 741)
Female and
male breast
cancer
(N = 83)
Breast and
ovarian
cancer
(N = 279)
Female
breast
cancer only
(N = 401)
Proportionoffamiliesresolved
Courtesy of MC King, UW
31. NGS
panels
in
“real
life”
(Mauer
CB,
et
al,
GIM
2013)
Retrospec:ve
review
of
all
NGS
cancer
panels
ordered
by
a
large
academic
cancer
gene:cs
program
(University
of
Texas,
Dallas)
4/2012
-‐1/
2013
Various
panels
(not
including
BRCA1/2)
• 1,233/1,521
(81.1%)
new
cancer
gene:cs
pa:ents
evaluated
had
gene:c
tes:ng.
• NGS
panels
were
ordered
on
60
(4.9%)
of
these
pa:ents.
32. • Breast
cancer
pa:ents
–
36/37
previously
nega:ve
BRCA1/BRCA2
tes:ng.
• Most
other
tested
pa:ents
were
also
personally
affected
with
cancer
• Deleterious
results:
• 5/50
(10%)
of
those
who
had
an
NGS
panel
•
Compare
to:
131/1,233
(10.6%)
single-‐gene
tests
ordered
at
the
same
center
in
the
study
:me
frame-‐deleterious
result
NGS
panels
in
“real
life”
(Mauer
CB,
et
al,
GIM
2013)
33.
34.
35. Clinical
U$lity
of
NGS
panels
(Mauer
CB,
et
al,
GIM
2013)
30
(60%)
–
no
effect
on
management
decisions.
15
(30%)
introduced
uncertainty
regarding
the
pa:ents’
cancer
risks.
5
(10%)-‐
directly
influenced
management
decisions.
“The
CHEK2
posi-ve
pa-ents
were
counseled
according
to
the
management
guideline
previously
established
at
our
ins:tu:on.”
“The
RAD51C,
ATM,
and
MUTYH
muta:on
results
prompted
a
thorough
review
of
the
literature”
38. Conclusions
• Who
–
all
women
with
ovarian
cancer,
and
probably
all
women
with
breast
cancer.
• What
–
Ideally
–
BRCA1/BRCA2
+
syndromic
genes
separately,
NGS
as
research.
(NCCN
–
NGS
as
second
:er,
with
gene:cist)
• Not
clearly
possible
as
BRCA1/BRCA2
are
incorporated
into
NGS
panels.
• DATA
COLLECTION
–
reclassify
VUS,
understand
cancer
risks.
39. Institute of Medical Genetics, Shaare Zedek Medical Center:
Sari Lieberman, Ariela Tomer, Vered Koltuv, Carmit Cohen
Dr. Efrat Gabai-Kapara , Chaya Hackett,
Lab: Dr. Rachel Beeri, Doris Goldschmidt, Dr. Esther Korzin-Bez,
GCs: Hila Fridman, Sivan Koka, Dr. Adi Ben-Yehuda, Dr. Galit Lazer-
Derbeko, Shachar Zuckerman, Yulia Grinshpun-Cohen.
CoordinationL Sara Ribak, Liora Bruchim, Ronit Eliahu, Noam Zaslansky
Dr. Avraham Ben-Chetrit, Dr. Oded Olsha, Dr. Amnon Lahad
Sheba Medical Center, Tel Hashomer
Prof. Bella Kaufman, Dr. Shlomo Segev, Michal Chami, Prof. Raphael
Catane, Dr. Miri Sklair, Prof. Eitan Friedman
Terem Medical Center Hala Breast Clinic
Dr. Keren Djemal, Toby Davidian Dr. Strano, Judy Kopp
Efrat Medical Center Terem Modiin Medical Center
Dr. Ben Zev, Dr. Yitchak Glick Dr. Todd Zalut, Chaviv Gabai
Thank you:
Supported
by
the
Breast
Cancer
Research
Founda$on,
(BCRF),
NY,
USA
Israel
Cancer
Associa$on
(Israel
Breast
Cancer
Consor$um)
40. Which
genes?
NICE
Recommenda:on
(2013,
unchanged
from
2004)
• Muta$on
tests
• 1.5.5
Tests
aimed
at
muta:on
finding
should
first
be
carried
out
on
an
affected
family
member
where
possible.
[2004]
• 1.5.6
If
possible,
the
development
of
a
gene:c
test
for
a
family
should
usually
start
with
the
tes:ng
of
an
affected
individual
(muta:on
searching/screening)
to
try
to
iden:fy
a
muta:on
in
the
appropriate
gene
(such
as
BRCA1,
BRCA2
or
TP53)
(see
recommenda-ons
1.5.8–1.5.13).
[2004]
• 1.5.7
A
search/screen
for
a
muta:on
in
a
gene
(such
as
BRCA1,
BRCA2
or
TP53)
should
aim
for
as
close
to
100%
sensi-vity
as
possible
for
detec-ng
coding
altera-ons
and
the
whole
gene(s)
should
be
searched.
[2004]
41. In
the
American
College
of
Medical
Gene:cs
and
Genomics
(ACMG)
recommenda:ons
(1)
sequence
varia$on
is
previously
reported
and
is
a
recognized
cause
of
the
disorder.
(2)
sequence
varia:on
is
previously
unreported
and
is
of
the
type
which
is
expected
to
cause
the
disorder.
(3)
sequence
varia:on
is
previously
unreported
and
is
of
the
type
which
may
or
may
not
be
causa:ve
of
the
disorder.
(4)
sequence
varia:on
is
previously
unreported
and
is
probably
not
causa:ve
of
disease.
(5)
sequence
varia$on
is
previously
reported
and
is
a
recognized
neutral
variant.
(6)
sequence
varia:on
is
previously
not
known
or
expected
to
be
causa:ve
of
disease,
but
is
found
to
be
associated
with
a
clinical
presenta:on
42. ACMG
results
report
guideline
• (1)
the
gene
• analyzed
and
the
presence
or
absence
of
a
variant,
the
nature
• of
the
muta:on,
and
whether
it
is
conserva:ve
or
nonconserva:ve;
• (2)
The
category
(1–6)
within
which
the
variants
• falls;
(3)
The
basis
upon
which
this
classifica:on
was
made;
• (4)
Tes:ng
methodology
and
analy:c
sensi:vity;
(5)
Available
• data
on
penetrance
and
expressivity
of
previously
reported
• variants;
(6)
Strategies
for
further
classifica:on
of
novel
• variants
(Richards
et
al.
2008).
It
is
recommended
that
novel
• variants
with
unknown
pathogenicity
not
be
reported
to
the
• pa:ent,
but
be
studied
within
the
research
context
in
efforts
to
• further
refine
the
classifica:on
(Berg
et
al.
2011).
43. • GeneDx
categorizes
genes
based
on
level
of
risk,
with
“Significantly
• Increased
Risk”
genes
having
a
rela:ve
risk≥4,
• “Moderately
Increased
Risk”
genes
having
a
rela:ve
risk
of
• 2–4,
and
genes
that
confer
an
increased
risk,
the
exact
magnitude
• of
which
is
unknown
due
to
lack
of
data.