Prediction of Cancer Prevention

From Mammogram Screening to Identification of BRCA1/2 Mutation Carriers in Underserved Populations

Linda S. Robinson, Ashley Hendrix, Xian Jin Xie, Jingsheng Yan, Sara Pirzadeh-Miller, Mary Pritzlaff, Parker Read, Sarah Pass, David Euhus, Theodora S. Ross

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: The US Preventative Service Task Force recommends that physicians perform a genetic risk assessment to identify women at risk for BRCA1/2 mutations associated with hereditary breast and ovarian cancer (HBOC) syndrome. However, outcomes data after a diagnosis of HBOC syndrome especially in diverse populations, are minimal. Here we asked if genetic screening of high-risk underserved women identified in the mammogram population reduces cancer incidence. Methods: We evaluated 61,924 underserved women at screening mammography for family histories suggestive of HBOC syndrome over the course of 21 months. Data were collected retrospectively from patients at two safety net hospitals through chart review. A computer model was used to calculate the long-term effect of this screening on cancer incidence by assessing both the mutation detection rate and the completion of prophylactic surgeries in BRCA1/2 mutation carriers. Findings: We identified 20 of the 85 (23.5%) expected BRCA1/2 mutation carriers in the underserved population. The frequencies of prophylactic mastectomies and oophorectomies in the mutation carriers were 25% and 40%, respectively. Using these data, our model predicted only an 8.8% reduction in both breast and ovarian cancer in the underserved patients. This contrasts with a 57% reduction in breast cancer and 51% reduction in ovarian cancer in an insured reference population. Our data indicate that underserved patients with HBOC syndrome are difficult to identify and when identified are limited in their ability to adhere to NCCN guidelines for cancer prevention. Interpretation: Screening for women at risk for HBOC syndrome in mammogram populations will only prevent cancers if we can increase compliance with management guidelines. This study provides prototypic baseline data for step-wise analysis of the efficacy of the use of family history analysis in the mammography setting for detection and management of HBOC syndrome.

Original languageEnglish (US)
Pages (from-to)1827-1833
Number of pages7
JournalEBioMedicine
Volume2
Issue number11
DOIs
StatePublished - Nov 1 2015

Fingerprint

Hereditary Breast and Ovarian Cancer Syndrome
Vulnerable Populations
Screening
Mutation
Mammography
Neoplasms
Ovarian Neoplasms
Population
Safety-net Providers
Guidelines
Risk assessment
Surgery
Breast Neoplasms
Aptitude
Incidence
Genetic Testing
Ovariectomy
Advisory Committees
Mutation Rate
Early Detection of Cancer

Keywords

  • BRCA1/2
  • Genetic testing
  • Hereditary breast and ovarian cancer syndrome
  • Population screening
  • Underserved

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Prediction of Cancer Prevention : From Mammogram Screening to Identification of BRCA1/2 Mutation Carriers in Underserved Populations. / Robinson, Linda S.; Hendrix, Ashley; Xie, Xian Jin; Yan, Jingsheng; Pirzadeh-Miller, Sara; Pritzlaff, Mary; Read, Parker; Pass, Sarah; Euhus, David; Ross, Theodora S.

In: EBioMedicine, Vol. 2, No. 11, 01.11.2015, p. 1827-1833.

Research output: Contribution to journalArticle

Robinson, LS, Hendrix, A, Xie, XJ, Yan, J, Pirzadeh-Miller, S, Pritzlaff, M, Read, P, Pass, S, Euhus, D & Ross, TS 2015, 'Prediction of Cancer Prevention: From Mammogram Screening to Identification of BRCA1/2 Mutation Carriers in Underserved Populations', EBioMedicine, vol. 2, no. 11, pp. 1827-1833. https://doi.org/10.1016/j.ebiom.2015.10.022
Robinson, Linda S. ; Hendrix, Ashley ; Xie, Xian Jin ; Yan, Jingsheng ; Pirzadeh-Miller, Sara ; Pritzlaff, Mary ; Read, Parker ; Pass, Sarah ; Euhus, David ; Ross, Theodora S. / Prediction of Cancer Prevention : From Mammogram Screening to Identification of BRCA1/2 Mutation Carriers in Underserved Populations. In: EBioMedicine. 2015 ; Vol. 2, No. 11. pp. 1827-1833.
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abstract = "Background: The US Preventative Service Task Force recommends that physicians perform a genetic risk assessment to identify women at risk for BRCA1/2 mutations associated with hereditary breast and ovarian cancer (HBOC) syndrome. However, outcomes data after a diagnosis of HBOC syndrome especially in diverse populations, are minimal. Here we asked if genetic screening of high-risk underserved women identified in the mammogram population reduces cancer incidence. Methods: We evaluated 61,924 underserved women at screening mammography for family histories suggestive of HBOC syndrome over the course of 21 months. Data were collected retrospectively from patients at two safety net hospitals through chart review. A computer model was used to calculate the long-term effect of this screening on cancer incidence by assessing both the mutation detection rate and the completion of prophylactic surgeries in BRCA1/2 mutation carriers. Findings: We identified 20 of the 85 (23.5{\%}) expected BRCA1/2 mutation carriers in the underserved population. The frequencies of prophylactic mastectomies and oophorectomies in the mutation carriers were 25{\%} and 40{\%}, respectively. Using these data, our model predicted only an 8.8{\%} reduction in both breast and ovarian cancer in the underserved patients. This contrasts with a 57{\%} reduction in breast cancer and 51{\%} reduction in ovarian cancer in an insured reference population. Our data indicate that underserved patients with HBOC syndrome are difficult to identify and when identified are limited in their ability to adhere to NCCN guidelines for cancer prevention. Interpretation: Screening for women at risk for HBOC syndrome in mammogram populations will only prevent cancers if we can increase compliance with management guidelines. This study provides prototypic baseline data for step-wise analysis of the efficacy of the use of family history analysis in the mammography setting for detection and management of HBOC syndrome.",
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