Opportunity for Cancer Prevention: 1 in 4 Unaffected Women ......Syndrome testing, some in part due...
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RESULTS COHORT DEMOGRAPHICS, COMPLETION RATES ● 55% (n=2334) of paents completed the digital ID tool. ● 94% (n=2199) of respondents did not report a personal history of cancer (“unaffected”) and had and average age of 42 years. ● The majority of unaffected paents were Caucasian (Figure 1). CRITERIA INSIGHTS ● Without accounng for known family mutaons, 23% (n=506) of unaffected paents met NCCN criteria for hereditary cancer tesng across criteria types. ● Breast and gyn-cancer criteria were heavily favored compared to colorectal-related criteria (Figure 2). CRITERIA NUANCES ● An addional 1.3% met criteria based on known familial mutaon to bring the total meets-criteria rate to 24.3%. ● Known family mutaons had similar distribuons to criteria distribuons: 82% had known mutaons in BRCA1 or BRCA2, 13% had mutaons in genes associated with Lynch Syndrome, and 6% had had APC or MUTYH mutaons. ● 6.5% met criteria for mulple syndromes, all of whom met criteria for both BRCA1/2-related and Lynch Syndrome tesng, some in part due to known family mutaons. Opportunity for Cancer Prevenon: 1 in 4 Unaffected Women Meet Hereditary Cancer Tesng Criteria Leslie Bucheit, MS, CGC; Kaylene Ready, MS, CGC; Jonathan Brown, MS; Jim Goldberg, MD, FACOG, FACMG Disclosure: All authors are current or former employees of Myriad Genecs and/or Myriad Women’s Health METHODS CONCLUSIONS ● Nearly 1 in 4 unaffected paents presenng for annual OB/GYN visits met NCCN genec tesng criteria for hereditary cancer syndromes, namely BRCA1/2-related and Lynch Syndromes. ● Paents in this cohort skewed towards meeng criteria for BRCA1/2-related syndromes. This suggests that paents may benefit from educaon about colorectal cancer, parcularly the importance of reporng colorectal-related family history to guide individualized care for cancer prevenon including genec tesng. This may also reflect the fact that BRCA1/2-related guidelines have expanded more rapidly than Lynch Syndrome guidelines in recent years. ● Standardized intervenons to assess family history, such as a digital ID tool, may facilitate idenficaon of paents at risk for hereditary cancer syndromes. BACKGROUND ● Esmates show 5-10% of cancer is hereditary. Such esmates are derived from populaons affected with cancer; the prevalence of hereditary cancer syndromes is not well defined in the unaffected populaon. ● Approximately 1 in 500 1 individuals in the general populaon have mutaons in BRCA1 or BRCA2 and 1 in 300 2 have mutaons in genes associated with Lynch Syndrome. ● ACOG states OB/GYNs play an important role in idenfying hereditary cancer syndromes (HCS) and recommends standardizaon for each paent to opmize idenficaon. 3,4 ● This study describes the prevalence of common hereditary cancer syndromes among unaffected female paents as measured by meeng Naonal Comprehensive Cancer Network (NCCN) criteria 5 for genec tesng, following use of a standardized digital idenficaon (ID) tool to capture personal or family cancer history. Figure 1: Distribuon of Ethnicies for Unaffected Paents Compleng Digital ID Tool (N=2199). REFERENCES 1. GeneReviews. BRCA1 and BRCA2 Associated Hereditary Breast and Ovarian Cancer. hps://www.ncbi.nlm.nih.gov/books/ NBK1247/. Accessed Mar 12, 2019. 2. Lynch Syndrome Fact Sheet. The Jackson Laboratory. hps:// www.jax.org/educaon-and-learning/clinical-and-connuing- educaon/cancer-resources/lynch-syndrome Accessed Mar 22, 2019. 3. ACOG Pracce Bullen 182. Hereditary Breast and Ovarian Cancer. Sept 2017. 4. ACOG Commiee Opinion 478: Family History as a Risk Assessment Tool. March 2011, Reaffirmed 2018. 5. NCCN Criteria for Hereditary Breast and Ovarian cancer; colorectal cancers. V2.2017. 6. Bucheit et al (2019).Validaon of a digital idenficaon tool for individuals at risk for hereditary cancer syndromes. Hered Cancer Clin Pract hps://doi.org/10.1186/s13053-018-0099-8. Figure 2: NCCN Tesng Criteria Types Met by Unaffected Paents (N=506). All posters available at research.myriadwomensheatlh.com Other 7% (N=154) Caucasian 60% (N=1,323) Asian 16% (N=356) African American 10% (N=212) Ashkenazi Jewish 7% (N=154) 4226 paents were sent personalized link via SMS or e-mail to a validated digital ID tool 6 prior to their annual well visit with an OB/GYN Paent completed prompts regarding personal and/or family history of cancer related to NCCN criteria for BRCA-related, Lynch, and Polyposis syndromes • How would you describe your ethnic background? • Have you ever been diagnosed with cancer? • Is there a history of cancer in your family? • Has anyone else in your family been diagnosed with cancer? • Have you had any colon polyps? • Has a family member had colon polyps? • Has anyone in your family tested posive for a cancer-related gene mutaon? Responses were collected between February 1, 2018 and September 1, 2018. Data were de-idenfied and analyzed to determine how many paents met NCCN criteria as strafied by personal cancer history status. Polyposis 3% (N=16) BRCA1/2-related 82% (N=414) Lynch 15% (N=76)
Transcript of Opportunity for Cancer Prevention: 1 in 4 Unaffected Women ......Syndrome testing, some in part due...
RESULTS
COHORT DEMOGRAPHICS, COMPLETION RATES
● 55% (n=2334) of patients completed the digital ID tool.
● 94% (n=2199) of respondents did not report a personalhistory of cancer (“unaffected”) and had and averageage of 42 years.
● The majority of unaffected patients were Caucasian(Figure 1).
CRITERIA INSIGHTS
● Without accounting for known family mutations, 23%(n=506) of unaffected patients met NCCN criteria forhereditary cancer testing across criteria types.
● Breast and gyn-cancer criteria were heavily favoredcompared to colorectal-related criteria (Figure 2).
CRITERIA NUANCES
● An additional 1.3% met criteria based on knownfamilial mutation to bring the total meets-criteria rateto 24.3%.
● Known family mutations had similar distributionsto criteria distributions: 82% had known mutationsin BRCA1 or BRCA2, 13% had mutations in genesassociated with Lynch Syndrome, and 6% had had APCor MUTYH mutations.
● 6.5% met criteria for multiple syndromes, all of whommet criteria for both BRCA1/2-related and LynchSyndrome testing, some in part due to known familymutations.
Opportunity for Cancer Prevention: 1 in 4 Unaffected Women Meet Hereditary Cancer Testing CriteriaLeslie Bucheit, MS, CGC; Kaylene Ready, MS, CGC; Jonathan Brown, MS; Jim Goldberg, MD, FACOG, FACMGDisclosure: All authors are current or former employees of Myriad Genetics and/or Myriad Women’s Health
METHODS
CONCLUSIONS● Nearly 1 in 4 unaffected patients
presenting for annual OB/GYN visitsmet NCCN genetic testing criteria forhereditary cancer syndromes, namelyBRCA1/2-related and Lynch Syndromes.
● Patients in this cohort skewed towardsmeeting criteria for BRCA1/2-relatedsyndromes. This suggests that patientsmay benefit from education aboutcolorectal cancer, particularly theimportance of reporting colorectal-relatedfamily history to guide individualizedcare for cancer prevention includinggenetic testing. This may also reflect thefact that BRCA1/2-related guidelineshave expanded more rapidly than LynchSyndrome guidelines in recent years.
● Standardized interventions to assessfamily history, such as a digital ID tool,may facilitate identification of patients atrisk for hereditary cancer syndromes.
BACKGROUND● Estimates show 5-10% of cancer is hereditary. Such estimates are derived
from populations affected with cancer; the prevalence of hereditary cancersyndromes is not well defined in the unaffected population.
● Approximately 1 in 5001 individuals in the general population have mutationsin BRCA1 or BRCA2 and 1 in 3002 have mutations in genes associated withLynch Syndrome.
● ACOG states OB/GYNs play an important role in identifying hereditarycancer syndromes (HCS) and recommends standardization for each patient tooptimize identification.3,4
● This study describes the prevalence of common hereditary cancer syndromesamong unaffected female patients as measured by meeting NationalComprehensive Cancer Network (NCCN) criteria5 for genetic testing, followinguse of a standardized digital identification (ID) tool to capture personal orfamily cancer history.
Figure 1: Distribution of Ethnicities for Unaffected Patients Completing Digital ID Tool (N=2199).
REFERENCES1. GeneReviews. BRCA1 and BRCA2 Associated Hereditary Breast
and Ovarian Cancer. https://www.ncbi.nlm.nih.gov/books/NBK1247/. Accessed Mar 12, 2019.
2. Lynch Syndrome Fact Sheet. The Jackson Laboratory. https://www.jax.org/education-and-learning/clinical-and-continuing-education/cancer-resources/lynch-syndrome Accessed Mar22, 2019.
3. ACOG Practice Bulletin 182. Hereditary Breast and OvarianCancer. Sept 2017.
4. ACOG Committee Opinion 478: Family History as a RiskAssessment Tool. March 2011, Reaffirmed 2018.
5. NCCN Criteria for Hereditary Breast and Ovarian cancer;colorectal cancers. V2.2017.
6. Bucheit et al (2019).Validation of a digital identification toolfor individuals at risk for hereditary cancer syndromes. HeredCancer Clin Pract https://doi.org/10.1186/s13053-018-0099-8.
Figure 2: NCCN Testing Criteria Types Met by Unaffected Patients (N=506).
All posters available at research.myriadwomensheatlh.com
Other7% (N=154)
Caucasian60%(N=1,323)
Asian16% (N=356)
African American10% (N=212)
Ashkenazi Jewish7% (N=154)
4226 pa�ents were sent personalized link via SMS or e-mail to a validated digital ID tool6 prior to their annual well visit with an OB/GYN
Pa�ent completed prompts regarding personal and/or family history of cancerrelated to NCCN criteria for BRCA-related, Lynch, and Polyposis syndromes
• How would you describe your ethnic background?• Have you ever been diagnosed with cancer?• Is there a history of cancer in your family?• Has anyone else in your family been diagnosed with cancer?• Have you had any colon polyps?• Has a family member had colon polyps?• Has anyone in your family tested posi�ve for a cancer-related gene muta�on?
Responses were collected between February 1, 2018 and September 1, 2018.Data were de-iden�fied and analyzed to determine how many pa�ents met
NCCN criteria as stra�fied by personal cancer history status.
Polyposis3% (N=16)
BRCA1/2-related82% (N=414)
Lynch15% (N=76)
