“BRCA1/2 mutation carriers have increased risk of contralateral breast cancer (CBC), with age at first diagnosis a significant predictor of CBC risk, according to a study published online Dec. 23 in the Journal of Clinical Oncology.
“Alexandra J. van den Broek, from the Netherlands Cancer Institute in Amsterdam, and colleagues examined overall and age-specific estimates of CBC risk for young patients with breast cancer with or without BRCA1/2 mutations. Data were included for 6,294 patients with invasive breast cancer diagnosed under 50 years of age and treated between 1970 and 2003; participants were tested for the most prevalent BRCA1/2 mutations.”
Most of the recent developments in prostate cancer treatment have addressed the timing and duration of androgen deprivation, who should receive radiation treatments, and the timing of the few available chemotherapy options. But this month’s big news is a welcome change: metastatic castration-resistant prostate cancers (mCRPCs) that harbor mutations in BRCA2 or one of a few other genes have a remarkable response to olaparib (Lynparza), a drug that inhibits the enzyme PARP1. Continue reading…
“Multigene testing of women who tested negative for BRCA1 and BRCA2 found some of them harbored other harmful genetic mutations—most commonly, moderate-risk breast and ovarian cancer genes, as well as Lynch syndrome genes (which increase the risk of ovarian cancer)—according to an article by Desmond et al in JAMA Oncology.
“Multigene panel genetic tests are increasingly recommended for patients evaluated for a predisposition to hereditary breast/ovarian cancer. However, the rapid introduction of these tests has raised concerns, because many of the tested genes are low- to moderate-risk genes for which consensus management guidelines have not been introduced or were introduced only very recently, according to the study background.
“Leif W. Ellisen, MD, PhD, of Massachusetts General Hospital Cancer Center, and coauthors wanted to determine how often multigene panel testing would identify mutations that warranted some clinical action among women appropriately tested but lacking BRCA1 and BRCA2 mutations.”
“Breast cancer survivors with a family history of the disease, including those who carry BRCA1 and BRCA2 gene mutations, gained more weight over the course of four years than cancer-free women—especially if they were treated with chemotherapy, according to a prospective study by Johns Hopkins Kimmel Cancer Center researchers.
“Data from earlier studies suggest that breast cancer survivors who gain weight may have a higher risk of having their cancer return, the researchers say, noting that gains of 11 pounds or more are also associated with a higher risk of developing cardiovascular disease.
“For the study, the researchers reviewed a baseline questionnaire and a follow-up one completed four years later by 303 breast cancer survivors and 307 cancer-free women enrolled in an ongoing and long-term study at the Kimmel Cancer Center of women with a family history of breast or ovarian cancer. Study participants completed a baseline and at least one follow-up questionnaire between 2005 and 2013, and one-quarter of the subjects were premenopausal.”
“A group of international researchers is making the case that genetic tests that look for multiple hereditary genes suspected of being linked to breast cancer should not be offered until they are proven to be valid and useful in clinical practice.
“Such tests, made by several companies including Myriad Genetics Inc, Ambry Genetics, Invitae and Illumina Inc, cover up to 100 inherited cancer genes, including more than 20 for breast cancer.
“They have become increasingly popular since June 2013, when the U.S. Supreme Court invalidated patents held by Myriad on BRCA1 and BRCA2, two well-characterized genes that put a woman at high risk for breast, ovarian and other cancers.
“What the researchers are concerned about are lesser-known genes included in the tests.
” ‘The reality is that we don’t have good risk estimates for mutations that occur in many of the genes on the panels,’ said Fergus Couch, a breast cancer expert at Mayo Clinic in Rochester, Minnesota.”
“A Silicon Valley start-up with some big-name backers is threatening to upend genetic screening for breast and ovarian cancer by offering a test on a sample of saliva that is so inexpensive that most women could get it.
“At the same time, the nation’s two largest clinical laboratories, Quest Diagnostics and LabCorp, normally bitter rivals, are joining with French researchers to pool their data to better interpret mutations in the two main breast cancer risk genes, known as BRCA1 and BRCA2. Other companies and laboratories are being invited to join the effort, called BRCA Share.
“The announcements being made on Tuesday, although coincidental in their timing, speak to the surge in competition in genetic risk screening for cancer since 2013, when the Supreme Court invalidated the gene patents that gave Myriad Genetics a monopoly on BRCA testing.
“The field has also been propelled by the actress and filmmaker Angelina Jolie, who has a BRCA1 mutation and has written about her own decision to have her breasts, ovaries and fallopian tubes removed to sharply reduce her risk of developing cancer.
“But the issue of who should be tested remains controversial. The effort of the start-up, Color Genomics, to ‘democratize access to genetic testing,’ in the words of the chief executive, Elad Gil, is generating concern among some experts.”
The gist: Recent research shows that testing for BRCA1 and BRCA2 mutations might be useful for patients with triple-negative breast cancer, even if they have no family history of breast cancer.
“The high prevalence of deleterious mutations in predisposition genes in patients with triple-negative breast cancer unselected for family history suggests germline genetic testing for BRCA1 and BRCA2 mutations may be appropriate in this population, according to study results.
“However, further analyses of non-BRCA genes are needed to assess their utility in this setting, researchers wrote.
“Fergus J. Couch, PhD, of the department of laboratory medicine and pathology at Mayo Clinic in Rochester, Minn., and colleagues evaluated data from 1,824 women with triple-negative breast cancer who were enrolled on one of 12 studies. All women were unselected for family history of breast or ovarian cancer, and most were non-Hispanic white (97%). The median age of the population at diagnosis was 51 years (range, 22-93).”
“The addition of MRI to mammography significantly improved screening sensitivity among women who harbored BRCA1 or BRCA2 mutations, according to study results.
“The sensitivity of the screening combination also was comparable among women aged older than 50 years and those aged younger than 50 years, results showed.
“Xuan-Anh Phi, PhD, of University Medical Center Groningen in the Netherlands, and colleagues pooled individual patient data from six screening trials of high-risk individuals.
“The trials comprised a combined 1,951 women with BRCA1/2 mutations. The median age of the entire population was 41 years; 16.9% were aged 50 to 59 years and 5.5% were aged 60 years or older.
“Of the breast cancers detected, 141 occurred in women aged younger than 50 years, and 43 occurred in women aged 50 years or older.
“MRI detected 78.8% of the cancers, and mammography detected 38.6%. The combination of MRI and mammography detected 88.6% of the cancers and was associated with a significant improvement in screening sensitivity compared with mammography alone (93.4% vs. 39.6%; P˂.001). However, the combination of both screening methods was associated with a reduced specificity compared with mammography alone (80.3% vs. 93.6%; P=.0016).”
“In an Australian study reported in the Journal of Clinical Oncology, White et al found that a telephone-based peer-support intervention reduced breast cancer distress among women with a BRCA1 or BRCA2 gene mutation.
“In the study, 207 mutation carriers reporting interest in talking to other mutation carriers were randomly assigned to the peer-support intervention (n = 105) or usual care (n = 102). The intervention involved trained peer volunteers’ contacting study participants six times over 4 months to provide informational, emotional, and practical support. Outcomes included breast cancer distress (measured by Impact of Event Scale), anxiousness, unmet information needs, and stress and confidence (measured by Cognitive Appraisals About Genetic Testing scale). Outcomes were assessed at the end of intervention (4 months after randomization) and 2 months later…
“The investigators concluded: ‘The intervention is effective in reducing distress and unmet information needs for this group of women. Identifying strategies for prolonging intervention effects is warranted.’ ”