abstract: Follow-up of carriers of BRCA1 and BRCA2 variants of unknown significance: variant reclassification and surgical decisions.

Blogger's Note: while this article is specific to BRCA 1/2 it also would apply to other genetic syndromes eg. Lynch Syndrome, Peutz-Jeghers 
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Follow-up of carriers of BRCA1 and BRCA2 variants of unknown significance: variant reclassification and surgical decisions.:


Genet Med. 2011 Dec;13(12):998-1005

Abstract
PURPOSE:
Approximately 5-10% of patients who undergo genetic testing of BRCA1 and BRCA2 receive a variant of unknown significance (VUS) result. The ambiguous nature of a VUS may increase difficulty in patient understanding and decision making regarding risk reduction and surveillance options, including cancer risk-reducing surgeries. VUS reclassification to benign or deleterious may occur in time; however, clinical decisions may need to be made expeditiously, and some patients may pursue irreversible treatments before VUS reclassification.

METHODS:
We reviewed the surgical decisions of 107 women postdisclosure of a BRCA VUS result counseled at our institute between 1998 and 2009.

CONCLUSION:
Among women receiving a BRCA VUS result at our center, 11 of 107 (10.3%) pursued cancer risk-reducing mastectomy and 22 of 107 (20.6%) pursued cancer risk-reducing bilateral salpingo-oophorectomy. Reclassification of VUS occurred up to 9 years after testing, and 5 of 22 (22.7%) women followed up for 8 or more years continue to have a VUS result. We discuss considerations for providers of genetic services to discuss with patients who receive a VUS result.

abstract: Eligibility criteria in private and public coverage policies for BRCA genetic testing and genetic counseling.

Eligibility criteria in private and public coverage policies for BRCA genetic testing and genetic counseling

Genet Med. 2011 Dec;13(12):1045-50. doi: 10.1097/GIM.0b013e31822a8113.

Abstract

PURPOSE:

Coverage policies for genetic services for hereditary cancers are of interest because the services influence cancer risk reduction for both persons with cancer and their family members. We compared coverage policies for BRCA genetic testing and genetic counseling among selected payers in the United States to illuminate eligibility criteria variation that may explain differential access by insurance type. We compared these policies with policies for breast cancer screening with magnetic resonance imaging to consider whether payers apply a unique policy approach to genetic services.

METHODS:

We conducted a case study of large private and public payers selected on number of covered lives. We examined coverage policies for BRCA genetic testing, genetic counseling, and screening with magnetic resonance imaging and the eligibility criteria for each. We compared eligibility criteria against National Comprehensive Cancer Network guidelines.

RESULTS:

Eligibility criteria for BRCA testing were related to personal history and family history of cancer. Although private payers covered BRCA testing for persons with and without cancer, the local Medicare carrier in our study only covered testing for persons with cancer. In contrast, Arizona's Medicaid program did not cover BRCA testing. Few payers had detailed eligibility criteria for genetic counseling. Private payers have more detailed coverage policies for both genetic services and screening with magnetic resonance imaging in comparison with public payers.

CONCLUSION:

Despite clinical guidelines establishing standards for BRCA testing, we found differences in coverage policies particularly between private and public payers. Future research and policy discussions can consider how differences in private and public payer policies influence access to genetic technologies and health outcomes.

abstract: Microsatellite Instability in Saliva from Patients with Hereditary Non-polyposis Colon Cancer (HNPCC/Lynch Syndrome) and Siblings Carrying Germline Mismatch Repair Gene Mutations

Microsatellite Instability in Saliva from Patients with Hereditary Non-polyposis Colon Cancer and Siblings Carrying Germline Mismatch Repair Gene Mutations

"Saliva testing, a less-invasive procedure than PBL ( peripheral blood lymphocytes) testing, is more sensitive and appears to be a viable alternative for identifying MSI in carriers with MMR mutations."

abstract: Assessing residents' disclosure of adverse events: traditional objective structured clinical examinations versus mixed reality.

Assessing residents' disclosure of adv... [J Obstet Gynaecol Can. 2012] - PubMed - NCBI

J Obstet Gynaecol Can. 2012 Apr;34(4):367-73.

Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON.

Abstract

Objective: 
The skill of disclosing adverse events is difficult to assess. Assessment of this competency in medical trainees is commonly achieved via the objective structured clinical examination (OSCE) using a standardized patient (SP). We hypothesized that the addition of a simulated clinical adverse event prior to the SP encounter could increase trainees' engagement and empathy, thereby improving performance. The objective of this study was to explore whether experiencing a simulated adverse event prior to an SP encounter alters resident performance on a disclosure OSCE.


Conclusion: 
The assessment of adverse event disclosure was not enhanced by the addition of a simulated experience. Study participants reported that the simulation did not provide the contextual information required to elicit empathy and a sense of being emotionally invested in the adverse event.

press release: Community Oncology Continues Precipitous Consolidation of Cancer Care -- WASHINGTON, April 4, 2012 /PRNewswire/ --

Community Oncology Continues Precipitous Consolidation of Cancer Care -- WASHINGTON, April 4, 2012 /PRNewswire/ --

Community Oncology Practice Impact Report Apr 4, 2013 (U.S. closures etc by state)_4-4-12F.pdf (application/pdf Object)

Community_Oncology_Practice_Impact_Report_4-4-12F.pdf (application/pdf Object)

"This is an update to the last Community Oncology Alliance (COA) Practice Impact Report, which was issued on 3/31/11. This report is derived from a tracking database on the changing oncology treatment landscape. The database is compiled from private and public sources.
Included in this report are a table of impacted practices by state and a map depicting the impact.

• As of the date of this update, 1,254 clinics/practices during the past 4½ years have been impacted as follows:

— 241 Clinics Closed — Denotes individual clinic sites that have closed.
— 442 Practices Struggling Financially — Denotes practices (possibly comprised of multiple clinic sites) that have financial difficulties......

Aprl 5th, 2012: Who Gets Ovarian Cancer? | Mayo Clinic Podcasts

Who Gets Ovarian Cancer? | Mayo Clinic Podcasts

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Who Gets Ovarian Cancer?

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Posted on April 5, 2012 by mayoclinic

When it comes to ovarian cancer, are you at risk?  In this Medical Edge Radio episode, Mayo Clinic Dr. Paul Haluska provides some insight.
To listen, click the link below.
Who Gets Ovarian Cancer

Google Scholar search: Low-Grade Ovarian Serous Neoplasms (Low-Grade Serous Carcinoma and Serous Borderline Tumor) Associated With High-Grade Serous Carcinoma - Google Scholar

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repost from Sept 2011 - abstract: Suicide in women with gynecologic cancer(priority posting)

abstract: Suicide and Cardiovascular Death after a Cancer Diagnosis — NEJM

Suicide and Cardiovascular Death after a Cancer Diagnosis — NEJM

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Original Article

N Engl J Med 2012; 366:1310-1318 April 5, 2012

Background

Receiving a diagnosis of cancer is a traumatic experience that may trigger immediate adverse health consequences beyond the effects of the disease or treatment.

Conclusions

In this large cohort study, patients who had recently received a cancer diagnosis had increased risks of both suicide and death from cardiovascular causes, as compared with cancer-free persons.

abstract: Phase II Study of Gemcitabine and Docetaxel in Recurrent Platinum Resistant Ovarian Cancer

Abstract

To evaluate the activity of gemcitabine and docetaxel in patients with recurrent ovarian cancer.

Methods: 
Patients with platinum-resistant disease and prior treatment with paclitaxel received treatment with docetaxel on day 1 and gemcitabine on days 1 and 8, repeated every three weeks.

Results: 
Twenty patients, with a platinum-free interval of three months, were enrolled. Overall response rate was 25%. Treatment was associated with significant myelosuppression.

Conclusions: 
In chemotherapy-resistant patients, this regimen exhibited encouraging activity. Excessive myelosuppression led to early closure. This was prevented by administering docetaxel on day 8 (instead of day 1) and prophylactic use of G-CSF. (blood products)

abstract: Ovarian cancer: insights into genetics and pathogeny

Abstract

".......The classic conception of ovarian cancer pathogeny, based on the role of the ovarian surface epithelium, is currently reconsidered, and a novel hypothesis is formulated, which supports direct involvement of the Fallopian tubes for the serous type. Although recent research suggests the implication of immune/inflammatory cells by specific mechanisms in ovarian cancer pathogenesis, there is yet reliable evidence concerning their modality of direct action and/or modulation of tumoral growth. Thus, ovarian carcinogenesis remains a research challenge....

abstract: Meta-analysis on the association between non-steroidal anti-inflammatory drug use and ovarian cancer.

Br J Clin Pharmacol. 2012 Apr 3

Abstract

Aim: 
Animal and in vitro studies suggest that the use of non-steroidal anti-inflammatory drugs (NSAIDs) may be associated with reduced risk for ovarian cancer; however, results from these studies have been inconsistent. The aim of our study is to review and summarize the evidence provided by longitudinal studies on the association between NSAID use and ovarian cancer risk.

Methods:
A comprehensive literature search for articles published up to December 2011 was performed. Prior to performing a meta-analysis, the studies were evaluated for publication bias and heterogeneity. Relative risk (RR) or odds ratio (OR) were calculated.


Conclusions: 
Our findings indicate that there is no strong evidence of an association between Aspirin/NA-NSAID use and ovarian cancer. However, this subject deserves further investigation.

abstract: Low-Grade Ovarian Serous Neoplasms (Low-Grade Serous Carcinoma and Serous Borderline Tumor) Associated With High-Grade Serous Carcinoma or Undifferentiated Carcinoma: Report of a Series of Cases of an Unusual Phenomenon

Low-Grade Ovarian Serous Neoplasms (Low-Grade Serous Carcino... : The American Journal of Surgical Pathology

American Journal of Surgical Pathology: Abstract Recent literature has suggested a dual pathway of ovarian serous carcinogenesis, with most serous carcinomas falling into 1 of 2 categories, low grade and high grade. These are considered to represent 2 distinct tumor types with a different underlying pathogenesis and associated with different molecular events, clinical behavior, and prognosis. Low-grade serous carcinoma is thought to evolve in many instances from a preexisting serous borderline tumor and cystadenoma. Given the distinct pathogenesis and different molecular events, it is expected that the coexistence of low-grade and high-grade serous carcinoma would be rare or may even be mutually exclusive; moreover, there are very few reported examples in the literature.