Cancer Risk Reduction

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Judy Garber - One of the best experts on this subject based on the ideXlab platform.

  • use of endocrine therapy for breast Cancer Risk Reduction asco clinical practice guideline update
    Journal of Clinical Oncology, 2019
    Co-Authors: Kala Visvanathan, Judy Garber, Carol J Fabian, Elissa T Bantug, Abenaa M Brewster, Nancy E Davidson, Andrea Decensi, Justin D Floyd, E Hofstatter, Seema A Khan
    Abstract:

    PURPOSETo update the ASCO guideline on pharmacologic interventions for breast Cancer Risk Reduction and provide guidance on clinical issues that arise when deciding to use endocrine therapy for bre...

  • genetic familial high Risk assessment breast and ovarian version 2 2015 featured updates to the nccn guidelines
    Journal of The National Comprehensive Cancer Network, 2016
    Co-Authors: Mary B Daly, Judy Garber, Robert Pilarski, Jennifer E Axilbund, Michael Berry, Saundra S Buys, Beth Crawford, Meagan Farmer, Susan Hatters Friedman, Seema A Khan
    Abstract:

    The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast and Ovarian provide recommendations for genetic testing and counseling and Risk assessment and management for hereditary Cancer syndromes. Guidelines focus on syndromes associated with an increased Risk of breast and/or ovarian Cancer and are intended to assist with clinical and shared decision-making. These NCCN Guidelines Insights summarize major discussion points of the 2015 NCCN Genetic/Familial High-Risk Assessment: Breast and Ovarian panel meeting. Major discussion topics this year included multigene testing, Risk management recommendations for less common genetic mutations, and salpingectomy for ovarian Cancer Risk Reduction. The panel also discussed revisions to genetic testing criteria that take into account ovarian Cancer histology and personal history of pancreatic Cancer.

  • breast Cancer Risk Reduction version 2 2015 clinical practice guidelines in oncology clinical practice guidelines in oncology
    Journal of The National Comprehensive Cancer Network, 2015
    Co-Authors: Therese B Bevers, Judy Garber, Mary B Daly, John H Ward, Banu Arun, Graham A Colditz, Kenneth H Cowan, Mary L Gemignani, William J Gradishar, Larissa A Korde
    Abstract:

    Breast Cancer is the most frequently diagnosed malignancy in women in the United States and is second only to lung Cancer as a cause of Cancer death. To assist women who are at increased Risk of developing breast Cancer and their physicians in the application of individualized strategies to reduce breast Cancer Risk, NCCN has developed these guidelines for breast Cancer Risk Reduction.

  • Risk reducing salpingo oophorectomy for the prevention of brca1 and brca2 associated breast and gynecologic Cancer a multicenter prospective study
    Journal of Clinical Oncology, 2008
    Co-Authors: Noah D Kauff, Tara M Friebel, Gareth D Evans, Claudine Isaacs, Judy Garber, Henry T. Lynch, Susan M Domchek, Mark E Robson, Rosalind A Eeles, Susan L Neuhausen
    Abstract:

    Purpose Risk-reducing salpingo-oophorectomy (RRSO) has been widely adopted as a key component of breast and gynecologic Cancer Risk-Reduction for women with BRCA1 and BRCA2 mutations. Despite 17% to 39% of all BRCA mutation carriers having a mutation in BRCA2, no prospective study to date has evaluated the efficacy of RRSO for the prevention of breast and BRCAassociated gynecologic (ovarian, fallopian tube or primary peritoneal) Cancer when BRCA2 mutation carriers are analyzed separately from BRCA1 mutation carriers.

  • primary fallopian tube malignancies in brca positive women undergoing surgery for ovarian Cancer Risk Reduction
    Journal of Clinical Oncology, 2007
    Co-Authors: Michael J Callahan, Judy Garber, Christopher P Crum, Fabiola Medeiros, David Kindelberger, Julia A Elvin, Colleen M Feltmate, Ross S Berkowitz, Michael G Muto
    Abstract:

    Purpose To review the frequency and location of malignancies detected after prophylactic salpingo-oophorectomy in women with BRCA mutations. Methods Medical records and pathology findings were reviewed from BRCA-positive women undergoing prophylactic surgery for ovarian Cancer Risk Reduction who underwent complete examination of the adnexa. Patients undergoing this procedure between January 1999 and January 2007 were identified. Results From January 1999 to January 2007, 122 BRCA-positive patients underwent prophylactic surgery in the Division of Gynecologic Oncology at Brigham and Women's Hospital. The median age was 46.5 years (range, 33 to 76 years). Seven (5.7%) were found to have an early malignancy in the upper genital tract and all patients were age ≥ 44 years at diagnosis. Of seven consecutive Cancers culled between January 1999 and January 2007, all (100%) originated in the fimbrial or ampullary region of the tube; six had an early (intraepithelial) component. Two were associated with surface imp...

Paul E Goss - One of the best experts on this subject based on the ideXlab platform.

Seema A Khan - One of the best experts on this subject based on the ideXlab platform.

  • use of endocrine therapy for breast Cancer Risk Reduction asco clinical practice guideline update
    Journal of Clinical Oncology, 2019
    Co-Authors: Kala Visvanathan, Judy Garber, Carol J Fabian, Elissa T Bantug, Abenaa M Brewster, Nancy E Davidson, Andrea Decensi, Justin D Floyd, E Hofstatter, Seema A Khan
    Abstract:

    PURPOSETo update the ASCO guideline on pharmacologic interventions for breast Cancer Risk Reduction and provide guidance on clinical issues that arise when deciding to use endocrine therapy for bre...

  • genetic familial high Risk assessment breast and ovarian version 2 2015 featured updates to the nccn guidelines
    Journal of The National Comprehensive Cancer Network, 2016
    Co-Authors: Mary B Daly, Judy Garber, Robert Pilarski, Jennifer E Axilbund, Michael Berry, Saundra S Buys, Beth Crawford, Meagan Farmer, Susan Hatters Friedman, Seema A Khan
    Abstract:

    The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast and Ovarian provide recommendations for genetic testing and counseling and Risk assessment and management for hereditary Cancer syndromes. Guidelines focus on syndromes associated with an increased Risk of breast and/or ovarian Cancer and are intended to assist with clinical and shared decision-making. These NCCN Guidelines Insights summarize major discussion points of the 2015 NCCN Genetic/Familial High-Risk Assessment: Breast and Ovarian panel meeting. Major discussion topics this year included multigene testing, Risk management recommendations for less common genetic mutations, and salpingectomy for ovarian Cancer Risk Reduction. The panel also discussed revisions to genetic testing criteria that take into account ovarian Cancer histology and personal history of pancreatic Cancer.

  • soy isoflavone supplementation for breast Cancer Risk Reduction a randomized phase ii trial
    Cancer Prevention Research, 2012
    Co-Authors: Seema A Khan, Robert T Chatterton, Nancy Michel, Michelle Bryk, Oukseub Lee, David Ivancic, Richard Heinz, Carola M Zalles, Irene Helenowski, Borko Jovanovic
    Abstract:

    Soy isoflavone consumption may protect against breast Cancer development. We conducted a phase IIB trial of soy isoflavone supplementation to examine its effect on breast epithelial proliferation and other biomarkers in the healthy high-Risk breast. One hundred and twenty-six consented women underwent a random fine-needle aspiration (rFNA); those with 4,000 or more epithelial cells were randomized to a double-blind 6-month intervention of mixed soy isoflavones (PTIG-2535) or placebo, followed by repeat rFNA. Cells were examined for Ki-67 labeling index and atypia. Expression of 28 genes related to proliferation, apoptosis, and estrogenic effect was measured using quantitative reverse transcriptase PCR. Hormone and protein levels were measured in nipple aspirate fluid (NAF). All statistical tests were two-sided. Ninety-eight women were evaluable for Ki-67 labeling index. In 49 treated women, the median Ki-67 labeling index was 1.18 at entry and 1.12 post intervention, whereas in 49 placebo subjects, it was 0.97 and 0.92 (P for between-group change: 0.32). Menopausal stratification yielded similar results between groups, but within premenopausal soy-treated women, Ki-67 labeling index increased from 1.71 to 2.18 (P = 0.04). We saw no treatment effect on cytologic atypia or NAF parameters. There were significant increases in the expression of 14 of 28 genes within the soy, but not the control group, without significant between-group differences. Plasma genistein values showed excellent compliance. A 6-month intervention of mixed soy isoflavones in healthy, high-Risk adult Western women did not reduce breast epithelial proliferation, suggesting a lack of efficacy for breast Cancer prevention and a possible adverse effect in premenopausal women. Cancer Prev Res; 5(2); 309–19. ©2012 AACR.

  • soy isoflavone supplementation for breast Cancer Risk Reduction a randomized phase ii trial
    Cancer Prevention Research, 2012
    Co-Authors: Seema A Khan, Robert T Chatterton, Nancy Michel, Michelle Bryk, Oukseub Lee, David Ivancic, Richard Heinz, Carola M Zalles, Irene Helenowski, Borko Jovanovic
    Abstract:

    Soy isoflavone consumption may protect against breast Cancer development. We conducted a phase IIB trial of soy isoflavone supplementation to examine its effect on breast epithelial proliferation and other biomarkers in the healthy high-Risk breast. One hundred and twenty-six consented women underwent a random fine-needle aspiration (rFNA); those with 4,000 or more epithelial cells were randomized to a double-blind 6-month intervention of mixed soy isoflavones (PTIG-2535) or placebo, followed by repeat rFNA. Cells were examined for Ki-67 labeling index and atypia. Expression of 28 genes related to proliferation, apoptosis, and estrogenic effect was measured using quantitative reverse transcriptase PCR. Hormone and protein levels were measured in nipple aspirate fluid (NAF). All statistical tests were two-sided. Ninety-eight women were evaluable for Ki-67 labeling index. In 49 treated women, the median Ki-67 labeling index was 1.18 at entry and 1.12 post intervention, whereas in 49 placebo subjects, it was 0.97 and 0.92 (P for between-group change: 0.32). Menopausal stratification yielded similar results between groups, but within premenopausal soy-treated women, Ki-67 labeling index increased from 1.71 to 2.18 (P = 0.04). We saw no treatment effect on cytologic atypia or NAF parameters. There were significant increases in the expression of 14 of 28 genes within the soy, but not the control group, without significant between-group differences. Plasma genistein values showed excellent compliance. A 6-month intervention of mixed soy isoflavones in healthy, high-Risk adult Western women did not reduce breast epithelial proliferation, suggesting a lack of efficacy for breast Cancer prevention and a possible adverse effect in premenopausal women.

Henry T. Lynch - One of the best experts on this subject based on the ideXlab platform.

  • international trends in the uptake of Cancer Risk Reduction strategies in women with a brca1 or brca2 mutation
    British Journal of Cancer, 2019
    Co-Authors: Kelly A Metcalfe, Henry T. Lynch, Andrea Eisen, Leigha Senter, Susan Armel, Louise Bordeleau, Wendy S Meschino, Tuya Pal, Nadine Tung, Ava Kwong
    Abstract:

    Women with a BRCA1 or BRCA2 mutation face high Risks of breast and ovarian Cancer. In the current study, we report on uptake of Cancer screening and Risk-Reduction options in a cohort of BRCA mutation carriers from ten countries over two time periods (1995 to 2008 and 2009 to 2017). Eligible subjects were identified from an international database of female BRCA mutation carriers and included women from 59 centres from ten countries. Subjects completed a questionnaire at the time of genetic testing, which included past use of Cancer prevention options and screening tests. Biennial follow-up questionnaires were administered. Six-thousand two-hundred and twenty-three women were followed for a mean of 7.5 years. The mean age at last follow-up was 52.1 years (27–96 years) and 42.3% of the women had a prior diagnosis of breast Cancer. In all, 27.8% had a prophylactic bilateral mastectomy and  64.7% had a BSO. Screening with breast MRI increased from 70% before 2009 to 81% at or after 2009. There were significant differences in uptake of all options by country. For women who received genetic testing more recently, uptake of prophylactic mastectomy and breast MRI is significantly higher than those who received genetic testing more than 10 years ago. However, uptake of both BSO and breast MRI is not optimal, and interventions to increase uptake are needed.

  • preferences for breast Cancer Risk Reduction among brca1 brca2 mutation carriers a discrete choice experiment
    Breast Cancer Research and Treatment, 2017
    Co-Authors: Alexander Liede, Henry T. Lynch, Carol Mansfield, Kelly A Metcalfe, Melanie A Price, Carrie Snyder, Sue Friedman, Justyna Amelio, Joshua Posner, Steven A. Narod
    Abstract:

    Unaffected women who carry BRCA1 or BRCA2 mutations face difficult choices about reducing their breast Cancer Risk. Understanding their treatment preferences could help us improve patient counseling and inform drug trials. The objective was to explore preferences for various Risk-reducing options among women with germline BRCA1/2 mutations using a discrete-choice experiment survey and to compare expressed preferences with actual behaviors. A discrete-choice experiment survey was designed wherein women choose between hypothetical treatments to reduce breast Cancer Risk. The hypothetical treatments were characterized by the extent of breast Cancer Risk Reduction, treatment duration, impact on fertility, hormone levels, Risk of uterine Cancer, and ease and mode of administration. Data were analyzed using a random-parameters logit model. Women were also asked to express their preference between surgical and chemoprevention options and to report on their actual Risk-Reduction actions. Women aged 25–55 years with germline BRCA1/2 mutations who were unaffected with breast or ovarian Cancer were recruited through research registries at five clinics and a patient advocacy group. Between January 2015 and March 2016, 622 women completed the survey. Breast Cancer Risk Reduction was the most important consideration expressed, followed by maintaining fertility. Among the subset of women who wished to have children in future, the ability to maintain fertility was the most important factor, followed by the extent of Risk Reduction. Many more women said they would take a chemoprevention drug than had actually taken chemoprevention. Women with BRCA1/2 mutations indicated strong preferences for breast Cancer Risk Reduction and maintaining fertility. The expressed desire to have a safe chemoprevention drug available to them was not met by current chemoprevention options.

  • Risk reducing salpingo oophorectomy for the prevention of brca1 and brca2 associated breast and gynecologic Cancer a multicenter prospective study
    Journal of Clinical Oncology, 2008
    Co-Authors: Noah D Kauff, Tara M Friebel, Gareth D Evans, Claudine Isaacs, Judy Garber, Henry T. Lynch, Susan M Domchek, Mark E Robson, Rosalind A Eeles, Susan L Neuhausen
    Abstract:

    Purpose Risk-reducing salpingo-oophorectomy (RRSO) has been widely adopted as a key component of breast and gynecologic Cancer Risk-Reduction for women with BRCA1 and BRCA2 mutations. Despite 17% to 39% of all BRCA mutation carriers having a mutation in BRCA2, no prospective study to date has evaluated the efficacy of RRSO for the prevention of breast and BRCAassociated gynecologic (ovarian, fallopian tube or primary peritoneal) Cancer when BRCA2 mutation carriers are analyzed separately from BRCA1 mutation carriers.

  • effect of short term hormone replacement therapy on breast Cancer Risk Reduction after bilateral prophylactic oophorectomy in brca1 and brca2 mutation carriers the prose study group
    Journal of Clinical Oncology, 2005
    Co-Authors: Timothy R Rebbeck, Tara M Friebel, Susan L Neuhausen, Claudine Isaacs, Judy Garber, Henry T. Lynch, Mary B Daly, Theresa Wagner, Olufunmilayo I Olopade, Laura Van T Veer
    Abstract:

    Purpose Bilateral prophylactic oophorectomy (BPO) is widely used for Cancer Risk Reduction in women with BRCA1/2 mutations. Many premenopausal women choose to take hormone replacement therapy (HRT) after undergoing BPO to abrogate immediate symptoms of surgicallyinduced menopause. Thus, we evaluated whether the breast Cancer Risk Reduction conferred by BPO in BRCA1/2 mutation carriers is altered by use of post-BPO HRT. Methods We identified a prospective cohort of 462 women with disease-associated germline BRCA1/2 mutations at 13 medical centers to evaluate breast Cancer Risk after BPO with and without HRT. We determined the incidence of breast Cancer in 155 women who had undergone BPO and in 307 women who had not undergone BPO on whom we had complete information on HRT use. Postoperative follow-up was 3.6 years. Results Consistent with previous reports, BPO was significantly associated with breast Cancer Risk Reduction overall (hazard ratio [HR] 0.40; 95%CI, 0.18 to 0.92). Using mutation carriers without BPO or HRT as the referent group, HRT of any type after BPO did not significantly alter the Reduction in breast Cancer Risk associated with BPO (HR 0.37; 95% CI, 0.14 to 0.96). Conclusion Short-term HRT use does not negate the protective effect of BPO on subsequent breast Cancer Risk in BRCA1/2 mutation carriers. J Clin Oncol 23:7804-7810. © 2005 by American Society of Clinical Oncology

  • bilateral prophylactic mastectomy reduces breast Cancer Risk in brca1 and brca2 mutation carriers the prose study group
    Journal of Clinical Oncology, 2004
    Co-Authors: Timothy R Rebbeck, Tara M Friebel, Gareth D Evans, Susan L Neuhausen, Claudine Isaacs, Steven A. Narod, Judy Garber, Laura Van T Veer, Henry T. Lynch, Ellen T Matloff
    Abstract:

    Purpose Data on the efficacy of bilateral prophylactic mastectomy for breast Cancer Risk Reduction in women with BRCA1 and BRCA2 (BRCA1/2) mutations are limited, despite the clinical use of this Risk-management strategy. Thus, we estimated the degree of breast Cancer Risk Reduction after surgery in women who carry these mutations. Patients and Methods Four hundred eighty-three women with disease-associated germline BRCA1/2 mutations were studied for the occurrence of breast Cancer. Cases were mutation carriers who underwent bilateral prophylactic mastectomy and who were followed prospectively from the time of their center ascertainment and their surgery, with analyses performed for both follow-up periods. Controls were BRCA1/2 mutation carriers with no history of bilateral prophylactic mastectomy matched to cases on gene, center, and year of birth. Both cases and controls were excluded for previous or concurrent diagnosis of breast Cancer. Analyses were adjusted for duration of endogenous ovarian hormone ...

Beverly Moy - One of the best experts on this subject based on the ideXlab platform.

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