454 research outputs found
Long-term outcomes of hysterectomy with bilateral salpingo-oophorectomy: a systematic review and meta-analysis
No full textObjective: this study aimed to provide an up-to-date systematic review of “the long-term outcomes of bilateral salpingo-oophorectomy at the time of hysterectomy” and perform a meta-analysis for the reported associations. Data Sources: our study updated a previous systematic review by searching the literature using PubMed, Web of Science, and Embase for publications between January 2015 and August 2022. Study Eligibility Criteria: our study included studies of women who had a hysterectomy with bilateral salpingo-oophorectomy vs women who had a hysterectomy with ovarian conservation or no surgery. Methods: the quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations. Adjusted hazard ratios were extracted and combined to obtain fixed effect estimates. Results: compared with hysterectomy or no surgery, hysterectomy with bilateral salpingo-oophorectomy in young women was associated with decreased risk of breast cancer (hazard ratio, 0.78; 95% confidence interval, 0.73–0.84) but with an increased risk of colorectal cancer (hazard ratio, 1.27; 95% confidence interval, 1.10–1.47). In addition, it was associated with an increased risk of total cardiovascular diseases, coronary heart disease, and stroke with hazard ratios of 1.18 (95% confidence interval, 1.11–1.25), 1.17 (95% confidence interval, 1.10–1.25), and 1.20 (95% confidence interval, 1.10–1.31), respectively. Compared with no surgery, hysterectomy with bilateral salpingo-oophorectomy before the age of 50 years was associated with an increased risk of hyperlipidemia (hazard ratio, 1.44; 95% confidence interval, 1.25–1.65), diabetes mellitus (hazard ratio, 1.16; 95% confidence interval, 1.09–1.24), hypertension (hazard ratio, 1.13; 95% confidence interval, 1.06–1.20), dementia (hazard ratio, 1.70; 95% confidence interval, 1.07–2.69), and depression (hazard ratio, 1.39; 95% confidence interval, 1.22–1.60). The evidence on the association with all-cause mortality in young women showed substantial heterogeneity between the studies (I2=85%; P<.01). Conclusion: hysterectomy with bilateral salpingo-oophorectomy was associated with multiple long-term outcomes. The benefits of the addition of bilateral salpingo-oophorectomy to hysterectomy should be balanced against the risks.</p
Risks of second non-breast primaries following breast cancer in women: a systematic review and meta-analysis
No full textBackground: Second primary cancer incidence is rising among breast cancer survivors. We examined the risks of non-breast second primaries, in combination and at specific cancer sites, through a systematic review and meta-analysis. Methods: We conducted a systematic search of PubMed, Embase, and Web of Science, seeking studies published by March 2022. We included studies that reported standardized incidence ratios (SIRs), with associated standard errors, assessing the combined risk of second non-breast primaries following breast cancer. We performed meta-analyses of combined second primary risks, stratifying by age, follow-up duration, and geographic region. We also assessed second primary risks at several specific sites, stratifying by age. The inverse variance method with DerSimonian–Laird estimators was used in all meta-analyses, assuming a random-effects model. Associated biases and study quality were evaluated using the Newcastle–Ottawa scale. Results: One prospective and twenty-seven retrospective cohort studies were identified. SIRs for second non-breast primaries combined ranged from 0.84 to 1.84. The summary SIR estimate was 1.24 (95% CI 1.14–1.36, I
2: 99%). This varied by age: the estimate was 1.59 (95% CI 1.36–1.85) when breast cancer was diagnosed before age 50, which was significantly higher than in women first diagnosed at 50 or over (SIR: 1.13, 95% CI 1.01–1.36, p for difference: < 0.001). SPC risks were also significantly higher when based on Asian, rather than European, registries (Asia—SIR: 1.47, 95% CI 1.29–1.67. Europe—SIR: 1.16, 95% CI 1.04–1.28). There were significantly increased risks of second thyroid (SIR: 1.89, 95% CI 1.49–2.38), corpus uteri (SIR: 1.84, 95% CI 1.53–2.23), ovary (SIR: 1.53, 95% CI 1.35–1.73), kidney (SIR: 1.43, 95% CI 1.17–1.73), oesophagus (SIR: 1.39, 95% CI 1.26–1.55), skin (melanoma) (SIR: 1.34, 95% CI 1.18–1.52), blood (leukaemia) (SIR: 1.30, 95% CI 1.17–1.45), lung (SIR: 1.25, 95% CI 1.03–1.51), stomach (SIR: 1.23, 95% CI 1.12–1.36) and bladder (SIR: 1.15, 95% CI 1.05–1.26) primaries. Conclusions: Breast cancer survivors are at significantly increased risk of second primaries at many sites. Risks are higher for those diagnosed with breast cancer before age 50 and in Asian breast cancer survivors compared to European breast cancer survivors. This study is limited by a lack of data on potentially confounding variables. The conclusions may inform clinical management decisions following breast cancer, although specific clinical recommendations lie outside the scope of this review.
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A comparison of methods currently used in clinical practice to estimate familial breast cancer risks
No full textBackground: With the identification of genes predisposing to hereditary breast cancer, the accurate and consistent estimation of a woman's risk of developing breast cancer based on her family history is of paramount importance if national service guidelines are to be developed. Patients and methods: The residual lifetime risk of developing breast cancer was estimated for 200 women attending a breast cancer genetic assessment clinic by three different methods currently in use in the UK. Risks were computed on the basis of the Cancer and Steroid Hormone (CASH) study data and were classified as 'low/moderate' (< 20%) or 'high' (>20%). These risk categories are representative of those currently used to allocate surveillance and genetic testing. Risks were then compared to estimates derived by other methods used in current clinical practice, including those of Houlston and Murday. Results: The CASH data-based method ascribed 27% to the high risk category, as compared to 53% for the combined Houlston and Murday methods. A method based on the number of affected relatives alone ascribed only 14% to the high risk category. Overall, 108 (54%) women were placed in the same risk category by all three methods. Conclusions: This study demonstrates that there is a significant degree of variability between methods currently used to estimate breast cancer risk which has serious implications for individual patient management, service provision and multicentre studies evaluating the benefits of genetic testing for breast cancer susceptibility.</p
Risk of developing a second primary cancer in male breast cancer survivors: a systematic review and meta-analysis.
No full textBACKGROUND: With increasing survival after cancer diagnoses, second primary cancers (SPCs) are becoming more prevalent. We investigated the incidence and site of non-breast SPC risks following male breast cancer (BC). METHODS: PubMed, Embase and Web of Science were systematically searched for studies reporting standardised incidence ratios (SIRs) for SPCs published by March 2022. Meta-analyses used the generic inverse-variance method, assuming a random-effects model. We evaluated SIRs for overall SPCs, site-specific risks, by age at BC onset, time since BC onset and geographic region. We assessed study quality using routine techniques. RESULTS: Eight population-based retrospective cohort studies were identified. SIRs ranged from 1.05 to 2.17. The summary SIR estimate was 1.27 (95% CI: 1.03-1.56, I2: 86%), and there were increased colorectal (SIR: 1.29, 95% CI: 1.03-1.61), pancreatic (SIR: 1.64, 95% CI: 1.05-2.55) and thyroid (SIR: 5.58, 95% CI: 1.04-30.05) SPC risks. When an outlying study was excluded, the summary SIR for men diagnosed with BC before age 50 was 1.50 (95% CI: 1.21-1.85), significantly higher than men diagnosed at older ages (SIR: 1.14, 95% CI: 0.98-1.33). CONCLUSIONS: Male BC survivors are at elevated risks of developing second primary colorectal, pancreatic and thyroid cancers. The estimates may assist their clinical management and guide decisions on genetic testing
Cancer incidence in relatives of British Fanconi Anaemia patients.
No full textBACKGROUND: Fanconi anemia (FA) is an autosomal recessive DNA repair disorder with affected individuals having a high risk of developing acute myeloid leukaemia and certain solid tumours. Thirteen complementation groups have been identified and the genes for all of these are known (FANCA, B, C, D1/BRCA2, D2, E, F, G, I, J/BRIP1, L, M and N/PALB2). Previous studies of cancer incidence in relatives of Fanconi anemia cases have produced conflicting results. A study of British FA families was therefore carried out to investigate this question, since increases in cancer risk in FA heterozygotes would have implications for counselling FA family members, and possibly also for the implementation of preventative screening measures in FA heterozygotes.
METHODS: Thirty-six families took part and data was collected on 575 individuals (276 males, 299 females), representing 18,136 person years. In this cohort, 25 males and 30 females were reported with cancer under the age of 85 years, and 36 cancers (65%) could be confirmed from death certificates, cancer registries or clinical records.
RESULTS: A total of 55 cancers were reported in the FA families compared to an estimated incidence of 56.95 in a comparable general population cohort, and the relative risk of cancer was 0.97 (95% C.I. = 0.71-1.23, p = 0.62) for FA family members. Analysis of relative risk for individual cancer types in each carrier probability group did not reveal any significant differences with the possible exception of prostate cancer (RR = 3.089 (95% C.I. = 1.09 - 8.78; Chi2 = 4.767, p = 0.029).
CONCLUSION: This study has not shown a significant difference in overall cancer risk in FA families
Germline DICER1 mutations in human disease
No full textThe DICER1 gene, which codes for a protein of the same name, is vital to the production of microRNA. As small ~20nt fragments of RNA, microRNAs alter gene expression post-transcriptionally by directly binding to mRNA and affecting translation. Current estimates suggest that expression of 30-70% of all protein-coding genes is modified by microRNA activity.Germline DICER1 mutations have recently been associated with cases of pleuropulmonary blastoma, a childhood lung tumor. We have discovered germline DICER1 mutations to be associated with other diseases by identifying mutations in nearly 60 individuals within 15 different families and across 7 different disease phenotypes. These include cases of pleuropulmonary blastoma, cystic nephroma - a benign kidney tumor, and Wilms tumor - the malignant version of cystic nephroma. Furthermore, we have identified DICER1 mutations in several families with Sertoli-Leydig cell tumor (SLCT) - a rare, androgen producing cancer of the ovaries, and multinodular goiter (MNG) - a relatively common thyroid hyperplasia. We have demonstrated that DICER1 is the genetic link between SLCT and MNG first hypothesized in 1974 by Fraumeni and colleagues. Also, we have identified DICER1 to be the gene of the MNG1 locus at 14q32, which was first pinpointed to this region in 1997 and identified in several MNG families. We further expanded the disease phenotype associated with DICER1 mutation to include cervical embryonal rhabdomyosarcoma.While DICER1 is a postulated to be a human tumor suppressor gene, we found no evidence of loss of heterozygosity in tumor DNA, a finding supported by recent evidence that DICER1 is a tumor suppressor with unique characteristics. Profiling of miRNA in affected cells showed significant differences in expression of miRNAs compared to controls. We demonstrate that DICER1 mutations are associated with diseases other than pleuropulmonary blastoma, an unsurprising revelation when the far-reaching implications of microRNA production are considered. These developments may be utilized in future therapeutic endeavors and for screening of families which present with a similar array of disease.Le gène DICER1, qui code pour la protéine du même nom, est essentiel pour la production de microARNs. Ceux-ci étant aussi courts que 20 nucléotides, modifient l'expression des gènes ciblés en phase de posttranscription en se liant directement aux mARNs et en conséquences affectant leur translation. Présentement, on estime que l'expression de 30 à 70% de tous les gènes qui codent pour une protéine sont modifiés par des microARNs. Récemment, 60 à 70% de tous les cas de blastomes pleuropulmonaires, tumeurs pulmonaires infantiles, ont été associés à des mutations germinales de DICER1. Nous avons découvert que des mutations germinales de DICER1 sont impliquées dans un tableau de maladies en identifiant des mutations dans 60 personnes provenant de 15 familles différentes, ayant 7 phénotypes de maladies différents. Ceux-ci incluent des cas de blastomes pleuropulmonaires, de néphromes kystiques – des tumeurs rénales bénignes, et des tumeurs de Wilms – une forme maligne de la néphrome kystique. Par ailleurs, nous avons identifié des mutations de DICER1 dans plusieurs familles affectées par des tumeurs de cellules Sertoli-Leydig (TCSL) – un cancer rare de l'ovaire produisant de l'androgen, et la goitre multinodulaire (GMN) - une hyperplasie relativement fréquente de la thyroïde. Nous avons demontré que DICER1 est le lien entre TCSL et GMN ce qui a été suggéré en 1974 par Fraumeni et ses collegues. Nous avons également identifié que le gène MNG1 au locus 14q32 est DICER1. Cette région était découverte en 1997 dans plusieurs familles avec GMN. Nous avons élargi le phénotype des maladies associées avec DICER1, et ajouté le rhabdomyosarcome embryonnaire cervical à la liste. Quoique DICER1 est un gène suppresseur de tumeur, nous n'avons pas trouvé une preuve de la perte d'hétérozygotie dans l'ADN des tumeurs testées. Ceci est validé par des preuves récentes que DICER1 est un gène suppresseur de tumeur à caractère unique. L'expression des microARNs dans les cellules cancéreuses était significativement différente de celui observée dans les cellules normales. Nous avons démontré que les mutations de DICER1 sont associées à des maladies variées, une découverte pas très surprenante considérant son rôle de grande envergure dans la production de microARNs. Ces développements peuvent être utilisés dans de futurs efforts thérapeutiques et pour le dépistage des familles avec des maladies semblables
Risk-reducing surgery for individuals with cancer-predisposing germline pathogenic variants and no personal cancer history: a review of current UK guidelines
No full textIdentifying healthy carriers of germline pathogenic variants in high penetrance cancer susceptibility genes offers the potential for risk-reducing surgery. The NHS England National Genomic Test Directory offers germline and somatic testing to patients with certain cancers or rare and inherited diseases, or, in some cases, to their relatives. This review summarises current UK guidelines for risk-reducing surgical interventions available for individuals with no personal history of cancer, who are determined to carry germline pathogenic variants. An electronic literature search of NICE guidelines and PubMed citable articles was performed. NICE guidelines are available for bilateral mastectomy and are currently in development for risk-reducing bilateral salpingo-oophorectomy. Guidelines developed with affiliation to, or through relevant British Surgical Societies or international consensus, are available for risk-reducing hysterectomy, polypectomy, gastrectomy, and thyroidectomy. There is a disparity in the development and distribution of national guidelines for interventions amongst tumour types. Whilst we are focusing on UK guidelines, we anticipate they will be relevant much more generally and so of interest to a wider audience including where there are no national guidelines to refer to. We suggest that, as genetic testing becomes rapidly more accessible, guideline development for interventions should be more closely aligned to those for testing.</p
Jejunal atresia, periodic fevers and psoriatic arthropathy in Baraitser–Winter malformation syndrome
No full textWhen to Consider Risk-Reducing Mastectomy in BRCA1/BRCA2 Mutation Carriers with Advanced Stage Ovarian Cancer: a Case Study Illustrating the Genetic Counseling Challenges
No full textPALB2/FANCN: Recombining Cancer and Fanconi Anemia
No full textAbstract
Partner and localizer of BRCA2 (PALB2) was originally identified as a BRCA2-interacting protein that is crucial for key BRCA2 genome caretaker functions. It subsequently became clear that PALB2 was another Fanconi anemia (FA) gene (FANCN), and that monoallelic PALB2 mutations are associated with increased risk of breast and pancreatic cancer. Mutations in PALB2 have been identified in breast cancer families worldwide, and recent studies have shown that PALB2 also interacts with BRCA1. Here, we summarize the molecular functions and clinical phenotypes of this key DNA repair pathway component and discuss how its discovery has advanced our knowledge of both FA and adult cancer predisposition. Cancer Res; 70(19); 7353–9. ©2010 AACR.</jats:p
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