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Published in: Familial Cancer 3/2012

01-09-2012 | Original Article

A multidisciplinary clinic for individualizing management of patients at increased risk for breast and gynecologic cancer

Authors: Natalie J. Engel, Patricia Gordon, Darcy L. Thull, Beth Dudley, Judy Herstine, Rachel C. Jankowitz, Kristin K. Zorn

Published in: Familial Cancer | Issue 3/2012

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Abstract

Increasing awareness of the hereditary component of breast and ovarian cancer has driven interest in creating clinics for the patient population at high risk for these cancers. Identifying adequate space and appropriate staff, coordinating multiple providers’ schedules, establishing referral criteria, and addressing billing and reimbursement concerns are just some of the issues that are involved in the creation of a multidisciplinary high risk breast and ovarian cancer program. We provide an overview of the clinic structure at the Magee-Womens Hospital High Risk Breast and Ovarian Cancer Program (HRBOCP), which was created in 2002 due to recognition of a need for a more coordinated model of providing care for women at increased risk for breast and ovarian cancer. The goals of the HRBOCP are to evaluate women at high risk for breast and ovarian cancer and to organize their clinical care in a multidisciplinary setting staffed by experts in the field; to provide updates on new data regarding screening recommendations, prevention options, and risk factors pertinent to an individual’s cancer risk; to provide ongoing support to patients and to coordinate family communication when appropriate; and to facilitate enrollment in appropriate research studies and registries.
Literature
1.
go back to reference Hall JM, Lee MK, Newman B, Morrow JE, Anderson LA, Huey B, King MC (1990) Linkage of early-onset familial breast cancer to chromosome 17q21. Science 250(4988):1684–1689PubMedCrossRef Hall JM, Lee MK, Newman B, Morrow JE, Anderson LA, Huey B, King MC (1990) Linkage of early-onset familial breast cancer to chromosome 17q21. Science 250(4988):1684–1689PubMedCrossRef
2.
go back to reference Wooster R, Neuhausen SL, Mangion J, Quirk Y, Ford D, Collins N, Nguyen K, Seal S, Tran T, Averill D et al (1994) Localization of a breast cancer susceptibility gene, BRCA2, to chromosome 13q12-13. Science 265(5181):2088–2090PubMedCrossRef Wooster R, Neuhausen SL, Mangion J, Quirk Y, Ford D, Collins N, Nguyen K, Seal S, Tran T, Averill D et al (1994) Localization of a breast cancer susceptibility gene, BRCA2, to chromosome 13q12-13. Science 265(5181):2088–2090PubMedCrossRef
3.
go back to reference Ford D, Easton DF, Bishop DT, Narod SA, Goldgar DE (1994) Risks of cancer in BRCA1-mutation carriers. Breast Cancer Linkage Consortium. Lancet 343(8899):692–695PubMedCrossRef Ford D, Easton DF, Bishop DT, Narod SA, Goldgar DE (1994) Risks of cancer in BRCA1-mutation carriers. Breast Cancer Linkage Consortium. Lancet 343(8899):692–695PubMedCrossRef
4.
go back to reference Struewing JP, Hartge P, Wacholder S, Baker SM, Berlin M, McAdams M, Timmerman MM, Brody LC, Tucker MA (1997) The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. N Engl J Med 336(20):1401–1408PubMedCrossRef Struewing JP, Hartge P, Wacholder S, Baker SM, Berlin M, McAdams M, Timmerman MM, Brody LC, Tucker MA (1997) The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. N Engl J Med 336(20):1401–1408PubMedCrossRef
5.
go back to reference Whittemore AS, Gong G, Itnyre J (1997) Prevalence and contribution of BRCA1 mutations in breast cancer and ovarian cancer: results from three U.S. population-based case-control studies of ovarian cancer. Am J Hum Genet 60(3):496–504PubMed Whittemore AS, Gong G, Itnyre J (1997) Prevalence and contribution of BRCA1 mutations in breast cancer and ovarian cancer: results from three U.S. population-based case-control studies of ovarian cancer. Am J Hum Genet 60(3):496–504PubMed
6.
go back to reference Ford D, Easton DF, Stratton M, Narod S, Goldgar D, Devilee P, Bishop DT, Weber B, Lenoir G, Chang-Claude J, Sobol H, Teare MD, Struewing J, Arason A, Scherneck S, Peto J, Rebbeck TR, Tonin P, Neuhausen S, Barkardottir R, Eyfjord J, Lynch H, Ponder BA, Gayther SA, Zelada-Hedman M et al (1998) Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. The Breast Cancer Linkage Consortium. Am J Hum Genet 62(3):676–689PubMedCrossRef Ford D, Easton DF, Stratton M, Narod S, Goldgar D, Devilee P, Bishop DT, Weber B, Lenoir G, Chang-Claude J, Sobol H, Teare MD, Struewing J, Arason A, Scherneck S, Peto J, Rebbeck TR, Tonin P, Neuhausen S, Barkardottir R, Eyfjord J, Lynch H, Ponder BA, Gayther SA, Zelada-Hedman M et al (1998) Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. The Breast Cancer Linkage Consortium. Am J Hum Genet 62(3):676–689PubMedCrossRef
7.
go back to reference Chen S, Parmigiani G (2007) Meta-analysis of BRCA1 and BRCA2 penetrance. J Clin Oncol 25(11):1329–1333PubMedCrossRef Chen S, Parmigiani G (2007) Meta-analysis of BRCA1 and BRCA2 penetrance. J Clin Oncol 25(11):1329–1333PubMedCrossRef
9.
go back to reference Walsh T, Casadei S, Coats KH, Swisher E, Stray SM, Higgins J, Roach KC, Mandell J, Lee MK, Ciernikova S, Foretova L, Soucek P, King MC (2006) Spectrum of mutations in BRCA1, BRCA2, CHEK2, and TP53 in families at high risk of breast cancer. JAMA 295(12):1379–1388PubMedCrossRef Walsh T, Casadei S, Coats KH, Swisher E, Stray SM, Higgins J, Roach KC, Mandell J, Lee MK, Ciernikova S, Foretova L, Soucek P, King MC (2006) Spectrum of mutations in BRCA1, BRCA2, CHEK2, and TP53 in families at high risk of breast cancer. JAMA 295(12):1379–1388PubMedCrossRef
10.
go back to reference Rahman N, Seal S, Thompson D, Kelly P, Renwick A, Elliott A, Reid S, Spanova K, Barfoot R, Chagtai T, Jayatilake H, McGuffog L, Hanks S, Evans DG, Eccles D, Easton DF, Stratton MR (2007) PALB2, which encodes a BRCA2-interacting protein, is a breast cancer susceptibility gene. Nat Genet 39(2):165–167PubMedCrossRef Rahman N, Seal S, Thompson D, Kelly P, Renwick A, Elliott A, Reid S, Spanova K, Barfoot R, Chagtai T, Jayatilake H, McGuffog L, Hanks S, Evans DG, Eccles D, Easton DF, Stratton MR (2007) PALB2, which encodes a BRCA2-interacting protein, is a breast cancer susceptibility gene. Nat Genet 39(2):165–167PubMedCrossRef
11.
go back to reference Casadei S, Norquist BM, Walsh T, Stray S, Mandell JB, Lee MK, Stamatoyannopoulos JA, King MC (2011) Contribution of inherited mutations in the BRCA2-interacting protein PALB2 to familial breast cancer. Cancer Res 71(6):2222–2229PubMedCrossRef Casadei S, Norquist BM, Walsh T, Stray S, Mandell JB, Lee MK, Stamatoyannopoulos JA, King MC (2011) Contribution of inherited mutations in the BRCA2-interacting protein PALB2 to familial breast cancer. Cancer Res 71(6):2222–2229PubMedCrossRef
12.
go back to reference Lynch HT, Snyder C, Lynch J (2012) Hereditary breast cancer: practical pursuit for clinical translation. Ann Surg Oncol 19(6):1723–1731 Lynch HT, Snyder C, Lynch J (2012) Hereditary breast cancer: practical pursuit for clinical translation. Ann Surg Oncol 19(6):1723–1731
13.
go back to reference Cusack JC Jr., Hughes KS (2012) Managing patients at high risk for hereditary breast cancer: a guide for the practicing physician. Ann Surg Oncol 19(6):1721–1722 Cusack JC Jr., Hughes KS (2012) Managing patients at high risk for hereditary breast cancer: a guide for the practicing physician. Ann Surg Oncol 19(6):1721–1722
14.
go back to reference Walsh T, Casadei S, Lee MK, Pennil CC, Nord AS, Thornton AM, Roeb W, Agnew KJ, Stray SM, Wickramanayake A, Norquist B, Pennington KP, Garcia RL, King MC, Swisher EM (2011) Mutations in 12 genes for inherited ovarian, fallopian tube, and peritoneal carcinoma identified by massively parallel sequencing. Proc Natl Acad Sci USA 108(44):18032–18037PubMedCrossRef Walsh T, Casadei S, Lee MK, Pennil CC, Nord AS, Thornton AM, Roeb W, Agnew KJ, Stray SM, Wickramanayake A, Norquist B, Pennington KP, Garcia RL, King MC, Swisher EM (2011) Mutations in 12 genes for inherited ovarian, fallopian tube, and peritoneal carcinoma identified by massively parallel sequencing. Proc Natl Acad Sci USA 108(44):18032–18037PubMedCrossRef
15.
16.
go back to reference Pennington KP, Swisher EM (2012) Hereditary ovarian cancer: beyond the usual suspects. Gynecol Oncol 124(2):347–353PubMedCrossRef Pennington KP, Swisher EM (2012) Hereditary ovarian cancer: beyond the usual suspects. Gynecol Oncol 124(2):347–353PubMedCrossRef
17.
18.
go back to reference Wideroff L, Vadaparampil ST, Greene MH, Taplin S, Olson L, Freedman AN (2005) Hereditary breast/ovarian and colorectal cancer genetics knowledge in a national sample of US physicians. J Med Genet 42(10):749–755PubMedCrossRef Wideroff L, Vadaparampil ST, Greene MH, Taplin S, Olson L, Freedman AN (2005) Hereditary breast/ovarian and colorectal cancer genetics knowledge in a national sample of US physicians. J Med Genet 42(10):749–755PubMedCrossRef
19.
go back to reference McKinnon W, Naud S, Ashikaga T, Colletti R, Wood M (2007) Results of an intervention for individuals and families with BRCA mutations: a model for providing medical updates and psychosocial support following genetic testing. J Genet Couns 16(4):433–456PubMedCrossRef McKinnon W, Naud S, Ashikaga T, Colletti R, Wood M (2007) Results of an intervention for individuals and families with BRCA mutations: a model for providing medical updates and psychosocial support following genetic testing. J Genet Couns 16(4):433–456PubMedCrossRef
20.
go back to reference Karp J, Brown K, Sullivan MD, Massie MJ (1999) The prophylactic mastectomy dilemma: A support group for women at high genetic risk for breast cancer. J Genet Couns 8(3):163–173CrossRef Karp J, Brown K, Sullivan MD, Massie MJ (1999) The prophylactic mastectomy dilemma: A support group for women at high genetic risk for breast cancer. J Genet Couns 8(3):163–173CrossRef
21.
go back to reference Esplen MJ, Hunter J, Leszcz M, Warner E, Narod S, Metcalfe K, Glendon G, Butler K, Liede A, Young MA, Kieffer S, DiProspero L, Irwin E, Wong J (2004) A multicenter study of supportive-expressive group therapy for women with BRCA1/BRCA2 mutations. Cancer 101 Esplen MJ, Hunter J, Leszcz M, Warner E, Narod S, Metcalfe K, Glendon G, Butler K, Liede A, Young MA, Kieffer S, DiProspero L, Irwin E, Wong J (2004) A multicenter study of supportive-expressive group therapy for women with BRCA1/BRCA2 mutations. Cancer 101
22.
go back to reference Bancroft EK, Locke I, Ardern-Jones A, D’Mello L, McReynolds K, Lennard F, Barbachano Y, Barwell J, Walker L, Mitchell G, Dorkins H, Cummings C, Paterson J, Kote-Jarai Z, Mitra A, Jhavar S, Thomas S, Houlston R, Shanley S, Eeles RA (2010) The carrier clinic: an evaluation of a novel clinic dedicated to the follow-up of BRCA1 and BRCA2 carriers–implications for oncogenetics practice. J Med Genet 47(7):486–491PubMedCrossRef Bancroft EK, Locke I, Ardern-Jones A, D’Mello L, McReynolds K, Lennard F, Barbachano Y, Barwell J, Walker L, Mitchell G, Dorkins H, Cummings C, Paterson J, Kote-Jarai Z, Mitra A, Jhavar S, Thomas S, Houlston R, Shanley S, Eeles RA (2010) The carrier clinic: an evaluation of a novel clinic dedicated to the follow-up of BRCA1 and BRCA2 carriers–implications for oncogenetics practice. J Med Genet 47(7):486–491PubMedCrossRef
23.
go back to reference Antill YC, Shanahan M, Phillips K (2005) The integrated, multidisciplinary clinic: a new model for the ongoing management of women at high genetic risk for breast and ovarian cancer. Cancer Forum 29(2):107–110 Antill YC, Shanahan M, Phillips K (2005) The integrated, multidisciplinary clinic: a new model for the ongoing management of women at high genetic risk for breast and ovarian cancer. Cancer Forum 29(2):107–110
24.
go back to reference Kuschel B, Lux MP, Goecke TO, Beckmann MW (2000) Prevention and therapy for BRCA1/2 mutation carriers and women at high risk for breast and ovarian cancer. Eur J Cancer Prev 9(3):139–150PubMedCrossRef Kuschel B, Lux MP, Goecke TO, Beckmann MW (2000) Prevention and therapy for BRCA1/2 mutation carriers and women at high risk for breast and ovarian cancer. Eur J Cancer Prev 9(3):139–150PubMedCrossRef
25.
go back to reference Hilgart JS, Coles B, Iredale R (2012) Cancer genetic risk assessment for individuals at risk of familial breast cancer. Cochrane Database Syst Rev 2:CD003721 Hilgart JS, Coles B, Iredale R (2012) Cancer genetic risk assessment for individuals at risk of familial breast cancer. Cochrane Database Syst Rev 2:CD003721
26.
go back to reference Ardern-Jones A, Eeles RA (2004) Development in clinical practice: follow up clinic for BRCA mutation carriers: a case study highlighting the “virtual clinic”. Hered Cancer Clin Pract 2:77–79PubMedCrossRef Ardern-Jones A, Eeles RA (2004) Development in clinical practice: follow up clinic for BRCA mutation carriers: a case study highlighting the “virtual clinic”. Hered Cancer Clin Pract 2:77–79PubMedCrossRef
27.
go back to reference Pichert G, Jacobs C, Jacobs I, Menon U, Manchanda R, Johnson M, Hamed H, Firth C, Evison M, Tutt A, de Silva L, Langman C, Izatt L (2010) Novel one-stop multidisciplinary follow-up clinic significantly improves cancer risk management in BRCA1/2 carriers. Fam Cancer 9(3):313–319PubMedCrossRef Pichert G, Jacobs C, Jacobs I, Menon U, Manchanda R, Johnson M, Hamed H, Firth C, Evison M, Tutt A, de Silva L, Langman C, Izatt L (2010) Novel one-stop multidisciplinary follow-up clinic significantly improves cancer risk management in BRCA1/2 carriers. Fam Cancer 9(3):313–319PubMedCrossRef
28.
go back to reference Firth C, Jacobs C, Evison M, Pichert G, Izatt L, Hunter MS (2011) Novel one-stop multidisciplinary follow-up clinic for BRCA1/2 carriers: patient satisfaction and decision making. Psycho-oncology 20(12):1301–1308PubMedCrossRef Firth C, Jacobs C, Evison M, Pichert G, Izatt L, Hunter MS (2011) Novel one-stop multidisciplinary follow-up clinic for BRCA1/2 carriers: patient satisfaction and decision making. Psycho-oncology 20(12):1301–1308PubMedCrossRef
29.
go back to reference Cuzick J, DeCensi A, Arun B, Brown PH, Castiglione M, Dunn B, Forbes JF, Glaus A, Howell A, von Minckwitz G, Vogel V, Zwierzina H (2011) Preventive therapy for breast cancer: a consensus statement. Lancet Oncol 12(5):496–503PubMedCrossRef Cuzick J, DeCensi A, Arun B, Brown PH, Castiglione M, Dunn B, Forbes JF, Glaus A, Howell A, von Minckwitz G, Vogel V, Zwierzina H (2011) Preventive therapy for breast cancer: a consensus statement. Lancet Oncol 12(5):496–503PubMedCrossRef
30.
go back to reference Ravdin PM (2010) The lack, need, and opportunities for decision-making and informational tools to educate primary-care physicians and women about breast cancer chemoprevention. Cancer Prev Res (Phila) 3(6):686–688CrossRef Ravdin PM (2010) The lack, need, and opportunities for decision-making and informational tools to educate primary-care physicians and women about breast cancer chemoprevention. Cancer Prev Res (Phila) 3(6):686–688CrossRef
31.
go back to reference Kaplan CP, Haas JS, Perez-Stable EJ, Des Jarlais G, Gregorich SE (2005) Factors affecting breast cancer risk reduction practices among California physicians. Prev Med 41(1):7–15PubMedCrossRef Kaplan CP, Haas JS, Perez-Stable EJ, Des Jarlais G, Gregorich SE (2005) Factors affecting breast cancer risk reduction practices among California physicians. Prev Med 41(1):7–15PubMedCrossRef
32.
go back to reference Sabatino SA, McCarthy EP, Phillips RS, Burns RB (2007) Breast cancer risk assessment and management in primary care: provider attitudes, practices, and barriers. Cancer Detect Prev 31(5):375–383PubMedCrossRef Sabatino SA, McCarthy EP, Phillips RS, Burns RB (2007) Breast cancer risk assessment and management in primary care: provider attitudes, practices, and barriers. Cancer Detect Prev 31(5):375–383PubMedCrossRef
33.
go back to reference Cuzick J (2009) Use of selective estrogen receptor modulators in the prevention of breast cancer: an overview of the randomized trials. Cancer Res 69 (24 Supp):Abstract 905 Cuzick J (2009) Use of selective estrogen receptor modulators in the prevention of breast cancer: an overview of the randomized trials. Cancer Res 69 (24 Supp):Abstract 905
35.
go back to reference Freedman AN, Yu B, Gail MH, Costantino JP, Graubard BI, Vogel VG, Anderson GL, McCaskill-Stevens W (2011) Benefit/risk assessment for breast cancer chemoprevention with raloxifene or tamoxifen for women age 50 years or older. J Clin Oncol 29(17):2327–2333 Freedman AN, Yu B, Gail MH, Costantino JP, Graubard BI, Vogel VG, Anderson GL, McCaskill-Stevens W (2011) Benefit/risk assessment for breast cancer chemoprevention with raloxifene or tamoxifen for women age 50 years or older. J Clin Oncol 29(17):2327–2333
36.
go back to reference Saslow D, Boetes C, Burke W, Harms S, Leach MO, Lehman CD, Morris E, Pisano E, Schnall M, Sener S, Smith RA, Warner E, Yaffe M, Andrews KS, Russell CA (2007) American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 57(2):75–89PubMedCrossRef Saslow D, Boetes C, Burke W, Harms S, Leach MO, Lehman CD, Morris E, Pisano E, Schnall M, Sener S, Smith RA, Warner E, Yaffe M, Andrews KS, Russell CA (2007) American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 57(2):75–89PubMedCrossRef
37.
go back to reference Rungruang B, Hood BL, Sun M, Hoskins E, Conrads TP, Zorn KK (2010) Novel surgical approaches for sampling the ovarian surface epithelium and proximal fluid proteome. J Proteome Res 9(11):6071–6076PubMedCrossRef Rungruang B, Hood BL, Sun M, Hoskins E, Conrads TP, Zorn KK (2010) Novel surgical approaches for sampling the ovarian surface epithelium and proximal fluid proteome. J Proteome Res 9(11):6071–6076PubMedCrossRef
Metadata
Title
A multidisciplinary clinic for individualizing management of patients at increased risk for breast and gynecologic cancer
Authors
Natalie J. Engel
Patricia Gordon
Darcy L. Thull
Beth Dudley
Judy Herstine
Rachel C. Jankowitz
Kristin K. Zorn
Publication date
01-09-2012
Publisher
Springer Netherlands
Published in
Familial Cancer / Issue 3/2012
Print ISSN: 1389-9600
Electronic ISSN: 1573-7292
DOI
https://doi.org/10.1007/s10689-012-9530-x

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