Is genetic testing for cancer survivors underutilized?


One study looks at whether or not women with histories of breast or ovarian cancer are receiving necessary genetic testing. Plus: Can in-office hysteroscopy reliably evaluate uterine pathology? Also, researchers say mammographic density changes should be monitored in patients undergoing hormone therapy as a possible indicator of breast cancer.

More than 80% of women with a history of either breast or ovarian cancer may not be receiving necessary genetic testing, according to a new study in the Journal of Clinical Oncology.

For the analysis, investigators used pooled cross-sectional data from 3 Cancer Control Modules on the National Health Interview Survey from 2005, 2010, and 2015. Women with a history of breast and/or ovarian cancer who met select 2017 National Comprehensive Cancer Network eligibility criteria for age of diagnosis and family history were eligible.

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Of the 47,218 women who were studied, 2.7% had a history of breast cancer and 0.4% had a history of ovarian cancer. Among women with a history of breast cancer, 35.6% met one eligibility criterion. Of that subset, 29.0% discussed genetic testing; 20.2% were advised to undergo genetic testing; and 15.3% underwent genetic testing. Among the women with a history of ovarian cancer, 15.1% discussed genetic testing; 13.1% were advised to have genetic testing; and 10.5% underwent genetic testing. Looking at data on women who met only 4 breast cancer eligibility criteria and all of the patients who had a history of ovarian cancer, the investigators estimated that 1.2 to 1.3 million women failed to receive genetic testing.

The authors concluded that fewer than 1 in 5 women with a history of breast cancer or ovarian cancer who met select criteria had undergone genetic testing and most had never even discussed genetic testing with a health care provider. They said that national efforts to address these discrepancies are warranted.

NEXT: Can in-office hysteroscopy evaluate uterine pathology


Can in-office hysteroscopy reliably evaluate uterine pathology?

According to a new retrospective analysis in Menopause, outpatient hysteroscopy may be a reliable tool for evaluating and diagnosing uterine pathology.

Researchers studied data from all women who had been referred to a tertiary center outpatient hysteroscopy clinic between March 2011 and October 2016 for any of the following indications: thick endometrium, postmenopausal bleeding, and suspected polyp. Specimens obtained by hysteroscopy and hysterectomy were compared and evaluated for histological accuracy. Visual accuracy of hysteroscopy was evaluated by comparison with specimens collected through biopsy. Likelihood ratio, positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity were calculated to examine visual accuracy.

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The average age of women in the study was 54.14 (interquartile range 43.0-64.0). During the 712 visits recorded in the clinic log, a total of 408 pathological specimens were collected through outpatient hysteroscopies. Histological accuracy was examined in 15 women who eventually had hysterectomies. The total percent of agreement between hysteroscopy biopsies and pathology found by hysterectomy was 73% (kappa = 0.47). Visual accuracy was calculated with a 93.1% sensitivity, 52.1% specificity, 90.4% PPV, and 61.0% NPV.

Visual accuracy with hysteroscopy was generally higher for benign pathology than for pre- and malignant lesions. It was poor for diagnosis of hyperplasia, with sensitivity and specificity of 25.0% and 96.6%, respectively. For diagnosis of endometrial carcinoma, it was satisfactory, with sensitivity and specificity of 71.4% and 98.9%, respectively.

The researchers concluded that outpatient hysteroscopy is an adequate tool for evaluating benign pathology in the uterus. However, visual findings may not be sufficient and directed biopsies may be needed to improve diagnostic accuracy.

NEXT: Mammographic density as indicator of breast cancer risk


Mammographic density, hormonal therapy and breast cancer risk

In postmenopausal women who start hormonal therapy with estrogen plus progestin (E+P), changes in breast density should be monitored as a possible bellwether of breast cancer risk, say the authors of a new study case-control study. The data are from the Women’s Health Initiative (WHI) and were published in The Journal of National Cancer Institute.

The aim of the analysis was to determine whether mammographic density change associated with initiation of daily estrogen (0.625 mg) plus medroxyprogesterone acetate (2.5 mg) predicts breast cancer risk. In 174 women who later developed breast cancer (cases) and 733 healthy women (controls), mammographic density was assessed with mammograms taken prior to and 1 year after randomization. Logistic regression analyses were used to adjust for confounders and baseline mammographic density, when appropriate.

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In women in the E+P arm (97 cases, 378 controls), breast cancer risk rose 3% for each 1% positive change in percent mammographic breast density (odds ratio [OR] =1.03; 95% confidence interval [CI] 1.01-1.06). Breast cancer risk increased 3.6-fold for women in the highest quintile of mammographic density change (> 19.3% increase) (95% CI 1.52-8.56). After adjusting for change in mammography density, the effect of E+P use on breast cancer risk (OR 1.28, 95% CI 0.90-1.82) was eliminated (OR 1.00, 95% CI 0.66-1.51).

“The 1-year change in mammographic density after estrogen plus progestin initiation,” the authors said, “predicted subsequent increase in breast cancer risk.” They noted that all of the increased risk from E+P exposure was mediated through mammographic density change and encouraged physicians to evaluate changes in mammographic density in women who initiate the hormonal therapy and to discuss the breast cancer risk implications with them. 

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