Cancer Counseling Research Articles

Soziale Arbeit in der ambulanten Krebsberatung

Soziale Arbeit in der ambulanten Krebsberatung

BRCA1 and BRCA2 truncating mutations and variants of unknown significance in Egyptian female breast cancer patients

BackgroundBreast cancer is the most common malignancy among women worldwide and the leading cause of cancer death in economically developing countries. We sought to study the contribution of BRCA1/2 mutations to the burden of breast cancer in Egypt. Patients and methods103 Egyptian female breast cancer patients, unselected for age of onset or family history, were included in the study. Mutational screening of some exons of BRCA1/2 genes was performed using High Resolution Melting analysis followed by direct sequencing of detected variants. ResultsTwenty sequence variants were identified. According to the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG/AMP) guidelines, 8 variants were classified as pathogenic (Class 5), 1 as likely pathogenic and 11 as variants of unknown significance (Class 3). The pathogenic variants comprised 5 novel frameshift mutations; BRCA1 c.5205delA and BRCA2 (c.3641delT, c.3291dupT, c.3292delA, and c.787dupA) mutations; 1 novel nonsense mutation (BRCA2 c.3280A>T) and 2 previously described missense mutations (BRCA1 c.117T>G, c.110C>A). ConclusionThis study provides the results of our attempt to delineate the genetic aspect of breast cancer among the Egyptian population and emphasizes the necessity of implementing screening strategies for early diagnosis and counseling for breast cancer in Egypt.

Employing multiple-attribute utility technology to evaluate publicity activities for cancer information and counseling programs in Japan

BackgroundCancer Information and Support Centers (CISCs), which are set up at designated cancer care hospitals (DCCHs) according to the national cancer control programs in Japan, are expected to provide cancer patients and their families with information and counseling, but their public recognition remains low. Therefore, it is necessary to evaluate the publicity activities of CISCs. MethodsIn this study, we evaluated two types of activities for publicizing CISCs conducted inside and outside one of the DCCHs (‘Inside Activity’ and ‘Outside Activity’, respectively) by multi-attribute utility technology (MAUT). Seven types of stakeholders, including physicians (n = 5), nurses (n = 4), CISC cancer counselors (n = 5), executives (n = 5), office department staff (n = 5), and licensed social insurance consultants in the hospital (n = 5), as well as patients and citizens (n = 19) were involved in the evaluation. ResultsEight goals of the program for publicizing CISCs were determined. The utility score for each goal was separately calculated for Inside Activity and Outside Activity, and those of the eight goals were summed up to obtain an overall utility score for each activity. Finally, no substantial difference in overall utility score was found between the activity types (Inside Activity = 82.00 vs. Outside Activity = 81.18). ConclusionsIt is implied that omitting or reducing either activity should be avoided in streamlining publicity activities at the CISCs. Despite the limited external validity of the finding, the methodology presented in this study is widely applicable to evaluate other multifaceted programs under an increasingly tight budget in the oncology setting. As the MAUT approach enables us to obtain numerical data for priority settings, it will contribute to rationalized healthcare management, especially in the oncology setting in which objective evaluations of the national cancer-related control programs are lacking and a broad range of stakeholders is involved.

Abstract PO-051: Genetic counseling for high-risk public hospital patients: A randomized and preference-based trial compares delivery in person, by phone, and video

Abstract In public health settings, where availability of genetic counseling (GC) and testing for hereditary breast and ovarian cancer is limited, telehealth could expand access to academic centers where these services are concentrated. However, little is known about the effectiveness of remote modes for ethnically diverse and low health literacy patients. Methods. From 2017-20 UCSF researchers partnered with 3 public hospitals to conduct a partially randomized preference noninferiority trial with English-, Spanish-, and Cantonese-speaking patients with strong personal and/or family history of cancer. Participants received GC in person, by phone, or via video. Pre- and post-GC telephone surveys measured study outcomes: knowledge, cancer- specific distress, decisional conflict, risk perception, and satisfaction. A subset of 23 participants was recruited for case studies (CS) to elucidate quantitative findings. CS integrated patient and counselor in-depth interviews, GC session transcripts, and survey and tracking data for a multi-dimensional understanding of each individual’s GC experience. Results. Among 23,633 family history forms collected, 1,574 patients were eligible; 1404 were reached and 708 consented. Of 394 randomized, 322 attended GC and 312 completed the final survey. After GC, mean knowledge scores increased, and cancer-specific distress and decisional conflict decreased overall. Counseling attendance varied significantly by assigned mode (75% via video at a clinic, 77% in person, and 92% by phone), but the modes yielded noninferior outcomes. Respondents overwhelmingly rated all modes as “very convenient” and satisfaction with counseling as “very high.” Compared with baseline, knowledge increased significantly regardless of mode. However, this increase was significantly less for African Americans and for those with less education (with each adjusted for the other) across all modes. Completion of genetic testing (GT) was the inverse of counseling attendance: 94% in person, 93% video, and 65% by phone. Case studies (CS) revealed the complexities of counseling public hospital patients. Phone patients valued the access despite connection issues, but phone appointments tended to be briefer, and qualitative interviews suggested that communication was less effective by phone. While many phone patients said they would not be able to access GC any other way, several felt they would get more out it in person. Importantly, GT was offered on the spot to in-person patients while some counseled by phone had second thoughts and other barriers. CS of video counseling found benefits similar to in-person GC such as use of visual cues and formation of meaningful connections. Conclusion. Our findings indicate that GC can be delivered to high-risk public hospital patients remotely by phone, video, or in-person in order to fill a gap in access to critical genetic services. Further research is needed to achieve optimal outcomes for all patients and to increase the rate of testing for those counseled by phone. Citation Format: Rena J Pasick, Susan L. Stewart, Robin Lee, Claudia Guerra, Celia Kaplan, Galen Joseph, Selina Flores, Janice Tsoh, Niharika Dixit, Miya Frick, Heather Cedermaz, Lily Wong, Amal Khoury, Brittany Campbell. Genetic counseling for high-risk public hospital patients: A randomized and preference-based trial compares delivery in person, by phone, and video [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-051.

The Impact of Increasing Sun Protection Counseling and Skin Cancer Screening.

Skin cancer is the most common cancer in the United States. Skin cancer is a broad term that includes squamous cell carcinoma, basal cell carcinoma, and melanoma. Melanoma is the most concerning of the three types of skin cancer and is the focus of this project. The projected number of individuals impacted by a new diagnosis of melanoma in 2020 is a staggering 100,350 coupled with an estimated 6,850 patients dying from melanoma each year. In Wisconsin, it is estimated there will be 2,190 new cases of melanoma, and 150 deaths in 2020. Expanding patient's knowledge about the risk and benefits of skin cancer screenings, techniques, and characteristics will enhance understanding of the significance of skin cancer. The purpose of this study was to assess current skin cancer knowledge and raise awareness by providing education regarding skin cancer risks and statistics among manufacturing employees in Wisconsin. A quality improvement procedure took place as employees of a Midwestern global manufacturer were educated about self-skin screens, skin cancer risks, and the importance of sun protective behaviors. Pre- and post-education surveys were distributed and obtained. A total of 16 individuals participated in the study, and the results were clinically significant. Providing education about skin cancer risks and sun protection behaviors improved employee's knowledge base by 50%. Although individuals identified skin cancer as an area of high concern, few reported knowing how to prevent skin cancer and the risks for skin cancer before being provided the related education. Therefore, it is evident, even with this small group that simple skin cancer counseling offers great benefit in helping increase knowledge among those educated about skin cancer risk factors and sun protective behaviors.

Inadequacies in genetic testing referrals and counseling in prostate cancer.

43 Background: Recent studies have recognized the high prevalence of germline mutations in genes affecting DNA repair in patients with prostate cancer. In recognition of their growing clinical significance, the NCCN guidelines recommend genetic counselling in prostate cancer pts with certain risk factors. The application of these guidelines in clinical practice were evaluated. Methods: All new clinic visits of prostate cancer pts at UAB from January 2019 – June 2019 were identified and analyzed. We constructed a flow diagram of the UAB two-step referral model, and performed a chart review and analyzed the new clinic visits. We then sent a 10-item questionnaire to providers at UAB to collect information on germline genetic testing patterns, general approach to testing, and the barriers of GC, and actions to overcome barriers. Results: From January to June 2019, 57 new prostate cancer patients were seen, of which 23 had metastatic disease, 20 had high or intermediate risk localized disease and remaining had biochemical recurrence. In total, 38 had an indication for GC. The most common indication was metastatic disease in 23 pts (40%) and localized high risk in 15 pts (26%). Significantly 33% of 24 patients with early onset prostate cancer < 60 yrs did not meet NCCN defined criteria for testing. Only 39% of the 38 eligible patients were referred, with testing completed in 11% of those with indications. The response rate to the survey was 91%. 30% of respondents reported that they would be comfortable completing genetic counseling themselves, and the most commonly reported barrier to providing the testing themselves was time, and lack of expertise/experience. 70% percent of providers cited that lack of genetics workforce was a barrier to genetic testing, and 60% cited lack of knowledge of genetic testing and genetics and the inadequate coordination of referrals were barriers. Conclusions: While a majority of prostate cancer patients seen in the oncology clinic meet criteria for GC, referrals are inconsistent, and only a handful of eligible patients complete testing. From the survey results, the areas that need to be improved from the provider’s side are education and comfort with genetic testing. From a systems perspective, the need for more genetics workforce, and better process workflows are required to improve the uptake of Genetic Testing Referral and Testing. The interventions of practice transformation and education need to be implemented, and tested at UAB to improve adherence to the NCCN guidelines for genetic testing of prostate cancer.

Impact of early nutrition counseling in head and neck cancer patients with normal nutritional status.

Nutritional counseling is frequently overlooked in cancer patients with normal nutritional status. This study aimed to evaluate the impact of nutritional counseling in head and neck cancer (HNC) patients with normal nutritional status prior to concurrent chemoradiotherapy (CCRT). A total of 243 patients with pretreatment normal nutritional status and locally advanced HNC receiving concurrent chemoradiotherapy (CCRT) at three medical centers were enrolled. All patients were retrospectively allocated into the early (≤ 2 weeks, n = 105, 43.2%), late (> 2 weeks, n = 102, 42.0%), and no nutritional counseling groups (n = 36, 14.8%) according to the time interval between the date of CCRT initiation and the first date of nutritional counseling for comparison. The 1-year overall survival rates were 95.0%, 87.5%, and 81.3% in the early, late, and no nutritional counseling groups (p = 0.035), respectively. The median body weight changes at end of CCRT were - 4.8% (range, - 13.3 to 8.7%), - 5.6% (range, - 21.9 to 5.6%), and - 8.6% (range, - 20.3 to 2.4%) in patients in the early, late, and no nutritional counseling groups, respectively. The early termination of chemotherapy rates and the incompletion rates of planned radiotherapy were 1.9% and 1.9%, 2.9%, and 2.0%, 13.9%, and 19.4% in patients in the early, late, and no nutritional counseling groups, respectively. Our findings strongly suggest that while some HNC patients may have pretreatment normal nutritional status, early nutritional counseling is nevertheless essential for the improvement of treatment tolerance and survival outcome.

Cutaneous Leiomyomatosis – Case Report and Literature Review

Cutaneous leiomyomas are uncommon benign smooth muscle tumors that comprise of three distinct types such as piloleiomyoma, angioleiomyoma, and genital leiomyoma. The discovery in 2001 of the association between cutaneous leiomyomas, uterine leiomyomas in women, and an aggressive form of renal cell cancer (RCC) underscores the importance of accurate dermatologic diagnosis of CL so that appropriate cancer screening and counseling of patients and at-risk relatives can be instituted. The present case report will discuss the pathogenesis, clinical manifestations, diagnosis, and management of a piloleiomyoma.

Awareness is the first step: What Ghanaian community pharmacists know about cancer.

The goal of this study was to access the knowledge of a representative sample of community pharmacists in Ghana on general cancer, risk factors, signs and symptom and most common cancer counseling points known to community pharmacists. A structured online questionnaire was administered to 435 registered community pharmacists in the sixteen regions of Ghana.Key findings: Mean score for knowledge of cancer among community pharmacists was 6.8 ± 1.61 points out of a maximum score of 15 points, categorizing the overall knowledge as inadequate. The overall assessment of pharmacists' knowledge revealed that 74.6% of the participants had inadequate level of knowledge on cancer. Mean score for knowledge of cancer signs and symptoms among community pharmacists was 3.55 ± 1.85 out of a maximum score of 7 points, categorizing the overall knowledge as inadequate. The overall evaluation indicated that 79.03% of pharmacists had inadequate knowledge of signs and symptoms cancer. Mean score for knowledge of risk factors of cancer among community pharmacists was 5.25 ± 1.15 out of a maximum score of 12 points, categorizing the overall knowledge as inadequate. The overall assessment of the knowledge score indicates that 70.34% of pharmacists had inadequate knowledge about causes and risk factors of cancer. Almost all participating pharmacists (96.5%) recommended counselling point was avoidance of smoking as a cancer preventive measure. An inverse significant correlation was found between age and knowledge scores of signs and symptoms of cancer (r = -0.077, P = 0.038). There was a statistically significant relationship between pharmacists' level of knowledge on cancer (whether adequate or inadequate) and the cancer items. Knowledge of cancer, its signs and symptoms and its risk factors were inadequate among community pharmacists in Ghana. Efforts should be made to improve knowledge of community pharmacists on cancer through continuous education. Also, undergraduate pharmacy training in oncology should encourage to close knowledge gap of community pharmacists on cancer.

Genetic Counseling for Hereditary Gastric and Pancreatic Cancer in High-Risk Gastrointestinal Cancer Clinics: An Effective Strategy.

The identification of high-risk groups of gastric (GC) and pancreatic adenocarcinoma (PC) due to a hereditary basis could imply a benefit in the affected families by establishing personalized preventive strategies. We aimed at assessing the diagnostic yield of GC/PC hereditary syndromes in individuals evaluated based on specific clinical criteria. In total, 77 unrelated individuals (45 from GC group/32 from PC group) were recruited: 51 (66.2%) cancer diagnosis ≤60 years, 3 (4%) with personal history of GC/PC and other cancer and 23 (29.8%) due to family history. Immunohistochemical analysis of DNA mismatch repair proteins was performed in 38 (49.3%) available tumors, being pathological in one (2%) GC. A genetic analysis was performed if clinical criteria of hereditary syndrome were fulfilled, identifying a mutation in 10/22 (45.5%) families [7/16 (43.7%) with GC and 3/6 (50%) with PC] and 19 (24.7%) fulfilled criteria of familial cancer. Diagnosis of cancer <40 years and personal history of other cancers were independent risk factors of a hereditary syndrome [OR:11.3 (95%IC 1.9–67); p = 0.007 and OR:17.4 (95% IC 2.5–119.9); p = 0.004; respectively]. The selection of patients based on clinical criteria leads to high diagnostic yield, detecting a causative germline mutation in almost half of the cases; therefore, both meticulous genetic counseling and use of multi-gen panels is crucial.

Chronic Disease Counseling and Screening by Dental Professionals: Results From NHANES, 2011-2016.

IntroductionDental visits may provide an opportunity to counsel and screen for chronic disease prevention. However, few studies have used nationally representative data to assess the potential role of dental professionals in chronic disease prevention. We examined the percentage of US adults who reported chronic disease counseling and screening by dental professionals.MethodsWe analyzed data from the National Health and Nutrition Examination Survey 2011–2016 for 5,541 participants aged 30 or older who reported seeing a dental professional in the past year and estimated the percentage who reported receiving counseling about selected chronic disease prevention during the visit. We used logistic regressions to examine associations between risk factors and counseling.ResultsOverall, 4.0% (standard error [SE], 0.3) of adults were told by a dental professional about the benefits of checking blood glucose, 42.4% (SE, 2.9) giving up tobacco (among tobacco users), 26.6% (SE, 1.2) about checking for oral cancer, and 43.0% (SE, 1.8) had an oral cancer examination. Groups with risk factors were more likely to receive health behavior counseling than those without (eg, those previously told they had diabetes risk factors were more likely to receive blood glucose counseling than those without [8.1% vs 3.3%, P < .05]). The pattern for oral cancer counseling and receiving an oral cancer examination was different: adults without oral cancer risk factors (no tobacco use, normal/underweight, and/or excellent/very good health) were more likely to receive oral cancer counseling or screening. Adjusted analyses did not change these associations.ConclusionMost adults were not counseled about chronic disease prevention during a visit with a dental professional. Current tobacco users and those with overweight or obesity were more likely to report receiving counseling.

Effects of Breast Cancer Counseling on Attitudes of Acting Mothers in BSE in Timpag Village, Kerambitan Subdistrict, Tabanan Regency, Bali-Indonesia

This study aims to determine the effect of breast cancer counseling on the attitude of mothers doing BSE actions. The study design used a pretest-posttest model to measure the knowledge and attitudes of 45 respondents. Data from research results were collected using a questionnaire and data analysis using the Rank Wilcoxon statistical test. The results showed: (1) Before giving counseling, knowledge included as many as 34 categories (75.56%), 9 categories as enough (20.00%), and 2 categories as good (4.44%), while attitudes included negative categories were 32 (71.11%) and positive categories were 13 (28.89%). (2) After being given knowledge counseling including as many as 3 categories (6.67%), sufficient categories as many as 5 (11.11%), and good categories as many as 37 (82.22%), while attitudes including negative categories as much as 4 ( 8.89%) and positive categories as much as 41 (91.11%). The Wilcoxon test with a p value of &lt;0.05 was said to have a difference, namely the value of p = 0,000, and the value of Z count - 5,393 which means that there is an effect of breast cancer counseling on the attitude of mothers doing BSE in Timpag Village.

Germline variants discovered in lymphoma patients undergoing tumor profiling: a case series.

Clinical tumor sequencing protocols often depend on obtaining germline DNA from patients to aid in the identification of de novo variants in the tumor, and therefore come with the possibility for the incidental discovery of germline variants. Ninety-one adult patients with lymphoma were consented and enrolled in MIONCOSEQ, an IRB-approved tumor profiling protocol that utilizes an exome sequencing platform. Charts were retrospectively reviewed for germline variants from sequencing results, personal and/or family history of cancer and genetic counseling referral. After review of the 91 lymphoma cases, seven (8%) cases revealed germline variants. Only one of these, CHEK2 p.I157T, has been previously recovered as a germline variant in lymphoma. Two of the seven patients received genetic counseling, two died before genetic counseling could be arranged and three did not follow-up with a genetics provider. None of the patients had a personal or family history that would have otherwise suggested an indication for cancer genetics referral, especially notable as lymphoma is not traditionally associated with inherited cancer syndromes. Importantly, as only two of seven patients had appropriate genetic counseling for their variant, timely genetic counseling should be a critical part of all tumor profiling platforms that use non-tumor DNA.

Sperm count and future challenges for cancer patients

Cancer has significantly harmful effects on sperm count, motility and sexual life of the survivor, thereby adversely affecting the fertility and post cancer quality of life. Use of safer chemotherapeutic agents, protection from radiation damage, cryopreservation of sperm and testicular tissue and use of protective drugs to reduce testicular damage is recommended. More research is needed to safeguard fertility of cancer affected children as testicular tissue cryopreservation is the only fertility preservation option. Advanced understanding of in vitro sperm production is needed. In this era of advanced assisted reproduction, the minimum requirement for fertilization is one healthy sperm for one oocyte. Children born after chemotherapy do not have statistically significant increase in malignant neoplasms. Proper cancer counseling and referral for fertility preservation are of high importance to protect fertility. The focus of this review is to share knowledge of sperm formation, importance of sperm count, nature of damage to male fertility, remedies to overcome damage and to improve post cancer quality of life of male cancer survivors.

Abstract D006: Community Research Collaboration to develop a promotor-based hereditary breast cancer education program for Spanish-speaking Latinos

Abstract Breast cancer is the most common cancer in Latinas and the leading cause of cancer death. Latinas tend to be diagnosed later, have poorer survival rates, and receive poorer quality care than white women. It has been well documented that women at high risk for hereditary breast cancer (women with strong family history, or BRCA1 or BRCA2 carriers) greatly benefit from genetic counseling, which enhances early cancer detection or risk-reduction strategies. Despite the growing availability of genetic counseling and testing for hereditary breast cancer, awareness and use of these services is low among Latinas. We developed a comprehensive, culturally-appropriate set of materials for a community health educator (promotor)-led hereditary breast cancer educational program for the Latino community. The conceptual framework used to design didactic curriculum and the program structure was based on the construct of “relational culture.” Materials were developed through an iterative process that involved exposure of the target populations to draft materials, discussion, and modification of materials. The focus groups took place in the cities of San Francisco, San Jose, Concord and Pittsburg between March 2018 and May 2019. We conducted 7 focus groups, including a total of 68 women (35 promotores, and 33 community members). On average, participants were 43 years old (SD= 11.62), and had been living in the U.S. for 16 years (SD= 7.55). Approximately eighty percent of the sample had limited English proficiency, fifty-one percent had public insurance, and forty-nine percent had a high school education. Sixty percent of them were unemployed, and seventy-two percent were born in Mexico. The conversation during the focus group sessions was directed towards hereditary breast cancer baseline knowledge, perceptions and learning preferences among Spanish-speaking Latino participants. A thematic analysis of the focus groups yielded five main themes: barriers, importance, dissemination, educational, and culture. 1) Barriers referred to the program’s ability to overcome traditional barriers to healthcare for Latinos; 2) Importance related to the significance of the program’s content; 3) Dissemination referred to the easiness and value of disseminating the information covered in the program; 4) Educational related to the program’s informational nature; and 5) culture referred to the program being perceived as culturally-appropriate. Results revealed that participants thought the materials were easy to understand, attractive, and engaging. They believed that the content would be easy to disseminate and important to the community. However, given that the materials encompassed genetics content, some promotores and community members expressed confusion, and feeling overwhelmed. To address this, materials were simplified, and additional didactic content was included. Future research is needed to determine the impact of the educational program on genetic counseling and screening behavior. Citation Format: Rebeca Almeida, Alejandra Lopez-Macha, Tania Dugatkin, Ysabel Duron, Laura Fejerman. Community Research Collaboration to develop a promotor-based hereditary breast cancer education program for Spanish-speaking Latinos [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D006.

Abstract A034: Extending the reach of genetic counseling to the safety net: Study design and recruitment challenges of a randomized trial

Abstract Genetic counseling (GC) for hereditary breast and ovarian cancer is available mainly in academic settings. Despite equal risk, most low income public hospital patients remain unaware and untested. Remote counseling may be a solution, but research has been limited to phone counseling for insured patients. Our study compares in-person, phone, and video conference GC among high-risk patients in 3 public hospitals to determine the comparative effectiveness of GC delivered across modes with regard to patients’ knowledge, cancer distress, decisional conflict, perceived stress, risk perception, satisfaction, and recall. We also assessed whether patients have a preference for counseling mode and how that affects outcomes. This report describes the study design and lessons learned regarding recruitment. We conducted a multicenter partially randomized preference noninferiority trial with English-, Spanish-, and Cantonese-speaking patients assigned by randomization or patients´ preference to one of the three GC modes. High-risk patients were identified using a family history screener in clinics or by physician referral. Study staff verified risk by phone, invited participation, conducted informed consent, and administered a baseline survey. Enrollees were asked whether they could be randomized or if they preferred one GC mode. They were then given a GC appointment and called again within 2 weeks of counseling for a follow-up survey. Power calculations required 270 randomized patients. A total of 23,401 screener forms yielded 824 likely to be high-risk; 656 completed baseline surveys. Race/ethnic composition was 40% Latinx, 25% white, 19% African American, and 8% Asian. Of these, 531 were counseled, and 505 completed final surveys (283 from randomized patients). The majority (64%) of non-randomized patients chose counseling by phone, 33% chose in person, 3% chose video. • At every step, participation exceeded our projections, showing that diverse low-income patients were interested in participating in research that they deemed relevant. • Our greatest recruitment challenges were due more to settings than to patients. Collection of screeners varied greatly by month and/or clinic. Oncologists valued the risk services offered by the study, but intensive engagement was necessary with front-line staff/supervisors because of their job demands. • Partial randomization functioned well. Prior studies showed that many high-risk women refuse randomization for GC. Adding a preference arm necessitated a larger sample, but greater inclusiveness yields more generalizable findings. • Recruitment of Chinese-speaking patients was low (2.5%) due largely to structural barriers which we continue to explore. Practice-based safety net research presents numerous challenges that require close partnerships, extensive planning, and highly skilled staff capable of sensitive personnel engagement. The work is rewarded by real-world findings, the sine qua non in efforts to eliminate cancer disparities. Citation Format: Claudia Guerra, Robin Lee, Susan L Stewart, Celia Kaplan, Galen Joseph, Janice Tsoh, Niharika Dixit, Heather Cedermaz, Jin Kim, Jane Campbell, Lily X Wang, Amal Khoury, Cindy Hellman-Wylie, Rena J Pasick. Extending the reach of genetic counseling to the safety net: Study design and recruitment challenges of a randomized trial [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A034.

Genetic predisposition to childhood cancer: A retrospective cohort analysis in a multidisciplinary genetic cancer counseling Unit.

e13643 Background: The incidence of childhood cancer in Spain is 18, 2 cases per 100.000 inhabitants per year. The presence of predisposing genetic factors has been revealed in approximately 10% of patients, in them the detection of genetic mutations associated is essential in order to establish the correct clinical management of patients and their relatives. However, genetic counseling in this population is currently underestimated since, not all patients with pediatric malignancies have a family history of cancer or other clinical signs to suspect and inheritance syndrome. Methods: The Unit for Predisposition to Child and Adolescent Cancer of the University Hospital La Paz in Madrid, Spain, is composed by the Units of Clinical Oncology, Pediatric Hemathology-Oncology, and Genetics. Inclusion criteria are based on the characteristics of the individual's neoplasia, family characteristics and other phenotypic characteristics.The molecular study is carried out through Next Generation Sequencing, Direct Sequencing and / or MLPA. In the present study, a retrospective and descriptive analysis of the cases studied from September 2018 to December 2019 was carried out. Results: The Pediatric Cancer Predisposition Functional Unit of the La Paz University Hospital attended during the years 2018 and 2019 a 58 patients with suspected predisposition syndromes to childhood cancer belonging to 41 families. The following inheritance syndromes have been identified: hereditary retinoblastoma in 14 families with mutation in the RB1 gene, Li Fraumeni syndrome in 1 family with mutation in the TP53 gene, multiple endocrine neoplasia type 2A by RET gene mutation in 1 family, 1 hereditary melanoma syndrome with a CDKN2A mutation, and inheritance family leukemia in 1 family with a PAX5 gene mutation. Other cases studied have been negative-non informative, with the following neoplasms of the index cases: unilateral retinoblastoma, hepatoblastoma, hamartomatous colon polyposis, lymphoma, leukemia and soft tissue sarcoma. In addition to the molecular diagnosis of the index case, both cases and family members received genetic counseling and adequate clinical management, adapted to each syndrome. Conclusions: The multidisciplinary and specialized approach improves the diagnosis and monitoring of patients with suspected syndromes of predisposition to childhood cancer and allows the establishment of prevention strategies and early diagnosis individualized to each family.

Implementation of SADARI in the Early Detection of Breast Cancer in Young Women High School of West Aceh Regency

Breast cancer (carcinoma mammae) is a condition where cells have lost control and normal mechanisms, resulting in abnormal growth, rapid and uncontrolled which occurs in breast tissue.. Early detection of breast cancer aims to find cancer in the early stage so that the treatment is better. The detection is done by doing SADARI, SADARI is an easy examination to find a lump or agility others. The case of cancer of West Aceh Regency in 2015 S/d 2017 recorded the number of cases of breast cancer at most 24.43% compared with other cancers. Women aged 50 years more who have breast cancer reaches 52%, 35% at the age of less than 40 years, 22% of women aged 30 years and the younger age exposed to breast cancer is the age of 15 and 18 years. The study aims to determine the influence of breast cancer counseling and breast-check training (SADARI) in an effort to improve the knowledge and skills of young women in the Act of SADARI for prevention and decrease in cases of breast cancer. This research uses Quasi-Experimental design. The research plan is one group before and after intervention design, or one group pre and posttest design. The population in this study is young women SMAN District ACEH Barat with samples amounting to 30 young women. The results of the study concluded that there was an effect of BSE Implementation (counseling about breast cancer and breast self-examination training) in an effort to increase the knowledge of young women about breast cancer and the skills of young women in breast self-examination.

Genetic Counseling Clinic at AIIMS (New Delhi).

The field of genetic counseling in India has enormously transformed over the past few years. Genetic counseling is a communication process which deals with the human problems associated with the occurrence or risk of occurrence of a genetic disorder in a family. Genetic counseling is not merely having a conversation based on genomic data. It addresses the "information needs" of a particular patient, and customizes a session according to each patient's individual circumstances, thereby aiding in decision-making. In 2012, AIIMS (New Delhi) became the first tertiary care center in North India to provide genetic counseling for cancer. Among 200 cases that were referred for genetic counseling to the AIIMS clinic at the Department of Surgical Disciplines, about 30% of patients chose to undergo testing. Five cases of BRCA1/2 mutation were found conforming to the hereditary breast and ovarian cancer syndrome. There was one case of TP53 mutation conforming to Li-Fraumeni syndrome. One case each of Xeroderma Pigmentosum (XP) and Cowden's syndrome was also detected. All these cases were offered risk-reducing measures and put under life-long surveillance as per protocol. Their family members were also offered genetic counseling and subsequent testing if they agreed. Cancer genetic counseling service was a new exercise, and hence, several challenges were faced. The clinical utility of genetic testing, coupled with counseling, should be established by trials. Documenting the achievements of counseling by surrogate parameters like "improved recruitment rate of patients for genetic tests" and "improved patient satisfaction levels" will go a long way in garnering the much needed institutional support.

Points to consider: is there evidence to support BRCA1/2 and other inherited breast cancer genetic testing for all breast cancer patients? A statement of the American College of Medical Genetics and Genomics (ACMG)

Points to consider: is there evidence to support BRCA1/2 and other inherited breast cancer genetic testing for all breast cancer patients? A statement of the American College of Medical Genetics and Genomics (ACMG)