Risk Reduction Procedures Research Articles

Identification of Understanding of Disaster Preparedness in the School Environment

Flores Island is vulnerable towards natural disasters. Therefore, it requires an effective disaster warning ma-nagement. In this context, schools play an important role in disaster warning system. However, not all schools implement Disaster Risk Reduction (DRR) procedures effectively. Therefore, efforts are needed to improve disaster warning system among schools by integrating the three pillar principles, which include safe facilities, effective disaster management, and resilience education. This study aims to understand the state of school readiness in the Flores region and assess the extent to which these schools apply the three pillar criteria for school disaster warning system. The research method used is a qualitative descriptive ap-proach, with data collection through an open questionnaire distributed using Google Forms. The result showed that the locations of the respondent's schools are spread across the most disaster-prone areas of Flo-res, especially along the coastal areas. In addition, there are still many schools in the region that have diffe-rent levels of understanding and awareness regarding to disaster warning system. Based on that issue, the program for activating the disaster warning system in school area is very important to apply and can increase public awareness of disaster warning system. To achieve that idea, a collaboration between school commit-tees, external parties, and the Flores community is essential to strengthen the school infrastructure and to build an effective response towards potential disaster risks and threats.

Outcomes of Different Quality of Life Assessment Modalities After Breast Cancer Therapy

Improvement in clinical understanding of the priorities of patients with breast cancer (BC) regarding postoperative aesthetic outcomes (AOs) is needed. To assess expert panel and computerized evaluation modalities against patient-reported outcome measures (PROMs), the gold standard of AO assessment, in patients after surgical management of BC. Embase, MEDLINE, PsycINFO, PubMed, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov were interrogated from inception through August 5, 2022. Search terms included breast conserving AND aesthetic outcome AND breast cancer. Ten observational studies were eligible for inclusion, with the earliest date of database collection on December 15, 2022. Studies with at least 1 pairwise comparison (PROM vs expert panel or PROM vs computerized evaluation with Breast Cancer Conservation Treatment cosmetic results [BCCT.core] software) were considered eligible if they included patients who received BC treatment with curative intent. Studies reporting solely on risk reduction or benign surgical procedures were excluded to ensure transitivity. Two independent reviewers extracted study data with an independent cross-check from a third reviewer. The quality of included observational studies was assessed using the Newcastle-Ottawa Scale, and the level of evidence quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Confidence in network meta-analysis results was analyzed with the Confidence in Network Meta-analysis semiautomated tool. Effect size was reported using random-effects odds ratios (ORs) and cumulative ratios of ORs with 95% credibility intervals (CrIs). The primary outcome of this network meta-analysis was modality (expert panel or computer software) discordance from PROMs. Four-point Likert responses across PROMs, expert panel assessment, and BCCT.core evaluation of AOs were assessed. A total of 10 observational studies including 3083 patients (median [IQR] age, 59 [50-60] years; median [range] follow-up, 39.0 [22.5-80.5] months) with reported AOs were assessed and homogenized in 4 distinct Likert response groups (excellent, very good, satisfactory, and bad). Overall network incoherence was low (χ22 = 0.35; P = .83). Overall, panel and software modalities graded AO outcomes worse than PROMs. Specifically, for excellent vs all other responses, the panel to PROM ratio of ORs was 0.30 (95% CrI, 0.17-0.53; I2 = 86%) and the BCCT.core to PROM ratio of ORs was 0.28 (95% CrI, 0.13-0.59; I2 = 95%), while the BCCT.core to panel ratio of ORs was 0.93 (95% CrI, 0.46-1.88; I2 = 88%). In this study, patients scored AOs higher than both expert panels and computer software. Standardization and supplementation of expert panel and software AO tools with racially, ethnically, and culturally inclusive PROMs is needed to improve clinical evaluation of the journey of patients with BC and to prioritize components of therapeutic outcomes.

Towards safety4.0: A novel approach for flexible human-robot-interaction based on safety-related dynamic finite-state machine with multilayer operation modes.

In the era of Industry 4.0 and agile manufacturing, the conventional methodologies for risk assessment, risk reduction, and safety procedures may not fulfill the End-User requirements, especially the SMEs with their product diversity and changeable production lines and processes. This work proposes a novel approach for planning and implementing safe and flexible Human-Robot-Interaction (HRI) workspaces using multilayer HRI operation modes. The collaborative operation modes are grouped in different clusters and categorized at various levels systematically. In addition to that, this work proposes a safety-related finite-state machine for describing the transitions between these modes dynamically and properly. The proposed approach is integrated into a new dynamic risk assessment tool as a promising solution toward a new safety horizon in line with industry 4.0.

Should routine risk reduction procedures for the prevention and control of pandemics become a standard in all oncological outpatient clinics? The prospective COVID-19 cohort study: protect-CoV

Limited knowledge exists on the effectiveness of preventive preparedness plans for the care of outpatient cancer patients during epidemics or pandemics. To ensure adequate, timely and continuous clinical care for this highly vulnerable population, we propose the establishment of preventive standard safety protocols providing effective early phase identification of outbreaks at outpatient cancer facilities and communicating adapted standards of care. The prospective cohort study Protect-CoV conducted at the LMU Klinikum from mid-March to June 2020 investigated the effectiveness of a rapid, proactive and methodical response to protect patients and interrupt SARS-CoV-2 transmission chains during the first pandemic wave. The implemented measures reduced the risk of infection of individual cancer patients and ensured safe adjunctive infusion therapy in an outpatient setting during the early COVID-19 pandemic. In addition to the immediate implementation of standard hygiene procedures, our results underscore the importance of routine PCR testing for the identification of asymptomatic or pre-symptomatic COVID-19 cases and immediate tracing of positive cases and their contacts. While more prospective controlled studies are needed to confirm these results, our study illustrates the importance of including preventative testing and tracing measures in the standard risk reduction procedures at all out patient cancer centers.

Editorial

Kate Harding Women’s health continues to make headline news both in the UK and globally. There is increasing data on the safety of COVID-19 vaccinations in pregnancy, with benefits not just for the pregnant woman but also her yet-to-be-born baby (with decreased infant admission for COVID-19 in the first 6 months of life for those born to vaccinated mothers). In my practice, the message seems to be getting through, but we must still listen to those who are worried by vaccination and explore their fears individually. The impact of the pandemic on our patients is often hidden, with reduced attendance at screening programmes, prolonged waiting lists (particularly affecting those with ‘benign’ disease) and the effect on home life with potentially increased (and less recognised) domestic abuse; this last impact is discussed in this issue of TOG in a timely commentary by Dey and Thakar. The impact on those of us practicing in O&G is clear, too: we are all tired and yet being asked to work harder than ever. Please make use of whatever resources you have available to ensure that you maintain some balance in your life. Get outside for a walk in the spring air, relax with friends, family or just a good book, remind yourself of the times when you made a positive difference to your patients. We all need to look after ourselves if we are going to be able to look after others. As usual in TOG we have something for everyone and – I hope – learning for all. I particularly recommend the article on oophorectomy at the time of benign hysterectomy. This article challenges the previous belief that in women, approaching or beyond the menopause, oophorectomy at the time of hysterectomy was a sensible prophylactic procedure. Jakes et al. discuss in detail the function of the ovary post-menopause, the risk of malignant change later in life and alternative risk reduction procedures. These benefits and risks should be discussed with all women undergoing hysterectomy for benign conditions; perhaps an information leaflet could be produced based on this article to improve information sharing and the consent process. Brown et al. discuss the important topic of paraneoplastic syndromes, explaining the breadth of paraneoplastic presentations that may be associated with gynaecological malignancies. Greater awareness of these may both improve our ability to manage them and increase our level of ‘suspicion’ in patients with these complications, leading us to explore the possibility of underlying malignancy. While pregnancy may be a risky time for the fetus, there has been little focus on the outcome of babies born following high-risk pregnancy. Aiken and Dunkerton explore this in their article Impact of the intrauterine environment on future reproductive and metabolic health. Currently there is little we as clinicians can do during pregnancy to ‘improve’ the intrauterine environment, and the focus therefore needs to be on prepregnancy optimisation and possibly long-term follow-up of at-risk individuals. Thomson et al. have described the sadly common (and increasing) problem of opioid misuse in pregnancy. They discuss in detail the complications associated with opioid misuse and the need for a full multidisciplinary approach to supporting these often complex families. Yates et al. explore fetal cardiac arrhythmias. These are not an uncommon finding, occurring in up to 3% of all pregnancies, but few are pathological or associated with poor outcome. It is these babies that this article focuses on. The authors discuss in detail the management of the various tachy- and bradyarrhythmias, including both pharmacological treatments (usually given via the mother) and peripartum care (including the difficulty of intrapartum monitoring). While care plans may come from tertiary centres, we all need to understand them so we can support our women locally. Jo Morrison has written a comprehensive Spotlight on… gynaecological cancer, in which she highlights the breadth of papers in TOG on this subject in just the past 5 years. I strongly recommend this excellent overview not just for our trainees (and those doing their exams) but for anyone wanting an update on this subject.

Investigating men's motivations to engage in genetic screening for BRCA1 and BRCA2 mutations.

BRCA1 and BRCA2 mutations are associated with an increased risk of developing numerous cancers, including breast, ovarian, pancreatic, melanoma and prostate cancer. Men face BRCA-related cancer risks as women do. However, there is considerably less research on the psychological determinants of men engaging in BRCA1/2-related cancer prevention compared to women. The present research aimed to study the determinants of men’s motivations to engage in genetic screening for BRCA1 and BRCA2 through the lens of the Health Action Process Approach. One hundred and twenty-five men (mean age = 58.53 y/o, SD = 10.37) completed an online survey. The intention to undergo genetic screening for BRCA1/2 mutations in men was significantly and positively associated with self-efficacy and risk perception. Moreover, having offspring positively affected intention as well. The relationships between intention (and planning) and positive outcome expectancies, age, and family history of breast-related cancer were not statistically significant. Most information on BRCA1 and BRCA2 mutations is tailored to women due to the availability of effective surgical risk reduction procedures for women’s breast and ovarian cancer. Future research should focus on the best methods of communicating informed decision-making for men facing the risk of such mutations.

Determinants of Disaster Risk Reduction procedures implementation: A Case of Egyptian General Petroleum Corporation.

Purpose – The purpose of the study was to establish the determinants of disaster risk reduction procedures implementation in Egyptian general petroleum corporation. The major obstacle, however, has been inadequate regulatory compliance. The study’s objectives were to find out the effect of strategic planning, the role of staff competence, and the effect of top management support on the implementation of DRR procedures. Design/methodology/approach – The study used a conceptual framework that involves both independent and dependent variables. Independent variables for this study are strategic planning, staff competence, top management support, while the dependent variable is the implementation of DRR procedures. The study used a descriptive survey design and sampled 43 participants. Questionnaires were used to collect data which was analyzed according to the research objectives. Findings – The study found out that both staff competence and support from top management were a significant prediction of implementation of DRR procedures and strategic planning was not a significant predictor of implementation of DRR procedures. The study recommends that management of EGPC to accord staff maximum support to enhance DRR procedures implementation and recommends that top management should decentralization of the decision-making process for DRR; they also should provide incentives to those preparing strategic plans for DRR. Giving incentives and involving workers in important decisions would go a long way in motivating them and thereby enhance the implementation of DDR procedures. Originality/value – The study represents one of the first attempts in the literature to establish the determinants of disaster risk reduction procedures implementation in the Egyptian petroleum sector.

The Association of COVID-19 Incidence with Sport and Face Mask Use in United States High School Athletes.

The relationships between different sports, face mask use and COVID-19 risk among high school athletes remains unknown. The purpose of this study was to evaluate the influence of sport characteristics and face mask use on COVID-19 incidence among high school athletes. Descriptive Epidemiology Study Setting: United States High School Athletic Departments Participants: Athletic Directors Interventions: None Main Outcome Measures: Surveys were completed regarding sport re-initiation, COVID-19 cases, and risk reduction procedures in fall 2020. Separate mixed effects Poisson regression models were developed to evaluate the associations between reported COVID-19 incidence and 1) sport characteristics (contact/non-contact, individual/team, indoor/outdoor) and 2) face mask use while playing (yes/no). 991 schools had restarted fall sports, representing 152,484 athletes on 5,854 teams. 2,565 cases of COVID-19 were reported, representing a case rate of 1,682 cases per 100,000 athletes and an incidence rate of 24.6 cases per 100,000 player-days. COVID-19 incidence was lower among outdoor versus indoor sports (incidence rate ratio [IRR]=0.54, 95% CI=0.49-0.60, p<0.001) and non-contact versus contact sports (IRR=0.78 [0.70-0.87], p<0.001), but not team versus individual sports (IRR=0.96 [0.84-1.1], p=0.49). Face mask use was associated with a decreased incidence in girls' volleyball (IRR=0.53 [0.37-0.73], p<0.001), boys' basketball (IRR=0.53 [0.33-0.83], p=0.008) and girls' basketball (IRR=0.36 [0.19-0.63], p<0.001), and approached statistical significance in football (IRR=0.79 [0.59-1.04], p=0.10) and cheer/dance (IRR=0.75 [0.53-1.03], p=0.081). In this nationwide survey of high school athletes, lower COVID-19 incidence was independently associated with participation in outdoor versus indoor and non-contact versus contact sports, but not team versus individual sports. Face mask use was associated with decreased COVID-19 incidence among indoor sports, and may be protective among outdoor sports with prolonged close contact between participants.

COVID-19 Planning in United States Adolescent Sports: A Survey of 1880 Organizations Representing More Than 500 000 Youth Athletes.

High schools and youth sport organizations that restarted participation in the fall of 2020 during the COVID-19 pandemic relied on information sources to develop risk-mitigation procedures. To compare the risk-mitigation procedures and information sources used by high school athletic departments and youth sport organizations. Cross-sectional study. Surveys of high school and youth sport organization programs from across the United States. A total of 1296 high schools and 584 youth sport organizations, representing 519 241 adolescent athletes, responded to the surveys. Surveys regarding restarting sport, COVID-19 cases, risk-reduction procedures, and the information sources used to develop risk-reduction plans in the fall of 2020 were distributed to high school athletic directors and youth sport directors throughout the United States. The proportions of high schools and youth sport organizations using different risk-reduction procedures and information sources were compared using the χ2 test. High schools used more risk-reduction procedures than did youth sport organizations (high schools = 7.1 ± 2.1 versus youth sport organizations = 6.3 ± 2.4; P < .001) and were more likely than youth sport organizations to use symptom monitoring (high schools = 93% versus youth sport organizations = 85%, χ2 = 26.3; P < .001), temperature checks on site (66% versus 49%, χ2 = 53.4; P < .001), face masks for athletes during play (37% versus 23%, χ2 = 38.1; P < .001) and when off the field (81% versus 71%, χ2 = 26.1; P < .001), social distancing for staff (81% versus 68%, χ2 = 43.3; P < .001) and athletes off the field (83% versus 68%, χ2 = 57.6; P < .001), and increased facility disinfection (92% versus 70%, χ2 = 165.0; P < .001). Youth sport organizations relied more on information from sport national governing bodies than did high schools (youth sport organizations = 52% versus high schools = 10%, χ2 = 411.0; P < .001), whereas high schools were more likely to use information from sources such as the National Athletic Trainers' Association (high schools = 20% versus youth sport organizations = 6%, χ2 = 55.20; P < .001) and the National Federation of State High School Associations (high schools = 72% versus youth sport organizations = 15%, χ2 = 553.00; P < .001) for determining risk-reduction strategies. High schools and youth sport organizations reported using a broad range of risk-reduction procedures, but the average number was higher among high schools than youth sport organizations. Use of information from the Centers for Disease Control and Prevention and local health authorities was high overall, but use of information from professional health care organizations was low. Professional health care organizations should consider using additional measures to improve information uptake among stakeholders in youth sports.

COVID-19 in US Youth Soccer Athletes During Summer 2020.

As sports are reinitiated around the United States, the incidence of COVID-19 among youth soccer athletes remains unknown. To determine the incidence of COVID-19 among youth soccer athletes and the risk-mitigation practices used by youth soccer organizations. Cohort study. Survey distributed to Elite Clubs National League member clubs. Youth soccer club directors throughout the United States. Surveys were completed in late August 2020 regarding the club's current phase of return to soccer (individual only, group noncontact, group contact), date of reinitiation, number of players, cases of COVID-19, and risk-reduction procedures being implemented. Case and incidence rates were compared with national pediatric data and county data from the prior 10 weeks. A negative binomial regression model was developed to predict club COVID-19 cases using the local incidence rate and phase of return as covariates and the log of club player-days as an offset. A total of 124 respondents had reinitiated soccer, representing 91 007 players with a median duration of 73 days (interquartile range = 53-83 days) since restarting. Of the 119 clubs that had progressed to group activities, 218 cases of COVID-19 were reported among 85 861 players. Youth soccer players had a lower case rate and incidence rate than children in the United States (254 versus 477 cases per 100 000; incidence rate ratio = 0.511, 95% CI = 0.40, 0.57; P < .001) and the general population in the counties where data were available (268 versus 864 cases per 100 000; incidence rate ratio = 0.202, 95% CI = 0.19, 0.21; P < .001). After adjusting for the local COVID-19 incidence, we found no relationship between the club COVID-19 incidence and the phase of return (noncontact: b = 0.35 ± 0.67, P = .61; contact: b = 0.18 ± 0.67, P = .79). Soccer clubs reported using a median of 8 (interquartile range = 6-10) risk-reduction procedures. The incidence of COVID-19 among youth soccer athletes was relatively low when compared with the background incidence among children in the United States during the summer of 2020. No relationship was identified between the club COVID-19 incidence and the phase of return to soccer.

Addressing risk management difficulties in children with food allergies.

Risk is a concept inherent in every medical procedure. It can be defined as the probability of an adverse event in a defined population over a specified period of time. In the frame of food allergy management, it might be related to a diagnostic procedure, a treatment, or the consumption of foods. The risk of an adverse event can also be augmented by individual factors. This rostrum article discusses various aspects faced by children with food allergies in the light of risk, and their practical implications. Identifying personal risks for severe reaction, such as unstable asthma, and correcting them whenever possible also contribute to a reduction of the risk inherent to food allergy. Among the facets discussed, oral food challenges (OFC) are the most common diagnostic procedures implying an inherent risk. The risk of OFCs can be minimized by correct indication and timing of the test, a safe setting, as well as by ensuring that the patient is otherwise well without potential stressor potentially increasing the risk of a more severe reaction. Oral immunotherapy (OIT) has been studied as a potential treatment for increasing the threshold dose for reaction, and thus reducing the risk of accidental reaction. Nevertheless, the procedure is not devoid of risk as the patients may and do often react during the course of the procedure. Ingestion of trace amounts in processed foods, mainly in community settings such as restaurants, schools, or day care, represents a potential risk of reactions, although for a minority of patients. Precautionary allergen labeling (PAL) is a widespread strategy to reduce the potential risk of reactions due to traces. However, PAL is currently inefficient due to inconsistent labeling, also not indicating a clear maximum amount possibly present in the manufactured food. Finally, cost-effectiveness needs to be considered in risk management, as many risk reduction procedures are clearly not cost-effective.

Knowledge, Attitudes, Willingness to Pay, and Patient Preferences About Genetic Testing and Subsequent Risk Management for Cancer Prevention.

Knowledge, attitudes, and patient preferences about genetic testing and subsequent risk management for cancer prevention among average risk populations are understudied, especially among Hispanics. This study was to assess these items by conducting an in-person survey in this understudied population. We conducted in-person surveys using a self-administered, structured questionnaire among young women in 2017. Survey questions were adapted from other validated surveys. This study had 677 participants in the final analyses. Data were collected in 2017 and analyzed in 2018 and 2019. Participants had little knowledge about genes or breast cancer risk, but most felt that genetic testing for cancer prevention is "a good idea" (87.0%), "a reassuring idea" (84.0%), and that "everyone should get the test" (87.7%). Most (64.0%) of these women would pay up to $25 for the test, 29.3% would pay $25-$500, and < 10% would pay more than $500 for the test. When asked about a hypothetical scenario of high breast cancer risk, 34.2% Hispanics and 24.5% non-Hispanics would choose chemoprevention. Women would be less likely to choose risk reduction procedures, such as mastectomy (19.6% among Hispanics and 15.1% among non-Hispanics) and salpingo-oophorectomy (11.8% among Hispanics and 10.7% among non-Hispanics). In this low-income, mostly Hispanic population, knowledge about genetic testing and cancer risk is poor, but most have positive opinions about genetic testing for cancer prevention. However, their strong preference for chemoprevention and lesser preference for prophylactic surgeries in a hypothetical scenario underscore the importance of genetic counseling and education.

Abstract P6-08-27: Disparities in cascade screening in BRCA1 or BRCA2 mutation carriers. Exploring rate and barriers in a Mexican population

Abstract Background. Hereditary predisposition explains 10-15% of Breast cancer (BC), individuals carrying germline BRCA1 andBRCA2 mutations have a 46-87% lifetime risk for BC. According to ACOG, Genetic Cascade Testing (GCT) refers to the performance of genetic counseling (GC) and testing in blood relatives of individuals who have been identified with specific genetic mutations. CGT could offer advantages to relatives in order to adjust surveillance and even offer risk reduction procedures. Even if CGT should be more affordable, its cost is still a burden for most Mexican health care institutions and patients (pts) as well. Herein, we intended to explore the CGT rate, and describe the barriers to CGT in Mexican pts with BC. Methods. Through this retrospective work, we collected clinical, demographic and familial information of BRCA1&amp;2 mutation carriers diagnosed from nov2014-mars2019. Through GC or medical record review, we explored if some of the relatives older than 18 years had GT, and if CGT was complete for their 1st and 2nd degree relatives. Finally, pts available for an interview were asked to list CGT barriers. Also, we asked them whether a GC session was offered to their relatives. Descriptive and parametric tests were used. Results. We identified 27 pts carriers of a pathogenic variant in BRCA1 or BRCA2. 16 pts (59%) were carriers of BRCA1 mutations. Mean age was 44.52y (SD 10.3). (48.1%) 13 pts held bachelor or a higher degree. 6 pts (22.22%) reported some CGT. 2 pts (7.4%) described GT in offspring, and 1 pt (3.4%) in siblings. 2 pts described GT in 2nd or 3rd degree relatives. Nonetheless, only 1 pt (3.7%) had complete GT for 1st degree relatives. 5 pts were not available for interview, 2 deceased before we started collecting these data, and 2 pts were had their result too recently. Thus, we conducted 18 interviews. All patients had a positive attitude toward GT. The barriers described were: in 16 cases (88.8%) lack of coverage; in 12 (66.66%), the cost of GT; in 5 cases (27.7%), the relatives were beneficiaries of other health care institution, or declined the test because they were males and perceived a low risk. In 4 cases (22.22%), the relatives had not access to a genetics department, or indolence was referred too. In 3 cases (16.6%) family issues were reported. In 2 cases (11.11%), the relatives were comfortable having only clinical surveillance or their primary physician counseled it. A GC session in relatives was only performed in 9 families (33.3%). We found no association between CGT and age of diagnosis (p=0.372), education (p=0.301) or year of prescription of GT (p=0.477). Conclusion. Overall, we found a low cascade testing rate among our BRCA positive pts, and only one case was described as complete. Lack of coverage and cost of GT are described as the most important barriers. Only 1 pt disclosed the price of GT ($1000 for every single relative tested), which is not affordable for most of the population. Male gender was associated with lower testing rate, CG is necessary to improve understanding of risks according to gender and inheritance. Better communication between the different health care institutions could be helpful in order to identify relatives at risk. Unfortunately, we didn’t gather information about income, which could have an association with CGT. New modalities of GT are becoming more affordable and probably, more pts should be counseled about these options. Our sample is small, but it could be representative of a large issue along the whole country. Citation Format: Guillermo Pacheco-Cuellar, Karen Campos-Gomez, Juan Jesus Valdes-Andrade, Saul Campos-Gomez. Disparities in cascade screening in BRCA1 or BRCA2 mutation carriers. Exploring rate and barriers in a Mexican population [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-08-27.

Enhancing access to genetic cancer risk assessment (GCRA) in Monterrey, Mexico: The beginning of a prevention program.

e13150 Background: In limited-resource countries like Mexico, GCRA is not routinely provided due to elevated costs, lack of public coverage for testing and prophylactic surgeries, and limited GCRA expertise or awareness among providers and patients. Thus, GCRA services in Mexico are 20 years behind higher income countries, resulting in suboptimal care and limited opportunity for prevention. The Breast Cancer Center TecSalud established formal GCRA services for underserved patients by recruiting a cancer geneticist who provides care at no added expense to patients, building academic collaborations for training and research with City of Hope, and enabling free genetic testing through the Clinical Cancer Genomics Community Research Network, supported in part by the Breast Cancer Research Foundation. Aim: To report the uptake of the GCRA program by patients and relatives at TecSalud from January 2016 - December 2018. Methods: Eligibility includes Mexican women who meet hereditary breast cancer testing criteria and family members of mutation carriers. Risk reduction procedures are covered by Seguro Popular and/or the NGO Fundación Santos y de la Garza Evia. Results: GCRA was offered to 255 patients and 74 at risk relatives, with an increasing reach (proportion of those eligible who access the program). A significant growth of cascade testing and access to risk reduction surgery over time are noted. Conclusions: A growing number of referrals and GCRA visits shows improving reach, possibly due to engagement of the multidisciplinary team and increased patient awareness. The expansion of cascade testing and performance of risk-appropriate surgeries reflects a maturing prevention program. Key determinants of our progress are collaborations that provided us with crucial mentorship, access to genetic assays, as well as the increasing involvement of local leaders, administrators and benefactors for the establishment of vital clinical and research capacity. Multilevel efforts should continue to enhance the delivery of standard of medical care for the most vulnerable and underserved high-risk patients and families. [Table: see text]

BRCA Mutations in the Young, High-Risk Female Population: Genetic Testing, Management of Prophylactic Therapies, and Implications for Plastic Surgeons.

Growing public awareness of hereditary breast cancers, notably BRCA1 and BRCA2, and increasing popularity of personalized medicine have led to a greater number of young adult patients presenting for risk-reduction mastectomies and breast reconstruction. Plastic surgeons must be familiar with treatment guidelines, necessary referral patterns, and particular needs of these patients to appropriately manage their care. Genetic testing for BRCA1 and BRCA2 is most often reserved for patients older than the age of consent, and can be performed in the young adult population (aged 18 to 25 years) with the appropriate preemptive genetic counseling. Subsequent risk-reduction procedures are usually delayed until at least the latter end of the young adult age range, and must be considered on an individualized basis with regard for a patient's level of maturity and autonomy. Prophylactic mastectomies in young adults also can serve to aid the unique psychosocial needs of this population, although the long-term psychological and physical ramifications must be considered carefully. With the development of nipple-sparing mastectomy and improvement in reconstructive techniques, risk-reducing surgery has become more accepted in the younger population. Immediate, implant-based reconstruction is a common reconstructive technique in these patients but requires extensive discussion regarding reconstructive goals, the risk of possible complications, and long-term implications of these procedures. Comprehensive, continuous support with multispecialty counseling is necessary throughout the spectrum of care for the high-risk, young adult patient.

Age-dependent Characteristics in Women with Breast Cancer: Mastectomy and Reconstructive Trends at an Urban Academic Institution

Breast reconstruction is an important aspect of treatment after breast cancer. Postmastectomy reconstruction bears a significant impact on a woman's postsurgical confidence, sexuality, and overall well-being. Previous studies have inferred that women under age 40 years have unique characteristics that distinguish them from an older cohort. Identifying age-dependent trends will assist with counseling women on mastectomy and reconstruction. To identify age-dependent trends, 100 consecutive women were sampled from a prospectively maintained breast reconstruction database at an urban academic institution from June 2010 through June 2013. Women were placed into two cohorts <40 and ≥40 as well cohorts by decade (20s, 30s, 40s, 50s, and 60s). Statistical trends were reported as odds of risk per year of increasing age using logistic regression; linear regression, χ(2), and Fischer's exact were used to compare <40 and ≥40 and split cohorts for comparison. Comorbidities, tumor staging, oncologic treatment including chemotherapy and radiation, disease characteristics and genetics, and mastectomy, reconstructive and symmetry procedures were evaluated. Statistical analysis was performed using SAS software. In 100 patients of the sample study cohort, 151 reconstructions were performed. Increasing age was associated with one or more comorbidities [odds ratio (OR) = 1.07, P = 0.005], whereas younger age was associated with metastatic disease (OR = 0.88, P = 0.006), chemotherapy (OR = 0.94, P = 0.01), and radiation (OR = 0.94, P = 0.006); split cohorts demonstrated similar trends (P < 0.005). Mastectomy and reconstructive characteristics associated with younger age included bilateral mastectomy (OR = 0.94, P = 0.004), tissue expander (versus autologous flap) (OR = 0.94, P = 0.009), extra high implant type (OR = 0.94, P = 0.049), whereas increasing use of autologous flaps and contralateral mastopexy symmetry procedures (OR = 1.09, P = 0.02) were associated with an aging cohort. Increasing age was not associated with an increasing likelihood of complications (P = 0.75). Age-related factors play a role in the treatment of patients with breast cancer. Younger women typically present with more aggressive features requiring oncologic treatment including chemotherapy and radiation. Mastectomy and reconstructive choices also demonstrate age-dependent characteristics. Women in younger age groups are more likely to pursue risk-reduction procedures and implant-based strategies, whereas older women had a higher propensity for abdominal-based autologous reconstruction. In addition, preferential reconstructive strategies correlate with age-dependent archetypical features of the breast (higher profile implants in younger patients; autologous reconstruction on affected side mimicking natural ptosis, and contralateral mastopexy in older patients). These trends seem to be consistent with each increasing year of age. Age-related preferences and expectations, age-dependent body habitus and breast shape, and lifetime risk play a role in the choices pursued for mastectomy and reconstruction.

Abstract IA23: Steps to address the profound disparity in access to genetic cancer risk assessment in Mexico: Documenting hereditary breast and ovarian cancer and the beginning of a prevention program

Abstract IA23: Steps to address the profound disparity in access to genetic cancer risk assessment in Mexico: Documenting hereditary breast and ovarian cancer and the beginning of a prevention program

Study of the Carrier State for Five BRCA1/BRCA2 Deleterious Mutations in Bulgarian Women with Breast Cancer

Summary Genetic testing for BRCA 1/2 mutation is a well recognized medical management tool. Identification of healthy carriers of such mutations allows effective risk reduction procedures to be performed. There is no data reported on the founder mutations in the Bulgarian population. To evaluate the contribution of genetic factors to breast cancer (BC), we investigated the carrier state of Bulgarian women with BC for five common (according to BIC database) deleterious BRCA1/2 mutations. The list of patients diagnosed with BC between January 2011 and April 2012 was obtained from the Cancer Registry of University Hospital, Pleven. Eighty-two women with BC were interviewed and a pedigree was constructed of each of them. The patients were classified into seven categories, according to personal, disease and family history. Based on the preliminary prepared selection criteria and the personal family history, we defined a target group of 33 Bulgarian women with BC. They were screened for five deleterious mutations: 5382insC in BRCA1 and 6174delT, 6079del4, 8138del5, 5946delCT in BRCA2, by DNA sequencing. The genetic analysis detected none of the tested mutations. Two polymorphic variants were found in BRCA2 gene: c.5744C&gt;T (rs4987117, SNP database) in exonl 1E in one patient and c.7806-14T&gt;C (rs9534262, SNP database) in exonl7 in 22 patients. In conclusion, without basic information on the founder mutations in the population, the genetic screening for the specific mutations in a small group of tested patients is ineffective.

When ‘raw sex’ turns to a ‘raw deal’ … taking the opportunity to think about sex? Interviews with HIV-positive gay men diagnosed with acute hepatitis C

Since 2001, cases of hepatitis C virus (HCV) sexual transmission have been reported in France, among HIV-positive gay men who do not inject drugs. An earlier study focused on the incidence of acute hepatitis C and risk factors associated with HCV transmission. The present study, based on in-depth interviews, aimed to highlight the biography, the sexual practices and the experiences of gay men infected with HCV. Beyond an apparent uniformity, the group of interviewees illustrates a variety of situations, life stories and health pathways, depending on their age. These well-adjusted gay men were used to engaging in unprotected sexual practices, but before their diagnosis they largely ignored HCV-transmission risk, which was associated in their mind with a pejorative drug addict image. Once diagnosed with acute hepatitis C, they experienced a critical and emotional period during which they were open to discuss their sexual practices and reconsider risk-reduction procedures, without being willing to give up on their satisfying sex life. Health educators should consider labelling hepatitis C as an STI in order to disrupt its negative image and to help HIV-positive gay man raise their awareness of HCV-transmission risks and implement better risk-reduction strategies.

High Human Immunodeficiency Virus Incidence in a Cohort of Rwandan Female Sex Workers

Measurement of human immunodeficiency virus(HIV) incidence among female sex workers in Rwanda is a key part of preparing for HIV prevention trials. HIV-negative, nonpregnant female sex workers (N =397) were tested for HIV-1, sexually transmitted infections, and pregnancy quarterly for 12 months, and again at a 1-time year 2 visit. Additional women (N=156) were tested for HIV at baseline and 6 to 12 months thereafter in a parallel study. A total of 19 participants seroconverted during follow-up,with 13 in the first 12 months. The 12-month HIV incidence rate (IR)was 3.5 (95% confidence interval: 1.6, 5.4) per 100 person-years (PY).There was a nonsignificant downward trend from 4.6/100 PY (1.6, 7.7)in the first 6 months to 2.2 (0.1, 4.4) in the second 6 months (IR ratio:2.1 [95% confidence interval: 0.7, 7.8]). The year 2 IR was 2.1 (0.4,3.7), and the HIV IR in the parallel study (in the absence of frequent study visits) was 3.3/100 PY (0, 7.0). HIV testing history, lifetime pregnancies, recent initiation of sex work, gonorrhea, syphilis, and change in reproductive intentions were associated with incident HIV infection. Incidence of pregnancy, herpes simplex virus-type 2,trichomoniasis, gonorrhea, chlamydia, and syphilis per 100 PY were as follows: 26.3 (21.9, 30.7), 8.7 (4.0, 13.4), 16.9 (12.7, 21.1), 12.1 (8.2,15.9), 8.1 (5.1, 11.2), and 6.2 (3.7, 8.7). The HIV/sexually transmitted infections burden int his group was high. HIV IR was highest in the first 6 months of the cohort, and in the parallel study in which there were no risk-reduction procedures. HIV prevention and family planning interventions are needed.