title: Prediction of Cancer Prevention: From Mammogram Screening to Identification of BRCA1/2 Mutation Carriers in Underserved Populations.
abstract: BACKGROUND
  The US Preventative Service Task Force recommends that physicians perform a genetic risk assessment to identify women at risk for BRCA1/2 mutations associated with hereditary breast and ovarian cancer (HBOC) syndrome. However, outcomes data after a diagnosis of HBOC syndrome especially in diverse populations, are minimal. Here we asked if genetic screening of high-risk underserved women identified in the mammogram population reduces cancer incidence.
  
  
  METHODS
  We evaluated 61,924 underserved women at screening mammography for family histories suggestive of HBOC syndrome over the course of 21 months. Data were collected retrospectively from patients at two safety net hospitals through chart review. A computer model was used to calculate the long-term effect of this screening on cancer incidence by assessing both the mutation detection rate and the completion of prophylactic surgeries in BRCA1/2 mutation carriers.
  
  
  RESULTS
  We identified 20 of the 85 (23.5%) expected BRCA1/2 mutation carriers in the underserved population. The frequencies of prophylactic mastectomies and oophorectomies in the mutation carriers were 25% and 40%, respectively. Using these data, our model predicted only an 8.8% reduction in both breast and ovarian cancer in the underserved patients. This contrasts with a 57% reduction in breast cancer and 51% reduction in ovarian cancer in an insured reference population. Our data indicate that underserved patients with HBOC syndrome are difficult to identify and when identified are limited in their ability to adhere to NCCN guidelines for cancer prevention.
  
  
  CONCLUSIONS
  Screening for women at risk for HBOC syndrome in mammogram populations will only prevent cancers if we can increase compliance with management guidelines. This study provides prototypic baseline data for step-wise analysis of the efficacy of the use of family history analysis in the mammography setting for detection and management of HBOC syndrome.
authors: Department of Cancer Genetics, University of Texas Southwestern Medical Center's Harold Simmons Comprehensive Cancer Center, Dallas and Moncrief Cancer Institute, Fort Worth, TX, USA.
authors: Linda S
authors: LS
authors: Robinson
authors: Department of Cancer Genetics, University of Texas Southwestern Medical Center's Harold Simmons Comprehensive Cancer Center, Dallas and Moncrief Cancer Institute, Fort Worth, TX, USA.
authors: Ashley
authors: A
authors: Hendrix
authors: Department of Biostatistics and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, USA; Harold Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center,Dallas, TX, USA.
authors: Xian-Jin
authors: XJ
authors: Xie
authors: Department of Biostatistics and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, USA; Harold Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center,Dallas, TX, USA.
authors: Jingsheng
authors: J
authors: Yan
authors: Department of Cancer Genetics, University of Texas Southwestern Medical Center's Harold Simmons Comprehensive Cancer Center, Dallas and Moncrief Cancer Institute, Fort Worth, TX, USA.
authors: Sara
authors: S
authors: Pirzadeh-Miller
authors: Department of Cancer Genetics, University of Texas Southwestern Medical Center's Harold Simmons Comprehensive Cancer Center, Dallas and Moncrief Cancer Institute, Fort Worth, TX, USA.
authors: Mary
authors: M
authors: Pritzlaff
authors: Department of Cancer Genetics, University of Texas Southwestern Medical Center's Harold Simmons Comprehensive Cancer Center, Dallas and Moncrief Cancer Institute, Fort Worth, TX, USA.
authors: Parker
authors: P
authors: Read
authors: Department of Cancer Genetics, University of Texas Southwestern Medical Center's Harold Simmons Comprehensive Cancer Center, Dallas and Moncrief Cancer Institute, Fort Worth, TX, USA.
authors: Sarah
authors: S
authors: Pass
authors: Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
authors: David
authors: D
authors: Euhus
authors: Department of Cancer Genetics, University of Texas Southwestern Medical Center's Harold Simmons Comprehensive Cancer Center, Dallas and Moncrief Cancer Institute, Fort Worth, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Theodora S
authors: TS
authors: Ross
mesh_terms: D003198:Computer Simulation; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing; D061325:Hereditary Breast and Ovarian Cancer Syndrome / Q000453:epidemiology* / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery; D006579:Heterozygote; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008954:Models, Biological; D009154:Mutation; D059645:Mutation Rate; D011159:Population Surveillance; D013781:Texas / Q000453:epidemiology
keywords: BRCA1/2; Genetic testing; Hereditary breast and ovarian cancer syndrome; Population screening; Underserved