Yanin Chavarri-Guerra

Uptake of Risk-Reducing Surgeries in an International Real-World Cohort of Hispanic Women

PURPOSE Women with pathogenic variants (PVs) in breast cancer (BC) and ovarian cancer (OC) associated genes are candidates for cancer risk-reducing strategies. Limited information is available regarding risk-reducing surgeries (RRS) among Hispanics. The aim of this study was to describe the uptake of RRS in an international real-world experience of Hispanic women referred for genetic cancer risk assessment (GCRA) and to identify factors affecting uptake. METHODS Between July 1997 and December 2019, Hispanic women, living in the United States or in Latin America, enrolled in the Clinical Cancer Genomics Community Research Network registry were prospectively included. Demographic characteristics and data regarding RRS were obtained from chart reviews and patient-reported follow-up questionnaires. Median follow-up was 41 months. RESULTS Among 1,736 Hispanic women referred for GCRA, 27.2% women underwent risk-reducing mastectomy (RRM), 25.5% risk-reducing salpingo-oophorectomy (RRSO) and, 10.7% both surgeries. Among BRCA carriers, rates of RRM and RRSO were 47.6% and 56.7%, respectively. In the multivariate analyses, being a carrier of a BC susceptibility gene (odds ratio [OR], 3.44), personal history of BC (OR, 6.22), living in the US (OR, 3.90), age ≤50 years (OR, 1.68) and, family history of BC (OR, 1.56) were associated with a higher likelihood of undergoing RRM. Carrying an OC susceptibility gene (OR, 6.72) was associated with a higher likelihood of undergoing RRSO. CONCLUSION The rate of RRS among Hispanic women is suboptimal. PV carriers, women with personal history of cancer, and those with a family history of cancer were more likely to have RRS, with less uptake outside the US. Understanding personal and systemic factors influencing uptake may enable interventions to increase risk appropriate uptake of RRS.

Uptake of Risk-Reducing Measures, Cascade Testing, and Related Challenges Among Carriers of Breast Cancer–Associated Germline Pathogenic Variants in Mexico

PURPOSE Genetic cancer risk assessment (GCRA) provides pathogenic variant (PV) carriers with the invaluable opportunity to undertake timely cancer risk-reducing (RR) measures and initiate cascade testing (CT). This study describes the uptake of these strategies and the related barriers among breast cancer–associated germline PV carriers in Mexico. METHODS Carriers who were at least 6 months after disclosure of genetic test results at two GCRA referral centers were invited to answer a survey assessing sociodemographic characteristics, awareness of their carrier status and its implications, uptake of RR measures according to international guidelines by PV, CT initiation, and associated challenges. RESULTS Of the eligible carriers, 246/384 (64%) answered the survey (median age: 44 years). Most were female (88%), married/in domestic partnership (66%), and had personal breast/ovarian cancer history (61%). PVs included BRCA1/ 2 (75%), CHEK2 (10%), PALB2 (5%), ATM (5%), NF1 (2%), RAD51C (2%), PTEN (1%), and TP53 (1%). Most (87%) participants were aware of their carrier status. When recommended, 37% underwent RR bilateral mastectomy, 48% RR oophorectomy, 70% annual mammogram, and 20% breast magnetic resonance imaging. Challenges hindering the uptake of RR measures included financial limitations (67%), lack of recommendation by their physician (35%), and fear (24%). Nearly all (98%) claimed sharing their results with their relatives. CT was initiated in 63% of families and was associated with carriers being married/in domestic partnership ( P = .04) and believing GCRA was useful ( P < .001). CONCLUSION Despite the resource-constrained setting, relevant rates of RR measures and CT were observed. Targeted interventions to reduce out-of-pocket expenses and improve patient-physician communication and patients' understanding on carrier status are warranted to enhance the overall benefit of GCRA and ultimately improve the provision of patient-centered care to both carriers and their at-risk relatives.

Trends in Cervical Cytology Test Reports and Cervical Dysplasia Severity according to Social Deprivation in Mexico (2013–2019): An Analysis of a National Database

Abstract Background: Cervical cancer is a leading cause of cancer-related mortality in women living in low- and middle-income countries such as Mexico. Preventive and screening programs are often inaccessible to socially deprived populations, whose limited access to timely diagnosis and treatment reduces the chance of detecting premalignant lesions early. Methods: Cervical malignant and premalignant lesion positivity rates were analyzed from 2013 to 2016 using the Bethesda system, whereas human papillomavirus (HPV) positivity rates were analyzed from 2017 to 2019. Both were stratified according to state-level Social Deprivation Indices in Mexico, published by the National Council for the Evaluation of Social Development Policy. The data originated from the four main healthcare providers in Mexico. Data processing and statistical analyses were performed using Joinpoint Regression Software and SPSS version 25. Results: Positivity rates for dysplasia and atypia varied across social deprivation levels. A downward trend in premalignant lesion positivity rates was observed. This varied across social deprivation groups, with differing annual percentage changes (APC). The greatest decrease occurred in high-grade cervical intraepithelial dysplasia (CIN 2–3) in states with very high social deprivation, with an estimated APC of −22.1% (−30% to −14.7%; P = 0.001). HPV positivity by PCR ranged from 11% to 24% between 2017 and 2019. The estimated APC for invasive cervical carcinoma was −22.3% [95% confidence interval (CI); −54.4% to 19.8%], which was not statistically significant (P = 0.223). Conclusions: Our study highlights a decline in cervical dysplasia positivity rates. These declines were uneven across social deprivation levels. Impact: Reducing health inequities is essential to prevent, detect, and treat cervical cancer and its precursors.