Lisa M. DiGianni

Complementary and Alternative Medicine Use Among Women With Breast Cancer

Complementary and alternative medicine (CAM) use has increased in recent years, with at least 42% of individuals in the United States using some form of CAM in 1997. CAM includes a variety of modalities, ranging from nutritionally based interventions to behavioral techniques. This article reviews the status of CAM use among women with breast cancer. Patients are increasingly incorporating CAM into cancer prevention and treatment regimens. The prevalence of CAM use by breast cancer patients varies; however, it is typically higher than among individuals in the general population. Commonly used CAMs among women with breast cancer include nutritional/dietary supplements, relaxation strategies, and various types of social support groups. Apart from psychosocial interventions, little scientific evidence exists regarding the efficacy of CAM use for breast cancer patients. A common theme seen in many studies is that CAM use in women with breast cancer is highly correlated with increased psychosocial distress.

Anticipated Versus Actual Emotional Reactions to Disclosure of Results of Genetic Tests for Cancer Susceptibility: Findings From p53 and BRCA1 Testing Programs

PURPOSE We examined the ability of individuals undergoing genetic testing for cancer susceptibility in two structured research protocols to accurately anticipate emotional reactions to disclosure of their test result. We explored whether accuracy of emotional anticipation was associated with postdisclosure psychologic adjustment. METHODS Data from 65 individuals were analyzed; 24 members of Li-Fraumeni cancer syndrome families were tested for p53 mutations (all 24 were unaffected), and 41 subjects with hereditary breast-ovarian cancer susceptibility were tested for BRCA1 mutations (34 were unaffected and seven were affected). Subjects were from families in which a germline mutation had been previously identified. At the pretest session, subjects rated the extent to which they anticipated feeling each of six emotional states (relief, happiness, sadness, guilt, anger, and worry) after disclosure that they did or did not carry the familial mutation. After receiving their test result, they rated their feelings on the same scale of emotions for the appropriate condition. Extent of accuracy and association with psychologic distress at 6 months, as assessed with standardized measures, were evaluated. RESULTS Overall, mean levels of emotional reactions after receiving test results were not different from those anticipated before result disclosure. However, affected BRCA1 carriers experienced higher levels of anger and worry than they had anticipated. Underestimation of subsequent distress emotions related to test result was associated with a significant increase in general psychologic distress at 6 months. CONCLUSION Unaffected individuals in cancer-predisposition testing programs are generally accurate in anticipating emotional reactions to test results. However, cancer patients may underestimate their distress after disclosure of positive results and could benefit from intervention strategies.

F18-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography Screening in Li-Fraumeni Syndrome

CONTEXT Individuals with Li-Fraumeni syndrome (LFS) have an inherited cancer predisposition to a diverse array of malignancies beginning early in life; survivors of one cancer have a markedly elevated risk of additional primary tumors. The underlying genetic defect in the majority of the families is a germline mutation in the TP53 tumor suppressor gene. The diversity of tumors and rarity of families have contributed to the difficulty in devising effective screening recommendations for members of LFS kindreds. OBJECTIVE To gather preliminary data with which to evaluate F18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) imaging as a potential surveillance modality to detect early malignancies in asymptomatic members of LFS kindreds. DESIGN, SETTING, AND PARTICIPANTS Members of LFS families with documented germline TP53 mutations or obligate carrier status, no history of cancer within 5 years of enrollment, and no symptoms of cancer or ill-health were offered FDG-PET/CT scanning as a screening test in a comprehensive US cancer center from 2006 to 2007. Scans were initially reviewed clinically, then centrally reviewed by an expert radiologist. MAIN OUTCOME MEASURE The primary outcome was the detection of new primary cancers using FDG-PET/CT scanning. RESULTS Of 15 individuals, baseline FDG-PET/CT scan identified asymptomatic cancers in 3 (20%). Two individuals had papillary thyroid cancers (stage II and stage III) and one individual had stage II esophageal adenocarcinoma. CONCLUSIONS These preliminary data provide the first evidence for a potential cancer surveillance strategy that may be worthy of further investigation for patients with LFS. Concerns about radiation exposure and other challenges inherent in screening high-risk patients will require further consideration.

Gastric cancer in individuals with Li-Fraumeni syndrome

Purpose: Li-Fraumeni syndrome is a rare hereditary cancer syndrome associated with germline mutations in the TP53 gene. Although sarcomas, brain tumors, leukemias, breast and adrenal cortical carcinomas are typically recognized as Li-Fraumeni syndrome-associated tumors, the occurrence of gastrointestinal neoplasms has not been fully evaluated. In this analysis, we investigated the frequency and characteristics of gastric cancer in Li-Fraumeni syndrome.Methods: Pedigrees and medical records of 62 TP53 mutation-positive families were retrospectively reviewed from the Dana-Farber/National Cancer Institute Li-Fraumeni syndrome registry. We identified subjects with gastric cancer documented either by pathology report or death certificate and performed pathology review of the available specimens.Results: Among 62 TP53 mutation-positive families, there were 429 cancer-affected individuals. Gastric cancer was the diagnosis in the lineages of 21 (4.9%) subjects from 14 families (22.6%). The mean and median ages at gastric cancer diagnosis were 43 and 36 years, respectively (range: 24–74 years), significantly younger compared with the median age at diagnosis in the general population based on Surveillance Epidemiology and End Results data (71 years). Five (8.1%) families reported two or more cases of gastric cancer, and six (9.7%) families had cases of both colorectal and gastric cancers. No association was seen between phenotype and type/location of the TP53 mutations. Pathology review of the available tumors revealed both intestinal and diffuse histologies.Conclusions: Early-onset gastric cancer seems to be a component of Li-Fraumeni syndrome, suggesting the need for early and regular endoscopic screening in individuals with germline TP53 mutations, particularly among those with a family history of gastric cancer.

Complementary Medicine Use before and 1 Year Following Genetic Testing for BRCA1/2 Mutations

Purpose: We explored change in complementary and alternative medicine (CAM) use by unaffected women and cancer survivors from enrollment into a randomized BRCA1/2 testing program to CAM use 1 year following results disclosure. Methods: A cohort of 243 high-risk women completed questionnaires at enrollment into a BRCA1/2 randomized trial and 1 year post results disclosure. Uses of several CAMs for cancer prevention were explored, including ingestible, behavioral, and physical modalities. Assessment of the change in CAM use from baseline to 1 year follow-up was conducted using a repeated self-administered questionnaire. Correlates of the number of CAMs used at 1 year were explored using multivariable linear regression models. Results: Among the subset of women who changed their CAM behavior from enrollment to 1 year following BRCA1/2 results disclosure, there was a significantly higher proportion who changed from no CAM use to CAM use among the overall cohort (P = 0.01), among women without cancer at enrollment (P = 0.003), among women found to be BRCA1/2 carriers (P = 0.03), and among women randomized to the genetic counseling intervention arm of the study (P = 0.009). Number of CAMs used at 1 year was positively associated with number of CAMs used at baseline, sunscreen use, and BRCA1/2 mutation status. Conclusion: High-risk women who have received BRCA1/2 counseling and testing frequently adopt new CAM use in the first year after learning their genetic status. Mutation carriers frequently initiate CAM use after learning their genetic status as part of their cancer preventive regimen. Further studies are warranted to determine the efficacy of CAM-related strategies for cancer prevention. (Cancer Epidemiol Biomarkers Prev 2006;15(1):70–5)

Healthy baby second-hand smoke study: project brief.

Although a number of studies have assessed diVerences in personal and interpersonal factors between smokers and non-smokers (for example, age, smoking during previous pregnancies, partner smoking status), there has been little attention to the social context in which women make decisions about prenatal health behaviours. 1 For pregnant women who are poor, undereducated, and facing housing or economic crises, the immediate benefits provided by smoking may outweigh the long term risks of smoking during pregnancy. In order to improve the eVectiveness of smoking interventions for pregnant women, it may be necessary to place smoking in the broader social context in which these women live, and integrate it into other programs that address basic life needs. The Healthy Baby Second-Hand Smoke Study was a pilot program designed to evaluate the role of public health nurses in delivering a novel smoking intervention to limited income, high risk pregnant women. The Healthy Baby Program (HBP) is a social service program that provides medical and social service outreach to low income pregnant women who are at risk for poor birth outcomes because of their medical history or socioeconomic circumstances. A collaboration was formed with the HBP to develop the HBP Second-Hand Smoke intervention, which was designed to motivate pregnant women towards reducing their household exposure to second hand smoke and towards smoking cessation, and to provide skills to those who want to quit smoking. Because of the attention to other life issues provided by the Healthy Baby Program, it was hypothesised that participants might be more able to address smoking as an important health issue. Methods

A randomized trial of two different genetic counseling interventions for BRCA1/2 genetic testing

1002 Background: We compared a randomly assigned standard genetic counseling (GC) intervention by genetic counselors versus an enhanced informed consent (EC) [modeled on routine chemotherapy informed consent] administered by oncology nurses for women enrolled into a BRCA1/2 testing program for several outcomes: satisfaction, risk perception, genetics knowledge, psychological state and health behaviors. METHODS A cohort of 236 of 310 high-risk women enrolled in a BRCA1/2 randomized control trial of semi-structured counseling interventions completed all questionnaires at enrollment, test result disclosure, 4 months and 1-year post disclosure. Women were asked about their satisfaction with the testing program at results disclosure only using the Shiloh scale; breast cancer risk perception, knowledge of cancer genetics and the Impact of Events scale at all time points. For the repeated measures, comparison was made for differences in trends over time and between the intervention arms. Exploring separately for cancer status and genetic test result, multivariate analysis of variance (MANOVA) for repeated measures was used to assess the statistical significance of the within subjects change over time and the main effects of the intervention/gene test result. Regarding satisfaction with the testing program, the Fishers exact test was used to assess differences between intervention. RESULTS The overall cohort, cancer survivors, and women receiving a negative or variant BRCA1/2 result were significantly more satisfied with the GC intervention than with the EC intervention on several sub-scales. No differences were found between intervention on breast cancer risk perception or psychological state, where mutation status was significant. Contrary to expectation, knowledge of cancer genetics was not superior in the GC arm. CONCLUSIONS Genetic counseling by genetic counselors does not prepare women better for the results of BRCA1/2 genetic testing, though women generally prefer it to a more informed consent approach to testing administered by oncology nurses within a structured program. Additional data on health behaviors will be presented. No significant financial relationships to disclose.