A moral dilemma, to tell or not to tell.

Had a genetic test? You should be told if its implications change

https://tinyurl.com/y3429t9p

People often expect genetic results to be certain, but sometimes this isn’t the case. Our understanding can change even for variants in well-known genes like BRCA1: some of these have turned out not to be as closely linked to cancer as we thought a few years ago.

https://tinyurl.com/y3agvlt3

What should happen in situations like this? Should people be re-contacted if interpretation of their genetic results changes? Professional guidance on this matter comes from the European Society of Human Genetics.

https://tinyurl.com/yxasqq7g

There are no standardized criteria, practices or systems in place for re-contacting to occur. There is however a moral and legal right to know

Ovarian cancer? Maybe you should blame the pope.

Contraception: the way you take the pill has more to do with the pope than your health

https://tinyurl.com/y78dgkdk

The seven-day break was designed into the pill in a failed attempt to persuade the Vatican to accept the new form of contraception as an extension of the natural menstrual cycle. 

If oral contraception is not resumed by the ninth day after stopping, ovulation will occur.  Women who ovulate have a higher risk of ovarian cancer.

Some Clinicians now favour extended or continuous pill regimens. Using contraceptive pills in this way is “off licence”.

It is malpractice not to do genetic testing

Genetic Testing and Results in a Population-Based Cohort of Breast Cancer Patients and Ovarian Cancer Patients

https://doi.org/10.1200/JCO.18.01854

The study included all women diagnosed with ovarian cancer (OC) in California and Georgia between 2013 and 2014.When tested for all genes associated with OC, 14.5% had mutations.

Only one third of those with OC had genetic test results. The incidence of testing was lower in blacks and uninsured patients.

Germline and somatic genetic testing in ovarian cancer patients

https://doi.org/10.1111/1471-0528.15171

The inherited BRCA mutation rate in patients with advanced OC is 13%. BRCA mutation is not associated with low-grade OC. Spontaneous BRCA mutations occur in 7%. Knowledge of BRCA mutation will change therapy

Racial disparity in ovarian cancer outcomes

https://www.usahealthsystem.com/news/african-american-patients-with-ovarian-cancer

Although less likely to develop ovarian cancer, black women have consistently worse survival compared with white women.

A pre-existing immune response is linked to worse survival rates compared with their white counterparts. Five genes are overexpressed in African American patients associated with the IDO immune pathway*.

African American enrolment is 19 times lower than expected for ovarian clinical trials, which causes bias towards therapy trials targeting white women.

*The IDO Pathway restricts T-cell function limiting immune reactions to cancer