BackgroundIdentifying patients with BRCA mutations is clinically important to inform on the potential response to treatment and for risk management of patients and their relatives. However, traditional referral routes may not meet clinical needs, and therefore, mainstreaming cancer genetics has been shown to be effective in some high-income and high health-literacy settings. To date, no study has reported on the feasibility of mainstreaming in low-income and middle-income settings, where the service considerations and health literacy could detrimentally affect the feasibility of mainstreaming.MethodsThe Mainstreaming Genetic Counselling for Ovarian Cancer Patients (MaGiC) study is a prospective, two-arm observational study comparing oncologist-led and genetics-led counselling. This study included 790 multiethnic patients with ovarian cancer from 23 sites in Malaysia. We compared the impact of different method of delivery of genetic counselling on the uptake of genetic testing and assessed the feasibility, knowledge and satisfaction of patients with ovarian cancer.ResultsOncologists were satisfied with the mainstreaming experience, with 95% indicating a desire to incorporate testing into their clinical practice. The uptake of genetic testing was similar in the mainstreaming and genetics arm (80% and 79%, respectively). Patient satisfaction was high, whereas decision conflict and psychological impact were low in both arms of the study. Notably, decisional conflict, although lower than threshold, was higher for the mainstreaming group compared with the genetics arm. Overall, 13.5% of patients had a pathogenic variant in BRCA1 or BRCA2, and there was no difference between psychosocial measures for carriers in both arms.ConclusionThe MaGiC study demonstrates that mainstreaming cancer genetics is feasible in low-resource and middle-resource Asian setting and increased coverage for genetic testing.

Hematological malignancy in pregnancy is a rare condition which leads to lack of prospective study and randomized control trial. Nevertheless, it has own challenge to the medical field in term of managing patient with the said condition. The dilemma is to decide among the necessities of continuation of pregnancy, the choice of diagnostic tools and chemotherapeutic drugs, and the timing of initiation treatment without disregarding the women's wish and preferences. The process often has a profound psychological burden on patients and family members. Furthermore, delays in diagnosis and intervention will adversely affect the outcomes of pregnancy and the disease itself. The effect of teratogenicity of chemotherapeutic drugs on the fetus and the progression of the disease during pregnancy are the main concern in treating this group of patients. This article will review the management and outcomes of 6 cases of hematological malignancy in pregnancy in one center (3 Hodgkin lymphoma, 1 chronic myeloid leukemia, 1 hairy cell leukemia, and 1 myeloproliferative neoplasms).  The outcomes of the pregnancy cases in this article were five successful live births with one case of early neonatal death due to prematurity with a history of second-trimester loss. The treatment was initiated during the second trimester to reduce the risk of chemotherapy to the fetus. Even though a few cases had fetal growth compromise but the fetal outcomes seem to be good with early interventions and multidisciplinary approached.