Objective-To compare the accuracy of cancer progression prediction of the molecular-genetics and morphometry-based Endometrial Intraepithelial Neoplasia (EIN) and the WHO-94 classification schemes in endometrial hyperplasias.Study Design-A multicenter multivariate analysis of 477 endometria, with a required 1 year minimum cancer-free interval from the index biopsy (1-18 years follow-up). Comparison with 197 patients with <1 year follow-up.Results-24/477 (5.0%) hyperplasias progressed to cancer over an average of 4 years (10 yrs maximum). According to WHO94, 16/123 (13%) atypical and 8/354 (2.3%) non-atypical hyperplasias progressed (Hazard ratio=HR=7). 22/118 (19%) of EINs and 2/359 (0.6%) of non-EINs progressed (HR=45). EIN was prognostic within each WHO94 subcategory. Progression rates in simple (SH), complex (CH), simple atypical (SAH), and complex atypical (CAH) hyperplasias with EIN were 3, 22, 17 and 38% respectively, contrasting with 0.0-2.0% if EIN was absent. EIN detected precancer (sensitivity 92%) better than WHO94 atypical hyperplasias collectively (67%) or CAH alone (46%). With Cox regression EIN was the strongest prognostic index of future endometrial cancer. The same holds for patients with <1 year follow-up (HR for EIN, Atypia and CAH 58, 7 and 8 respectively). Conclusions-The

No abstract

Germline BRCA1/2 testing of breast and ovarian cancer patients is growing rapidly as the result affects both treatment and cancer prevention in patients and relatives. Through the DNA-BONus study we offered BRCA1/2 testing and familial risk assessment to all new patients with breast (N = 893) or ovarian (N = 122) cancer diagnosed between September 2012 and April 2015, irrespective of family history or age, and without prior face-to-face genetic counselling. BRCA1/2 testing was accepted by 405 (45.4%) and 83 (68.0%) of the patients with breast or ovarian cancer, respectively. A pathogenic BRCA1/2 variant was found in 7 (1.7%) of the breast cancer patients and 19 (22.3%) of the ovarian cancer patients. In retrospect, all BRCA1/2 mutation carriers appeared to fulfill current criteria for BRCA1/2 testing. Hospital Anxiety and Depression Scale (HADS) scores showed that the mean levels of anxiety and depression were comparable to those reported for breast and gynecological cancer patients in general, with a significant drop in anxiety symptoms during a 6-month follow-up period, during which the test result was forwarded to the patients. These results show that BRCA1/2 testing is well accepted in newly diagnosed breast and ovarian cancer patients. Current test criteria based on age and family history are sufficient to identify most BRCA1/2 mutation carriers among breast cancer patients. We recommend germline BRCA1/2 testing in all patients with epithelial ovarian cancer because of the high prevalence of pathogenic BRCA1/2 variants. INTRODUCTIONBreast cancer is by far the most common cancer in women worldwide, with more than 1.6 million new cases diagnosed each year. Ovarian cancer is substantially less common, with ∼ 240 000 new cases each year, but with higher mortality. 1 Most cases of breast and ovarian cancer are sporadic, but a minor fraction (2-8% and 8-15%, respectively) is caused by inheritance of pathogenic germline variants in BRCA1 or BRCA2, with variation in prevalence and relative contribution of BRCA1 and BRCA2 in different populations. [2][3][4][5][6][7][8] It is important to identify these patients because the presence of such germline variants affects treatment, follow-up and further cancer prevention in patients with breast or ovarian cancer. 9,10 In addition, it may strongly influence upon their close relatives, as BRCA1/2 testing can identify healthy BRCA1/2 mutation carriers at high risk and thereby prevent cancer and cancer-related deaths through increased surveillance and prophylactic surgery. [10][11][12][13][14][15][16] The most common current practice of BRCA1/2 testing is based on referral of suspected high-risk patients to clinical genetics services for specialized face-to-face genetic counselling. This procedure traditionally includes collection and confirmation of family history, risk

No abstract

A majority of patients experienced symptomatic recurrence, but many patients failed to make an appointment earlier than scheduled. Most first recurrences occurred within two years of primary treatment; the mean annual incidence rate for years 3-5 after primary treatment was <7%. New models for follow up of gynecological cancer patients could be considered.