10610 Background: Cancer risk and characteristics in older females with BRCA1/2 mutations are less well studied, and the role of risk-reducing strategies in this population remains unclear. Methods: From a database of 1070 female carriers of BRCA1/2 pathogenic (PV) or likely pathogenic variants (LPV) seen at Nancy and James Grosfeld Cancer Genetics Center in Beaumont Health from January 2006 to December 2021, we identified 283 females who lived to age 65 or older. We analyzed cancer risk and clinical characteristics, focusing on females with cancer diagnosed at age 65 or older. Results: Of the 283 BRCA1/2 carriers, 229 (81%) had a cancer diagnosis, out of which 84 (37%) were diagnosed at age 65 or older. Of all the breast cancer diagnoses (n = 173), 45 (26%) were diagnosed at age 65 or older. Among these 45 patients, median age at diagnosis was 69 years (65-87); majority were BRCA2 carriers (62%), with invasive ductal carcinoma (80%), ER-positive (58%), PR-negative (55%), HER2-negative (97%), high grade (55%) and had stage I or II disease (78%). Fifteen patients (38%) were triple-negative. A minority (32%) received adjuvant chemotherapy, 43% received adjuvant endocrine therapy, and 54% received adjuvant radiation. During a median follow-up of 205 months for all breast cancers (n = 173), there were 52 recurrences, 28 of these (54%) were diagnosed at age 65 or older, of which 13 were contralateral (median time to recurrence: 140 months); 5 were local/regional (median time: 186 months) and 10 were metastatic (median time: 76 months). Ten of the 13 contralateral recurrences (77%) were in BRCA1 carriers. Of the ovarian cancer diagnoses (n = 69), 27 (39%) were diagnosed at age 65 or older. Among these 27 patients, median age at diagnosis was 71 years (65-87); majority were BRCA2 carriers (74%), had serous carcinoma (84%), with stage III or IV disease (96%). Of all ovarian cancers (n = 69), there were 15 recurrences (22%), 9 of them (60%) were diagnosed at age 65 or older. Of the 8 pancreatic cancers, 6 were diagnosed at age 65 or older. Of the 283 BRCA1/2 carriers, 249 still had at least one breast at the time of genetic testing, and 34% elected for risk-reducing mastectomy (RRM). Of the 177 patients with intact ovaries, 71% opted for risk-reducing salpingo-oophorectomy (RRSO). Compared to BRCA carriers with cancer diagnosed under age 65, a smaller proportion of those diagnosed at age 65 or older opted to undergo RRM (26% vs. 40%) or RRSO (67% vs. 78%). Conclusions: Our study reveals that female BRCA1/2 mutation carriers over age 65 continue to retain a significant risk of cancer, including breast, contralateral breast, ovarian, and pancreatic cancer. This finding supports the importance of continued high-risk surveillance and risk-reducing interventions in this growing demographic. Further studies are needed to better define the cancer risks and optimal management of older females with BRCA1/2 mutations.
Thrombotic thrombocytopenic purpura (TTP) is a type of thrombotic microangiopathy that is characterized by microangiopathic haemolytic anaemia, consumption thrombocytopenia and organ injury. It is caused by a severe deficiency of ADAMTS13, which can be either congenital or acquired. There is a plethora of things that can cause the acquired form, including medications and infections. Vaccines have also been shown to cause TTP. In the midst of the COVID-19 pandemic, with multiple new vaccines being developed and distributed to the masses, the medical community needs to be aware of adverse events associated with these new vaccines. We present a case of TTP following administration of the Moderna booster vaccine.
INNO-LiPA Extra-II kit (Fujirebio), based on PCR-reverse hybridization. Results Among 110 women with CIN2/3 (n=19) and invasive cancer (n=91), early antibodies to any HPV early antigen were detected in 58(53%). The difference between CIN2/3 (47.4%) and cancer (53.8%) was not significant (p=0.62). All 58 were positive for antibodies to HPV16 CE2/NE6/E7. HPV18/31/45 E7 antibodies were detected additionally in 1,1 and 2 cases, respectively. Among 40 controls (normal cytology and negative HPV DNA on Hybrid Capture), any early HPV antibodies were detected in 8(20.0%) cases with HPV16 CE2/ NE6/E7 in 3(7.5%), HPV18 E7 in 2(5%), HPV31 E7 in 5 (12.5%), and HPV45 E7 in 3(7.5%). On HPV genotyping, 88 (80.0%) cases had any high-risk (hr)HPV type, commonest being HPV16(69%), HPV18(5%), HPV31/33(3% each), HPV35/45/59(2% each). Single hrHPV infections were detected in 77 patients, 7 had single hrHPV infections other than HPV16. Multiple hrHPV infections were detected in 11 (10%) patients. Conclusions The serological test detects a high proportion of cases detected by INNO-LiPA. Further development of this simple, affordable technology holds promise to facilitate cervical screening and triage in community settings.
BACKGROUNDCirculating tumor DNA are short DNA sequences of tumor cells shed into systemic circulation. Serial monitoring of ctDNA levels and immediate correlation with imaging findings has not been well-described in lung cancer.
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