10579 Background: The clinical utility of hereditary cancer multigene testing is well-established. Most testing has been performed in the White European population, with a relative shortage of data in other ethnic groups. Evaluation of hereditary cancer variants within diverse ethnic populations is important to drive accurate variant interpretation. This study aims to review the outcomes of hereditary cancer testing in an ethnically diverse U.S. population. Methods: We conducted a retrospective analysis of 8,888 test results from a 31-gene hereditary cancer test using next-generation sequencing with copy number variant analysis. Results were separated into seven categories based on the ethnicity selected on the test requisition: African American (AA), Asian (A), Ashkenazi Jewish (AJ), Hispanic (H), White (W), Other (O), and Unknown (U). O was used for any handwritten ethnicity or if multiple ethnicities were selected and U if no ethnicity was chosen. We quantified the number of negative, positive (pathogenic or likely pathogenic (P/LP) variant) and variant of uncertain significant (VUS) results for each ethnic group. We tallied the gene and variant for each result with a positive, negative or VUS. We used a Fisher's Exact test and Bonferroni-adjusted p-values to account for multiple hypothesis testing. Results: Of the 8,888 orders reviewed, 45% were non-White ethnic groups. The P/LP variant rate was lower for AA (4%, p=2e-04) compared to W (9%). The VUS rate was higher for O, AA and A (48%, 56%, and 57%; p=0.0045, 3.1e-17 and 4.8e-06, respectively), compared to 38% in W. Lower negative rates were found in A and AA (37% and 40%; p=0.00024 and 9.4e-10, respectively), and trending lower in O (46%, p=0.0097), compared to 58% for W. The VUS rate for H is 41% (p value = 0.095). Conclusions: Our results suggest that non-Whites may be at a disadvantage when it comes to hereditary cancer multigene testing due to the higher rate of VUS results. The inverse correlation between the overall rates of VUS and negative results when comparing these populations suggests there may be limited variant information for the non-White population in medical literature and available databases. This underrepresentation may make it more difficult to accurately characterize a variant. Despite the small sample size, these findings are consistent with previous publications; however, gene specific outcomes could not be evaluated. This finding suggests that providers could give these patients uninformative results more often, which has potential to impact screening protocols for these families. More research is needed to understand the impact of variant classification across ethnicities to decrease health disparities.
Background: Hereditary cancer risk assessment is standard of care in the obstetrics and gynecology (ob/gyn) practice. Historical data indicates 1 in 12 individuals have a family history consistent with hereditary cancer(1), however recent data from a small community practice found that 1 in 4 women met National Comprehensive Cancer Network (NCCN) criteria for genetic testing(2). The aim of this study was to assess the number of women who meet NCCN criteria for genetic testing in a diverse population across the United States (US) by using a computer program that conducts conversations with patients (a.k.a. chatbot) for risk assessment(3). Method: We partnered with Clear Genetics Inc. (San Francisco, CA) to use a HIPAA compliant chatbot for collecting personal and family history of cancer from women in 28 ob/gyn practices across the US. Patients received a text message or email asking them to complete the chatbot five days before their scheduled appointment. Reminders were sent at three days and again one day prior if not completed. After history collection was complete, an algorithm determined if the patient had a known familial variant or met NCCN guidelines for hereditary cancer testing, including BRCA-Related Breast and/or Ovarian Cancer, Lynch, and Polyposis syndromes(3). Incomplete chats, minors under age 18 or those who declined to provide information were excluded. Additionally, some ob/gyn practices elected to exclude pregnant patients. Results: Over 15,000 chatbots were sent to patients. Overall, 65% of patients completed the chatbot and 26% of these patients met NCCN criteria or had a known familial variant(3). 14.5% of completed assessments were excluded (1.2% declined, 1.4% minors and 11.9% pregnant patients). Some patients received the chatbot less than five days before their appointment due to administrative delays at the ob/gyn practice, and 15% of intended recipients did not receive the chatbot due to incorrect contact information. Patients reviewed their experience with an average rating of 4.6 out of 5. Conclusions: A novel chatbot tool was used to collect pertinent cancer history and provide NCCN criteria assessment to identify patients for inherited cancer risk. This study population was nearly four times the size of the most recent study identifying 1 in 4 women met NCCN criteria for genetic testing. In addition, this study was more diverse - examining multiple ob/gyn practices across the US compared to a single community practice. Results of this study were consistent with newly reported data indicating 1 in 4 patients meet NCCN criteria for hereditary cancer testing. There is a need for increased education and tools to help ob/gyn practices identify these patients consistent with ACOG Practice Guideline 634(4), in light of a higher number of patients who need genetic testing. References: 1. Scheuner MT, McNeel TS, Freeman AN. Population prevalence of familial cancer and common hereditary cancer syndromes. The 2005 California Health Interview Survey. Genet Med. 2010;12(11):726-35) 2. DeFrancesco MS, Walman RN, Pearlstone M, Karanik D, Bernhisel R, Logan J, Alico LA, Adkins RT. Hereditary Cancer Risk Assessment and Genteic Testing in the Community-Practice Setting. Cancer: Clinical Practice and Quality 2018;132(5):1121-1129. 3. National Comprehensive Cancer Network. Genetic/Familial High-Risk Assessment: Breast and Ovarian (Version 2.2019) and Colorectal (Version 1.2018). Available from: Http://www.nccn.org/. 4. ACOG Committee Opinion No. 634. Hereditary cancer syndromes and risk assessment. Obstet Gynecol 2015: 125:1538-43. Citation Format: Lindsay Dohany, Heidi Owen, Ashley Reeves, Christina Settler. Hereditary cancer risk assessment using a chatbot in women presenting to obstetrics and gynecology practices across the U.S. [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-08-39.
underwent ERCP with sphincterotomy and 9/13 were treated conservatively. In patients undergoing sphincterotomy, there were no procedural complications and all had relief of pain (two patients later solicited further ERCP and sphincterotomy). Conclusion In this series, secretin-MRCP was valuable in a group of patients with suspected SOD. Most scan findings for this indication are normal, but in some patients an abnormal scan is valuable in giving a positive diagnosis. A subgroup of these may benefit from ERCP with sphincterotomy, while others respond adequately to conservative therapy. Competing interests None declared. OC-150 A DECADE OF CHANGE IN THE MANAGEMENT OF SEVERE GASTROINTESTINAL HAEMORRHAGE
My impression is that once severe [laryngeal] spasm has been allowed to develop, nothing can be done until the false and true cords have relaxed." I can assure him that it is unnecessary to wait until the patient is "pulseless, black, and virtually on the point of death." I have never yet, during a good many years' experience, met a laryngeal spasm which could not be dealt with by intubation with a gum-elastic catheter (urethral or as supplied for purposes of anaesthesia is equally suitable, of about 7 mm. diameter for adults). The smooth rounded end of such a catheter will pass between cords in spasm easily, quickly, and without trauma. I always have several size; handy when anaesthetizing. As the American gentleman is alleged to have replied when asked why his hip-pocket contained a gun: 1 I don't need it often, but when I do I need it darned quick."-I am, etc., London, N.W.11. STEPHEN COFFIN.
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