16 research outputs found
Attitude towards and factors affecting uptake of population based BRCA testing in the Ashkenazi Jewish population: a cohort study
Objective
To evaluate factors affecting unselectedāpopulationābasedāBRCAātesting in AshkenaziāJews (AJ).
Design
Cohortāstudy set within recruitment to the GCaPPSātrial (ISRCTN73338115).
Setting
NorthāLondon AJāpopulation.
Population or Sample
AJ women/men >18āyears, recruited through selfāreferral.
Methods
AJāwomen/men underwent preātest counselling for BRCAātesting through recruitment clinics (clusters). Consenting individuals provided bloodāsample for BRCAātesting. Socioādemographic/familyāhistory/knowledge/psychological wellābeing data alongāwith benefits/risks/culturalāinfluences (18āitemāquestionnaire measuring āattitudeā) were collected.
4āitem likertāscales analysed initial āinterestā and āintentionātoātestā preācounselling. Uniā&āmultivariable logisticāregressionāmodels evaluated factors affecting uptake/interest/intentionāto undergo BRCAātesting. Statistical inference was based on cluster robust standardāerrors and joint Waldātests for significance. ItemāResponseāTheory and gradedāresponseāmodels modelled responses to 18āitem questionnaire.
Main Outcome Measures
Interest, intention, uptake, attitude towards BRCAātesting.
Results
935 (women=67%/men=33%; meanāage=53.8(S.D=15.02) years) individuals underwent preātest geneticācounselling. Preācounselling 96% expressed interest but 60% indicated clear intentionāto undergo BRCAātesting. Subsequently 88% opted for BRCAātesting. BRCAārelated knowledge (p=0.013) and degreeālevel education(p=0.01) were positively and negatively (respectively) associated with intentionātoātest. Being married/cohabiting had fourāfold higherāodds for BRCAātesting uptake (p=0.009). Perceived benefits were associated with higher preācounselling odds for interest and intentionāto undergo BRCAātesting. Reduced uncertainty/reassurance were the most important factors contributing to decisionāmaking. Increased importance/concern towards risks/limitations (confidentiality/insurance/emotionalāimpact/inability to prevent cancer/marriageāability/ethnicāfocus/stigmatization) were significantly associated with lowerāodds of uptakeāof BRCAātesting, and discriminated between acceptors and decliners. Maleāgender/degreeālevelāeducation (p=0.001) had weaker, while having children had stronger (p=0.005) attitudes towards BRCAātesting.
Conclusions
BRCAātesting in the AJāpopulation has high acceptability. Preātest counselling increases awareness of disadvantages/limitations of BRCAātesting, influencing final costābenefit perception and decisionāmaking on undergoing testing.
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Randomised trial of population-based BRCA testing in Ashkenazi Jews: long-term outcomes
Ā© 2019 Royal College of Obstetricians and Gynaecologists Objective: Unselected population-based BRCA testing provides the opportunity to apply genomics on a population-scale to maximise primary prevention for breast-and-ovarian cancer. We compare long-term outcomes of population-based and family-history (FH)/clinical-criteria-based BRCA testing on psychological health and quality of life. Design: Randomised controlled trial (RCT) (ISRCTN73338115) GCaPPS, with two-arms: (i) population-screening (PS); (ii) FH/clinical-criteria-based testing. Setting: North London Ashkenazi-Jewish (AJ) population. Population/Sample: AJ women/men. Methods: Population-based RCT (1:1). Participants were recruited through self-referral, following pre-test genetic counselling from the North London AJ population. Inclusion criteria: AJ women/men >18Ā years old; exclusion-criteria: prior BRCA testing or first-degree relatives of BRCA-carriers. Interventions: Genetic testing for three Jewish BRCA founder-mutations: 185delAG (c.68_69delAG), 5382insC (c.5266dupC) and 6174delT (c.5946delT), for (i) all participants in PS arm; (ii) those fulfilling FH/clinical criteria in FH arm. Linear mixed models and appropriate contrast tests were used to analyse the impact of BRCA testing on psychological and quality-of-life outcomes over 3Ā years. Main outcome measures: Validated questionnaires (HADS/MICRA/HAI/SF12) used to analyse psychological wellbeing/quality-of-life outcomes at baseline/1-year/2-year/3-year follow up. Results: In all, 1034 individuals (691 women, 343 men) were randomised to PS (nĀ =Ā 530) or FH (nĀ =Ā 504) arms. There was a statistically significant decrease in anxiety (PĀ =Ā 0.046) and total anxiety-&-depression scores (PĀ =Ā 0.0.012) in the PS arm compared with the FH arm over 3Ā years. No significant difference was observed between the FH and PS arms for depression, health-anxiety, distress, uncertainty, quality-of-life or experience scores associated with BRCA testing. Contrast tests showed a decrease in anxiety (PĀ =Ā 0.018), health-anxiety (PĀ <Ā 0.0005) and quality-of-life (PĀ =Ā 0.004) scores in both PS and FH groups over time. Eighteen of 30 (60%) BRCA carriers identified did not fulfil clinical criteria for BRCA testing. Total BRCA prevalence was 2.9% (95% CI 1.97ā4.12%), BRCA1 prevalence was 1.55% (95% CI 0.89ā2.5%) and BRCA2 prevalence was 1.35% (95% CI 0.74ā2.26%). Conclusion: Population-based AJ BRCA testing does not adversely affect long-term psychological wellbeing or quality-of-life, decreases anxiety and could identify up to 150% additional BRCA carriers. Tweetable abstract: Population BRCA testing in Ashkenazi Jews reduces anxiety and does not adversely affect psychological health or quality of life
Cluster-randomised non-inferiority trial comparing DVD-assisted and traditional genetic counselling in systematic population testing for BRCA1/2 mutations.
BACKGROUND: Newer approaches to genetic counselling are required for population-based testing. We compare traditional face-to-face genetic counselling with a DVD-assisted approach for population-based BRCA1/2 testing. METHODS: A cluster-randomised non-inferiority trial in the London Ashkenazi Jewish population. INCLUSION CRITERIA: Ashkenazi Jewish men/women >18ā
years; exclusion criteria: (a) known BRCA1/2 mutation, (b) previous BRCA1/2 testing and (c) first-degree relative of BRCA1/2 carrier. Ashkenazi Jewish men/women underwent pre-test genetic counselling prior to BRCA1/2 testing in the Genetic Cancer Prediction through Population Screening trial (ISRCTN73338115). Genetic counselling clinics (clusters) were randomised to traditional counselling (TC) and DVD-based counselling (DVD-C) approaches. DVD-C involved a DVD presentation followed by shorter face-to-face genetic counselling. Outcome measures included genetic testing uptake, cancer risk perception, increase in knowledge, counselling time and satisfaction (Genetic Counselling Satisfaction Scale). Random-effects models adjusted for covariates compared outcomes between TC and DVD-C groups. One-sided 97.5% CI was used to determine non-inferiority. SECONDARY OUTCOMES: relevance, satisfaction, adequacy, emotional impact and improved understanding with the DVD; cost-minimisation analysis for TC and DVD-C approaches. RESULTS: 936 individuals (clusters=256, mean-size=3.6) were randomised to TC (n=527, clusters=134) and DVD-C (n=409, clusters=122) approaches. Groups were similar at baseline, mean age=53.9 (SD=15) years, women=66.8%, men=33.2%. DVD-C was non-inferior to TC for increase in knowledge (d=-0.07; lower 97.5% CI=-0.41), counselling satisfaction (d=-0.38, 97.5% CI=1.2) and risk perception (d=0.08; upper 97.5% CI=3.1). Group differences and CIs did not cross non-inferiority margins. DVD-C was equivalent to TC for uptake of genetic testing (d=-3%; lower/upper 97.5% CI -7.9%/1.7%) and superior for counselling time (20.4 (CI 18.7 to 22.2) min reduction (p<0.005)). 98% people found the DVD length and information satisfactory. 85-89% felt it improved their understanding of risks/benefits/implications/purpose of genetic testing. 95% would recommend it to others. The cost of genetic counselling for DVD-C=Ā£7787 and TC=Ā£17ā
307. DVD-C resulted in cost savings=Ā£9520 (Ā£14/volunteer). CONCLUSIONS: DVD-C is an effective, acceptable, non-inferior, time-saving and cost-efficient alternative to TC. TRIAL REGISTRATION NUMBER: ISRCTN 73338115
Cluster-randomised non-inferiority trial comparing DVD-assisted and traditional genetic counselling in systematic population testing for BRCA1/2 mutations
BACKGROUND: Newer approaches to genetic counselling are required for population-based testing. We compare traditional face-to-face genetic counselling with a DVD-assisted approach for population-based BRCA1/2 testing. METHODS: A cluster-randomised non-inferiority trial in the London Ashkenazi Jewish population. INCLUSION CRITERIA: Ashkenazi Jewish men/women >18ā
years; exclusion criteria: (a) known BRCA1/2 mutation, (b) previous BRCA1/2 testing and (c) first-degree relative of BRCA1/2 carrier. Ashkenazi Jewish men/women underwent pre-test genetic counselling prior to BRCA1/2 testing in the Genetic Cancer Prediction through Population Screening trial (ISRCTN73338115). Genetic counselling clinics (clusters) were randomised to traditional counselling (TC) and DVD-based counselling (DVD-C) approaches. DVD-C involved a DVD presentation followed by shorter face-to-face genetic counselling. Outcome measures included genetic testing uptake, cancer risk perception, increase in knowledge, counselling time and satisfaction (Genetic Counselling Satisfaction Scale). Random-effects models adjusted for covariates compared outcomes between TC and DVD-C groups. One-sided 97.5% CI was used to determine non-inferiority. SECONDARY OUTCOMES: relevance, satisfaction, adequacy, emotional impact and improved understanding with the DVD; cost-minimisation analysis for TC and DVD-C approaches. RESULTS: 936 individuals (clusters=256, mean-size=3.6) were randomised to TC (n=527, clusters=134) and DVD-C (n=409, clusters=122) approaches. Groups were similar at baseline, mean age=53.9 (SD=15) years, women=66.8%, men=33.2%. DVD-C was non-inferior to TC for increase in knowledge (d=-0.07; lower 97.5% CI=-0.41), counselling satisfaction (d=-0.38, 97.5% CI=1.2) and risk perception (d=0.08; upper 97.5% CI=3.1). Group differences and CIs did not cross non-inferiority margins. DVD-C was equivalent to TC for uptake of genetic testing (d=-3%; lower/upper 97.5% CI -7.9%/1.7%) and superior for counselling time (20.4 (CI 18.7 to 22.2) min reduction (p<0.005)). 98% people found the DVD length and information satisfactory. 85-89% felt it improved their understanding of risks/benefits/implications/purpose of genetic testing. 95% would recommend it to others. The cost of genetic counselling for DVD-C=Ā£7787 and TC=Ā£17ā
307. DVD-C resulted in cost savings=Ā£9520 (Ā£14/volunteer). CONCLUSIONS: DVD-C is an effective, acceptable, non-inferior, time-saving and cost-efficient alternative to TC. TRIAL REGISTRATION NUMBER: ISRCTN 73338115
Ink bleed-through removal of historical manuscripts based on hyperspectral imaging
Old manuscripts can be degraded by different reasons over time. The ink bleed-through from the back side of the page is a common problem which compromises the readability and the aesthetics of the document. Unsupervised bleed-through removal is a challenging task as pixel intensity of bleed-through areas can be very similar to fine-details of the writing. This paper provides a brief review about state-of-the-art methods for bleed-through removal. Moreover, we propose an algorithm for the segmentation of the bleed-through areas from a manuscript collected from the National Library of Oslo using hyperspectral imaging. This work also presents the restoration of the collected manuscript applying inpainting algorithms based on our segmentation approach
RANDOMISED TRIAL OF UNSELECTED BRCA TESTING IN ASHKENAZI JEWS: LONG TERM OUTCOMES AND FACTORS AFFECTING UPTAKE OF TESTING
Abstract from ESGO Annual Meeting Abstract
Jewish Cultural and Religious factors and uptake of Population based BRCA testing across denominations: a cohort study
Objective:
To evaluate the association of Jewish cultural and religious identity and denominational affiliation with interest in, intention to undertake and uptake of population-based BRCA (Breast Cancer Gene)-testing.
Design:
Cohort-study set within recruitment to GCaPPS-trial (ISRCTN73338115).
Setting:
London Ashkenazi-Jewish (AJ) population.
Population or sample:
AJ men and women, >18 years.
Methods:
Participants were self-referred, and attended recruitment clinics (clusters) for pre-test counselling. Subsequently consenting individuals underwent BRCA testing. Participants self-identified to one Jewish denomination: Conservative/Liberal/Reform/Traditional/Orthodox/Unaffiliated. Validated scales measured Jewish Cultural-Identity (JI) and Jewish Religious-identity (JR). Four-item Likert-scales analysed initial āinterestā and āintention to testā pre-counselling. Item-Response-Theory and graded-response models, modelled responses to JI and JR scales. Ordered/multinomial logistic regression modelling evaluated association of JI-scale, JR-scale and Jewish Denominational affiliation on interest, intention and uptake of BRCA testing.
Main outcome measures:
Interest, intention, uptake of BRCA testing.
Results:
In all, 935 AJ women/men of mean age = 53.8 (S.D = 15.02) years, received pre-test education and counselling through 256 recruitment clinic clusters (median cluster size = 3). Denominational affiliations included Conservative/Masorti = 91 (10.2%); Liberal = 82 (9.2%), Reform = 135 (15.1%), Traditional = 212 (23.7%), Orthodox = 239 (26.7%); and Unaffiliated/Non-practising = 135 (15.1%). Overall BRCA testing uptake was 88%. Pre-counselling, 96% expressed interest and 60% intention to test. JI and JR scores were highest for Orthodox, followed by Conservative/Masorti, Traditional, Reform, Liberal and Unaffiliated Jewish denominations. Regression modelling showed no significant association between overall Jewish Cultural or Religious Identity with either interest, intention or uptake of BRCA testing. Interest, intention and uptake of BRCA testing was not significantly associated with denominational affiliation.
Conclusions:
Jewish religious/cultural identity and denominational affiliation do not appear to influence interest, intention or uptake of population-based BRCA testing. BRCA testing was robust across all Jewish denominations