Modelos y organización de una unidad de consejo genético

Hereditary cancer affects 5-10% of the oncologic patients that we see ordinary in a medical oncology department. However, the great majority of the oncologist have a little knowledgement about this issue. The molecular and clinical advances in this field has provided us to detect high risk people to suffer some types of cancer, because they are germline mutation carriers in any susceptibility genes (genetic tests) and, also, the possibility of reduce the risk of suffering this disease almost in 100% of the cases (prophylactic surgery).In this paper we analyze the state-of-the-art in some aspects of hereditary cancer and its clinical management, also a little review about the psycological situations in this type of clinical counselling

Consejo Genético

Hereditary cancer affects 5-10% of the oncologic patients that we see ordinary in a medical oncology department. However, the great majority of the oncologist have a little knowledgement about this issue. The molecular and clinical advances in this field has provided us to detect high risk people to suffer some types of cancer, because they are germline mutation carriers in any susceptibility genes (genetic tests) and, also, the possibility of reduce the risk of suffering this disease almost in 100% of the cases (prophylactic surgery). In this paper we analyze the state-of-the-art in some aspects of hereditary cancer and its clinical management, also a little revision about the psychological situations in this type of clinical counselling

Hábitos de vida saludables, género y cáncer

If we had to classify the risk factors making us more prone to develop cancer we could simply divide them into endogenous and exogenous factors. Among the endogenous factors we could find all those relating to heredity (genetic predisposition) or with non-hereditary molecular alterations that make our cells become malignant more easily. These factors are not modifiable; however, exogenous factors depend on lifestyle choices, which are. These factors have an influence on a large percentage of the most prevalent cancers nowadays, such as colon, breast and lung cancer. Taking action on tobacco and obesity would reduce the incidence of cancer by 30-40% in the industrialised countries. This article reviews the role of negative lifestyle choices in the development of cancer.Si tuviésemos que clasificar los factores de riesgo que nos hacen más proclives a desarrollar cáncer podríamos hacerlo, de una manera sencilla, en factores endógenos y exógenos. Dentro de los primeros estarían todos aquellos que tienen que ver con la herencia (genes de predisposición) o con alteraciones moleculares no hereditarias que hacen que nuestras células se “vuelvan” malignas con más facilidad, estos factores son inmodificables. Sin embargo, los factores exógenos dependen de los llamados “hábitos de vida”, son factores modificables e influyen en un porcentaje importante de los cánceres más prevalentes en la actualidad, como son el de colon, mama y pulmón. Actuando sobre el tabaco y la obesidad se reduciría entre un 30%y 40% la incidencia de cáncer en los países industrializados. Este artículo es una revisión del papel de los hábitos de vida negativos en la producción del cáncer

Modelos y organización de una unidad de consejo genético

Hereditary cancer affects 5-10% of the oncologic patients that we see ordinary in a medical oncology department. However, the great majority of the oncologist have a little knowledgement about this issue. The molecular and clinical advances in this field has provided us to detect high risk people to suffer some types of cancer, because they are germline mutation carriers in any susceptibility genes (genetic tests) and, also, the possibility of reduce the risk of suffering this disease almost in 100% of the cases (prophylactic surgery).In this paper we analyze the state-of-the-art in some aspects of hereditary cancer and its clinical management, also a little review about the psycological situations in this type of clinical counselling

Serum, Saliva, and Gingival Crevicular Fluid Osteocalcin: Their Relation to Periodontal Status and Bone Mineral Density in Postmenopausal Women

Background: Periodontitis and osteoporosis are characterized by the loss of bone mass. Osteocalcin levels have been postulated as a marker of inhibition of bone formation. The aim of the present study was to assess plasma, saliva, and gingival crevicular fluid (GCF) levels of osteocalcin and correlate them with periodontitis and osteoporosis. Methods: Seventy-three postmenopausal women, over 35 years old, were recruited for the study. Serum, saliva, and GCF osteocalcin were measured. Vertebral bone mineral density was measured by dual-energy x-ray absorptiometry. Differences between groups were assessed by analysis of variance (ANOVA), chi-square test, and non-parametric Kruskal-Wallis test. Results: Thirty-four (46.6%) were classified in the normal healthy bone group, 11 women (15.1%) in the osteopenic group, and 28 women (38.4%) in the osteoporotic group. No statistically significant differences between these densitometric groups were observed in probing depth (P = 0.24); clinical attachment level (P = 0.11); or mean osteocalcin concentrations in serum, saliva, and GCF. Twenty-seven (37.0%) of the women were classified without periodontitis (NPG) and 63.0% (N = 46) with periodontal disease (PG). There were no statistical differences in serum and saliva osteocalcin concentrations between these two groups. GCF osteocalcin concentrations were significantly higher in the PG women than in the NPG group (P = 0.008). Mean probing depth correlated significantly with GCF osteocalcin concentrations (r = 0.35; P = 0.002). Conclusion: The results further support the concept that osteocalcin levels in GCF correlates with periodontal but not with osteoporosis status

Aplicación del cuestionario multidimensional del impacto de la evaluación de riesgo de cáncer (MICRA), en una muestra española

It is studied the psychosocial impact of Counselling Genetic Oncology (CGO) on the participants who have received the genetic test results. A sample of 59 participants that had undertaken genetic testing and received results was assessed by The Multidimensional Impact of Cancer Risk Assessment (MICRA) Questionnaire.It was studied possible differences in psychosocial impact according to: result type of, previous oncologist diagnosis, time passed from result communication and type of hereditarysyndrome. The outcomes showed that GCO does notproduce negative psychosocial impact. There were not differences by previous diagnosis,time communication and type of hereditary syndrome on MICRA. It is necessary more research for Spanish MICRA adaptation with the purpose to dispose of a specific instrument effective for psyhosocial impact study of genetic testing

Cirugía profiláctica como medida preventiva del cáncer de mama y ovario hereditario

Prophylactic surgery has become a very useful prevention tool for women at high risk of breast and ovarian cancer. Both prophylactic mastectomy and oophorectomy are considered as aggressive methods and women who are considering this procedure must have a very difficult decision making process to decide which preventive measures they choose. Both surgeries have demonstrated their efficacy to reduce cancer risk, but not to eliminate risk completely. This procedures may produce a negative impact on this women who undergone it, so it is necessary to assess every women who is considering this option and the psychological impact that it may produce.In this paper we try to review the state of art about psychological impact of prophylactic mastectomy and oophorectomy, and the most important issues that must be considered by women that are thinking about this surgery. Issues like efficacy, quality of life, satisfaction with the procedure and most important negative surgery effects are included in this paper.La cirugía profiláctica se ha convertido en una herramienta de prevención que se utiliza cada vez con más frecuencia en mujeres de alto riesgo de padecer cáncer de mama y ovario hereditario. Tanto la mastectomía como la ooforectomía profilácticas son medidas de prevención muy agresivas, que en muchos casos van a requerir para las mujeres a las que se les ofrece un difícil proceso de toma de decisión acerca de las medidas a llevar a cabo. Ambos tipos de cirugía han demostrado su eficacia como medidas de reducción de riesgo de cán¬cer, si bien no eliminan totalmente el riesgo de enfermedad. Sin embargo, estos procedimientos pueden provocar un impacto negativo en las mujeres que los llevan a cabo, lo que pone de manifiesto la necesidad de valorar detenidamente la realización de cirugías, así como el impacto psicológico que puede tener sobre cada mujer. En el presente artículo se pretende hacer una revisión que permita conocer el estado actual acerca del impacto psicológico de la mastectomía y la ooforectomía, así como de los aspectos más importantes que han de te¬nerse en cuenta a la hora de llevarlos a cabo. Aspectos como la eficacia del procedimiento, la calidad de vida, la satisfacción con la ciru¬gía y los aspectos negativos más importantes derivados de este procedimiento se comentan a continuación

Psychological impact and intervention needs in genetic counseling for women with hereditary breast cancer risk

Se exponen los aspectos psicológicos del Consejo Genético Oncológico en cáncer de mama (CGO). El CGO tiene como beneficio principal para los participantes obtener certidumbre, ser capaces de estimar el riesgo de desarrollar cáncer hereditario, adoptar medidas preventivas, y ayudar a los otros familiares. El CGO mejora la percepción de riesgo en los participantes, pero en muchos de ellos persisten errores debidos a fallos en la comprensión de la información y sesgos cognitivos o emocionales. La información en CGO debe partir de que las estimaciones de riesgo son herramientas para tomar decisiones que afectan a la salud y no una mera predicción de enfermedad. Es preferible informar del riesgo en términos de probabilidades absolutas, y evitar términos de riesgo relativo. Los valores de los participantes y las consecuencias para su bienestar a largo plazo deben ser incorporados al proceso de toma de decisiones. Los participantes deben valorar sus decisiones en términos de las ventajas que pueda suponer y no como correcto/incorrecto. La participación en CGO no tiene consecuencias adversas para la salud mental de la mayoría de los participantes. La comunicación abierta entre los miembros de la familia es un importante determinante de la adaptación al proceso. La intervención psicológica es necesaria en los siguientes casos: a) los participantes que tienen problemas de comunicación familiar; b) el ser el primer probando; c) los participantes que muestran un alto nivel de estrés previo al consejo genético, ansiedad, pe simismo, o pérdida de autoestima; d) antecedentes psicopatológicos familiares; e) los participantes que han tenido experiencia negativas de cáncer en la familia durante la adolescencia (11-20 años); f) la muerte reciente por cáncer de un familiar y el duelo; g) diagnóstico reciente de cáncer o recurrencia; f) el consultante declina continuar el CGO; g). Los portadores que no esperan serlo: h) los que consideran realizar cirugía profiláctica.The psychological aspects of genetic counseling for breast cancer are reviewed. The principal profits for the genetic counseling participants are: to obtain certainty, be capable of estimating the risk of developing hereditary cancer, to take preventive measures, and to help their relatives. Genetic risk counselling has been shown to improve significantly the accuracy of risk perception, but a significant proportion of women continue to hold misperceptions, which is caused by problems to understand the information and cognitive or emotional biases. The estimations of risk should be a mean to assist in health decision-making and not a mere predictor of cancer. It is preferable to provide the estimations about cancer risk in absolute probabilities, and to avoid terms of relative risk. The values of the participants and the consequences for his well-being in the long term must be incorporated to the process of decision-making. The participants must view their decisions in terms of the advantages/disadvantages and not as correct/wrong. The participation in CGO does not have negative consequences in mental health for the most people. The open communication among relatives is an important determinant of the adjustment to the process. The psychological intervention is necessary for the following conditions: a) the participants who have problems of familiar communication; b) those who are tested first; c) high levels of distress, anxiety, pessimism, or low self-esteem prior to testing; d) having lost a relative to hereditary cancer during the adolescence (11-20 years); e) the recent death of a relative from cancer and grief; f) recent diagnosis of cancer or recurrence; g) the participants who decline genetic testing; h) carriers who do not expect to be carriers; i) those who consider to undergoing prophylactic surgery

Consejo Genético

Hereditary cancer affects 5-10% of the oncologic patients that we see ordinary in a medical oncology department. However, the great majority of the oncologist have a little knowledgement about this issue. The molecular and clinical advances in this field has provided us to detect high risk people to suffer some types of cancer, because they are germline mutation carriers in any susceptibility genes (genetic tests) and, also, the possibility of reduce the risk of suffering this disease almost in 100% of the cases (prophylactic surgery). In this paper we analyze the state-of-the-art in some aspects of hereditary cancer and its clinical management, also a little revision about the psychological situations in this type of clinical counselling

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