Termo de consentimento e análise de material biológico armazenado

OBJETIVO: Relatar uma experiência envolvendo a obtenção de termo de consentimento livre e esclarecido (TCLE) para estudo retrospectivo realizado no Instituto Nacional de Câncer (INCA). O mesmo envolvia a revisão de prontuários e a análise de blocos de parafina de pacientes com câncer de cólon operados entre 2000 e 2004. Respeitando a resolução 196/96 do Conselho Nacional de Saúde e a determinação do Comitê de Ética em Pesquisa (CEP) do INCA, buscou-se obter o consentimento informado. MÉTODOS: Nas consultas agendadas, conseguiu-se aplicar o termo a apenas quatro pacientes, durante três meses. Foram enviadas então pelo correio duas cópias do TCLE, juntamente com um sumário e um envelope selado para o re-envio aos pesquisadores. Antes da postagem, tentou-se contato telefônico. RESULTADOS: Obteve-se retorno de 115 dos 155 TCLE enviados (74%). Dentre as respostas recebidas, 111 consentiram participar do estudo, houve uma recusa e foi informado que três pacientes haviam falecido. O tempo entre o envio da correspondência e o recebimento da resposta variou entre 2 e 89 dias (mediana: 10 dias). Houve sucesso no contato telefônico com 60 dos 160 pacientes (37,5%). Para os que já haviam falecido e para os que não retornaram o TCLE, o CEP aprovou a dispensa do mesmo. O custo final do envio dos envelopes foi de R$1.004,40. CONCLUSÃO: A busca de comunicação telefônica e postal com pacientes para a obtenção de TCLE de estudo clínico retrospectivo é factível. A maioria respondeu ao contato e consentiu participar. Há, porém, custos e riscos agregados que não podem ser desprezados.OBJECTIVE: To present practical experience in obtaining consent form (CF) for a study performed at the "Instituto Nacional de Câncer" involving research on stored biologic samples from patients operated for colon cancer from 2000 to 2004. According to the Brazilian National Health Council resolution nº196/96, researchers must make every effort to obtain consent from patients participating in clinical studies, which is reinforced by the Research Ethics Committee (REC). METHODS: After attempting phone contact, two copies and a synopsis of the CF were posted to each patient, with a stampedreturn envelope. RESULTS: 160 patients were included in the study. The attempt of phone contact was successful with 60 of them (37.5$1,004.40. CONCLUSION: Obtaining consent by postal and phone communication for retrospective genetic research with stored tissue samples is feasible. Most responded to contact and consented to participate, but there were costs and risks that cannot be neglected

Cancer-related worry and risk perception in Brazilian individuals seeking genetic counseling for hereditary breast cancer

In Brazil, the population in general has little knowledge about genetic risks, as well as regarding the role and importance of the Cancer Genetic Counseling (CGC). The goal of this study was to evaluate cancer-related worry and cancer risk perception during CGC sessions in Brazilian women at-risk for hereditary breast cancer. This study was performed in 264 individuals seeking CGC for hereditary breast cancer. Both cancer-affected and unaffected individuals were included. As results, individuals with and without cancer reported different motivations for seeking CGC and undergoing genetic testing. A correlation was observed between age at the first CGC session and age at which the closest relative was diagnosed with cancer. Multivariate analysis showed that educational level, cancer risk discussion within the family, and number of deaths by cancer among first-degree relatives influenced positively the cancer risk perception. In conclusion, the results of this study indicate that cancer-related worry and cancer risk perception are significant aspects of morbidity in individuals seeking CGC, whether they are cancer-affected or unaffected. CGC has an important role in health education and cancer prevention for its potential of promoting an accurate perception of the risk

Clinical and Molecular Assessment of Patients with Lynch Syndrome and Sarcomas Underpinning the Association with MSH2 Germline Pathogenic Variants

Lynch syndrome (LS) is a hereditary cancer-predisposing syndrome associated most frequently with epithelial tumors, particularly colorectal (CRC) and endometrial carcinomas (EC). The aim of this study was to investigate the relationship between sarcomas and LS by performing clinical and molecular characterization of patients presenting co-occurrence of sarcomas and tumors from the LS spectrum. We identified 27 patients diagnosed with CRC, EC, and other LS-associated tumors who had sarcomas in the same individuals or families. Germline genetic testing, mismatch repair (MMR) protein immunohistochemistry, microsatellite instability (MSI), and other molecular analyses were performed. Five LS patients presenting personal or family history of sarcomas were identified (3 MSH2 carriers and 2 MLH1), with 2 having Muir–Torre phenotypes. For two MSH2 carriers we confirmed the etiology of the sarcomas (one liposarcoma and two osteosarcomas) as LS-related, since the tumors were MSH2/MSH6-deficient, MSI-high, or presented a truncated MSH2 transcript. Additionally, we reviewed 43 previous reports of sarcomas in patients with LS, which revealed a high frequency (58%) of MSH2 alterations. In summary, sarcomas represent a rare clinical manifestation in patients with LS, especially in MSH2 carriers, and the analysis of tumor biological characteristics can be useful for definition of tumor etiology and novel therapeutic options