This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Counsel patients regarding pathogenic variants and how they may impact genes resulting in HBOC syndrome
2. Recall criteria that should prompt further evaluation regarding a patient’s risk for HBOC and further genetic testing
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Genoox, Inc., and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2019, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Hereditary Breast and Ovarian Cancer (HBOC) syndrome occurs because of a deleterious mutation in a cancer predisposing gene that is passed through the maternal or paternal germline. Pathogenic variants in the BRCA1 and BRCA2 genes explain only approximately 10% of ovarian cancers and 3-5% of breast cancers but confer a high lifetime risk of developing cancer (4 to 6 times compared to average). Mutations in other genes, such as PALB2, CHEK2, CDH1 and ATM, can also result in breast and ovarian cancer and are being added to cancer gene testing panels. ACOG and USPSTF recommend that evaluating risk of HBOC be a routine part of practice.
Meeting one or more of the following criteria warrants further
Note: Close blood relative is a 1st, 2nd or 3rd degree relative
Individual has personal history of ovarian cancer (includes fallopian tube and primary peritoneal cancers)
Personal history of breast cancer with any one or more of the following (personal history of breast cancer includes invasive and ductal carcinoma in situ)
Individual from a family with a known deleterious BRCA1/BRCA2 gene mutation
Personal history of male breast cancer
Personal history of metastatic prostate cancer (radiographic or biopsy-proven)
Personal history of high-grade prostate cancer (Gleason score ≥7) at any age with
Personal history of pancreatic cancer at any age with
Personal history of pancreatic cancer and Ashkenazi Jewish ancestry
BRCA1/BRCA2 pathogenic mutation detected by tumor profiling on any tumor type in the absence of germline mutation analysis
Family history only
HBOC is primarily associated with breast and ovarian cancers, but individuals with HBOC are at increased risk for other cancers, including pancreatic and prostate cancers. BRCA2 in particular has been associated with possibly a 7% lifetime risk of pancreatic cancer. There are other heritable cancer syndromes aside from HBOC that increase risk for breast cancer, such as Cowden (PTEN mutation) or Li-Fraumeni (TP53 mutation). Consider Lynch syndrome in families with ovarian cancer, especially if uterine and/or colon cancer are present. Newer breast cancer panels can now sequence multiple ovarian and breast cancer-causing genes.
Note: Because medical interventions can prevent severe morbidity and mortality, Hereditary Breast-Ovarian Cancer (HBOC) syndrome is on the ACMG list of ‘secondary’ findings. In summary, the ACMG document on reporting such findings makes the following recommendations:
Take a post-test and get CME credits
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.