by Karen Greendale, MA, CGC
HeritX participated in the Sixth International Symposium on Hereditary Breast and Ovarian Cancer (HBOC) held in Montreal May 10-13, 2016.
The conference, entitled “BRCA 2016: Challenges and Opportunities” brought together more than 600 scientists, clinicians, genetic counselors and individuals and families affected by HBOC. Participants traveled from 26 countries to discuss the latest in BRCA research and patient care. Dr. Thomas Bock represented HeritX with the poster presentation entitled “The HeritX Global Initiative to Prevent Inherited BRCA Cancer.” The HeritX poster was the only presentation on non-surgical prevention of BRCA cancers and was enthusiastically received. HeritX’s poster described the HeritX Global Initiative including its goals, strategies, and multidisciplinary approach comprised of researchers, the biopharmaceutical community and at-risk individuals and families. The presentation also shared the R&D Roadmap developed at the HeritX International Banbury Conference in November 2015. Many researchers, clinicians and affected individuals stopped by the poster to discuss collaborative opportunities and ways to support this new global initiative to find non-surgical ways to prevent inherited BRCA cancers.
According to event organizer Dr. William Foulkes, “This year’s symposium was the best attended and most vibrant one we have hosted. While all the presentations were of high quality, the icing on the cake was definitely Francis Collins’ Marla Miller Memorial Lecture, which combined personal reflections with a bold vision for personalized medicine. This ended the conference on a high note.” In his introduction of Dr. Collins, Director of the National Institutes of Health (USA), Dr. Foulkes highlighted HeritX’s Banbury Conference as the most recent key milestone on the journey to a better future for families affected by inherited BRCA cancer.
The conference agenda included experts from across the spectrum and from around the world. Sessions included a broad variety of topics including BRCA biology and gene variants, BRCA-related ovarian cancer, (surgical) prevention of HBOC, and “new challenges in genetic counseling in the era of panel testing,” among others. These provided participants with the most recent research and clinical findings as well as the current state of the art for caring for HBOC patients. One speaker, Ms. Jill Stopfer from Boston, described the ways that genetic counseling for cancer genes is becoming more complex and how the demand for professional genetic counseling services is escalating.
Many of the presentations and discussions focused on new and emerging topics in BRCA.
One of the most engaging discussions of a current hot issue in BRCA was a “point/counterpoint” debate on whether population-based screening for BRCA mutations is a good idea. Dr. Steven Narod from Toronto argued in favor of population-based genetic testing, although he acknowledged that such a strategy would only be reasonable if 1) testing was limited to BRCA1 and BRCA2, 2) the government did not subsidize the program, 3) pre-test genetic counseling and post-test interpretation of negative results were not required, and 4) other limitations were set. Dr. Nicoline Hoogerbrugge from the Netherlands argued against population-based genetic testing and in favor of the current standard of offering genetic testing to individuals with strong family histories indicative of inherited cancer. Some of her concerns related to practical and ethical issues and to the unproven cost-effectiveness of such a policy. She was also concerned about the sparse data on risk of mutation carriers without positive family histories and about the need to interpret large numbers of variants of uncertain significance. The moderator of this lively discussion, Dr. Mark Robson from Memorial Sloan Kettering Cancer Center in New York, called for an informal vote on the issue. Perhaps not surprisingly, the room was divided with significant numbers voting both pro and con.
International cooperation to advance BRCA research was evident throughout the conference. Dr.Douglas Easton from Cambridge, UK, described how researchers and organizations increasingly cooperate across geographies to solve one of the most pressing issues for patients and their doctors; namely, how to define the clinical impact of specific variants of uncertain significance (VUS). Dr. Matti Rookus from the Netherlands reported on an interesting new meta-analysis of prior studies, which takes a new look at oophorectomy’s potential to reduce breast cancer risk. Oophorectomy has traditionally been considered as reducing breast cancer risk by reducing a woman’s exposure to estrogen during her lifetime. However, once various biases are removed, the degree of breast cancer risk reduction achieved with removing ovaries may be less than originally estimated. Other emerging topics with significant discussion included increasing understanding of alternative DNA repair pathways, which are laying the groundwork for new BRCA therapies.
Living with risk.
Although primarily a scientific conference. BRCA families were not left out. The meeting included a one-day conference specifically for BRCA gene carriers, at-risk individuals, families and the general public. This meeting focused on important topics directly affecting patients, such as the latest in breast reconstruction techniques and sexuality and intimacy after cancer treatment or risk-reducing surgery. The powerful story of the reality of “Living with Risk” was shared by a strong mother and daughter team.
The well organized and scientifically compelling symposium was chaired by Dr. William Foulkes of the Program in Cancer Genetics at McGill University, and Dr. Harley Eisman of the HBOC Foundation, a Canadian nonprofit focused on awareness, education, support and research related to familial breast and ovarian cancer.