CE Activity 11-06B
The Role of the Clinician in Preventing Cancer: Hereditary Cancer Assessment as an Emerging Standard of Practice Accreditation Statement and Post-Test FACULTY: Lee P. Shulman, MD, FACOG, FACMG The Anna Ross Lapham Professor of Obstetrics and Gynecology Chief, Division of Clinical Genetics Co-Director, Northwestern Ovarian Cancer Early Detection and Prevention Program Feinberg School of Medicine Northwestern University, Chicago, IL Karen J. Spielbusch, CFNP Nurse Practitioner New Mexico Gynecology Consultants Albuquerque, NM INTENDED AUDIENCE: This continuing education (CE) activity has been designated to meet the educational needs of nurse practitioners, nurse-midwives, registered nurses, health educators, physicians, physician assistants, pharmacists, and other clinicians who provide care to women. CE APPROVAL PERIOD: March 1, 2012 through March 1, 2013 ESTIMATED TIME TO COMPLETE THIS ACTIVITY: 1.5 hours PROGRAM DESCRIPTION/IDENTIFICATION OF NEED: The material in this program is based on material from a symposium on October 13, 2011, at the 14th Annual NPWH Premier Women's Healthcare Conference, October 12-15, 2011, Austin, Texas. A physician and a nurse practitioner discussed Hereditary Breast and Ovarian Cancer (HBOC) and Lynch syndrome, hereditary cancer testing, how to incorporate testing into practice, and how to manage patients with identified inherited risk of cancer. Case studies were presented to walk the participants through the entire process of identifying risk to counseling, testing, and managing the identified mutation carrier. The educational need for this program was assessed through a comprehensive review of current literature and an assessment of educational gaps demonstrated by past conference attendees. Numerous studies named hereditary cancer syndromes as a critical area of need for primary care provider-targeted continuing medical education. New study data, ACOG committee opinions, discussions surrounding previous research, and ACOG practice bulletins continue to be released in the field of hereditary cancers. Clinicians who work in Ob/Gyn and women’s health practices are viewed by many women as the preventative arm of medicine. In fact, if only the early diagnosis or prevention of cancer is addressed, it is typical for women to be routinely screened for breast, cervical and colorectal cancers at their annual well-woman visit or referred for further screening tests. In addition to their role as prevention specialists they may also have long-term professional relationships that increase their opportunity to counsel, educate, allay anxiety and provide the much needed interventions necessary if a woman is identified as a mutation carrier.
CE Activity 11-06B
EDUCATIONAL OBJECTIVES: After completing this activity, the participant will be able to: Identify the family history and other indicators for testing for Hereditary Breast and Ovarian Cancer (HBOC) and Lynch syndrome. Explain the benefits of risk assessment followed by hereditary cancer testing of women at a specific threshold for risk of HBOC and Lynch syndrome. Describe the medical management strategies for the BRCA1/2 and MLH1, MSH2, MSH6, PMS2, and EPCAM mutation carriers. ACCREDITATION STATEMENT: This activity has been evaluated and approved by the Continuing Education Approval Program of the National Association of Nurse Practitioners in Women’s Health (NPWH) for 1.5 contact hours of CE credit, including 0.15 contact hours of pharmacology content. FACULTY DISCLOSURES: NPWH policy requires all faculty to disclose any affiliation or relationship with a commercial interest that may cause a potential, real, or apparent conflict of interest with the content of a CE program. NPWH does not imply that the affiliation or relationship will affect the content of the CE program. Disclosure provides participants with information that may be important to their evaluation of an activity. Faculty are also asked to identify any unlabeled/unapproved uses of drugs or devices made in their presentation. Lee P. Shulman, MD, is a consultant for Bayer, Teva, GSK, Sequenom, Genzyme and Myriad Genetics Laboratories, Inc.; receives research support from Bayer; and has received honoraria from Bayer, Teva, GSK, Merck, Sequenom, and Genzyme. He is on the Speakers' Bureau for Bayer, Teva, Merck, GSK, and Sequenom. Karen J. Spielbusch, CFNP, is a consultant for Myriad Genetics Laboratories, Inc. DISCLOSURE OF UNLABELED USE: NPWH policy requires authors to disclose to participants when they are presenting information about unlabeled use of a commercial product or device or an investigational use of a drug or device not yet approved for any use. DISCLAIMER: 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 in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. SUCCESSFUL COMPLETION OF THE ACTIVITY: Successful completion of this activity requires the participant to: (a) read the learning objectives, disclosures, and disclaimers; (b) study the material in the learning activity; (c) complete the post-test online via one of the following methods: The Ob/Gyn Nurse 1) Log on to http://www.theobgynnurse.com. 2) On the home page, scroll down to Continuing Education Activities and open The Role of the Clinician in Preventing Cancer: Hereditary Cancer Assessment as an Emerging Standard of Practice, CE Activity 1106B. 3) Print out the post-test and evaluation, complete, and return the activity evaluation and post-test answers only to address or fax number on the post-test/evaluation form. 4) Earn a score of 70% or higher on the post-test to receive CE credit.
CE Activity 11-06B
NPWH 1) Log on to http://www.npwh.org. 2) Click on CE Activities in the Professional Education dropdown at the top of the page. 3) Open The Role of the Clinician in Preventing Cancer: Hereditary Cancer Assessment as an Emerging Standard of Practice post-test and evaluation form, CE Activity 11-06B. 4) Print out the post-test and evaluation, complete, and return the activity evaluation and post-test answers only to address or fax number on the post-test/evaluation form. 5) Earn a score of 70% or higher on the post-test to receive CE credit. COMMERCIAL SUPPORT: The symposium and this program have been made possible by an educational grant from Myriad Genetics Laboratories, Inc. The symposium was sponsored by The National Association of Nurse Practitioners in Women’s Health and the Global Education Group, Inc.
CE Activity 11-06B
The Role of the Clinician in Preventing Cancer: Hereditary Cancer Assessment as an Emerging Standard of Practice Lee P. Shulman, MD, FACOG, FACMG, and Karen J. Spielbusch, CFNP Post Test Questions 1.
Which of the following statements about women with a BRCA 1 or BRCA 2 mutation is true? a. Such women also have a predisposition for developing endometrial cancer. b. The gene mutation is the only factor causing these women to develop breast cancer. c. There are actions that can be taken by these women to decrease their chances of developing breast cancer. d. Once they develop breast cancer, their prognosis is worse than that of women without the mutation.
2.
Which of the following characteristics of inherited breast cancers is true? a. They have an earlier age at onset. b. They tend to become metastatic. c. They are usually BRCA1- or BRCA2-negative. d. They result in shorter survival rates.
3.
Lynch syndrome: a. is associated with specific oncogenes. b. confers a lifetime risk of ovarian cancer of about 25%. c. includes a 10% risk of developing breast cancer. d. is associated with endometrial, ovarian, and colorectal cancer.
4.
Which of the following statements about BRCA1/2 gene mutations is true? a. Most women who develop cancer under the age of 35 are mutation carriers. b. These mutations can be inherited from either parent in an autosomal dominant fashion. c. Women with such mutations have a higher risk of developing cervical cancer. d. Oral contraceptives are contraindicated in women who are mutation carriers.
5.
Which of the following are risk factors for breast cancer in women: i. ii. iii. iv. a. i, ii
family history of breast cancer age breast implants late menopause
b. i, ii, iii c. i, ii, iv d. i, ii, iii, iv
CE Activity 11-06B 6.
Risk assessment for hereditary cancers: a. can identify the need for genetic testing. b. involves taking a family history. c. assists in determining patient management. d. All of the above.
7. Which of the following statements about ovarian cancer is false? a. Premalignant ovarian cancer can be detected by annual screening. b. The incidence of ovarian cancer is approximately 1.5% in the general U.S. population. c. 5% of all cancer deaths in the U.S. are due to ovarian cancer. d. Oral contraceptives have been shown to reduce the risk of ovarian cancer. 8. Which of the following statements are true? i. All women require genetic testing to determine their risk of breast and ovarian cancer. ii. Women with lifestyle factors predisposing them to gynecologic cancers should be offered genetic testing. iii. Most gynecologic malignancies occur in women with little or no family history of the malignancy. iv. Annual endometrial biopsies should be offered to women with a strong family history of colon cancer. a. i, ii b. ii, iii c. iii, iv d. ii, iii, iv 9.
Genetic testing is strongly indicated when: i. breast cancer is diagnosed at any age. ii. both breast and ovarian cancer have been diagnosed. iii. a woman with premenopausal breast cancer who is of Ashkenazi Jewish descent. iv. a woman's father was diagnosed with breast cancer. a. ii, iii. b. i, ii, iii. c. ii, iii, iv. d. i, iii, iv
10. A 75-year old woman is diagnosed with colon cancer. Her family history identifies a younger sister who died of endometrial cancer at the age of 45 and a father diagnosed with colon cancer at 70, who died at the age of 82. Would genetic testing benefit this woman? a. Yes. b. No. 11. A 53-year old Jewish woman is found to have a couple of small lumps in one breast during her annual check-up. There is no known family history of cancer. She has two healthy older sisters and a younger brother; both parents were of Ashkenazi descent and they and their siblings were between the ages of 86 and 92 when they died. She is sent for a mammogram. Would genetic testing benefit this woman? a. Yes. b. No.
CE Activity 11-06B
Activity Evaluation Form and Application for Continuing Education Credit
The Role of the Clinician in Preventing Cancer: Hereditary Cancer Assessment as an Emerging Standard of Practice Thank you for taking the time to complete this Evaluation Form. This brief questionnaire will help us evaluate the program and provide valuable feedback for the development of future programs. I am a:
NP
RN PA MD DO
PharmD
Other _________________________
Please evaluate the following:
The learning objectives designed for this activity can help me strive to… 1.
2.
3.
Not Met
Reinforcement
Moderate Improvement
Significant Improvement
Identify the family history and other indicators for hereditary cancer risk assessment, hereditary cancer testing, HBOC, and Lynch syndrome.
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Explain the benefits of risk assessment followed by hereditary cancer testing of women at a specific threshold of risk for HBOC and Lynch syndrome.
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4
Describe the medical management strategies for the BRCA 1/2 and MLH1, MSH2, MSH6, and EPCAM mutation carriers.
1
2
3
4
Activity Effectiveness
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The information presented will help me improve patient care. The content of the activity was relevant to me. The activity related to my practice needs. Overall, the activity met my expectations.
How likely are you to recommend an activity like this to a colleague? Extremely Unlikely
1
2
Neutral
3
4
5
Extremely Likely
6
7
Will the information presented cause you to make any changes in your practice?
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9
YES
10
NO
If YES, please describe any change(s) you plan to make in your practice as a result of this activity. __________________________________________________________________________________________ __________________________________________________________________________________________ What did you like best about this activity? ________________________________________________________ __________________________________________________________________________________________ What about this activity would you like to improve? ________________________________________________ __________________________________________________________________________________________ Based upon the information presented in this activity, which of the following statements best reflects your sentiment toward education for Hereditary Cancer Syndromes? a.
I have learned everything I need to learn about Hereditary Cancer Syndromes.
b. I would like to learn more about Hereditary Cancer Syndromes. c. Overall, this activity was satisfactorily free from commercial bias.
YES
If you are faxing this form, fax to NPWH at (202) 543-9858.
NO