The Accuracy of BRCA1/2 Mutation Prediction Models in Different Ethnicity and Gender: Experience in a Chinese Cohort, Kwong, A., Wong, C., Suen, D., Choi, C., Wong, C., Law, F., Kurian, A. W., et al, A High Percentage of Triple Negative Tumors Present as Palpable Masses. These include guideline-specific cancer risk management recommendations for patients and their families, such as screening with breast magnetic resonance imaging and risk-reducing surgeries, which have the potential to reduce substantially the morbidity and mortality associated with a hereditary cancer predisposition. Challenges remain for the broad adoption of panel tests, some of which will be addressed by the accumulation of large public databases of annotated clinical variants. It was validated on manually annotated data from 224 patients with recurrence and achieved 0.94 AUROC. We analyzed the care of patients with breast cancer and mapped Common Procedural Terminology (CPT) codes to the corresponding cost conversion factor and date in the CMS Medicare fee schedule. Kwan, M. L., John, E. M., Caan, B. J., Lee, V. S., Bernstein, L., Cheng, I., Gomez, S. L., Henderson, B. E., Keegan, T. H., Kurian, A. W., Lu, Y., Monroe, K. R., Roh, J. M., Shariff-Marco, S., Sposto, R., Vigen, C., Wu, A. H. The California Breast Cancer Survivorship Consortium (CBCSC): prognostic factors associated with racial/ethnic differences in breast cancer survival. Our objective was to characterize trends in annual surveillance mammography participation among women with a personal history of breast cancer over a 13-year period.We examined annual surveillance mammography participation from 2004 to 2016 in a nationwide sample of commercially insured women with prior breast cancer. We report a significant ethnic disparity in HER2-positive breast cancer in a large population-based cohort enriched for Asian-Americans. Use, attitudes, and perceptions of tumor genomic testing: Survey of TAPUR physicians. Moderate-to-high risks for pancreatic (OR 4.21; 95% CI 3.24-5.47), prostate (OR 2.58; 95% CI 1.93-3.44), gastric (OR 2.97; 95% CI 1.66-5.31) and invasive ductal breast (OR 2.03; 95% CI 1.89-2.19) cancers were estimated for ATM PV carriers. Women with BRCA1 or BRCA2 (BRCA1/2) mutations must choose between prophylactic surgeries and screening to manage their high risks of breast and ovarian cancer, comparing options in terms of cancer incidence, survival, and quality of life. Two widely used models, BRCAPRO and BOADICEA, were developed using data from non-Hispanic Whites (NHW), but their accuracies have not been evaluated in other racial/ethnic populations.We evaluated the BRCAPRO and BOADICEA models in a population-based series of African American, Hispanic, and NHW breast cancer patients tested for BRCA1 and BRCA2 mutations. The long-term goal is to enhance standard clinicopathologic measures of low- versus high-risk DCIS and to enable risk-appropriate treatment.We studied three common chromosomal copy number alterations (CNA) in IBC and designed fluorescence in situ hybridization-based assay to measure copy number at these loci in DCIS samples. Multivariate models evaluated correlates of missing work for >1 month and stopping work altogether versus missing work for 1 month.In this diverse sample, most patients (62%) underwent lumpectomy; 16% underwent unilateral mastectomy (8% with reconstruction); and 23% underwent bilateral mastectomy (19% with reconstruction). Extended aromatase inhibitor therapy in women 50-79had small absolute benefits and gains were offset by adverse events (loss of 0.06 discounted QALYs). Rates of patient portal messaging did not differ between English-speaking and LEP groups on multivariable analysis; however, patients with LEP were less likely to have a portal account (adjusted OR, 0.89; 95% CI, 0.83 to 0.96). View details for DOI 10.1080/13691058.2014.939227, View details for Web of Science ID 000342208800012. Antimicrobial exposure during curative-intent treatment of triple-negative breast cancer (TNBC) may lead to gut microbiome dysbiosis, decreased circulating and tumor-infiltrating lymphocytes, and inferior outcomes. Katz, S. J., Tocco, R., Hawley, S. T., An, L., Hodan, R., Ward, K. C., Kurian, A. W. Association of germline genetic testing results with chemotherapy regimens received by women with early-stage breast cancer. E-cadherin (CDH1) truncating mutations have been shown to be present in approximately 30% of families with hereditary diffuse gastric cancer (HDGC) and are associated with a significantly increased risk of gastric cancer and lobular breast cancer.Individuals from a large kindred with HDGC who were identified to have a CDH1 mutation prospectively underwent comprehensive screening with stool occult blood testing, standard upper gastrointestinal endoscopy with random gastric biopsies, high-magnification endoscopy with random gastric biopsies, endoscopic ultrasonography, CT, and PET scans to evaluate the stomach for occult cancer. Factors associated with reporting higher toxicity severity included receipt of chemotherapy (odds ratio [OR], 2.2; 95% confidence interval [95% CI], 2.0-2.5), receipt of both chemotherapy and radiotherapy (OR, 1.3; 95% CI, 1.0-1.7), and Latina ethnicity (OR vs whites: 1.3; 95% CI, 1.1-1.5). the G2/M phase in tumor cell lines, and potentiates the cell cycle effects of DNA damaging Model input parameters were derived from meta-analyses, clinical trials, and large observational data. Agrawal, A., Benedict, C., Nouriani, B., Medina, J., Kurian, A. W., Spiegel, D. Insights From a Temporal Assessment of Increases in US Private Payer Coverage of Tumor Sequencing From 2015 to 2019. In the discovery cohort, imaging subtypes stratified patients with significantly different 5-year RFS rates of 79.6%, 65.2%, 52.5% (logrank P=0.025), and remained as an independent predictor after adjusting for clinicopathological factors (hazard ratio=2.79, P=0.016). Receipt of initial care in ACS program hospitals varied by race/ethnicity-highest among non-Latina White patients (45%), and lowest among African Americans (21%). expression profile in tumor samples. Li-Fraumeni syndrome is a highly penetrant cancer syndrome associated with a high lifetime risk for cancer, including soft tissue sarcomas, osteosarcomas, premenopausal breast cancer, colon cancer, gastric cancer, adrenocortical carcinoma, and brain tumors. The state of two of the three copy number gains in DCIS was associated with a risk of IBC that was 9.07 times that of no copy number gains, and the presence of gains at all three genomic loci in DCIS was associated with a more than 17-fold risk (P = 0.0013).CNAs have the potential to improve the identification of high-risk DCIS, defined by presence of concurrent IBC. There was no evidence that the BMI or weight associations differed by underlying familial risk (P>0.2). Use of other lipid-lowering medications was also associated with increased cancer survival (P-interaction (int)=0.57). [4] In March 2008, she was appointed an assistant professor of medicine and health research and policy at Stanford University. For more information, please contact Janet Pan, 650-723-0628. Detection of mutations has implications for targeted screening and prevention strategies for probands, and for genetic counseling and testing of their family members. Ho, P. J., Khng, A. J., Tan, B. K., Tan, E. Y., Tan, S. M., Tan, V. K., Lim, G. H., Aronson, K. J., Chan, T. L., Choi, J. Y., Dennis, J., Ho, W. K., Hou, M. F., Ito, H., Iwasaki, M., John, E. M., Kang, D., Kim, S. W., Kurian, A. W., Kwong, A., Lophatananon, A., Matsuo, K., Mohd-Taib, N. A., Muir, K., Murphy, R. A., Park, S. K., Shen, C. Y., Shu, X. O., Teo, S. H., Wang, Q., Yamaji, T., Zheng, W., Bolla, M. K., Dunning, A. M., Easton, D. F., Pharoah, P. D., Hartman, M., Li, J. Genome-wide and transcriptome-wide association studies of mammographic density phenotypes reveal novel loci. Results One image feature measuring heterogeneity (ie, information measure of correlation) was significantly associated with prognosis (false-discovery rate < 0.1), and at a cutoff of 0.57 stratified patients into two groups with different recurrence-free survival rates (log-rank P = .024). Results did not vary by diagnosis year.Among patients with high genetic risk, clinicians' recommendations, potential treatment implications, and protections against discrimination were motivating factors to undergo genetic testing, but fewer than half recalled clinicians providing all this information, and this did not improve over time. Patients who had genetic counseling were twice as likely to recall clinicians informing them about all queried topics. Future work should explore reasons behind the high levels of sexual dysfunction and unmet needs in female survivors.It is important to routinely screen for sexual health concerns among female cancer survivors at all phases of the cancer trajectory including years posttreatment. Afghahi, A., Mathur, M., Thompson, C. A., Mitani, A., Rigdon, J., Desai, M., Yu, P. P., de Bruin, M. A., Seto, T., Olson, C., Kenkare, P., Gomez, S. L., Das, A. K., Luft, H. S., Sledge, G. W., Sing, A. P., Kurian, A. W. Yield of multiplex panel testing compared to expert opinion and validated prediction models. We identified 31 potential novel loci with the lead variant showing an association with breast cancer risk at P, View details for DOI 10.1038/s41467-020-15046-w, View details for PubMedCentralID PMC7057957. Kurian, A. W., Canchola, A. J., Ma, C. S., Clarke, C. A., Gomez, S. L. Natural Language Processing Approaches to Detect the Timeline of Metastatic Recurrence of Breast Cancer. Clinician estimates of systemic recurrence risk were provided for patient sub-groups with DCIS and with low-, intermediate-, and high-risk invasive disease. We undertook the current analysis to determine population-based distributions of breast cancer subtypes among six ethnic Asian groups in California. Eckhert, E. n., Laniakea, B. n., Kurian, A. W. NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 1.2020. He played a key role in bringing Oracle 9i application server to market. Few studies have examined the ways in which physicians use the RS to recommend adjuvant systemic chemotherapy or patients' experiences with testing and decision making.This study surveyed 3880 women treated for breast cancer in 2013-2014; they were identified from the Los Angeles County and Georgia Surveillance, Epidemiology, and End Results registries (response rate, 71%). Each asymptomatic patient did well postoperatively, and no patient has recurred. Adopters were less likely to be BlueCross BlueShield members (P < .05) and more likely to use a third-party policy (P < .001). Most had Stage 4 disease (n=80; 25.6%). Performance of mutation risk prediction models in a racially diverse multi-gene panel testing cohort. The safety of single-agent nab-paclitaxel has been Kwong, A., Ng, E. K., Law, F. B., Wong, H. N., Wa, A., Wong, C. L., Kurian, A. W., West, D. W., Ford, J. M., Ma, E. S. Genetic Polymorphisms as Predictors of Breast Cancer Risk, Identification of BRCA1/2 Founder Mutations in Southern Chinese Breast Cancer Patients Using Gene Sequencing and High Resolution DNA Melting Analysis. ATM PVs are associated with multiple cancer risks and, while professional society guidelines support that carriers are eligible for increased breast and pancreatic cancer screening, increased screening for prostate and gastric cancer may also be warranted. A., Giles, G. G., Grip, M., Gunel, P., Gndert, M., Hahnen, E., Haiman, C. A., Hkansson, N., Hall, P., Hamann, U., Hart, S. N., Hartikainen, J. M., Hartmann, A., He, W., Hooning, M. J., Hoppe, R., Hopper, J. L., Howell, A., Hunter, D. J., Jager, A., Jakubowska, A., Janni, W., John, E. M., Jung, A. Y., Kaaks, R., Keupers, M., Kitahara, C. M., Koutros, S., Kraft, P., Kristensen, V. N., Kurian, A. W., Lacey, J. V., Lambrechts, D., Le Marchand, L., Lindblom, A., Linet, M., Luben, R. N., Lubiski, J., Lush, M., Mannermaa, A., Manoochehri, M., Margolin, S., Martens, J. W., Martinez, M. E., Mavroudis, D., Michailidou, K., Milne, R. L., Mulligan, A. M., Muranen, T. A., Nevanlinna, H., Newman, W. G., Nielsen, S. F., Nordestgaard, B. G., Olshan, A. F., Olsson, H., Orr, N., Park-Simon, T. W., Patel, A. V., Peissel, B., Peterlongo, P., Plaseska-Karanfilska, D., Prajzendanc, K., Prentice, R., Presneau, N., Rack, B., Rennert, G., Rennert, H. S., Rhenius, V., Romero, A., Roylance, R., Ruebner, M., Saloustros, E., Sawyer, E. J., Schmutzler, R. K., Schneeweiss, A., Scott, C., Shah, M., Smichkoska, S., Southey, M. C., Stone, J., Surowy, H., Swerdlow, A. J., Tamimi, R. M., Tapper, W. J., Teras, L. R., Terry, M. B., Tollenaar, R. A., Tomlinson, I., Troester, M. A., Truong, T., Vachon, C. M., Wang, Q., Hurson, A. N., Winqvist, R., Wolk, A., Ziogas, A., Brauch, H., Garca-Closas, M., Pharoah, P. D., Easton, D. F., Chenevix-Trench, G., Schmidt, M. K. Recreational Physical Activity and Outcomes After Breast Cancer in Women at High Familial Risk. View details for DOI 10.1093/jnci/djab151. Gonzales, F. A., Sangaramoorthy, M. n., Dwyer, L. A., Shariff-Marco, S. n., Allen, A. M., Kurian, A. W., Yang, J. n., Langer, M. M., Allen, L. n., Reeve, B. BC-specific mortality was higher among African American women with at least some college education (HR 1.42, CI 1.11-1.82) compared to NHW women with similar education. Oncologists explained 17% of the variation in RS testing but little of the variation in chemotherapy receipt (3%) controlling for clinical factors. Google Cloud CEO Thomas Kurian says large-scale organizational changes and investments over the past year are paying off in the sales trenches for the No. We searched key electronic databases to identify studies evaluating hereditary cancer cascade testing. Enrolled patients underwent biannual clinical breast examinations and annual mammography, breast MRI, and DL.Forty-one women underwent an initial screen. Compared with cisgender heterosexual patients, those from SGM groups experienced a delay in time from symptom onset to diagnosis (median time to diagnosis, 34 vs 64 days; multivariable adjusted hazard ratio, 0.65; 95% CI, 0.42-0.99; P=.04), were more likely to decline an oncologist-recommended treatment modality (35 [38%] vs 18 [20%]; multivariable adjusted odds ratio, 2.27; 95% CI, 1.09-4.74; P=.03), and were more likely to experience a breast cancer recurrence (multivariable adjusted hazard ratio, 3.07; 95% CI, 1.56-6.03; P=.001).This study found that among patients with breast cancer, those from SGM groups experienced delayed diagnosis, with faster recurrence at a 3-fold higher rate compared with cisgender heterosexual patients. Automatic Inference of BI-RADS Final Assessment Categories from Narrative Mammography Report Findings. This study is aimed to determine the tolerability of the PF-03084014 plus docetaxel However, there are few data to guide screening regimens for these women.To estimate the benefits and harms of breast cancer screening strategies using mammography and MRI at various start ages for women with ATM, CHEK2, and PALB2 pathogenic variants.This comparative modeling analysis used 2 established breast cancer microsimulation models from the Cancer Intervention and Surveillance Modeling Network (CISNET) to evaluate different screening strategies. hope to learn more about how this type of genetic test is used clinically. Sposto, R., Keegan, T. H., Vigen, C., Kwan, M. L., Bernstein, L., John, E. M., Cheng, I., Yang, J., Koo, J., Kurian, A. W., Caan, B. J., Lu, Y., Monroe, K. R., Shariff-Marco, S., Gomez, S. L., Wu, A. H. Statin use and all-cancer survival: prospective results from the Women's Health Initiative. Mean age was 34 years; 66% were BRCA1 mutation carriers and 34% were BRCA2 mutation carriers. To test for the association with breast cancer risk, we carried out follow-up genotyping in 90,916 cases and 89,893 controls from the Breast Cancer Association Consortium. Among these and an additional 23 mutation-positive individuals enrolled from our clinics, most of the mutations (92%) were consistent with the spectrum of cancer(s) observed in the patient or family, suggesting that these results are clinically significant. Charges, claims, and reimbursements are related to cost but are nontransparent and proprietary. The goal of this study was to determine the effect on overall survival and progression free Overall, 1301 (43.9%) patients considered CPM (601 [24.8%] considered it very strongly or strongly); only 395 (38.1%) of them knew that CPM does not improve survival for all women with breast cancer. Kurian, A. W., Bernhisel, R. n., Larson, K. n., Caswell-Jin, J. L., Shadyab, A. H., Ochs-Balcom, H. n., Stefanick, M. L. Genetic Testing and Results in a Population-Based Cohort of Breast Cancer Patients and Ovarian Cancer Patients. is to compare efficacy and safety of a treatment with exemestane + everolimus to exemestane + Copy number alterations in chromosome 1q32, 8q24, and 11q13 were analyzed using fluorescence in situ hybridization (FISH). In 4.5% of BRCA-negative cases, we uncovered pathogenic variants in other genes, which appear clinically relevant. Parikh, D. A., Dickerson, J. C., Kurian, A. W. Combined associations of a polygenic risk score and classical risk factors with breast cancer risk. In 1996, the brothers switched companies when George was hired by McKinsey, and Thomas, by Oracle [7]. A local relapse biopsy four months later revealed the identical reversion mutation, and the patient subsequently died of metastatic breast cancer.We report a BRCA1 reversion mutation in a newly diagnosed triple-negative breast cancer patient that developed over 18 weeks of platinum-based neoadjuvant therapy. Ghataorhe, P., Kurian, A. W., Pickart, A., Trapane, P., Norton, J. On multivariable analysis with conventional clinicopathologic features, the copy number gains were significantly associated with concurrent IBC. Gallagher, S., Hughes, E., Kurian, A. W., Domchek, S. M., Garber, J., Probst, B., Morris, B., Tshiaba, P., Rosenthal, E., Roa, B., Wagner, S., Gutin, A., Weitzel, J. N., Lanchbury, J., Robson, M. E. Development and validation of natural language processing (NLP) algorithm for detection of distant versus local breast cancer recurrence and metastatic site. Among 146326 participants with median 14.6 follow-up years, 23067 incident cancers and 3152 cancer deaths were observed. Rates were stable from 2004 to 2009 (APC, 0.1%; 95% CI, -0.5% to 0.8%) but declined 1.5% annually from 2009 to 2016 (95% CI, -1.9% to -1.1%). No BMI-mortality associations were apparent in African Americans and Asian Americans. Katz, S., Friese, C., Li, Y., Deapen, D., Hamilton, A., Ward, K., Kurian, A. W. Higher peripheral lymphocyte count to predict survival in triple-negative breast cancer. To guide decisions informed by multiple health outcomes, we provide an online tool for joint use by patients with their physicians (http://brcatool.stanford.edu). In a multivariable model adjusted for age and subtype, there was no interaction between family history extent and PV prevalence for any gene except PALB2 (P = .037).Extent of family cancer history is not differentially associated with PVs across established breast cancer susceptibility genes and cannot be used to personalize genes selected for testing. Thirty-nine percent (95% CI, 36% to 41%) recalled hearing from a clinician that genetic discrimination is illegal. Multivariable logistic regression models accounting for family history were used to examine the association between pathogenic mutations and breast or ovarian cancer. Methods: We conducted semi-structured interviews with 11 major US payers, covering >160 million lives. Fifty Asian women and forty-nine white American women were enrolled. Alison Wagonfeld. View details for Web of Science ID 000618737701065, View details for Web of Science ID 000618737701241, View details for Web of Science ID 000618737700112, View details for Web of Science ID 000618737700120, View details for Web of Science ID 000618737700114. This review aims to summarize recent research on the relationship between statin use and cancer outcomes, in the context of clinical guidelines for statin use in patients with cancer or who are at high risk for cancer.A growing body of research has investigated the relationship between statins and cancer with mixed results. Ghanouni, P., Kurian, A. W., Margolis, D., Hartman, A., Mills, M. A., Plevritis, S. K., Ford, J. M., Daniel, B. L. BRCA1/2 mutations and cancer risk in Asian-Americans, Kurian, A. W., Chun, N. M., Mills, M. A., et al, A phase II breast cancer chemoprevention study of lovastatin in high-risk women: Initial feasibility data, Kurian, A. W., Sharma, V. B., Schwartz, E. J., et al, The role of BRCA1 in DNA repair and chemosensitivity. Early user testing demonstrated ease of use and app feasibility.TOGETHERCare, a novel mobile app, was developed with user input to track the care partner's health and report on survivor symptoms during home care. Hafeez Bhatti. We identified 1886 MBC patients, 512 (27.1%) of whom were de novo MBC patients and 1374 (72.9%) were recurrent MBC patients. Yang, Y. n., Shu, X. n., Shu, X. O., Bolla, M. K., Kweon, S. S., Cai, Q. n., Michailidou, K. n., Wang, Q. n., Dennis, J. n., Park, B. n., Matsuo, K. n., Kwong, A. n., Park, S. K., Wu, A. H., Teo, S. H., Iwasaki, M. n., Choi, J. Y., Li, J. n., Hartman, M. n., Shen, C. Y., Muir, K. n., Lophatananon, A. n., Li, B. n., Wen, W. n., Gao, Y. T., Xiang, Y. Katz, S. J., Bondarenko, I. n., Ward, K. C., Hamilton, A. S., Morrow, M. n., Kurian, A. W., Hofer, T. P. Common Model Inputs Used in CISNET Collaborative Breast Cancer Modeling. We used data from the Breast Cancer Association Consortium (BCAC) including 1062 women of European ancestry with metastatic breast cancer, 606 of whom died of breast cancer. View details for DOI 10.1200/JCO.20.02785. George Kurian was appointed CEO of $5.5 billion storage company NetApp about a year ago after a fast, meteoric rise at the company. Genomic landscape of ductal carcinoma in situ and association with progression. Clinical guidelines often use predicted lifetime risk from birth to define criteria for making decisions regarding breast cancer screening rather than thresholds based on absolute 5-year risk from current age.We used the Prospective Family Cohort Study of 14,657 women without breast cancer at baseline in which, during a median follow-up of 10years, 482 women were diagnosed with invasive breast cancer. Goodness-of-fit tests showed that the MA-PRS was well calibrated and predicted BC risk accurately in the tails of the distribution for both European and non-European women.The MA-PRS uses genetic ancestral composition to expand the utility of polygenic risk prediction to non-European women. Nevertheless, breast cancer mortality rates will be higher for women with higher PRS313 as increasing PRS313 is associated with an increased risk of disease. Previously unseen variants requiring interpretation accumulated rapidly, even after 1000 individuals had been tested. Ordered immune structures along the tumor-immune border were associated with compartmentalization and linked to survival. We estimate the impact of different risk-reducing options at various ages on life expectancy.We apply our previously developed Monte Carlo simulation model of screening and prophylactic surgery in BRCA1/2 mutation carriers. We analyzed data using descriptive statistics, chi2 and t tests.RESULTS: Three hundred twelve people with cancer participated and represented 38 states. View details for DOI 10.1200/CCI.19.00034. In silico analysis suggested a potential regulatory effect of the variants on the nearby target genes SDE2 and H3F3A. Tao, L., Gomez, S. L., Keegan, T. H., Kurian, A. W., Clarke, C. A. View details for PubMedID 31200352, View details for DOI 10.6004/jnccn.2018.7266, View details for Web of Science ID 000451115900020, View details for DOI 10.1001/jamaoncol.2018.4959, View details for Web of Science ID 000453212800036, View details for DOI 10.1158/1055-9965.EPI-17-1129, View details for Web of Science ID 000448896500013. Guidance is needed on managing patients with discrepant variants to support accurate risk assessment. However, significant controversy remains as to the timing, causes, generalizability, and longevity of this reported decline in incidence. However, each patient (6 of 6, 100%) was found to have multiple foci of T1 invasive diffuse gastric adenocarcinoma (pure signet-ring cell type). View details for Web of Science ID 000341349900011, View details for Web of Science ID 000336894600041, View details for Web of Science ID 000358613202339, View details for DOI 10.1200/jco.2014.32.15_suppl.6580, View details for Web of Science ID 000358613203765. Meta-analyses were conducted to combine the results from these two datasets.Of those 228 variants, an association was observed for 12 variants in 10 genes at a Bonferroni-corrected threshold of P, View details for DOI 10.1016/j.ebiom.2019.09.006, This study assessed uptake of the Oncotype DX 21-gene assay over time and characterized which sociodemographic and clinical factors are associated with test uptake among women with lymph node-positive (LN+), hormone receptor-positive, HER2-negative breast cancer.Invasive breast cancer cases diagnosed in 2010 through 2013 were included from a SEER database linked to 21-gene assay results performed at Genomic Health's Clinical Laboratory. Multivariable logistic regression analysis was performed to describe associations of CNAs with these two groups of DCIS.We examined 271 patients with DCIS (120 that did not develop IBC and 151 with concurrent IBC) for the presence of 1q, 8q24 and 11q13 copy number gains. - Cohort 2) Subjects who have received > 2 prior chemotherapy regimens for metastatic adjuvant chemotherapy. epithelial ovarian cancer. Our final MBC classifier achieved an area under the receiver operating characteristic curve (AUC) of 0.917, with sensitivity 0.861, specificity 0.878, and accuracy 0.870.To enable population-based research on MBC, we developed a framework for retrospective case detection combining EMR and CCR data. In 4.5 % of BRCA-negative cases, we uncovered pathogenic variants in genes... With conventional clinicopathologic features, the copy number gains were offset by events. Brca1 mutation carriers by adverse events ( loss of 0.06 discounted QALYs ) and gains were offset by adverse (. 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