Saturday, February 24, 2007 7:45 AM - 5:30 PM	Sunday, February 25, 2007 7:45 AM - 12:15 PM
7:45 A.M. Welcome Kevin S. Hughes, MD, FACS	7:45 A.M. Welcome Constance A. Roche, MSN, APRN, BC
8:00 A.M. Principles of Cancer Genetics David M. Euhus, MD An overview of genetics and cancer development. Types of genes and mutations that contribute to cancer development on germline and somatic cells will be discussed.	8:00 A.M. Chemoprevention: Prevention and Management for the Unaffected Carrier or Unaffected Suspected Carrier Victor G. Vogel, MD, MHS, FACP When a woman has, or is suspected of having, a BRCA1/2 mutation, how do we change her management to prevent cancer, or find it at an earlier, more treatable stage? What interventions work, which ones have promise, and what is on the horizon? If we identify more high risk women, we need guidelines on how to impact their health. Various issues will be addressed.
8:30 A.M. Cancer Risk Counseling: Who Will Do It? Constance A. Roche, MSN, APRN, BC Increased interest in BRCA testing has led to greater need for qualified cancer risk counseling services. Who can provide these services? What is the role of the risk assessment clinic?
9:00 A.M. The Essence of the Counseling Visit Jennifer Scalia, MS This session will outline essential components of counseling for hereditary cancer and describe the process from scheduling, information gathering, risk assessment, approaches to education, counseling and assistance with decision-making.	8:30 A.M. Management for the Carrier or Suspected Carrier with Cancer Bruce G. Haffty, MD Management of early stage breast cancer in the genetically predisposed patient remains challenging. This lecture will focus on the available literature evaluating management of breast cancer in familial breast cancer patients and those with BRCA1 and BRCA2 mutations. Controversies regarding breast conserving therapy in these patients will be discussed.
9:30 A.M. From the Test Tube to the Report: What Happens at the Lab Eric Rosenthal, PhD, ScM, LGC Genetic testing from the laboratory side. This session will outline the process of genetic testing and help sort out the meaning of deleterious mutations, variants, polymorphisms, rearrangements, BART, and more.	9:00 A.M. Pathologic Features and Tumor Markers of BRCA 1 and BRCA 2 Cancers: Effects on Adjuvant and Neoadjuvant Therapy Debu Tripathy, MD Inherited predisposition to breast cancer can occur with a strong penetrance in 5-10% of cases, with mutations in the BRCA 1 and 2 genes representing a majority of such germline genetic alterations. Specific phenotypic characteristics are associate with specific biomarkers, with BRCA-1 tumor being typically negative for hormone receptors and HER2 oncogene amplification where as BRCA-2-related breast cancers are usually hormone receptor-positive. Thus, tamoxifen prevention may be effective for prevention in BRCA-2 mutation carriers. BRCA-1-related tumors appear to have gene expression patters similar to that of the basal layer of breast epithelial cells, hence given the term “basal” phenotype, which is characterized by negative hormonal and HER receptor and other specific protein expression patterns. At the current time, adjuvant therapy recommendations are not specific to BRCA status, but rather follow the established guidelines for therapy based on stage and standard biomarkers including hormone receptors and HER2 gene status. Surgical therapy needs to reflect the risk of ipsilateral recurrence as well as new primary breast cancer risk.
10: 00 A.M. Break
10:30 A.M. Lessons Learned: From Beta Testing to Home Amy Tranin, RN, ARNP, MS, AOCN BRCA testing began in the early 90’s. Over the past several years, there has been increased use of BRCA testing to guide risk management decisions. The speaker will describe the evolution of BRCA testing, lessons learned since the cloning of the BRCA genes, review current practice trends and provide case examples.
11:00 A.M. The Risk Clinic Network: Linking Multiple Sites, While Financing the Effort Jeffery Weitzel, MD Risk assessment clinics bring the expertise needed for the assessment and management of high risk women into a single visit. This lecture will discribe the organization of a risk clinic and the extension to a multi state network of clinics. Economies of scale and the effort needed to cousel large numbers of patients will be addressed, as well as the financial aspects of the network.	9:30 A.M. If We Do Change Management, What is the Effect on Public Health? Victor G. Vogel, MD, MHS, FACP This session will address the population level impact of identifying high risk women and the impact of chemoprevention, prophylactic surgery, MRI and other measures. How can we affect cancer incidence and mortality.
	10:00 A.M. Break
11:30 A.M. Office Genetic Testing Susan Vosko, MD and Lani Pincus, CNM Dr. Vosko and Ms. Pincus will present their experiences with implementing a BRCA testing program in their community based, private Ob/Gyn practice. Participants will learn to identify at-risk patients, methods of counseling, testing and appropriate intervention should be a deleterious mutation be identified. The presenters will highlight the benefits of testing in a private practice setting and the need to make such testing more accessible to at-risk women. Practical aspects such as scheduling, billing and ways of marketing a testing program to other practitioners in the community to generate referrals will be addressed.	10:30 A.M. Decision Support in the Risk Clinic: Visualizations to Increase Understanding and Improve Management Decisions Kevin S. Hughes, MD, FACS There are a variety of management options available for the carrier or suspected carrier. Each of these options has risks and benefits that are modified by the age, menopausal and health status of the individual. How do we determine the appropriate management options for the individual, taking into account all confounding factors? The use of computer decision support and intuitive visualization will be discussed.
12:00 NOON Lunch Laurie Stein This speaker will recount her experience with hereditary breast and ovarian cancer.	11:00 A.M. Concurrent Breakout Sessions
1:00 P.M. What are the Known Genes Contributing to Heritable Breast Cancer and How do They Work? David M. Euhus, MD Multiple genes are known to be involved in cancer development when mutated at the germine level. The genes involved, their function at the cellular level will be described.	Practical Aspects of the Risk Clinic Visit Jennifer Scalia, MS In this workshop, the clinic visit will be dissected and discussed. Practical tips for taking a family history, identifying relevant information, and dealing with difficult issues that arise will be reviewed.
1:30 P.M. BRCA1 and 2: What do we Know, What do we Need to Learn? Impact of Environmental and Hormonal Factors Jeffrey Weitzel, MD Not every woman with a BRCA1 or BRCA2 mutation develops breast and ovarian cancer. What are the environmental and hormonal factors that impact on penetrance, and can we take advantage of this information to increase our success in cancer prevention?	Challenging Cases in Cancer Risk Counceling Amy Tranin, RN, ARNP, MS, AOCN Challenging cases will be presented with discussion about how they were addressed. Participants will have the opportunity to ask about their own cases and issues.
2:00 P.M. in Special Populations: Differences by Race, Ethnicity and National Origin Bruce G. Haffty, MD BRCA1 and BRCA2 testing has provided insights into the epidemiology of breast cancer and differences breast cancers developing in various ethnic groups and geographic populations. This lecture will focus on differences in the frequency and spectrum of BRCA1 and BRCA2 mutations in various ethnic populations, including Caucasian, African American and Asian populations.	Data: How Do you Record it, How Do you Avoid Problems, How Do you Use it, How Do you Share it? Greorges Grinstein, PhD The speakers will describe how to anticipate well-designed data collection, access and sharing. They will focus on their approach to providing different levels of data collection based on user response. They will provide examples of some key advantages and disadvantages of tablet data collection and how they have extended these systems to provide good use of tablet-based systems. They will also discuss data exchange via HL7 and provide various software examples (e.g. Progeny and CAGENE ).
2:30 P.M. Disclosure of Results from Genetic Research Studies: Ethical, Legal and Social Challenges in the New Millennium Lynn Dressler, DrPH, MA Disclosure of research results from genetic clinical research studies raises a variety of important ethical, legal and social issues. Although it has been customary to disclose aggregate data in clinical research studies, the disclosure of individual results has usually been limited to protocols which require such information for eligibility or randomization. On rare occasions, individual results have been disclosed to the research subject, their family and their treating physician. As we perform more genetic studies, both pharmacogenetic and disease development studies, where large segments of an individual’s genome are evaluated, we will increasingly obtain information that is incidental to the scope of the research study, yet may have significant clinical relevance for the research subject and their family. What are the conditions, if any, that would compel disclosure of results obtained in the research setting? What if our original intent was not to disclose information or the research subject had indicated “no re-contact” on the consent document? This session will address relevant regulatory guidance as well as the different perspectives regarding the tension between professional boundaries and moral intuition.	Ask the Expert: How Do you Use the Data From the First and Second Prevention Trial in Your Practice? Victor G. Vogel, MD, MHS, FACP STAR results are in. Now what? How do we distill the information and educate and advise our patients? The speaker will discuss chemoprevention in clinical practice and address the use of SERMs and what we can expect from the aromatase inhibitor trials.
	Using the Tablet PC System in Your Risk Clinic Sherwood S. Hughes, Brian Drohan, Christing Lawrence and John Sharko A software/hardware solution for identifying high risk women, and for managing a risk clinic has been developed at the Massachusetts General Hospital. This software is available free of charge to risk clinics. The speakers will demonstrate the software and describe how it is being used at various hospitals around the country. Its utility for patient care and research will be discussed.
3:00 P.M. Break	12:15 P.M. Adjourn
3:30 P.M. Other Cancers, Other Carriers: How Do We Manage Them? Eric Rosenthal, PhD, ScM, LGC BRCA1 and BRCA2 mutations are associated with other cancers besides breast and ovarian cancers. What is the level of evidence for these associations, how high is the risk, and how do we screen patients for these cancers? How do we manage and screen male carriers?
4:00 P.M. Helping Internists Identify and Refer More High Risk Women Louise Acheson, MD, MS Identification of carriers can allow changes in management that can decrease risk. However, this identification must occur before cancer develops. How do we help internists identify and refer more high risk women? How do we help high risk women identify themselves?
4:30 P.M. Caring for More Patients for High Risk Counseling: Managing Increasing Volume with Limited Resources Judy Garber, MD, MPH As more high risk women are identified, how do we manage the volume? How do we see more patients for high risk counseling? How do we take advantage of innovative ways to care for more patients without more resources, such as phone counseling, computer education, video counseling, websites, printed materials, videos, and group sessions.
5:15 P.M. Adjourn
5:30 P.M. Reception and Networking
Register early! Last year this course was full 30 days prior to the conference.