Limited Independent Follow-Up with Germline Testing of Variants Detected in BRCA1 and BRCA2 by Tumor-Only Sequencing.

Introduction: Genomic profiling is performed in patients with advanced or metastatic cancer, in order to direct cancer treatment, often sequencing tumor-only, without a matched germline comparator. However, because many of the genes analyzed on tumor profiling overlap with those known to be associated with hereditary cancer predisposition syndromes (HCPS), tumor-only profiling can unknowingly uncover germline pathogenic (P) and likely pathogenic variants (LPV). In this study, we evaluated the number of patients with P/LPVs identified in BRCA1 and BRCA2 (BRCA1/2) via tumor-only profiling, then determined the germline testing outcomes for those patients. Methods: A retrospective chart review was performed to identify patients with BRCA1/2 variants on tumor-only genomic profiling, and whether they had germline testing. Results: This study found that of 2923 patients with 36 tumor types who underwent tumor-only testing, 554 had a variant in BRCA1/2 (19.0%); 119 of the 554 patients (21.5%) had a P/LP BRCA1/2 variant, representing 4.1% of the overall population who underwent genomic profiling. Seventy-three (61.3%) of 119 patients with BRCA1/2 P/LPV on tumor-only testing did not undergo germline testing, 34 (28.6%) had already had germline testing before tumor-only testing, and 12 (10.1%) underwent germline testing after tumor-only testing. Twenty-eight germline BRCA1/2 P/LPVs were detected, 24 in those who had prior germline testing, and 4 among the 12 patients who had germline testing after tumor-only testing. Conclusion: Tumor-only testing is likely to identify P/LPVs in BRCA1/2. Efforts to improve follow-up germline testing is needed to improve identification of germline BRCA1/2 alterations.

Multiple social and environmental factors affect wildland fire response of full or less-than-full suppression.

Wildland fire incident commanders make wildfire response decisions within an increasingly complex socio-environmental context. Threats to human safety and property, along with public pressures and agency cultures, often lead commanders to emphasize full suppression. However, commanders may use less-than-full suppression to enhance responder safety, reduce firefighting costs, and encourage beneficial effects of fire. This study asks: what management, socioeconomic, environmental, and fire behavior characteristics are associated with full suppression and the less-than-full suppression methods of point-zone protection, confinement/containment, and maintain/monitor? We analyzed incident report data from 374 wildfires in the United States northern Rocky Mountains between 2008 and 2013. Regression models showed that full suppression was most strongly associated with higher housing density and earlier dates in the calendar year, along with non-federal land jurisdiction, regional and national incident management teams, human-caused ignitions, low fire-growth potential, and greater fire size. Interviews with commanders provided decision-making context for these regression results. Future efforts to encourage less-than-full suppression should address the complex management context, in addition to the biophysical context, of fire response.