Clinical Characterization and Risk Profile of Individuals Seeking Genetic Counseling for Hereditary Breast Cancer in Brazil

Hereditary breast cancer (HBC) accounts for 5–10% of breast cancer cases and it significantly increases the lifetime risk of cancer. Our objective was to evaluate the sociodemographic variables, family history of cancer, breast cancer (BC) screening practices and the risk profile of cancer affected or asymptomatic at-risk women that undergo genetic counseling for hereditary breast cancer in public Brazilian cancer genetics services. Estimated lifetime risk of BC was calculated for asymptomatic women using the Gail and Claus models. The majority of women showed a moderate lifetime risk of developing BC, with an average risk of 19.7% and 19.9% by the Gail and Claus models, respectively. The average prior probability of carrying a BRCA1/2 gene mutation was 16.7% and overall only 32% fulfilled criteria for a hereditary breast cancer syndrome as assessed by family history. We conclude that a significant number of individuals at high-risk for HBC syndromes may not have access to the benefits of cancer genetic counseling in these centers. Contributing factors may include insufficient training of healthcare professionals, disinformation of cancer patients; difficult access to genetic testing and/or resistance in seeking such services. The identification and understanding of these barriers is essential to develop specific strategies to effectively achieve cancer risk reduction in this and other countries were clinical cancer genetics is not yet fully established.     

Toward neuroanatomical models of analogy: a positron emission tomography study of analogical mapping

Several brain regions associated with analogical mapping were identified using (15)O-positron emission tomography with 12 normal, high intelligence adults. Each trial presented during scanning consisted of a source picture of colored geometric shapes, a brief delay, and a target picture of colored geometric shapes. Analogous pictures did not share similar geometric shapes but did share the same system of abstract visuospatial relations. Participants judged whether each source-target pairing was analogous (analogy condition) or identical (literal condition). The results of the analogy-literal comparison showed activation in the dorsomedial frontal cortex and in the left hemisphere; the inferior, middle, and medial frontal cortices; the parietal cortex; and the superior occipital cortex. Based on these results as well as evidence from relevant cognitive neuroscience studies of reasoning and of executive working memory, we hypothesize that analogical mapping is mediated by the left prefrontal and inferior parietal cortices.     

The Benefits of Stepping Into Others' Shoes: Perspective Taking Strengthens Transactive Memory

Perspective taking is an important requirement for effective communication. Teams working on knowledge-intensive tasks should benefit particularly. In a laboratory study, we examined whether perspective taking (vs. egocentrism) facilitated transactive memory when team members' knowledge was either different or similar. Perspective taking led teams to form more accurate transactive memory and agree more regarding each other's knowledge assessments. Corresponding effects were found when knowledge was similar. However, no interaction emerged. Our study shows that perspective taking is a cognitive state that can be induced with a short intervention and that can positively influence team-level outcomes such as transactive memory.     

The voices of the medical record

The medical record, as a managerial, historic, and legal document, serves many purposes. Although its form may be well established and many of the cases documented in it ‘routine’ in medical experience, what is written in the medical record nevertheless records decisions and actions of individuals. Viewed as an interpretive ‘text’, it can itself become the object of interpretation. This essay applies literary theory and methodology to the structure, content, and writing style(s) of an actual medical record for the purpose of exploring the relationship between the forms and language of medical discourse and the daily decisions surrounding medical treatment. The medical record is shown to document not only the absence of a consistent treatment plan for the patient studied but also a breakdown in communication between different health professionals caring for that patient. The paper raises questions about the kind of education being given to house staff in this instance. The essay concludes with a consideration of how such situations might be more generally avoided.     

Taking perspective in conversation: the role of mutual knowledge in comprehension

When people interpret language, they can reduce the ambiguity of linguistic expressions by using information about perspective: the speaker's, their own, or a shared perspective. In order to investigate the mental processes that underlie such perspective taking, we tracked people's eye movements while they were following instructions to manipulate objects. The eye fixation data in two experiments demonstrate that people do not restrict the search for referents to mutually known objects. Eye movements indicated that addressees considered objects as potential referents even when the speaker could not see those objects, requiring addressees to use mutual knowledge to correct their interpretation. Thus, people occasionally use an egocentric heuristic when they comprehend. We argue that this egocentric heuristic is successful in reducing ambiguity, though it could lead to a systematic error.