{ "@context": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/context/doc", "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133", "id": "CG-AC:AC133", "type": "ClinicalActionabilityReport", "metadata": { "schemaLabel": "AC-Sepio.Beta-1 (Unofficial)", "contentVersionId": "30620", "producedAtUTC": "Thu, 10 Sep 2026 19:38:51 -0000", "note": "DISCLAIMER: The SEPIO-inspired schema presented here is an initial prototype for Clinical Actionability curation summaries and has not been reviewed nor finalized by the ClinGen Data Exchange Modeling Team. We expect it to differ significantly from the final schema." }, "description": "JSON-LD representation of ClinGen Actionability Stage 2 report modeled with SEPIO. The hierarchically structured document will include:\n1. Contextual & topic information, such as the **conditions/diseases** and the **genes**.\n2. Categorized **evidence narratives**, with references.\n\t* This content corresponds to the texts within the *Actionability Summary Report*\n4. **Outcome & Intervention** pairs, with **consensus scoring** in 5 dimensions:\n\t1. Outcome Severity\n\t2. Outcome Likelihood\n\t3. Intervention Effectiveness\n\t4. Nature of the Intervention\n\t5. Total (Overall) Score\n\n*( Note: The summary report does not include the **Screening Survey** which led to preparation of the actionability report. )", "condition": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/co", "id": "CG-AC:AC133/co", "type": "GeneticCondition", "label": "Hereditary Breast and Ovarian Cancer" }, "outcome": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/ou/Breast%20Cancer%20%28BRCA1%29", "id": "CG-AC:AC133/ou/Breast Cancer (BRCA1)", "type": "Outcome", "label": "Breast Cancer (BRCA1)" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/ou/Ovarian%20Cancer%20%28BRCA1%29", "id": "CG-AC:AC133/ou/Ovarian Cancer (BRCA1)", "type": "Outcome", "label": "Ovarian Cancer (BRCA1)" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/ou/Breast%20Cancer%20%28BRCA2%29", "id": "CG-AC:AC133/ou/Breast Cancer (BRCA2)", "type": "Outcome", "label": "Breast Cancer (BRCA2)" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/ou/Ovarian%20Cancer%20%28BRCA2%29", "id": "CG-AC:AC133/ou/Ovarian Cancer (BRCA2)", "type": "Outcome", "label": "Ovarian Cancer (BRCA2)" } ], "intervention": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/intv/Surveillance", "id": "CG-AC:AC133/intv/Surveillance", "type": "Intervention", "label": "Surveillance" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/intv/Mastectomy", "id": "CG-AC:AC133/intv/Mastectomy", "type": "Intervention", "label": "Mastectomy" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/intv/Oophorectomy", "id": "CG-AC:AC133/intv/Oophorectomy", "type": "Intervention", "label": "Oophorectomy" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/intv/Surveillance", "id": "CG-AC:AC133/intv/Surveillance", "type": "Intervention", "label": "Surveillance" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/intv/Mastectomy", "id": "CG-AC:AC133/intv/Mastectomy", "type": "Intervention", "label": "Mastectomy" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/intv/Oophorectomy", "id": "CG-AC:AC133/intv/Oophorectomy", "type": "Intervention", "label": "Oophorectomy" } ], "clinicalActionabilityProfile": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/cap", "id": "CG-AC:AC133/cap", "type": "Assertion", "assertionMethod": "The ClinGen AWG developed a standardized protocol to generate evidence-based profiles of clinical actionability of genes and associated disorders in the form of summary reports and semiquantitative metric (SQM) scores.", "releaseDate": "Thu, 14 Aug 2025 00:00:00 -0000", "releaseNum": "1.1.7" }, "evidenceStatements": { "evidenceNarratives": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/en/ACMI2868", "id": "CG-AC:AC133/en/ACMI2868", "type": "EvidenceNarrative", "narrative": "Autosomal Dominant", "evidenceDomainTag": "Threat Materialization Chances.Modes of Inheritance" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/en/potgd", "id": "CG-AC:AC133/en/potgd", "type": "EvidenceNarrative", "narrative": "For women, lifetime risk estimates indicate that 12.3% will develop breast cancer and 2.8% will die from it, while 1.4% will develop ovarian cancer and 1% will die from it. Among these breast and ovarian cancer cases, BRCA mutations have a prevalence of 3% and 10%, respectively.", "evidenceDomainTag": "Nature of the Threat.Prevalence of the Genetic Disorder", "publication": [ "CG-AC:RF000594", "CG-AC:RF000595" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/en/nh", "id": "CG-AC:AC133/en/nh", "type": "EvidenceNarrative", "narrative": "BRCA-related breast and ovarian cancers occur at a younger age, typically prior to age 50, and breast cancers are more likely to be “triple-negative” (i.e. estrogen and progesterone receptor and HER2 negative). Compared to non-carriers with breast cancer, BRCA1 mutation carriers have significantly decreased overall survival rates both in the short- and long-term, though similar association was not detected for BRCA2 mutation carriers.", "evidenceDomainTag": "Nature of the Threat.Natural History", "publication": [ "CG-AC:RF000594", "CG-AC:RF000202" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/en/cf", "id": "CG-AC:AC133/en/cf", "type": "EvidenceNarrative", "narrative": "BRCA1 and BRCA2 mutations are associated with increased risks of breast, ovarian, fallopian tube, and primary peritoneal cancers in women. These mutations are also associated with breast cancer and, to a lesser extent, prostate cancer, in males. Both sexes may also be at an increased risk of pancreatic cancer. BRCA mutations are associated with a strong family history of breast and ovarian cancers and are found more frequently in the Ashkenazi Jewish population.", "evidenceDomainTag": "Nature of the Threat.Clinical Features", "publication": [ "CG-AC:RF000594", "CG-AC:RF000202" ] } ], "tieredEvidenceNarratives": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/ten/CDEC3140", "id": "CG-AC:AC133/ten/CDEC3140", "type": "TieredEvidenceNarrative", "evidenceSourceTier": "1", "narrative": "Current screening procedures for women of average risk are not likely to detect breast and ovarian cancer at an early enough stage to cure the disease. The age at onset of breast cancer is typically prior to age 50, before the start of typical surveillance among average risk populations. Ovarian cancer is typically metastatic when diagnosed, thus risk-reducing BSO bilateral salpingo-oophorectomy is currently the only effective strategy to reduce the risk of dying from ovarian cancer.", "evidenceDomainTag": "Condition Escape Detection.Chances to Escape Clinical Detection", "publication": [ "CG-AC:RF000594", "CG-AC:RF000203" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/ten/NOI3063", "id": "CG-AC:AC133/ten/NOI3063", "type": "TieredEvidenceNarrative", "narrative": "The interventions identified in this report include prophylactic surgery to remove target organs, invasive screening tests, and medications with potential side effects.", "evidenceDomainTag": "Acceptability of Intervention.Natures of Intervention" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/ten/ACPE4667", "id": "CG-AC:AC133/ten/ACPE4667", "type": "TieredEvidenceNarrative", "evidenceSourceTier": "1", "narrative": "Clinically significant mutations in BRCA1 are associated with a 46-57% risk of breast cancer and 40% risk of ovarian cancer by age 70. BRCA2 mutations are associated with a 50% risk of breast cancer and almost 20% risk of ovarian cancer by age 70.", "evidenceDomainTag": "Threat Materialization Chances.Penetrances", "publication": [ "CG-AC:RF000594", "CG-AC:RF000209" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/ten/EN3161", "id": "CG-AC:AC133/ten/EN3161", "type": "TieredEvidenceNarrative", "evidenceSourceTier": "3", "narrative": "The pathologic and clinical characteristics of tumors can differ by the type of mutation, including progression and variability in estrogen, progesterone, and human epidermal growth factor receptor status.", "evidenceDomainTag": "Threat Materialization Chances.Expressivity Notes", "publication": [ "CG-AC:RF000594" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/ten/RR2796", "id": "CG-AC:AC133/ten/RR2796", "type": "TieredEvidenceNarrative", "evidenceSourceTier": "Not provided", "narrative": "Information on relative risk was unavailable.", "evidenceDomainTag": "Threat Materialization Chances.Relative Risks" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/ten/PGM3071", "id": "CG-AC:AC133/ten/PGM3071", "type": "TieredEvidenceNarrative", "evidenceSourceTier": "1", "narrative": "BRCA mutations have an estimated 0.2-0.3% prevalence in the general population and 2.1% among women with Ashkenazi Jewish heritage.", "evidenceDomainTag": "Threat Materialization Chances.Prevalences of the Genetic Mutation", "publication": [ "CG-AC:RF000594" ] } ], "tieredRecommendations": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/tr/ACSU4118", "id": "CG-AC:AC133/tr/ACSU4118", "type": "TieredRecommendation", "evidenceSourceTier": "2", "recommendation": "Male carriers are recommended to have an annual breast exam. Information on effectiveness was not provided.", "evidenceDomainTag": "Effectiveness of Intervention.Surveillances", "publication": [ "CG-AC:RF000207" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/tr/ACSU4119", "id": "CG-AC:AC133/tr/ACSU4119", "type": "TieredRecommendation", "evidenceSourceTier": "1", "recommendation": "Screening methods for ovarian cancer have not been shown to be effective among women with BRCA mutations; however, annual gynecological exam, vaginal ultrasonography, and serum 125 (CA-125) can be used for screening.", "evidenceDomainTag": "Effectiveness of Intervention.Surveillances", "publication": [ "CG-AC:RF000206" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/tr/ACSU4117", "id": "CG-AC:AC133/tr/ACSU4117", "type": "TieredRecommendation", "evidenceSourceTier": "1", "recommendation": "More frequent and intensive breast cancer screening, including clinical breast exams, mammography, and MRI starting at age 25. However, no screening methods have been shown to be effective at reducing breast cancer incidence among BRCA mutation carriers.", "evidenceDomainTag": "Effectiveness of Intervention.Surveillances", "publication": [ "CG-AC:RF000594", "CG-AC:RF000203", "CG-AC:RF000204" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/tr/ACCA3824", "id": "CG-AC:AC133/tr/ACCA3824", "type": "TieredRecommendation", "evidenceSourceTier": "2", "recommendation": "Oral contraceptive use has been shown to be protective against ovarian cancer. However, some studies have suggested that oral contraceptive use increases the risk of breast cancer in women with BRCA mutations, though this effect has not been consistently demonstrated.", "evidenceDomainTag": "Effectiveness of Intervention.Circumstances to Avoid", "publication": [ "CG-AC:RF000207", "CG-AC:RF000208" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/tr/ACPM6954", "id": "CG-AC:AC133/tr/ACPM6954", "type": "TieredRecommendation", "evidenceSourceTier": "1", "recommendation": "Prophylactic surgery (e.g. bilateral mastectomy or salpingo-oophorectomy) has been shown to substantially reduce the risk for breast or ovarian cancer in both high-risk women and those who are BRCA mutation carriers. Breast cancer risk was reduced by 85-100% with mastectomy and by 37% to 100% with oophorectomy. Ovarian cancer risk was reduced by 69-100% with oophorectomy. Breast cancer-specific mortality was reduced by 81-100% after mastectomy and all-cause mortality was reduced by 55-100% after oophorectomy.", "evidenceDomainTag": "Effectiveness of Intervention.Patient Managements", "publication": [ "CG-AC:RF000594", "CG-AC:RF000203", "CG-AC:RF000205" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/tr/ACPM6955", "id": "CG-AC:AC133/tr/ACPM6955", "type": "TieredRecommendation", "evidenceSourceTier": "1", "recommendation": "Chemoprevention medications (e.g. tamoxifen, raloxifene) have been shown to reduce the incidence of breast cancer in high-risk women in the general population, but their effectiveness has not been assessed in the context of BRCA mutations.", "evidenceDomainTag": "Effectiveness of Intervention.Patient Managements", "publication": [ "CG-AC:RF000594", "CG-AC:RF000203", "CG-AC:RF000204" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/tr/ACPM6956", "id": "CG-AC:AC133/tr/ACPM6956", "type": "TieredRecommendation", "evidenceSourceTier": "Not provided", "recommendation": "The American College of Medical Genetics and Genomics (ACMG) has developed an ACT sheet to help clinical decision-making when BRCA1 and/or BRCA2 pathogenic variant(s) have been identified as a secondary finding: http://www.acmg.net/ACMG/UploadedPDFS/PDFDocuments/Hereditary-Breast-and-Ovarian-Cancer-ACT-Sheet.aspx", "evidenceDomainTag": "Effectiveness of Intervention.Patient Managements" } ] }, "evidenceCategory": { "outcomeEvidenceItem": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/oei", "id": "CG-AC:AC133/oei", "type": "EvidenceItem", "natureOfTheThreat": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/oei/nott", "id": "CG-AC:AC133/oei/nott", "type": "EvidenceLine", "prevalenceOfTheGeneticDisorder": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/oei/pgd", "id": "CG-AC:AC133/oei/pgd", "type": "EvidenceItem", "keyText": ">1-2 in 100", "sourceOfPopulation": "General population", "evidenceNarrative": { "@id": "CG-AC:AC133/en/potgd" } }, "clinicalFeatures": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/oei/cf", "id": "CG-AC:AC133/oei/cf", "type": "EvidenceItem", "evidenceNarrative": { "@id": "CG-AC:AC133/en/cf" } }, "naturalHistory": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/oei/nh", "id": "CG-AC:AC133/oei/nh", "type": "EvidenceItem", "evidenceNarrative": { "@id": "CG-AC:AC133/en/nh" } } }, "threatMaterializationChances": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/oei/tmc", "id": "CG-AC:AC133/oei/tmc", "type": "EvidenceLine", "modeOfInheritance": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/oei/moi", "id": "CG-AC:AC133/oei/moi", "type": "EvidenceItem", "keyText": "Autosomal Dominant", "evidenceNarrative": { "@id": "CG-AC:AC133/en/ACMI2868" } }, "prevalenceOfTheGeneticMutation": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/oei/pgm", "id": "CG-AC:AC133/oei/pgm", "type": "EvidenceItem", "keyText": "1-2 in 500", "sourceOfPopulation": "General population", "tieredEvidenceNarrative": { "@id": "CG-AC:AC133/ten/PGM3071" } }, "penetrance": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/oei/pe/ACPE4667", "id": "CG-AC:AC133/oei/pe/ACPE4667", "type": "EvidenceItem", "keyText": ">= 40 %", "tieredEvidenceNarrative": { "@id": "CG-AC:AC133/ten/ACPE4667" } } ], "relativeRisk": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/oei/rr/RR2796", "id": "CG-AC:AC133/oei/rr/RR2796", "type": "EvidenceItem", "keyText": "Unknown", "tieredEvidenceNarrative": { "@id": "CG-AC:AC133/ten/RR2796" } } ], "expressivity": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/oei/ex/EN3161", "id": "CG-AC:AC133/oei/ex/EN3161", "type": "EvidenceItem", "tieredEvidenceNarrative": { "@id": "CG-AC:AC133/ten/EN3161" } } ] } }, "interventionEvidenceItem": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/iei", "id": "CG-AC:AC133/iei", "type": "EvidenceItem", "acceptabilityOfIntervention": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/iei/aoi", "id": "CG-AC:AC133/iei/aoi", "type": "EvidenceLine", "natureOfIntervention": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/iei/noi/NOI3063", "id": "CG-AC:AC133/iei/noi/NOI3063", "type": "EvidenceItem", "tieredEvidenceNarrative": { "@id": "CG-AC:AC133/ten/NOI3063" } } ] }, "effectivenessOfIntervention": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/iei/eoi", "id": "CG-AC:AC133/iei/eoi", "type": "EvidenceLine", "patientManagement": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/iei/pm/ACPM6956", "id": "CG-AC:AC133/iei/pm/ACPM6956", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC133/tr/ACPM6956" } }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/iei/pm/ACPM6955", "id": "CG-AC:AC133/iei/pm/ACPM6955", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC133/tr/ACPM6955" } }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/iei/pm/ACPM6954", "id": "CG-AC:AC133/iei/pm/ACPM6954", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC133/tr/ACPM6954" } } ], "circumstanceToAvoid": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/iei/cta/ACCA3824", "id": "CG-AC:AC133/iei/cta/ACCA3824", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC133/tr/ACCA3824" } } ], "surveillance": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/iei/su/ACSU4117", "id": "CG-AC:AC133/iei/su/ACSU4117", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC133/tr/ACSU4117" } }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/iei/su/ACSU4119", "id": "CG-AC:AC133/iei/su/ACSU4119", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC133/tr/ACSU4119" } }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/iei/su/ACSU4118", "id": "CG-AC:AC133/iei/su/ACSU4118", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC133/tr/ACSU4118" } } ] }, "conditionEscapeDetection": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/iei/ced", "id": "CG-AC:AC133/iei/ced", "type": "EvidenceLine", "chanceToEscapeDetection": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC133/iei/cted/CDEC3140", "id": "CG-AC:AC133/iei/cted/CDEC3140", "type": "EvidenceItem", "tieredEvidenceNarrative": { "@id": "CG-AC:AC133/ten/CDEC3140" } } ] } } }, "references": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/RF000202", "id": "CG-AC:RF000202", "type": "Publication", "publicationType": "PMID", "citation": "Lee EH, Park SK, Park B, Kim SW, Lee MH, Ahn SH, Son BH, Yoo KY, Kang D. Effect of BRCA1/2 mutation on short-term and long-term breast cancer survival: a systematic review and meta-analysis. Breast Cancer Res Treat. (2010) 122(1):11-25.", "webUrl": "https://www.ncbi.nlm.nih.gov/pubmed/?term=20376556", "xdbref": [ "PMID:20376556" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/RF000203", "id": "CG-AC:RF000203", "type": "Publication", "publicationType": "PMID", "citation": "Moyer VA. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. (2014) 160(4):271-81.", "webUrl": "https://www.ncbi.nlm.nih.gov/pubmed/?term=24366376", "xdbref": [ "PMID:24366376" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/RF000204", "id": "CG-AC:RF000204", "type": "Publication", "publicationType": "Other", "citation": "Classification and care of people at risk of familial breast cancer and management of breast cancer and related risks in people with a family history of breast cancer. Nice. (2013) ", "webUrl": "https://www.nice.org.uk/guidance/cg164" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/RF000205", "id": "CG-AC:RF000205", "type": "Publication", "publicationType": "Other", "citation": "Management of early breast cancer. wellington (nz) new zealand guidelines group. Other. (2009) ", "webUrl": "https://www.health.govt.nz/system/files/documents/publications/mgmt-of-early-breast-cancer-aug09.pdf" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/RF000206", "id": "CG-AC:RF000206", "type": "Publication", "publicationType": "Other", "citation": "Ovarian carcinoma.. Other. (2009) ", "webUrl": "https://www.guidelinecentral.com/summaries/ovarian-carcinoma/" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/RF000207", "id": "CG-AC:RF000207", "type": "Publication", "publicationType": "Other", "citation": "Risk reduction and surveillance strategies for individuals at high genetic risk for breast and ovarian cancer. Other. (2011) ", "webUrl": "https://www.guideline.gov/content.aspx?id=38601" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/RF000208", "id": "CG-AC:RF000208", "type": "Publication", "publicationType": "Other", "citation": "Use of hormonal contraception in women with coexisting medical conditions. Other. (2006) ", "webUrl": "https://www.guideline.gov/content.aspx?id=10924" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/RF000209", "id": "CG-AC:RF000209", "type": "Publication", "publicationType": "PMID", "citation": "Chen S, Parmigiani G. Meta-analysis of BRCA1 and BRCA2 penetrance. J Clin Oncol. (2007) 25(11):1329-33.", "webUrl": "https://www.ncbi.nlm.nih.gov/pubmed/?term=17416853", "xdbref": [ "PMID:17416853" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/RF000594", "id": "CG-AC:RF000594", "type": "Publication", "publicationType": "Other", "citation": "true. 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