1
|
Carlsson L, Bedard PL, Kim RH, Metcalfe K. Psychological distress following multi-gene panel testing for hereditary breast and ovarian cancer risk. J Genet Couns 2024. [PMID: 39044246 DOI: 10.1002/jgc4.1940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 07/25/2024]
Abstract
Advances in our understanding of the genetic landscape of hereditary breast and ovarian cancer (HBOC) have led to the clinical adoption of multi-gene panel testing. Panel testing introduces new sources of genetic uncertainty secondary to the inclusion of moderate- and low-penetrance genes, as well as the increased likelihood of identifying a variant of uncertain significance (VUS). This cross-sectional study explored the post-test psychological functioning of women who underwent multi-gene panel testing for HBOC susceptibility genes. Two hundred and ninety-five women who underwent panel testing within the previous 2 years completed a study questionnaire to measure levels of cancer-related and genetic testing-related distress using the Impact of Events Scale (IES) and the Multidimensional Impact of Cancer Risk Assessment (MICRA), respectively. Multiple regression analyses were conducted to evaluate the relationship between genetic test results and levels of psychological distress captured by the IES and MICRA. In this cohort, a pathogenic variant (PV) was identified in 41 (14%) of participants, and 77 (26%) participants were found to have a VUS. In the multi-variate model, higher mean levels of genetic testing-related distress were observed in individuals with a PV (p < 0.001) or a VUS (p = 0.007) compared to those with a negative result. Furthermore, participants with a PV in a moderate-penetrance gene were found to have higher levels of genetic testing-related distress compared to those with a PV in a high-risk gene (p = 0.03). Overall, participants were highly satisfied with their genetic testing experience, with 92% of individuals reporting they would recommend testing to others. Our findings highlight differences in psychological outcomes based on both variant pathogenicity and gene penetrance, which contribute to our understanding of the impact of panel testing and sources of both cancer-related and genetic testing-related distress secondary to testing.
Collapse
Affiliation(s)
- Lindsay Carlsson
- Phase 1 Drug Development Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Philippe L Bedard
- Phase 1 Drug Development Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raymond H Kim
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Ontario Institute of Cancer Research, Toronto, Ontario, Canada
| | - Kelly Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Matthews LJ, Zhang Z, Martschenko DO. Schoolhouse risk: Can we mitigate the polygenic Pygmalion effect? Acta Psychol (Amst) 2024; 248:104403. [PMID: 39003994 DOI: 10.1016/j.actpsy.2024.104403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Although limited in predictive accuracy, polygenic scores (PGS) for educational outcomes are currently available to the public via direct-to-consumer genetic testing companies. Further, there is a growing movement to apply PGS in educational settings via 'precision education.' Prior scholarship highlights the potentially negative impacts of such applications, as disappointing results may give rise a "polygenic Pygmalion effect." In this paper two studies were conducted to identify factors that may mitigate or exacerbate negative impacts of PGS. METHODS Two studies were conducted. In each, 1188 students were randomized to one of four conditions: Low-percentile polygenic score for educational attainment (EA-PGS), Low EA-PGS + Mitigating information, Low EA-PGS + Exacerbating information, or Control. Regression analyses were used to examine differences between conditions. RESULTS In Study 1, participants randomized to Control reported significantly higher on the Rosenberg Self-Esteem Scale (RSES), Competence Scale (CS), Academic Efficacy Scale (AES) and Educational Potential Scale (EPS). CS was significantly higher in the Low EA-PGS + Mitigating information condition. CS and AES were significantly lower in the Low EA-PGS + Exacerbating information condition compared to the Low EA-PGS + Mitigating information condition. In Study 2, participants randomized to Control reported significantly higher CS and AES. Pairwise comparisons did not show significant differences in CS and AES. Follow-up pairwise comparisons using Tukey P-value correction did not find significant associations between non-control conditions. CONCLUSION These studies replicated the polygenic Pygmalion effect yet were insufficiently powered to detect significant effects of mitigating contextual information. Regardless of contextual information, disappointing EA-PGS results were significantly associated with lower assessments of self-esteem, competence, academic efficacy, and educational potential.
Collapse
Affiliation(s)
- Lucas J Matthews
- Columbia University, Department of Medical Humanities & Ethics, New York, NY, United States; The Hastings Center, New York, NY, United States.
| | - Zhijun Zhang
- New York State Psychiatric Institute, Department of Mental Health and Data Science, New York, NY, United States.
| | - Daphne O Martschenko
- Stanford Center for Biomedical Ethics and Department of Pediatrics, Stanford University; Stanford, CA, United States.
| |
Collapse
|
3
|
Kilbride MK, Kessler LJ, Cronier B, Park JJ, Cacioppo CN, Beem J, Bradbury AR. Test-takers' perspectives on consumer genetic testing for hereditary cancer risk. Front Genet 2024; 15:1374602. [PMID: 39050249 PMCID: PMC11266061 DOI: 10.3389/fgene.2024.1374602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/24/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose With few exceptions, research on consumer genetic testing for hereditary cancer risk has focused on tests with limited predictive value and clinical utility. Our study advances the existing literature by exploring the experiences and behaviors of individuals who have taken modern consumer genetic tests for cancer susceptibility that, unlike earlier tests, screen for medically significant variants. Methods We interviewed 30 individuals who had undergone consumer genetic testing for hereditary cancer risk between 2014 and 2019. We explored participants' pre-test sentiments (7 items), experiences receiving results (5 items), behavioral and health-related changes (6 items), and attitudes and beliefs (3 items). Data were analyzed for thematic content. Results Most participants reported a personal (n = 6) and/or family history (n = 24) of cancer, which influenced their choice to pursue testing. Before testing, most participants did not consult with a physician (n = 25) or receive genetic counseling (n = 23). Nevertheless, the majority felt that they understood test-related information (n = 20) and their results (n = 20), though a considerable number reported experiencing negative emotions related to their results. Most also shared their results with family members (n = 27). Overall, participants' attitudes towards consumer genetic testing for cancer risk were predominantly positive (n = 23). Conclusion This study offers new insights into how individuals use and perceive modern consumer genetic tests for hereditary cancer risk, focusing on their perceptions of the risks, benefits, and limitations of these services. Understanding test-takers' perspectives can potentially inform improvements aimed at ensuring that tests meet users' needs and deliver clinically valuable genetic risk assessments.
Collapse
Affiliation(s)
- Madison K. Kilbride
- Department of Philosophy, University of Utah, Salt Lake City, UT, United States
| | - Lisa Jay Kessler
- Master of Science Program in Genetic Counseling, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Brigitte Cronier
- Master of Science Program in Genetic Counseling, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jacqueline J. Park
- Kahlert School of Computing, University of Utah, Salt Lake City, UT, United States
| | - Cara N. Cacioppo
- Penn Telegenetics Program, University of Pennsylvania, Philadelphia, PA, United States
| | - Jordyn Beem
- University of Louisville, Louisville, KY, United States
| | - Angela R. Bradbury
- Division of Hematology-Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
4
|
Hall MJ, D'Avanzo PA, Chertock Y, Kelly PJA, Brajuha J, Singley K, Luck CC, Bass SB. Oncologists' perceptions of tumor genomic profiling and barriers to communicating secondary hereditary risks to African American cancer patients. BMC Cancer 2024; 24:412. [PMID: 38566032 PMCID: PMC10988900 DOI: 10.1186/s12885-024-12184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Tumor genomic profiling (TGP) identifies targets for precision cancer treatments, but also secondary hereditary risks. Oncologists are poorly trained to communicate the results of TGP, especially among patients with lower health literacy, poorer genetics knowledge, and higher mistrust. African American (AA) patients are especially vulnerable to poor understanding due to significant cancer disparities and lower uptake of TGP. The goal of this research is to inform the development of an internet-based brief educational support for oncologists to prepare them to provide better decisional support related to TGP for their AA cancer patients. METHODS This mixed-methods study used semi-structured interviews of oncologists to inform development of an online survey with a convenience sample of US-based oncologists (n = 50) to assess perceptions of the challenges of TGP and communicating results to AA patients. RESULTS Most interviewed oncologists felt it was important to consider racial/cultural differences when communicating about hereditary risks. Cost, family dynamics, discrimination concerns, and medical mistrust were identified as particularly salient. Survey respondents' views related to AAs and perceptions of TGP were strongly associated with years since completing training, with recent graduates expressing stronger agreement with statements identifying barriers/disadvantages to TGP for AA patients. CONCLUSIONS Oncologists who had more recently completed training expressed more negative perceptions of TGP and more perceived challenges in communicating about TGP with their AA patients. Focused training for oncologists that addresses barriers specific to AAs may be helpful in supporting improved communication about TGP and improved decisional support for AA patients with cancer considering TGP to evaluate their tumors.
Collapse
Affiliation(s)
- Michael J Hall
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Paul A D'Avanzo
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Yana Chertock
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Patrick J A Kelly
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Jesse Brajuha
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Katie Singley
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Caseem C Luck
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Sarah B Bass
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| |
Collapse
|
5
|
Matsuoka A, Fujimori M, Koyama T, Sato A, Mori K, Hirata M, Tanabe N, Nakachi K, Kato S, Okamoto H, Ogawa K, Komatsu H, Iwasaku M, Miyaji T, Uchitomi Y. Prevalence of psychological distress and associated factors among patients undergoing comprehensive genomic profiling testing: protocol for a multicentre, prospective, observational study. BMJ Open 2023; 13:e072472. [PMID: 37996226 PMCID: PMC10668223 DOI: 10.1136/bmjopen-2023-072472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Since May 2019, comprehensive genomic profiling (CGP) has been covered by Japan's health insurance system for patients with solid tumours that have progressed on standard chemotherapy, rare tumours or tumours of unknown primary origin. Although CGP has the potential to identify actionable mutations that can guide the selection of genomically matched therapies for patients with advanced cancer and limited treatment options, less than 10% of patients benefit from CGP testing, which may have a negative impact on patients' mental status. The aim of this study is to investigate the prevalence of psychological distress and associated factors among patients with advanced cancer who are undergoing CGP testing across Japan. METHODS AND ANALYSIS This multicentre, prospective cohort study will enrol a total of 700 patients with advanced cancer undergoing CGP testing. Participants will be asked to complete questionnaires at three timepoints: at the time of consenting to CGP testing (T1), at the time of receiving the CGP results (T2; 2-3 months after T1) and 4-5 months after T2 (T3). Primary outcome is the prevalence of depression as measured by the Patient Health Questionnaire-9 at the three timepoints. Secondary outcomes are the prevalence of anxiety and Quality of Life Score. Associated factors with psychological distress will also be examined, including knowledge about CGP, attitudes, values and preferences towards CGP, satisfaction with oncologists' communication and patient characteristics as well as medical information including CGP test results and genomically matched therapies if provided. The prevalence of depression and anxiety will be estimated using the unadjusted raw rates observed in the total sample. Longitudinal changes in measures will be explored by calculating differences between the timepoints. Multivariate associations between variables will be examined using multiple or logistic regression analysis depending on the outcomes to adjust for confounders and to identify outcome predictors. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board of the National Cancer Center Japan on 5 January 2023 (ID: 2022-228). Study findings will be disseminated through peer-reviewed journals and conference presentations. TRIAL STATUS The study is currently recruiting participants and the enrolment period will end on 31 March 2025, with an expected follow-up date of 31 March 2026. TRIAL REGISTRATION NUMBER UMIN000049964.
Collapse
Affiliation(s)
- Ayumu Matsuoka
- Division of Survivorship Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Maiko Fujimori
- Division of Survivorship Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Takafumi Koyama
- Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Ayako Sato
- Division of Survivorship Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Keita Mori
- Department of Biostatistics, Clinical Research Support Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Makoto Hirata
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Tokyo, Japan
| | - Noriko Tanabe
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Tokyo, Japan
| | - Kohei Nakachi
- Department of Medical Oncology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Shunsuke Kato
- Department of Clinical Oncology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroaki Okamoto
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan
| | - Kohei Ogawa
- Department of Medical Oncology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Hirokazu Komatsu
- Department of Hematology and Oncology, Nagoya City University Institute of Medical and Pharmaceutical Sciences, Nagoya, Japan
| | - Masahiro Iwasaku
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tempei Miyaji
- Division of Survivorship Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Yosuke Uchitomi
- Division of Survivorship Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| |
Collapse
|
6
|
Brock DC, Abbott M, Reed L, Kammeyer R, Gibbons M, Angione K, Bernard TJ, Gaskell A, Demarest S. Epilepsy panels in clinical practice: Yield, variants of uncertain significance, and treatment implications. Epilepsy Res 2023; 193:107167. [PMID: 37230012 DOI: 10.1016/j.eplepsyres.2023.107167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE There has been increasing utilization of genetic testing for pediatric epilepsy in recent years. Little systematic data is available examining how practice changes have impacted testing yields, diagnostic pace, incidence of variants of uncertain significance (VUSs), or therapeutic management. METHODS A retrospective chart review was performed at Children's Hospital Colorado from February 2016 through February 2020. All patients under 18 years for whom an epilepsy gene panel was sent were included. RESULTS A total of 761 epilepsy gene panels were sent over the study period. During the study period, there was a 292% increase in the average number of panels sent per month. The time from seizure onset to panel result decreased over the study period from a median of 2.9 years to 0.7 years. Despite the increase in testing, the percentage of panels yielding a disease-causing result remained stable at 11-13%. A total of 90 disease-causing results were identified, > 75% of which provided guidance in management. Children were more likely to have a disease-causing result if they were < 3 years old at seizure onset (OR 4.4, p < 0.001), had neurodevelopmental concerns (OR 2.2, p = 0.002), or had a developmentally abnormal MRI (OR 3.8, p < 0.001). A total of 1417 VUSs were identified, equating to 15.7 VUSs per disease-causing result. Non-Hispanic white patients had a lower average number of VUSs than patients of all other races/ethnicities (1.7 vs 2.1, p < 0.001). SIGNIFICANCE Expansion in the volume of genetic testing corresponded to a decrease in the time from seizure onset to testing result. Diagnostic yield remained stable, resulting in an increase in the absolute number of disease-causing results annually-most of which have implications for management. However, there has also been an increase in total VUSs, which likely resulted in additional clinical time spent on VUS resolution.
Collapse
Affiliation(s)
- Dylan C Brock
- Children's Hospital Colorado Anschutz Medical Campus, Aurora 13123 East 16th Avenue, Aurora, CO 80045; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Megan Abbott
- Children's Hospital Colorado Anschutz Medical Campus, Aurora 13123 East 16th Avenue, Aurora, CO 80045; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Laurel Reed
- Children's Hospital Colorado Anschutz Medical Campus, Aurora 13123 East 16th Avenue, Aurora, CO 80045; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Ryan Kammeyer
- Children's Hospital Colorado Anschutz Medical Campus, Aurora 13123 East 16th Avenue, Aurora, CO 80045; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Melissa Gibbons
- Children's Hospital Colorado Anschutz Medical Campus, Aurora 13123 East 16th Avenue, Aurora, CO 80045; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Katie Angione
- Precision Medicine Institute, Children's Hospital Colorado Anschutz Medical Campus, Aurora 1312 East 16th Avenue, Aurora, CO 80045, USA; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Timothy J Bernard
- Children's Hospital Colorado Anschutz Medical Campus, Aurora 13123 East 16th Avenue, Aurora, CO 80045; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Alisa Gaskell
- Precision Medicine Institute, Children's Hospital Colorado Anschutz Medical Campus, Aurora 1312 East 16th Avenue, Aurora, CO 80045, USA; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Scott Demarest
- Precision Medicine Institute, Children's Hospital Colorado Anschutz Medical Campus, Aurora 1312 East 16th Avenue, Aurora, CO 80045, USA; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| |
Collapse
|
7
|
Hunter CL, Helft PR. Yes, We Can, But Should We? Ethical Considerations in Reporting Germline Findings From Paired Tumor-Normal Genomic Testing in Patients With Advanced Cancer. J Clin Oncol 2022; 41:1982-1985. [PMID: 36469841 DOI: 10.1200/jco.22.00796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Cynthia L. Hunter
- Indiana University Health Department of Medical and Molecular Genetics, Indianapolis, IN
- Indiana University Health Precision Genomics, Indianapolis, IN
| | - Paul R. Helft
- Division of Hematology/Oncology, Department of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, IN
| |
Collapse
|
8
|
Comeaux JG, Culver JO, Lee JE, Dondanville D, McArthur HL, Quinn E, Gorman N, Ricker C, Li M, Lerman C. Risk‐reducing mastectomy decisions among women with mutations in high‐ and moderate‐ penetrance breast cancer susceptibility genes. Mol Genet Genomic Med 2022; 10:e2031. [PMID: 36054727 PMCID: PMC9544212 DOI: 10.1002/mgg3.2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/08/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Women harboring mutations in breast cancer susceptibility genes are at increased lifetime risk of developing breast cancer and are faced with decisions about risk management, including whether to undergo high‐risk screening or risk‐reducing mastectomy (RRM). National guidelines recommend BRCA1 or BRCA2 mutation carriers consider RRM, but that carriers of moderate penetrance mutations (e.g., ATM or CHEK2) should be managed based on family history. We aimed to investigate determinants of decision for RRM, and hypothesized that mutation status, age, family history, partner status, and breast cancer would impact RRM decision making. Methods We performed a retrospective study assessing RRM decisions for 279 women. Results Women with BRCA and moderate penetrance gene mutations, a personal history of breast cancer, or a first degree relative with a history of breast cancer were more likely to undergo RRM. Breast cancer status and age showed an interaction effect such that women with breast cancer were less likely to undergo RRM with increasing age. Conclusion Although national guidelines do not recommend RRM for moderate penetrance carriers, the rates of RRM for this population approached those for BRCA mutation carriers. Further insights are needed to better support RRM decision‐making in this population.
Collapse
Affiliation(s)
- Jacob G. Comeaux
- Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Julie O. Culver
- Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - John E. Lee
- Samuel Oschin Cancer CenterCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | | | - Heather L. McArthur
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Emily Quinn
- Human Genetics and GenomicsKeck Graduate InstituteClaremontCaliforniaUSA
| | - Nicholas Gorman
- Human Genetics and GenomicsKeck Graduate InstituteClaremontCaliforniaUSA
| | - Charité Ricker
- Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Ming Li
- Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Caryn Lerman
- Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| |
Collapse
|
9
|
Carlsson L, Thain E, Gillies B, Metcalfe K. Psychological and health behaviour outcomes following multi-gene panel testing for hereditary breast and ovarian cancer risk: a mini-review of the literature. Hered Cancer Clin Pract 2022; 20:25. [PMID: 35733200 PMCID: PMC9215075 DOI: 10.1186/s13053-022-00229-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Knowledge of the genetic mechanisms driving hereditary breast and ovarian cancer (HBOC) has recently expanded due to advances in gene sequencing technologies. Genetic testing for HBOC risk now involves multi-gene panel testing, which includes well characterized high-penetrance genes (e.g. BRCA1 and BRCA2), as well as moderate- and low-penetrance genes. Certain moderate and low penetrance genes are associated with limited data to inform cancer risk estimates and clinical management recommendations, which create new sources of genetic and clinical uncertainty for patients. PURPOSE The aim of this review is to evaluate the psychological and health behaviour outcomes associated with multi-gene panel testing for HBOC risk. The search was developed in collaboration with an Information Specialist (Princess Margaret Cancer Centre) and conducted in the following databases: MEDLINE, EMBASE, EMCare, PsycINFO, Epub Ahead of Publication. RESULTS Similar to the BRCA1/2 literature, individuals with a pathogenic variant (PV) reported higher levels of testing-related concerns and cancer-specific distress, as well as higher uptake of prophylactic surgery in both affected and unaffected individuals compared to those with variant of uncertain significance (VUS) or negative result. A single study demonstrated that individuals with a PV in a moderate penetrance gene reported higher rates of cancer worry, genetic testing concerns and cancer-related distress when compared to women with high penetrance PV. Analysis of cancer screening and prevention outcomes based upon gene penetrance were limited to two studies, with conflicting findings. CONCLUSION The findings in this review emphasize the need for studies examining psychological and health behavior outcomes associated with panel testing to include between group differences based upon both variant pathogenicity and gene penetrance. Future studies evaluating the impact of gene penetrance on patient-reported and clinical outcomes will require large samples to be powered for these analyses given that a limited number of tested individuals are found to have a PV.
Collapse
Affiliation(s)
- Lindsay Carlsson
- Drug Development Program, Princess Margaret Cancer Centre, 620 University Avenue, 8-132, Toronto, ON, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
| | - Emily Thain
- Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Brittany Gillies
- Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Canada
| | - Kelly Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute , Toronto, ON, Canada
| |
Collapse
|
10
|
Khan E, Kaphingst KA, Meyer White K, Sussman A, Guest D, Schofield E, Dailey YT, Robers E, Schwartz MR, Li Y, Buller D, Hunley K, Berwick M, Hay JL. Comprehension of skin cancer genetic risk feedback in primary care patients. J Community Genet 2022; 13:113-119. [PMID: 34797550 PMCID: PMC8799794 DOI: 10.1007/s12687-021-00566-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022] Open
Abstract
Few studies have examined comprehension and miscomprehension of genetic risk feedback for moderate-risk genes in the general population. We examined the prevalence and nature of accurate and inaccurate genetic risk feedback comprehension among those who received genetic testing for melanocortin-1-receptor (MC1R) gene variants that confer moderate melanoma risk. Participants (N = 145 Albuquerque, NM) were tested as part of a randomized controlled trial. Two weeks after receiving MC1R genetic risk feedback, participants answered open-ended questions regarding their reactions to the MC1R feedback report. Participants' comprehension of their feedback (average-risk or higher-risk for melanoma) was evaluated through qualitative analysis of open-ended responses. Most participants demonstrated comprehension of their feedback results (i.e., 63% of average-risk participants [ARPs]; 51% of higher-risk participants [HRPs]). Miscomprehension was evident in fewer participants (i.e., 16% of ARPs, 11% of HRPs). A few ARPs misunderstood the purpose of testing, whereas a few HRPs reported confusion about the meaning of their risk feedback. Some participants' responses to the open-ended questions were too ambiguous to ascertain comprehension or miscomprehension (i.e., 21% of ARPs, 38% of HRPs). Taken together, these findings suggest that genetic testing feedback for MC1R risk variants is largely comprehensible to general population participants. This study adds to the work examining comprehension and usage of common, moderate risk genetic information in public health contexts. However, to maximize the utility of genetic risk information in the general population, further research is needed to investigate and address areas where common genetic risk feedback misunderstandings occur.
Collapse
Affiliation(s)
- Erva Khan
- Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel, 281 1st Avenue, New York, NY, 10003, USA.
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute and Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Kirsten Meyer White
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Andrew Sussman
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Dolores Guest
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yvonne T Dailey
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Erika Robers
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Matthew R Schwartz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Keith Hunley
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
11
|
Uptake and acceptability of a mainstreaming model of hereditary cancer multigene panel testing among patients with ovarian, pancreatic, and prostate cancer. Genet Med 2021; 23:2105-2113. [PMID: 34257420 PMCID: PMC8556289 DOI: 10.1038/s41436-021-01262-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose: To address demands for timely germline information to guide treatments, we evaluated experiences of patients with ovarian, pancreatic, and prostate cancer with a mainstreaming genetic testing model wherein multigene panel testing was ordered by oncologists with standardized pre-test patient education, and genetic counselors delivered results and post-test genetic counseling via telephone. Methods: Among 1203 eligible patients, we conducted a prospective single-arm study to examine patient uptake and acceptability (via self-report surveys at baseline and three-weeks and three-months following result return) of this mainstreaming model. Results: Only 10% of eligible patients declined participation. Among 1054 tested participants, 10% had pathogenic variants (PV), 16% had variants of uncertain significance (VUS), and 74% had no variant identified (NV). Participants reported high initial acceptability, including high satisfaction with their testing decision. Variability over time in several outcomes existed for participants with PV or NV: Those with NV experienced a temporary increase in depression (pTime<0.001; pTime2<0.001), and those with PV experienced a small increase in genetic testing distress (p=0.03). Findings suggested that result type, sex, and cancer type were also associated with outcomes including clinical depression and uncertainty. Conclusion: This mainstreaming model may offer a feasible approach for extending access to germline genetic information.
Collapse
|
12
|
Culver JO, Ricker CN, Bonner J, Kidd J, Sturgeon D, Hodan R, Kingham K, Lowstuter K, Chun NM, Lebensohn AP, Rowe‐Teeter C, Levonian P, Partynski K, Lara‐Otero K, Hong C, Morales Pichardo J, Mills MA, Brown K, Lerman C, Ladabaum U, McDonnell KJ, Ford JM, Gruber SB, Kurian AW, Idos GE. Psychosocial outcomes following germline multigene panel testing in an ethnically and economically diverse cohort of patients. Cancer 2021; 127:1275-1285. [PMID: 33320347 PMCID: PMC8058169 DOI: 10.1002/cncr.33357] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/28/2020] [Accepted: 10/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known about the psychological outcomes of germline multigene panel testing, particularly among diverse patients and those with moderate-risk pathogenic variants (PVs). METHODS Study participants (N = 1264) were counseled and tested with a 25- or 28-gene panel and completed a 3-month postresult survey including the Multidimensional Impact of Cancer Risk Assessment (MICRA). RESULTS The mean age was 52 years, 80% were female, and 70% had cancer; 45% were non-Hispanic White, 37% were Hispanic, 10% were Asian, 3% were Black, and 5% had another race/ethnicity. Approximately 28% had a high school education or less, and 23% were non-English-speaking. The genetic test results were as follows: 7% had a high-risk PV, 6% had a moderate-risk PV, 35% had a variant of uncertain significance (VUS), and 52% were negative. Most participants (92%) had a total MICRA score ≤ 38, which corresponded to a mean response of "never," "rarely," or only "sometimes" reacting negatively to results. A multivariate analysis found that mean total MICRA scores were significantly higher (more uncertainty/distress) among high- and moderate-risk PV carriers (29.7 and 24.8, respectively) than those with a VUS or negative results (17.4 and 16.1, respectively). Having cancer or less education was associated with a significantly higher total MICRA score; race/ethnicity was not associated with the total MICRA score. High- and moderate-risk PV carriers did not differ significantly from one another in the total MICRA score, uncertainty, distress, or positive experiences. CONCLUSIONS In a diverse population undergoing genetic counseling and multigene panel testing for hereditary cancer risk, the psychological response corresponded to test results and showed low distress and uncertainty. Further studies are needed to assess patient understanding and subsequent cancer screening among patients from diverse backgrounds. LAY SUMMARY Multigene panel tests for hereditary cancer have become widespread despite concerns about adverse psychological reactions among carriers of moderate-risk pathogenic variants (mutations) and among carriers of variants of uncertain significance. This large study of an ethnically and economically diverse cohort of patients undergoing panel testing found that 92% "never," "rarely," or only "sometimes" reacted negatively to results. Somewhat higher uncertainty and distress were identified among carriers of high- and moderate-risk pathogenic variants, and lower levels were identified among those with a variant of uncertain significance or a negative result. Although the psychological response corresponded to risk, reactions to testing were favorable, regardless of results.
Collapse
Affiliation(s)
- Julie O. Culver
- USC Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCalifornia
| | - Charité N. Ricker
- USC Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCalifornia
| | - Joseph Bonner
- Center for Precision MedicineCity of Hope National Medical Center and Beckman Research InstituteDuarteCalifornia
| | | | - Duveen Sturgeon
- Center for Precision MedicineCity of Hope National Medical Center and Beckman Research InstituteDuarteCalifornia
| | - Rachel Hodan
- Stanford University School of MedicineStanfordCalifornia
| | - Kerry Kingham
- Stanford University School of MedicineStanfordCalifornia
| | - Katrina Lowstuter
- USC Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCalifornia
| | | | | | | | - Peter Levonian
- Stanford University School of MedicineStanfordCalifornia
| | - Katlyn Partynski
- USC Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCalifornia
| | | | - Christine Hong
- Center for Precision MedicineCity of Hope National Medical Center and Beckman Research InstituteDuarteCalifornia
| | - Jennifer Morales Pichardo
- Center for Precision MedicineCity of Hope National Medical Center and Beckman Research InstituteDuarteCalifornia
| | | | | | - Caryn Lerman
- USC Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesCalifornia
| | - Uri Ladabaum
- Stanford University School of MedicineStanfordCalifornia
| | - Kevin J. McDonnell
- Center for Precision MedicineCity of Hope National Medical Center and Beckman Research InstituteDuarteCalifornia
| | - James M. Ford
- Stanford University School of MedicineStanfordCalifornia
| | - Stephen B. Gruber
- Center for Precision MedicineCity of Hope National Medical Center and Beckman Research InstituteDuarteCalifornia
| | | | - Gregory E. Idos
- Center for Precision MedicineCity of Hope National Medical Center and Beckman Research InstituteDuarteCalifornia
| |
Collapse
|
13
|
Melas M, Subbiah S, Saadat S, Rajurkar S, McDonnell KJ. The Community Oncology and Academic Medical Center Alliance in the Age of Precision Medicine: Cancer Genetics and Genomics Considerations. J Clin Med 2020; 9:E2125. [PMID: 32640668 PMCID: PMC7408957 DOI: 10.3390/jcm9072125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022] Open
Abstract
Recent public policy, governmental regulatory and economic trends have motivated the establishment and deepening of community health and academic medical center alliances. Accordingly, community oncology practices now deliver a significant portion of their oncology care in association with academic cancer centers. In the age of precision medicine, this alliance has acquired critical importance; novel advances in nucleic acid sequencing, the generation and analysis of immense data sets, the changing clinical landscape of hereditary cancer predisposition and ongoing discovery of novel, targeted therapies challenge community-based oncologists to deliver molecularly-informed health care. The active engagement of community oncology practices with academic partners helps with meeting these challenges; community/academic alliances result in improved cancer patient care and provider efficacy. Here, we review the community oncology and academic medical center alliance. We examine how practitioners may leverage academic center precision medicine-based cancer genetics and genomics programs to advance their patients' needs. We highlight a number of project initiatives at the City of Hope Comprehensive Cancer Center that seek to optimize community oncology and academic cancer center precision medicine interactions.
Collapse
Affiliation(s)
- Marilena Melas
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA;
| | - Shanmuga Subbiah
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Glendora, CA 91741, USA;
| | - Siamak Saadat
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Colton, CA 92324, USA;
| | - Swapnil Rajurkar
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Upland, CA 91786, USA;
| | - Kevin J. McDonnell
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA
- Center for Precision Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| |
Collapse
|
14
|
Nestor JG, Marasa M, Milo-Rasouly H, Groopman EE, Husain SA, Mohan S, Fernandez H, Aggarwal VS, Ahram DF, Vena N, Bogyo K, Bomback AS, Radhakrishnan J, Appel GB, Ahn W, Cohen DJ, Canetta PA, Dube GK, Rao MK, Morris HK, Crew RJ, Sanna-Cherchi S, Kiryluk K, Gharavi AG. Pilot Study of Return of Genetic Results to Patients in Adult Nephrology. Clin J Am Soc Nephrol 2020; 15:651-664. [PMID: 32299846 PMCID: PMC7269209 DOI: 10.2215/cjn.12481019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/12/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Actionable genetic findings have implications for care of patients with kidney disease, and genetic testing is an emerging tool in nephrology practice. However, there are scarce data regarding best practices for return of results and clinical application of actionable genetic findings for kidney patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We developed a return of results workflow in collaborations with clinicians for the retrospective recontact of adult nephrology patients who had been recruited into a biobank research study for exome sequencing and were identified to have medically actionable genetic findings. RESULTS Using this workflow, we attempted to recontact a diverse pilot cohort of 104 nephrology research participants with actionable genetic findings, encompassing 34 different monogenic etiologies of nephropathy and five single-gene disorders recommended by the American College of Medical Genetics and Genomics for return as medically actionable secondary findings. We successfully recontacted 64 (62%) participants and returned results to 41 (39%) individuals. In each case, the genetic diagnosis had meaningful implications for the patients' nephrology care. Through implementation efforts and qualitative interviews with providers, we identified over 20 key challenges associated with returning results to study participants, and found that physician knowledge gaps in genomics was a recurrent theme. We iteratively addressed these challenges to yield an optimized workflow, which included standardized consultation notes with tailored management recommendations, monthly educational conferences on core topics in genomics, and a curated list of expert clinicians for patients requiring extranephrologic referrals. CONCLUSIONS Developing the infrastructure to support return of genetic results in nephrology was resource-intensive, but presented potential opportunities for improving patient care. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_04_16_12481019.mp3.
Collapse
Affiliation(s)
- Jordan G Nestor
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Maddalena Marasa
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Hila Milo-Rasouly
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Emily E Groopman
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - S Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Hilda Fernandez
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Vimla S Aggarwal
- Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - Dina F Ahram
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Natalie Vena
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York.,Institute for Genomic Medicine, Columbia University, New York, New York
| | - Kelsie Bogyo
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York.,Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - Andrew S Bomback
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Gerald B Appel
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Wooin Ahn
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - David J Cohen
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Pietro A Canetta
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Geoffrey K Dube
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Maya K Rao
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Heather K Morris
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Russell J Crew
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Simone Sanna-Cherchi
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Ali G Gharavi
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York .,Institute for Genomic Medicine, Columbia University, New York, New York
| |
Collapse
|
15
|
Perrino M, Cooke-Barber J, Dasgupta R, Geller JI. Genetic predisposition to cancer: Surveillance and intervention. Semin Pediatr Surg 2019; 28:150858. [PMID: 31931963 DOI: 10.1016/j.sempedsurg.2019.150858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cancer is one of the leading causes of early mortality for children and adolescents. Identifiable genetic cancer predisposition conditions account for a growing proportion of pediatric and adolescent cancer, likely due to increasing knowledge about various predisposition conditions, more widespread cancer genetic counseling, and available diagnostics. Greater awareness, data-driven surgical intervention and clinical surveillance can help facilitate cancer prevention and early detection at cancer stages more amenable to cure. An extensive literature review of published studies and expert opinion with consensus guidelines are reviewed. Specific syndromes where genetics, imaging and surgical intervention are utilized to benefit affected patients and families are presented. In many tumor predisposition syndromes, the underlying genetic diagnosis is made concurrently, or after, malignancy is identified. Improved recognition of underlying predispositions, along with appropriate surgical interventions and imaging surveillance should lead to increased patient survival.
Collapse
Affiliation(s)
- Melissa Perrino
- Department of Pediatrics, Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, United States
| | - Jo Cooke-Barber
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, United States
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, United States
| | - James I Geller
- Department of Pediatrics, Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, United States.
| |
Collapse
|
16
|
Faure MC, Matshabane OP, Marshall P, Appelbaum PS, Stein DJ, Engel ME, de Vries J. Does genetics matter for disease-related stigma? The impact of genetic attribution on stigma associated with rheumatic heart disease in the Western Cape, South Africa. Soc Sci Med 2019; 243:112619. [PMID: 31715540 DOI: 10.1016/j.socscimed.2019.112619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION A common concern in African genomic research is that such work may cause, or increase, stigma associated with particular diseases or population groups. While there is some evidence suggesting that genetic attribution of disease might impact stigma, there exists no evidence for the situation in African populations. With increasing genomic research in African populations, questions about the effect of genetic attribution on disease-related stigma are salient for stakeholders involved in implementation and regulation. To understand better the relationship between stigma and genetic attribution, we interviewed people with Rheumatic Heart Disease (RHD) in the Western Cape of South Africa. METHOD We conducted 11 focus group discussions with RHD patients of mixed-ancestry in the Western Cape, exploring the impact of genetic attribution on stigma. Participants had previously consented to participate in genomic research, attending information sessions on genetics. We explored the impact of genetic attribution by introducing both genetic and environmental causes to RHD and by specifically probing how these various causes would likely impact selected features of disease stigma. RESULTS Participants reported varying experiences of stigma relating to RHD, such as labelling, social exclusion and discrimination at the workplace. They had some understanding of genetics, either in general, or in relation to their illness. Participants' understanding depicted multiple causal models to explain RHD including genetic, environmental and bacterial causation. Overall, participants did not make a connection between genetics as a cause of RHD and their experiences of stigma. DISCUSSION In this study we found no support for the concern that genetic attribution of RHD, understood by participants in our study as a genetic predisposition to developing the disease, would impact stigma associated with it. Our findings provide some reassurance that genomic research may be unlikely to cause an increase in disease-related stigma in the South African context.
Collapse
Affiliation(s)
- Marlyn C Faure
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Olivia P Matshabane
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | | | | | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Mark E Engel
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| |
Collapse
|
17
|
Parens E, Appelbaum PS. On What We Have Learned and Still Need to Learn about the Psychosocial Impacts of Genetic Testing. Hastings Cent Rep 2019; 49 Suppl 1:S2-S9. [PMID: 31268574 PMCID: PMC6640636 DOI: 10.1002/hast.1011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Since the start of the program to investigate the ethical, legal, and social implications (ELSI) of the Human Genome Project in 1990, many ELSI scholars have maintained that genetic testing should be used with caution because of the potential for negative psychosocial effects associated with receiving genetic information. More recently, though, some ELSI scholars have produced evidence suggesting that the original ELSI concerns were unfounded, exaggerated, or, at a minimum, misdirected. At least in the contexts that have been most studied, large negative impacts have not been found in the vast majority of people studied. What might explain the discrepancy between the original hypothesized outcomes and the growing impression that large negative effects appear to be few and far between? And if the original predictions of large negative psychosocial effects were simply wrong, is it time for ELSI researchers to move on? Should genetic testing be routinized, and would it be appropriate to relax or abandon the practice of engaging patients in a process of detailed informed consent before they receive genetic information? To confront those questions, we convened a conference entitled "Looking for the Psychosocial Impacts of Genomic Information" to review what is known about the negative impacts of genetic information on a variety of populations and in multiple medical and social contexts, to explore the implications of the findings, and to consider whether future research might benefit from different methods than have been used to date.
Collapse
|