2
|
Shen EC, Srinivasan S, Passero LE, Allen CG, Dixon M, Foss K, Halliburton B, Milko LV, Smit AK, Carlson R, Roberts MC. Barriers and Facilitators for Population Genetic Screening in Healthy Populations: A Systematic Review. Front Genet 2022; 13:865384. [PMID: 35860476 PMCID: PMC9289280 DOI: 10.3389/fgene.2022.865384] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022] Open
Abstract
Studies suggest that 1-3% of the general population in the United States unknowingly carry a genetic risk factor for a common hereditary disease. Population genetic screening is the process of offering otherwise healthy patients in the general population testing for genomic variants that predispose them to diseases that are clinically actionable, meaning that they can be prevented or mitigated if they are detected early. Population genetic screening may significantly reduce morbidity and mortality from these diseases by informing risk-specific prevention or treatment strategies and facilitating appropriate participation in early detection. To better understand current barriers, facilitators, perceptions, and outcomes related to the implementation of population genetic screening, we conducted a systematic review and searched PubMed, Embase, and Scopus for articles published from date of database inception to May 2020. We included articles that 1) detailed the perspectives of participants in population genetic screening programs and 2) described the barriers, facilitators, perceptions, and outcomes related to population genetic screening programs among patients, healthcare providers, and the public. We excluded articles that 1) focused on direct-to-consumer or risk-based genetic testing and 2) were published before January 2000. Thirty articles met these criteria. Barriers and facilitators to population genetic screening were organized by the Social Ecological Model and further categorized by themes. We found that research in population genetic screening has focused on stakeholder attitudes with all included studies designed to elucidate individuals' perceptions. Additionally, inadequate knowledge and perceived limited clinical utility presented a barrier for healthcare provider uptake. There were very few studies that conducted long-term follow-up and evaluation of population genetic screening. Our findings suggest that these and other factors, such as prescreen counseling and education, may play a role in the adoption and implementation of population genetic screening. Future studies to investigate macro-level determinants, strategies to increase provider buy-in and knowledge, delivery models for prescreen counseling, and long-term outcomes of population genetic screening are needed for the effective design and implementation of such programs. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020198198.
Collapse
Affiliation(s)
- Emily C Shen
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,UNC Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Swetha Srinivasan
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Lauren E Passero
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Caitlin G Allen
- Department of Public Health Science, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Madison Dixon
- Department of Behavioral, Social, and Health Education Science, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Kimberly Foss
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Brianna Halliburton
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Laura V Milko
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Amelia K Smit
- The Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia.,Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia
| | - Rebecca Carlson
- Health Sciences Library, University of North Carolina, Chapel Hill, NC, United States
| | - Megan C Roberts
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| |
Collapse
|
3
|
Peloso GM, Beiser AS, Satizabal CL, Xanthakis V, Vasan RS, Pase MP, Destefano AL, Seshadri S. Cardiovascular health, genetic risk, and risk of dementia in the Framingham Heart Study. Neurology 2020; 95:e1341-e1350. [PMID: 32690788 DOI: 10.1212/wnl.0000000000010306] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the joint role of ideal cardiovascular health (CVH) and genetic risk on risk of dementia. METHODS We categorized CVH on the basis of the American Heart Association Ideal CVH Index and genetic risk through a genetic risk score (GRS) of common genetic variants and the APOE ε4 genotype in 1,211 Framingham Heart Study (FHS) offspring cohort participants. We used multivariable Cox proportional hazards regression models to examine the association between CVH, genetic risk, and incident all-cause dementia with up to 10 years of follow-up (mean 8.4 years, 96 incident dementia cases), adjusting for age, sex, and education. RESULTS We observed that a high GRS (>80th percentile) was associated with a 2.6-fold risk of dementia (95% confidence interval [CI] of hazard ratio [HR] 1.23-5.29; p = 0.012) compared with having a low GRS (<20th percentile); carrying at least 1 APOE ε4 allele was associated with a 2.3-fold risk of dementia compared with not carrying an APOE ε4 allele (95% CI of HR 1.49-3.53; p = 0.0002), and having a favorable CVH showed a 0.45-fold lower risk of dementia (95% CI of HR 0.20-1.01; p = 0.0527) compared to having an unfavorable CVH when all 3 components were included in the model. We did not observe an interaction between CVH and GRS (p = 0.99) or APOE ε4 (p = 0.16). CONCLUSIONS We observed that both genetic risk and CVH contribute additively to dementia risk.
Collapse
Affiliation(s)
- Gina M Peloso
- From the Departments of Biostatistics (G.M.P., A.S.B., V.X., A.L.D.) and Epidemiology (R.S.V.), Boston University School of Public Health; Boston University and NHLBI's Framingham Heart Study (A.S.B., C.L.S., V.X., R.S.V., A.L.D., S.S.), Framingham; Department of Neurology (A.S.B., C.L.S., A.L.D., S.S.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; Sections of Preventive Medicine & Epidemiology and Cardiology (V.X., R.S.V.), Department of Medicine, Boston University, MA; Melbourne Dementia Research Centre (M.P.P.), The Florey Institute for Neuroscience and Mental Health; Faculty of Medicine, Dentistry, and Health Sciences (M.P.P.), University of Melbourne, Parkville; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Hawthorn, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA.
| | - Alexa S Beiser
- From the Departments of Biostatistics (G.M.P., A.S.B., V.X., A.L.D.) and Epidemiology (R.S.V.), Boston University School of Public Health; Boston University and NHLBI's Framingham Heart Study (A.S.B., C.L.S., V.X., R.S.V., A.L.D., S.S.), Framingham; Department of Neurology (A.S.B., C.L.S., A.L.D., S.S.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; Sections of Preventive Medicine & Epidemiology and Cardiology (V.X., R.S.V.), Department of Medicine, Boston University, MA; Melbourne Dementia Research Centre (M.P.P.), The Florey Institute for Neuroscience and Mental Health; Faculty of Medicine, Dentistry, and Health Sciences (M.P.P.), University of Melbourne, Parkville; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Hawthorn, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Claudia L Satizabal
- From the Departments of Biostatistics (G.M.P., A.S.B., V.X., A.L.D.) and Epidemiology (R.S.V.), Boston University School of Public Health; Boston University and NHLBI's Framingham Heart Study (A.S.B., C.L.S., V.X., R.S.V., A.L.D., S.S.), Framingham; Department of Neurology (A.S.B., C.L.S., A.L.D., S.S.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; Sections of Preventive Medicine & Epidemiology and Cardiology (V.X., R.S.V.), Department of Medicine, Boston University, MA; Melbourne Dementia Research Centre (M.P.P.), The Florey Institute for Neuroscience and Mental Health; Faculty of Medicine, Dentistry, and Health Sciences (M.P.P.), University of Melbourne, Parkville; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Hawthorn, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Vanessa Xanthakis
- From the Departments of Biostatistics (G.M.P., A.S.B., V.X., A.L.D.) and Epidemiology (R.S.V.), Boston University School of Public Health; Boston University and NHLBI's Framingham Heart Study (A.S.B., C.L.S., V.X., R.S.V., A.L.D., S.S.), Framingham; Department of Neurology (A.S.B., C.L.S., A.L.D., S.S.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; Sections of Preventive Medicine & Epidemiology and Cardiology (V.X., R.S.V.), Department of Medicine, Boston University, MA; Melbourne Dementia Research Centre (M.P.P.), The Florey Institute for Neuroscience and Mental Health; Faculty of Medicine, Dentistry, and Health Sciences (M.P.P.), University of Melbourne, Parkville; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Hawthorn, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Ramachandran S Vasan
- From the Departments of Biostatistics (G.M.P., A.S.B., V.X., A.L.D.) and Epidemiology (R.S.V.), Boston University School of Public Health; Boston University and NHLBI's Framingham Heart Study (A.S.B., C.L.S., V.X., R.S.V., A.L.D., S.S.), Framingham; Department of Neurology (A.S.B., C.L.S., A.L.D., S.S.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; Sections of Preventive Medicine & Epidemiology and Cardiology (V.X., R.S.V.), Department of Medicine, Boston University, MA; Melbourne Dementia Research Centre (M.P.P.), The Florey Institute for Neuroscience and Mental Health; Faculty of Medicine, Dentistry, and Health Sciences (M.P.P.), University of Melbourne, Parkville; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Hawthorn, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Matthew P Pase
- From the Departments of Biostatistics (G.M.P., A.S.B., V.X., A.L.D.) and Epidemiology (R.S.V.), Boston University School of Public Health; Boston University and NHLBI's Framingham Heart Study (A.S.B., C.L.S., V.X., R.S.V., A.L.D., S.S.), Framingham; Department of Neurology (A.S.B., C.L.S., A.L.D., S.S.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; Sections of Preventive Medicine & Epidemiology and Cardiology (V.X., R.S.V.), Department of Medicine, Boston University, MA; Melbourne Dementia Research Centre (M.P.P.), The Florey Institute for Neuroscience and Mental Health; Faculty of Medicine, Dentistry, and Health Sciences (M.P.P.), University of Melbourne, Parkville; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Hawthorn, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Anita L Destefano
- From the Departments of Biostatistics (G.M.P., A.S.B., V.X., A.L.D.) and Epidemiology (R.S.V.), Boston University School of Public Health; Boston University and NHLBI's Framingham Heart Study (A.S.B., C.L.S., V.X., R.S.V., A.L.D., S.S.), Framingham; Department of Neurology (A.S.B., C.L.S., A.L.D., S.S.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; Sections of Preventive Medicine & Epidemiology and Cardiology (V.X., R.S.V.), Department of Medicine, Boston University, MA; Melbourne Dementia Research Centre (M.P.P.), The Florey Institute for Neuroscience and Mental Health; Faculty of Medicine, Dentistry, and Health Sciences (M.P.P.), University of Melbourne, Parkville; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Hawthorn, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA
| | - Sudha Seshadri
- From the Departments of Biostatistics (G.M.P., A.S.B., V.X., A.L.D.) and Epidemiology (R.S.V.), Boston University School of Public Health; Boston University and NHLBI's Framingham Heart Study (A.S.B., C.L.S., V.X., R.S.V., A.L.D., S.S.), Framingham; Department of Neurology (A.S.B., C.L.S., A.L.D., S.S.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), University of Texas Health Sciences Center, San Antonio; Sections of Preventive Medicine & Epidemiology and Cardiology (V.X., R.S.V.), Department of Medicine, Boston University, MA; Melbourne Dementia Research Centre (M.P.P.), The Florey Institute for Neuroscience and Mental Health; Faculty of Medicine, Dentistry, and Health Sciences (M.P.P.), University of Melbourne, Parkville; Centre for Human Psychopharmacology (M.P.P.), Swinburne University of Technology, Hawthorn, Australia; and Harvard T.H. Chan School of Public Health (M.P.P.), Boston, MA.
| |
Collapse
|
4
|
De S, Pietilä AM, Iso-Touru T, Hopia A, Tahvonen R, Vähäkangas K. Information Provided to Consumers about Direct-to-Consumer Nutrigenetic Testing. Public Health Genomics 2019; 22:162-173. [PMID: 31779000 DOI: 10.1159/000503977] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 10/08/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Nutrigenetic tests are often considered to be less serious compared to other health-related genetic tests, although they share similar ethical concerns. Nutrigenetic tests are mainly available through direct-to-consumer genetic testing (DTC GT) and increasing in popularity. OBJECTIVE To analyze the contents of nutrigenetic DTC GT websites with respect to the adequacy of the information provided to support a well-informed decision of purchasing the tests. METHODS The websites of DTC GT companies selling nutrigenetic tests that could be ordered online without involving any healthcare professional, available in English, marketing tests in Europe, the USA, Australia, or Canada, and accessible from Finland were included in the study (n = 38). Quantitative and qualitative content analyses of the websites were carried out with the help of a codebook. RESULTS Of the 38 websites, 8 included a clearly identifiable and easy-to-find information section about genetics. The quality and contents of these sections were often insufficient and/or misleading. Fourteen websites had specific sections discussing the risks related to GT, and on 13 signed informed consent was requested for GT. Furthermore, only 2 of the companies offered any kind of pretest consultation and 13 offered mostly separately charged posttest consultation. The complex structure of the websites made it difficult to find all key information, with many important aspects buried in legal documents, which were challenging to comprehend even for a professional. CONCLUSION The structure of the websites and the amount and quality of the content therein do not support a well-informed decision.
Collapse
Affiliation(s)
- Suchetana De
- School of Pharmacy/Toxicology, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Terhi Iso-Touru
- Production Systems/Animal Genetics, Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - Anu Hopia
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
| | - Raija Tahvonen
- Production Systems/Food Processing and Quality, Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - Kirsi Vähäkangas
- School of Pharmacy/Toxicology, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland,
| |
Collapse
|
5
|
Oliveri S, Ferrari F, Manfrinati A, Pravettoni G. A Systematic Review of the Psychological Implications of Genetic Testing: A Comparative Analysis Among Cardiovascular, Neurodegenerative and Cancer Diseases. Front Genet 2018; 9:624. [PMID: 30619456 PMCID: PMC6295518 DOI: 10.3389/fgene.2018.00624] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/23/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Genetic testing is performed for different purposes, such as identifying carriers, predicting a disease onset in presymptomatic individuals or confirming a diagnosis. However, these tests may have notable psychological effects, such as generating anxiety and depression. These effects may depend on people's perception of risk, severity, and controllability of the disease; and the availability of treatments. To date, there are no reports that analyze these factors specifically, and their role in influencing genetic test users' experience. Methods: We performed a systematic review of the psychological implication of undergoing genetic testing for cardiovascular, neurodegenerative and cancer diseases. Articles were searched on PubMed, Google Scholar, and PsychInfo. Results: 47 studies were included, 9 concerning cardiovascular disease, 18 neurodegenerative disorders, and 20 for cancer disease. According to the reviewed studies, people experience no significant increase in distress and anxiety, or adverse impacts on quality of life, except the Huntington disease, which is characterized by depressive symptoms, suicidal ideations, and hopelessness in gene carriers. People tend to consider genetic tests as valid information to take important preventive decisions. Genetic risk for cardiovascular disease is perceived to be manageable; genetic analysis for some neurodegenerative diseases (e.g., Alzheimer) or cancer (breast cancer in particular) is considered useful because the problem could be addressed in advance with preventive behaviors. Conclusions: Genetic tests should be proposed along with proper psychological support and counseling focused on users' genetic health literacy; perception of risk, beliefs about disease controllability, in order to foster fruitful medical decisions.
Collapse
Affiliation(s)
- Serena Oliveri
- Department of Oncology and Hematoncology, Interdisciplinary Research Center on Decision Making Processes, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO Istituto Europeo di Oncologia, Milan, Italy
| | - Federica Ferrari
- Applied Research Division for Cognitive and Psychological Science, IEO Istituto Europeo di Oncologia, Milan, Italy
| | - Andrea Manfrinati
- Applied Research Division for Cognitive and Psychological Science, IEO Istituto Europeo di Oncologia, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hematoncology, Interdisciplinary Research Center on Decision Making Processes, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO Istituto Europeo di Oncologia, Milan, Italy
| |
Collapse
|
8
|
Lacroix S, Cantin J, Nigam A. Contemporary issues regarding nutrition in cardiovascular rehabilitation. Ann Phys Rehabil Med 2016; 60:36-42. [PMID: 27641779 DOI: 10.1016/j.rehab.2016.07.262] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 06/23/2016] [Accepted: 07/07/2016] [Indexed: 12/20/2022]
Abstract
In this article, we discuss certain contemporary and controversial topics in cardiovascular (CV) nutrition including recent data regarding the health benefits of the Mediterranean diet, the role of saturated fatty acids, red meat and the microbiome in CV disease and the current role of personalized CV nutrition. Findings from the PREDIMED study now demonstrate the health benefits of the Mediterranean diet even in the absence of heart disease. The study highlighted that even small, sustained and easily implementable changes to diet can provide significant health benefits even in Mediterranean regions. Likewise, observational data in secondary prevention show that increased adherence to the Mediterranean diet is associated with good long-term clinical outcomes among subjects with stable coronary heart disease. The role of saturated fats in the development of CV disease remains controversial, although data suggest that these fats are associated with modestly increased risk of CV events. In contrast, the obesity epidemic currently driving the CV risk worldwide is in large part due to excess consumption of refined carbohydrates. Furthermore, a growing body of evidence suggests that the intestinal microbiome is highly sensitive to lifestyle choices and may play a pivotal role in modulating CV disease development. For example, recent evidence linking processed and unprocessed meats to increased CV risk pointed to the gut microbial metabolite trimethylamine N-oxide as a potential culprit. Finally, given the high interindividual variability in response to interventions including diet, personalized nutrition has potential to play a major role in tailoring diets based on genetic make-up to maximize health benefits. This approach is still in its infancy but is highly promising.
Collapse
Affiliation(s)
- Sébastien Lacroix
- The Microsoft Research, University of Trento Centre for Computational Systems Biology (COSBI), Piazza Manifattura 1, 38068 Rovereto, Italy; Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute, Montreal, Quebec, Canada H1T 1C8; Research Centre, Montreal Heart Institute, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8
| | - Jennifer Cantin
- Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute, Montreal, Quebec, Canada H1T 1C8; Research Centre, Montreal Heart Institute, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8
| | - Anil Nigam
- Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute, Montreal, Quebec, Canada H1T 1C8; Research Centre, Montreal Heart Institute, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1A8; Department of Medicine, Université de Montréal, Montréal, Québec, Canada H3T 1J4; PERFORM Centre, Concordia University, Montreal, Quebec, Canada H4B 1R6.
| |
Collapse
|