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Pastorino R, Pezzullo AM, Agodi A, de Waure C, Mazzucco W, Russo L, Bianchi M, Maio A, Farina S, Porcelli M, Tona DM, Di Pumpo M, Amore R, Wachocka M, Pasciuto T, Barchitta M, Magnano San Lio R, Favara G, Tuttolomondo A, Tramuto F, Morello G, De Bella DD, Fruscione S, Severino A, Liuzzo G, Boccia S. Efficacy of polygenic risk scores and digital technologies for INNOvative personalized cardiovascular disease PREVention in high-risk adults: protocol of a randomized controlled trial. Front Public Health 2024; 12:1335894. [PMID: 38947346 PMCID: PMC11211566 DOI: 10.3389/fpubh.2024.1335894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
Background Cardiovascular diseases (CVDs) pose a significant global health challenge, necessitating innovative approaches for primary prevention. Personalized prevention, based on genetic risk scores (PRS) and digital technologies, holds promise in revolutionizing CVD preventive strategies. However, the clinical efficacy of these interventions requires further investigation. This study presents the protocol of the INNOPREV randomized controlled trial, aiming to evaluate the clinical efficacy of PRS and digital technologies in personalized cardiovascular disease prevention. Methods The INNOPREV trial is a four-arm RCT conducted in Italy. A total of 1,020 participants, aged 40-69 with high 10-year CVD risk based on SCORE 2 charts, will be randomly assigned to traditional CVD risk assessment, genetic testing (CVD PRS), digital intervention (app and smart band), or a combination of genetic testing and digital intervention. The primary objective is to evaluate the efficacy of providing CVD PRS information, measured at baseline, either alone or in combination with the use of an app and a smart band, on two endpoints: changes in lifestyle patterns, and modification in CVD risk profiles. Participants will undergo a comprehensive assessment and cardiovascular evaluation at baseline, with follow-up visits at one, five, and 12 months. Lifestyle changes and CVD risk profiles will be assessed at different time points beyond the initial assessment, using the Life's Essential 8 and SCORE 2, respectively. Blood samples will be collected at baseline and at study completion to evaluate changes in lipid profiles. The analysis will employ adjusted mixed-effect models for repeated measures to assess significant differences in the data collected over time. Additionally, potential moderators and mediators will be examined to understand the underlying mechanisms of behavior change. Discussion As the largest trial in this context, the INNOPREV trial will contribute to the advancement of personalized cardiovascular disease prevention, with the potential to positively impact public health and reduce the burden of CVDs on healthcare systems. By systematically examining the clinical efficacy of PRS and digital interventions, this trial aims to provide valuable evidence to guide future preventive strategies and enhance population health outcomes.
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Affiliation(s)
- Roberta Pastorino
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angelo Maria Pezzullo
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
- Azienda Ospedaliero Universitaria Policlinico “G. Rodolico-San Marco”, Programme: Hospital Epidemiology and Translational Research: Epidemiological Surveillance, Risk Assessment and Control, Catania, Italy
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Walter Mazzucco
- Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone” di Palermo, Palermo, Italy
- Dipartimento PROMISE, Università degli Studi di Palermo, Palermo, Italy
| | - Luigi Russo
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Bianchi
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Maio
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Farina
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Porcelli
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diego Maria Tona
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Di Pumpo
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosarita Amore
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Malgorzata Wachocka
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tina Pasciuto
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Research Core Facilty Data Collection G-STeP, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Roberta Magnano San Lio
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Giuliana Favara
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Antonino Tuttolomondo
- Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone” di Palermo, Palermo, Italy
- Dipartimento PROMISE, Università degli Studi di Palermo, Palermo, Italy
| | - Fabio Tramuto
- Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone” di Palermo, Palermo, Italy
- Dipartimento PROMISE, Università degli Studi di Palermo, Palermo, Italy
| | - Gaia Morello
- Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone” di Palermo, Palermo, Italy
| | | | - Santo Fruscione
- Dipartimento PROMISE, Università degli Studi di Palermo, Palermo, Italy
| | - Anna Severino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli—IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli—IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Mauer Hall CB, Reys BD, Gemmell AP, Campbell CL, Pirzadeh-Miller SM. Downstream Revenue Generated by Patients With Hereditary Cancer in the Multigene Panel Testing Era. JCO Oncol Pract 2024:OP2300817. [PMID: 38815190 DOI: 10.1200/op.23.00817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/16/2024] [Accepted: 04/02/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE Patients with hereditary cancer syndromes face increased medical management recommendations to address their cancer risks. As multigene panels are the standard of testing today, more patients needing clinical intervention are being identified. This study calculates the downstream revenue (DSR) generated by patients ascertained by a genetic counselor (GC) with a hereditary cancer likely pathogenic/pathogenic variant (LPV/PV). METHODS Retrospective chart review was performed for patients seen in a high-volume cancer genetics clinic between October 1, 2009, and December 31, 2021, with LPV/PVs in hereditary cancer predisposition genes. DSR and work relative value units (wRVUs) were calculated for each patient before and after they met with a GC. Subgroup analyses calculated DSR/wRVUs from patients affected and unaffected with cancer and those whose genetic counseling visit was the first at the institution (naїve). RESULTS A total of 978 patients were available for analysis after exclusions were applied. Patients generated $73.06 million (M) in US dollars (USD) in DSR and 54,814 wRVUs after their initial genetic counseling visit. Unaffected patients (n = 370, 37.8%) generated $11.38M (USD) and 13,879 wRVUs; affected patients (n = 608, 62.2%) generated $61.68M (USD) and 40,935 wRVUs. Naïve patients (n = 367, 37.5%) generated $15.39M (USD) and 11,811 wRVUs; established patients (n = 611, 62.5%) generated $57.67M (USD) and 43,003 wRVUs. Unaffected, naïve patients (n = 204, 20.9%) generated $5.48M (USD) and 5,186 wRVUs. CONCLUSION By identifying patients with hereditary cancer, GCs can bring in substantial DSR for their institution. Naïve and unaffected patients provide the greatest GC value-add as these patients represent new business and revenue sources to the institution. As multigene panels continue to expand, the number of patients needing downstream services will increase. Recognizing patients at increased cancer risk will improve patient outcomes while simultaneously providing DSR for institutions.
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Affiliation(s)
- Caitlin B Mauer Hall
- Department of Health Care Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brian D Reys
- Cancer Genetics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Amber P Gemmell
- Cancer Genetics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Connor L Campbell
- Simmons Comprehensive Cancer Center Finance, University of Texas Southwestern Medical Center, Dallas, TX
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Gholap AD, Kapare HS, Pagar S, Kamandar P, Bhowmik D, Vishwakarma N, Raikwar S, Garkal A, Mehta TA, Rojekar S, Hatvate N, Mohanto S. Exploring modified chitosan-based gene delivery technologies for therapeutic advancements. Int J Biol Macromol 2024; 260:129581. [PMID: 38266848 DOI: 10.1016/j.ijbiomac.2024.129581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/26/2023] [Accepted: 01/06/2024] [Indexed: 01/26/2024]
Abstract
One of the critical steps in gene therapy is the successful delivery of the genes. Immunogenicity and toxicity are major issues for viral gene delivery systems. Thus, non-viral vectors are explored. A cationic polysaccharide like chitosan could be used as a nonviral gene delivery vector owing to its significant interaction with negatively charged nucleic acid and biomembrane, providing effective cellular uptake. However, the native chitosan has issues of targetability, unpacking ability, and solubility along with poor buffer capability, hence requiring modifications for effective use in gene delivery. Modified chitosan has shown that the "proton sponge effect" involved in buffering the endosomal pH results in osmotic swelling owing to the accumulation of a greater amount of proton and chloride along with water. The major challenges include limited exploration of chitosan as a gene carrier, the availability of high-purity chitosan for toxicity reduction, and its immunogenicity. The genetic drugs are in their infancy phase and require further exploration for effective delivery of nucleic acid molecules as FDA-approved marketed formulations soon.
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Affiliation(s)
- Amol D Gholap
- Department of Pharmaceutics, St. John Institute of Pharmacy and Research, Palghar 401404, Maharashtra, India
| | - Harshad S Kapare
- Department of Pharmaceutics, Dr. D. Y. Patil Institute of Pharmaceutical Sciences and Research, Pune 411018, Maharashtra, India
| | - Sakshi Pagar
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai 400019, India
| | - Pallavi Kamandar
- Institute of Chemical Technology, Mumbai, Marathwada Campus, Jalna 431203, India
| | - Deblina Bhowmik
- Institute of Chemical Technology, Mumbai, Marathwada Campus, Jalna 431203, India
| | - Nikhar Vishwakarma
- Department of Pharmacy, Gyan Ganga Institute of Technology and Sciences, Jabalpur 482003, Madhya Pradesh, India
| | - Sarjana Raikwar
- Department of Pharmaceutical Sciences, Dr. Harisingh Gour Central University, Sagar 470003, Madhya Pradesh, India
| | - Atul Garkal
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad 382481, Gujrat, India
| | - Tejal A Mehta
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad 382481, Gujrat, India
| | - Satish Rojekar
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Navnath Hatvate
- Institute of Chemical Technology, Mumbai, Marathwada Campus, Jalna 431203, India.
| | - Sourav Mohanto
- Department of Pharmaceutics, Yenepoya Pharmacy College & Research Centre, Yenepoya (Deemed to be University), Mangaluru, Karnataka 575018, India
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Barriers to genetic testing in clinical psychiatry and ways to overcome them: from clinicians' attitudes to sociocultural differences between patients across the globe. Transl Psychiatry 2022; 12:442. [PMID: 36220808 PMCID: PMC9553897 DOI: 10.1038/s41398-022-02203-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/08/2022] Open
Abstract
Genetic testing has evolved rapidly over recent years and new developments have the potential to provide insights that could improve the ability to diagnose, treat, and prevent diseases. Information obtained through genetic testing has proven useful in other specialties, such as cardiology and oncology. Nonetheless, a range of barriers impedes techniques, such as whole-exome or whole-genome sequencing, pharmacogenomics, and polygenic risk scoring, from being implemented in psychiatric practice. These barriers may be procedural (e.g., limitations in extrapolating results to the individual level), economic (e.g., perceived relatively elevated costs precluding insurance coverage), or related to clinicians' knowledge, attitudes, and practices (e.g., perceived unfavorable cost-effectiveness, insufficient understanding of probability statistics, and concerns regarding genetic counseling). Additionally, several ethical concerns may arise (e.g., increased stigma and discrimination through exclusion from health insurance). Here, we provide an overview of potential barriers for the implementation of genetic testing in psychiatry, as well as an in-depth discussion of strategies to address these challenges.
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Mittendorf KF, Knerr S, Kauffman TL, Lindberg NM, Anderson KP, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Zepp JM, Syngal S, Wilfond BS, Goddard KAB. Systemic Barriers to Risk-Reducing Interventions for Hereditary Cancer Syndromes: Implications for Health Care Inequities. JCO Precis Oncol 2021; 5:PO.21.00233. [PMID: 34778694 PMCID: PMC8585306 DOI: 10.1200/po.21.00233] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kathleen F. Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sarah Knerr
- School of Public Health, University of Washington, Seattle, WA
| | - Tia L. Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Nangel M. Lindberg
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | | | - Marian J. Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Jamilyn M. Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sapna Syngal
- Dana Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Katrina A. B. Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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Akras Z, Bungo B, Leach BH, Marquard J, Ahluwalia M, Carraway H, Grivas P, Sohal DP, Funchain P. Primer on Hereditary Cancer Predisposition Genes Included Within Somatic Next-Generation Sequencing Panels. JCO Precis Oncol 2019; 3:1-11. [DOI: 10.1200/po.18.00258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE It has been estimated that 5% to 10% of cancers are due to hereditary causes. Recent data sets indicate that the incidence of hereditary cancer may be as high as 17.5% in patients with cancer, and a notable subset is missed if screening is solely by family history and current syndrome-based testing guidelines. Identification of germline variants has implications for both patients and their families. There is currently no comprehensive overview of cancer susceptibility genes or inclusion of these genes in commercially available somatic testing. We aimed to summarize genes linked to hereditary cancer and the somatic and germline panels that include such genes. METHODS Germline predisposition genes were chosen if commercially available for testing. Penetrance was defined as low, moderate, or high according to whether the gene conferred a 0% to 20%, 20% to 50%, or 50% to 100% lifetime risk of developing the cancer or, when percentages were not available, was estimated on the basis of existing literature descriptions. RESULTS We identified a total of 89 genes linked to hereditary cancer predisposition, and we summarized these genes alphabetically and by organ system. We considered four germline and six somatic commercially available panel tests and quantified the coverage of germline genes across them. Comparison between the number of genes that had germline importance and the number of genes included in somatic testing showed that many but not all germline genes are tested by frequently used somatic panels. CONCLUSION The inclusion of cancer-predisposing genes in somatic variant testing panels makes incidental germline findings likely. Although somatic testing can be used to screen for germline variants, this strategy is inadequate for comprehensive screening. Access to genetic counseling is essential for interpretation of germline implications of somatic testing and implementation of appropriate screening and follow-up.
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Evans A, de Lacey S, Tremellen K. Australians' understanding of the decline in fertility with increasing age and attitudes towards ovarian reserve screening. Aust J Prim Health 2019; 24:428-433. [PMID: 30158051 DOI: 10.1071/py18040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/21/2018] [Indexed: 01/18/2023]
Abstract
The aim of this study is to determine Australians' understanding of the decline in fertility with age, social determinants that influence their decision to start a family and attitudes towards ovarian reserve screening as a tool allowing personalised reproductive life planning. An online survey of 383 childless Australian men and women, aged 18-45 years, was conducted. Both sexes overestimated natural and in vitro fertilization (IVF)-assisted fertility potential with increasing age, with the magnitude of overestimation being more pronounced for men and IVF treatment compared with natural conception. The primary determinants for starting a family were a stable relationship, followed by establishment of career; availability of accessible child care and paid parental leave were considered less important. Finally, the majority of women (74%) would alter their reproductive life planning if they were identified as having low ovarian reserve on screening. Despite increased education, Australians continue to have a poor understanding of age-related decline in natural and IVF-assisted conception, potentially explaining why many delay starting a family. Ovarian reserve screening may help identify individuals at increased risk of premature diminished fertility, giving these women the ability to bring forward their plans for natural conception or undertake fertility preservation (oocyte freezing).
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Affiliation(s)
- Alisha Evans
- Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
| | - Sheryl de Lacey
- Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
| | - Kelton Tremellen
- Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
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Waldman L, Shuman C, Cohn I, Kaiser A, Chitayat D, Wasim S, Hazell A. Perplexed by PGx? Exploring the impact of pharmacogenomic results on medical management, disclosures and patient behavior. Pharmacogenomics 2019; 20:319-329. [DOI: 10.2217/pgs-2018-0179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pharmacogenomic (PGx) tests represent significant advances in precision medicine. Our aim was to explore perceptions following the return of PGx results, medication management, and disclosure to providers. We surveyed clients who had PGx testing and conducted a chart review of PGx results. Respectively, 84% and 94% of participants found pre- and post-test genetic counseling helpful. There was a significant difference in disclosure, while 6% disclosed results to a pharmacist, 50% disclosed to a physician. Qualitative analysis identified three themes: 1) psychological response; 2) perceived utility; 3) experiences with disclosure. Our study supports the provision of genetic counseling for a non-disease related genetic test. Benefits of PGx testing can be optimized by the collaboration of physicians, pharmacists, genetic counselors and patients.
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Affiliation(s)
- Larissa Waldman
- Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl Shuman
- Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Iris Cohn
- Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Amy Kaiser
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - David Chitayat
- Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Prenatal Diagnosis & Medical Genetics Program, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Syed Wasim
- Fred A Litwin Family Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Allison Hazell
- Medcan Health Management, Inc., Toronto, Ontario, Canada
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Courtney E, Chin XW, Yuen J, Li ST, Chen Y, Allen JC, Tan V, Lim GH, Ngeow J. Risk management adherence following genetic testing for hereditary cancer syndromes: a Singaporean experience. Fam Cancer 2019; 17:621-626. [PMID: 29368260 DOI: 10.1007/s10689-018-0071-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Assessing adherence behavior among mutation carriers to cancer risk management guidelines is important for both service improvement and cost-effectiveness analyses, but such real-world data is often lacking. The present study aims to report adherence rates among mutation carriers in a recently established cancer genetics program in Singapore. We conducted a medical chart review of mutation carriers who had attended for genetic counseling and gathered data regarding risk management behavior, including cancer surveillance and/or risk-reducing surgery, and cancers subsequently detected. Of the 52 subjects included in the study, the majority were affected prior to genetic testing (78.8%) and had family history suggestive of a germline mutation (88.5%). The overall adherence rate was 96.2%, including 37 (74.0%) fully-adherent and 13 (26.0%) partially-adherent subjects, with five cancers subsequently detected. Among the 28 BRCA1/2 mutation carriers, adherence to breast cancer risk management was also high (89.3%), although uptake of risk-reducing bilateral salpingo-oophorectomy was not as common (60%). Whilst overall adherence in this cohort was high, BRCA1/2 mutation carriers may require targeted interventions to improve ovarian cancer risk management uptake. Additionally, further education among health professionals and the wider community regarding cancer genetics is needed to ensure the early identification of mutation carriers.
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Affiliation(s)
- Eliza Courtney
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Xin Wei Chin
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Jeanette Yuen
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Shao-Tzu Li
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Yanni Chen
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - John Carson Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Veronique Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Geok Hoon Lim
- KK Breast Centre, KK Women's and Children's Hospital, Singapore, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore. .,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
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Hill JA, Gedleh A, Lee S, Hougham KA, Dimaras H. Knowledge, experiences and attitudes concerning genetics among retinoblastoma survivors and parents. Eur J Hum Genet 2018; 26:505-517. [PMID: 29379195 DOI: 10.1038/s41431-017-0027-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/23/2017] [Accepted: 10/10/2017] [Indexed: 01/14/2023] Open
Abstract
Clinical genetic services are increasingly providing a more nuanced understanding of genetic disease diagnostics and future risk for patients. Effectively conveying genetic information is essential for patients to make informed decisions. This is especially important for survivors of heritable cancers such as retinoblastoma (childhood eye cancer), where survivors who carry a germline mutation in the RB1 gene are at increased risk of second cancers in adulthood, and of passing on the disease risk to future offspring. We conducted focus groups with adult survivors of retinoblastoma and parents of children with retinoblastoma, to uncover their knowledge of, experiences with and attitudes about retinoblastoma genetics and related impacts of the cancer. Results revealed that participants understood that retinoblastoma was a genetic disease, but often misunderstood the implications of genetics on cancer phenotype and risk. Experiences with genetic testing and counseling were generally positive, however, participants reported challenges in accessing genetic information and psychosocial support. Participants suggested more educational resources, peer-to-peer counseling, and psychosocial support would enhance uptake of important genetic information. The results of the study will inform patient-oriented approaches to deliver comprehensive genetic healthcare.
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Affiliation(s)
- Jessica A Hill
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Amal Gedleh
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Health Promotion, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Siwon Lee
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Health Promotion, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kaitlyn A Hougham
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada. .,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada. .,Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada. .,Department of Human Pathology, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
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Peterson EB, Chou WYS, Gaysynsky A, Krakow M, Elrick A, Khoury MJ, Kaphingst KA. Communication of cancer-related genetic and genomic information: A landscape analysis of reviews. Transl Behav Med 2018; 8:59-70. [PMID: 29385592 PMCID: PMC6065548 DOI: 10.1093/tbm/ibx063] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Cancer-related genetic and genomic testing (CGT) is changing cancer care by personalizing care options, leading to an era of precision medicine. Advances in and increased use of CGT add complexity to clinical communication. This landscape analysis assessed published reviews of communication issues related to CGT and discusses implications for practice and behavioral research. A comprehensive electronic literature search was conducted of peer-reviewed literature reviews on studies related to CGT communication published between January 2010 and January 2017, resulting in a final sample of 24 reviews. Reviews were categorized, with overlaps, into four domains across the genetic testing communication continuum. Reviews on CGT-related knowledge, attitudes, and perceptions (n = 8) found that despite substantial public interest, their knowledge and awareness remains low. Providers also reported insufficient knowledge and overall caution, particularly regarding direct-to-consumer (DTC) genetic testing. Reviews of decision-making about CGT and test uptake (n = 8) identified individual, interpersonal, and systems-level barriers to uptake. Reviews of patient-provider CGT communication (n = 8) revealed limited communication and little empirical research on outcomes of communication or efforts at improving clinical and family communication. There were mixed findings in reviews (n = 15) on the psychological and behavioral impact of CGT, and DTC testing particularly had little effect on behaviors. Taken together, there is very little extant research in CGT in minority and underserved communities. In order for scientific advances in CGT to translate into equitable, patient-centered care, behavioral research, including health literacy and communication, plays critical roles.
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Affiliation(s)
- Emily B Peterson
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Wen-ying Sylvia Chou
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Anna Gaysynsky
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Melinda Krakow
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Ashley Elrick
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Prevention and Control, Atlanta, GA, USA
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"Where Does it Come from?" Experiences Among Survivors and Parents of Children with Retinoblastoma in Kenya. J Genet Couns 2017; 27:574-588. [PMID: 29170903 DOI: 10.1007/s10897-017-0174-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/06/2017] [Indexed: 01/09/2023]
Abstract
Genetic testing and counseling have become integral to the timely control of heritable cancers, like the childhood eye cancer retinoblastoma. This study aimed to determine attitudes, knowledge and experiences related to retinoblastoma genetics, among survivors and parents of children with retinoblastoma in Kenya. This qualitative study used focus groups as the primary data collection method, coupled with a brief demographic questionnaire. Study settings were Kenyatta National Hospital and Presbyterian Church of East Africa Kikuyu Hospital. Thematic analysis was used to identify key themes. Thirty-one individuals participated in five focus groups. Two main concepts emerged: (1) the origins of retinoblastoma are unclear, and (2) retinoblastoma is associated with significant challenges. The lack of clarity surrounding the origins of retinoblastoma was linked to limited knowledge of retinoblastoma genetics, and limited genetic counseling delivery and uptake. The challenges associated with retinoblastoma were discussed in terms of the impact of the diagnosis on individuals and families, and unmet healthcare needs related to the diagnosis. Next steps will incorporate these findings to develop evidence-informed and accessible cancer genetic services in Kenya.
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14
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Harvey K, Diug B. Retail genetics. Aust Prescr 2017; 40:86-87. [PMID: 28798508 DOI: 10.18773/austprescr.2017.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ken Harvey
- School of Public Health and Preventive Medicine, Monash University, Melbourne
| | - Basia Diug
- Medical Education Research and Quality Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne
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Recent progress in genetics, epigenetics and metagenomics unveils the pathophysiology of human obesity. Clin Sci (Lond) 2017; 130:943-86. [PMID: 27154742 DOI: 10.1042/cs20160136] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/24/2016] [Indexed: 12/19/2022]
Abstract
In high-, middle- and low-income countries, the rising prevalence of obesity is the underlying cause of numerous health complications and increased mortality. Being a complex and heritable disorder, obesity results from the interplay between genetic susceptibility, epigenetics, metagenomics and the environment. Attempts at understanding the genetic basis of obesity have identified numerous genes associated with syndromic monogenic, non-syndromic monogenic, oligogenic and polygenic obesity. The genetics of leanness are also considered relevant as it mirrors some of obesity's aetiologies. In this report, we summarize ten genetically elucidated obesity syndromes, some of which are involved in ciliary functioning. We comprehensively review 11 monogenic obesity genes identified to date and their role in energy maintenance as part of the leptin-melanocortin pathway. With the emergence of genome-wide association studies over the last decade, 227 genetic variants involved in different biological pathways (central nervous system, food sensing and digestion, adipocyte differentiation, insulin signalling, lipid metabolism, muscle and liver biology, gut microbiota) have been associated with polygenic obesity. Advances in obligatory and facilitated epigenetic variation, and gene-environment interaction studies have partly accounted for the missing heritability of obesity and provided additional insight into its aetiology. The role of gut microbiota in obesity pathophysiology, as well as the 12 genes associated with lipodystrophies is discussed. Furthermore, in an attempt to improve future studies and merge the gap between research and clinical practice, we provide suggestions on how high-throughput '-omic' data can be integrated in order to get closer to the new age of personalized medicine.
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Iribarren C, Lu M, Jorgenson E, Martínez M, Lluis-Ganella C, Subirana I, Salas E, Elosua R. Clinical Utility of Multimarker Genetic Risk Scores for Prediction of Incident Coronary Heart Disease: A Cohort Study Among Over 51 000 Individuals of European Ancestry. ACTA ACUST UNITED AC 2016; 9:531-540. [PMID: 27780846 DOI: 10.1161/circgenetics.116.001522] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/28/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND We evaluated whether including multilocus genetic risk scores (GRSs) into the Framingham Risk Equation improves the predictive capacity, discrimination, and reclassification of asymptomatic individuals with respect to coronary heart disease (CHD) risk. METHODS AND RESULTS We performed a cohort study among 51 954 European-ancestry members of a Northern California integrated healthcare system (67% female; mean age 59) free of CHD at baseline (2007-2008). Four GRSs were constructed using between 8 and 51 previously identified genetic variants. After a mean (±SD) follow-up of 5.9 (±1.5) years, 1864 incident CHD events were documented. All GRSs were linearly associated with CHD in a model adjusted by individual risk factors: hazard ratio (95% confidence interval) per SD unit: 1.21 (1.15-1.26) for GRS_8, 1.20 (1.15-1.26) for GRS_12, 1.23 (1.17-1.28) for GRS_36, and 1.23 (1.17-1.28) for GRS_51. Inclusion of the GRSs improved the C statistic (ΔC statistic =0.008 for GRS_8 and GRS_36; 0.007 for GRS_12; and 0.009 for GRS_51; all P<0.001). The net reclassification improvement was 5% for GRS_8, GRS_12, and GRS_36 and 4% for GRS_51 in the entire cohort and was (after correcting for bias) 9% for GRS_8 and GRS_12 and 7% for GRS_36 and GRS_51 when analyzing those classified as intermediate Framingham risk (10%-20%). The number required to treat to prevent 1 CHD after selectively treating with statins up-reclassified subjects on the basis of genetic information was 36 for GRS_8 and GRS_12, 41 for GRS_36, and 43 for GRS_51. CONCLUSIONS Our results demonstrate significant and clinically relevant incremental discriminative/predictive capability of 4 multilocus GRSs for incident CHD among subjects of European ancestry.
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Affiliation(s)
- Carlos Iribarren
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.).
| | - Meng Lu
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
| | - Eric Jorgenson
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
| | - Manuel Martínez
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
| | - Carla Lluis-Ganella
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
| | - Isaac Subirana
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
| | - Eduardo Salas
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
| | - Roberto Elosua
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
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Li SX, Ye Z, Whelan K, Truby H. The effect of communicating the genetic risk of cardiometabolic disorders on motivation and actual engagement in preventative lifestyle modification and clinical outcome: a systematic review and meta-analysis of randomised controlled trials. Br J Nutr 2016; 116:924-34. [PMID: 27405704 PMCID: PMC4983776 DOI: 10.1017/s0007114516002488] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/30/2016] [Accepted: 05/19/2016] [Indexed: 11/06/2022]
Abstract
Genetic risk prediction of chronic conditions including obesity, diabetes and CVD currently has limited predictive power but its potential to engage healthy behaviour change has been of immense research interest. We aimed to understand whether the latter is indeed true by conducting a systematic review and meta-analysis investigating whether genetic risk communication affects motivation and actual behaviour change towards preventative lifestyle modification. We included all randomised controlled trials (RCT) since 2003 investigating the impact of genetic risk communication on health behaviour to prevent cardiometabolic disease, without restrictions on age, duration of intervention or language. We conducted random-effects meta-analyses for perceived motivation for behaviour change and clinical changes (weight loss) and a narrative analysis for other outcomes. Within the thirteen studies reviewed, five were vignette studies (hypothetical RCT) and seven were clinical RCT. There was no consistent effect of genetic risk on actual motivation for weight loss, perceived motivation for dietary change (control v. genetic risk group standardised mean difference (smd) -0·15; 95 % CI -1·03, 0·73, P=0·74) or actual change in dietary behaviour. Similar results were observed for actual weight loss (control v. high genetic risk SMD 0·29 kg; 95 % CI -0·74, 1·31, P=0·58). This review found no clear or consistent evidence that genetic risk communication alone either raises motivation or translates into actual change in dietary intake or physical activity to reduce the risk of cardiometabolic disorders in adults. Of thirteen studies, eight were at high or unclear risk of bias. Additional larger-scale, high-quality clinical RCT are warranted.
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Affiliation(s)
- Sherly X. Li
- Medical Research Council Epidemiology Unit, University
of Cambridge, Cambridge CB2 0QQ,
UK
| | - Zheng Ye
- Medical Research Council Epidemiology Unit, University
of Cambridge, Cambridge CB2 0QQ,
UK
| | - Kevin Whelan
- Diabetes and Nutritional Sciences Division, King’s
College London, London SE1 9NH, UK
| | - Helen Truby
- Department of Nutrition & Dietetics, Monash
University, Level 1, 264 Ferntree Gully
Road, Notting Hill, VIC 3168,
Australia
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18
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Kim JSM, Coyte PC, Cotterchio M, Keogh LA, Flander LB, Gaff C, Laporte A. The Impact of Receiving Predictive Genetic Information about Lynch Syndrome on Individual Colonoscopy and Smoking Behaviors. Cancer Epidemiol Biomarkers Prev 2016; 25:1524-1533. [PMID: 27528600 DOI: 10.1158/1055-9965.epi-16-0346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/02/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study investigated whether receiving the results of predictive genetic testing for Lynch syndrome, indicating the presence or absence of an inherited predisposition to various cancers, including colorectal cancer, was associated with change in individual colonoscopy and smoking behaviors, which could prevent colorectal cancer. METHODS The study population included individuals with no previous diagnosis of colorectal cancer, whose families had already identified deleterious mutations in the mismatch repair or EPCAM genes. Hypotheses were generated from a simple health economics model and tested against individual-level panel data from the Australasian Colorectal Cancer Family Registry. RESULTS The empirical analysis revealed evidence consistent with some of the hypotheses, with a higher likelihood of undergoing colonoscopy in those who discovered their genetic predisposition to colorectal cancer and a lower likelihood of quitting smoking in those who discovered their lack thereof. CONCLUSIONS Predictive genetic information about Lynch syndrome was associated with change in individual colonoscopy and smoking behaviors but not necessarily in ways to improve population health. IMPACT The study findings suggest that the impact of personalized medicine on disease prevention is intricate, warranting further analyses to determine the net benefits and costs. Cancer Epidemiol Biomarkers Prev; 25(11); 1524-33. ©2016 AACR.
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Affiliation(s)
- Joanne Soo-Min Kim
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Canadian Centre for Health Economics, Toronto, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Canadian Centre for Health Economics, Toronto, Canada
| | | | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Louisa B Flander
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
| | - Clara Gaff
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Canadian Centre for Health Economics, Toronto, Canada
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19
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Zierhut HA, Shannon KM, Cragun DL, Cohen SA. Elucidating Genetic Counseling Outcomes from the Perspective of Genetic Counselors. J Genet Couns 2016; 25:993-1001. [DOI: 10.1007/s10897-015-9930-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 12/20/2015] [Indexed: 12/01/2022]
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20
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Akhmetov I, Bubnov RV. Assessing value of innovative molecular diagnostic tests in the concept of predictive, preventive, and personalized medicine. EPMA J 2015; 6:19. [PMID: 26425215 PMCID: PMC4588236 DOI: 10.1186/s13167-015-0041-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/08/2015] [Indexed: 02/07/2023]
Abstract
Molecular diagnostic tests drive the scientific and technological uplift in the field of predictive, preventive, and personalized medicine offering invaluable clinical and socioeconomic benefits to the key stakeholders. Although the results of diagnostic tests are immensely influential, molecular diagnostic tests (MDx) are still grudgingly reimbursed by payers and amount for less than 5 % of the overall healthcare costs. This paper aims at defining the value of molecular diagnostic test and outlining the most important components of "value" from miscellaneous assessment frameworks, which go beyond accuracy and feasibility and impact the clinical adoption, informing healthcare resource allocation decisions. The authors suggest that the industry should facilitate discussions with various stakeholders throughout the entire assessment process in order to arrive at a consensus about the depth of evidence required for positive marketing authorization or reimbursement decisions. In light of the evolving "value-based healthcare" delivery practices, it is also recommended to account for social and ethical parameters of value, since these are anticipated to become as critical for reimbursement decisions and test acceptance as economic and clinical criteria.
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Affiliation(s)
- Ildar Akhmetov
- />Strategic Market Intelligence Dep., Unicorn, P.O.B. 91, Zhytomyr, 10020 Ukraine
| | - Rostyslav V. Bubnov
- />Clinical Hospital “Pheophania” of State Affairs Department, Zabolotny Str., 21, Kyiv, 03680 Ukraine
- />Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Zabolotny Str., 154, Kyiv, 03680 Ukraine
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21
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Kiedrowski LA, Owens KM, Yashar BM, Schuette JL. Parents' Perspectives on Variants of Uncertain Significance from Chromosome Microarray Analysis. J Genet Couns 2015; 25:101-11. [PMID: 25983052 DOI: 10.1007/s10897-015-9847-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/12/2015] [Indexed: 11/30/2022]
Abstract
Chromosomal microarray analysis (CMA) for unexplained anomalies and developmental delay has improved diagnosis rates, but results classified as variants of uncertain significance (VUS) may challenge both clinicians and families. We explored the impact of such results on families, including parental knowledge, understanding and interpretation. Semi-structured telephone interviews were conducted with parents (N = 14) who received genetic counseling for a VUS in their child. Transcripts were analyzed through an iterative coding process. Participants demonstrated a range of recall and personal interpretation regarding whether test results provided a causal explanation for their children's health issues. Participants maintained contradictory interpretations, describing results as answers while maintaining that little clarification of their child's condition had been provided. Reported benefits included obtaining medical services and personal validation. Parents described adaptation/coping processes similar to those occurring after positive test results. Recall of terminology, including "VUS" and precise CMA abnormalities, was poor. However, most demonstrated conceptual understanding of scientific uncertainty. All participants expressed intentions to return for recommended genetics follow-up but had misconceptions about how this would occur. These results provide insight into the patient-and-family experience when receiving uncertain genomic findings, emphasize the importance of exploring uncertainty during the communication process, and highlight areas for potential attention or improvement in the clinical encounter.
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Affiliation(s)
- Lesli A Kiedrowski
- Department of Cancer Genetics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9323, USA. .,Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA.
| | - Kailey M Owens
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - Jane L Schuette
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, USA
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22
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Goodlin GT, Roos AK, Roos TR, Hawkins C, Beache S, Baur S, Kim SK. Applying personal genetic data to injury risk assessment in athletes. PLoS One 2015; 10:e0122676. [PMID: 25919592 PMCID: PMC4412532 DOI: 10.1371/journal.pone.0122676] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 02/24/2015] [Indexed: 01/08/2023] Open
Abstract
Recent studies have identified genetic markers associated with risk for certain sports-related injuries and performance-related conditions, with the hope that these markers could be used by individual athletes to personalize their training and diet regimens. We found that we could greatly expand the knowledge base of sports genetic information by using published data originally found in health and disease studies. For example, the results from large genome-wide association studies for low bone mineral density in elderly women can be re-purposed for low bone mineral density in young endurance athletes. In total, we found 124 single-nucleotide polymorphisms associated with: anterior cruciate ligament tear, Achilles tendon injury, low bone mineral density and stress fracture, osteoarthritis, vitamin/mineral deficiencies, and sickle cell trait. Of these single nucleotide polymorphisms, 91% have not previously been used in sports genetics. We conducted a pilot program on fourteen triathletes using this expanded knowledge base of genetic variants associated with sports injury. These athletes were genotyped and educated about how their individual genetic make-up affected their personal risk profile during an hour-long personal consultation. Overall, participants were favorable of the program, found it informative, and most acted upon their genetic results. This pilot program shows that recent genetic research provides valuable information to help reduce sports injuries and to optimize nutrition. There are many genetic studies for health and disease that can be mined to provide useful information to athletes about their individual risk for relevant injuries.
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Affiliation(s)
- Gabrielle T Goodlin
- Departments of Developmental Biology and Genetics, Stanford University Medical Center, Stanford, CA, 94305, United States of America
| | - Andrew K Roos
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, 94305, United States of America
| | - Thomas R Roos
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, 94305, United States of America
| | - Claire Hawkins
- Department of Human Biology, Stanford University, Stanford, CA, 94305, United States of America
| | - Sydney Beache
- Department of Human Biology, Stanford University, Stanford, CA, 94305, United States of America
| | - Stephen Baur
- Departments of Developmental Biology and Genetics, Stanford University Medical Center, Stanford, CA, 94305, United States of America
| | - Stuart K Kim
- Departments of Developmental Biology and Genetics, Stanford University Medical Center, Stanford, CA, 94305, United States of America
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Affiliation(s)
- Gabrielle T Goodlin
- *Departments of Developmental Biology and Genetics, Stanford University Medical Center, Stanford, California; and †Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
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24
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Markus HS, Bevan S. Mechanisms and treatment of ischaemic stroke--insights from genetic associations. Nat Rev Neurol 2014; 10:723-30. [PMID: 25348005 DOI: 10.1038/nrneurol.2014.196] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The precise pathophysiology of ischaemic stroke is unclear, and a greater understanding of the different mechanisms that underlie large-artery, cardioembolic and lacunar ischaemic stroke subtypes would enable the development of more-effective, subtype-specific therapies. Genome-wide association studies (GWASs) are identifying novel genetic variants that associate with the risk of stroke. These associations provide insight into the pathophysiological mechanisms, and present opportunities for novel therapeutic approaches. In this Review, we summarize the genetic variants that have been linked to ischaemic stroke in GWASs to date and discuss the implications of these associations for both our understanding and treatment of ischaemic stroke. The majority of genetic variants identified are associated with specific subtypes of ischaemic stroke, implying that these subtypes have distinct genetic architectures and pathophysiological mechanisms. The findings from the GWASs highlight the need to consider whether therapies should be subtype-specific. Further GWASs that include large cohorts are likely to provide further insights, and emerging technologies will complement and build on the GWAS findings.
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Affiliation(s)
- Hugh S Markus
- Stroke Research Group, Department of Neurology, R3, Box 83, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Steve Bevan
- Stroke Research Group, Department of Neurology, R3, Box 83, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
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25
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Tremellen K, Savulescu J. Ovarian reserve screening: a scientific and ethical analysis. Hum Reprod 2014; 29:2606-14. [DOI: 10.1093/humrep/deu265] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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26
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Hirschberg AM, Chan-Smutko G, Pirl WF. Psychiatric implications of cancer genetic testing. Cancer 2014; 121:341-60. [PMID: 25234846 DOI: 10.1002/cncr.28879] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/17/2014] [Accepted: 04/24/2014] [Indexed: 12/21/2022]
Abstract
As genetic testing for hereditary cancer syndromes has transitioned from research to clinical settings, research regarding its accompanying psychosocial effects has grown. Men and women being tested for hereditary cancer syndromes may experience some psychological distress while going through the process of testing or after carrier status is identified. Psychological distress appears to decrease over the course of the first year and it is typically not clinically significant. Longer term studies show mixed results with some mutation carriers continuing to experience elevated distress. Baseline distress is the greatest risk factor for both immediate (weeks-12 months) and long-term psychological distress (18 mo-8 years post genetic testing). In addition to baseline psychological distress, other risk factors can be identified to help identify individuals who may need psychosocial interventions during the genetic testing process. The challenges of providing clinical care to the growing population of individuals identified to be at increased risk for heritable cancers present opportunities for research and new models of care.
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Abstract
Developments in genomics continue to increase the number of disorders for which genetic testing is available, whether in the primary healthcare system, through direct-to-consumer testing, or as part of expanded newborn screening panels. This paper reviews a robust literature on public attitudes toward genetics and genetic testing. In general, attitudes are positive about genetic research and new genomic technologies, with majorities indicating an interest in genetic testing. However, complex beliefs comprise the public's thinking about genetics. Attitudes are driven by beliefs about the type of genetic research, the personal and clinical utility of tests, and the area of genetics in which testing is applied. Limitations of current research are noted and suggestions made for future research.
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Affiliation(s)
- Holly Etchegary
- Clinical Epidemiology, Division of Medicine, Faculty of Medicine, Memorial University, Room H1407, Level 1, Health Sciences Centre, 300 Prince Phillip Drive, St John's, NL A1B 3V6, Canada
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Fisher E, Achilles S, Tönnies H. Predictive genetic testing, risk communication, and risk perception: an international expert meeting in Berlin, Germany. J Community Genet 2013; 5:1-5. [PMID: 24323368 DOI: 10.1007/s12687-013-0177-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 11/26/2013] [Indexed: 12/29/2022] Open
Affiliation(s)
- Eva Fisher
- Administrative Office of the German Commission on Genetic Testing, Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany,
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