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Primiero CA, Yanes T, Finnane A, Soyer HP, McInerney-Leo AM. A Systematic Review on the Impact of Genetic Testing for Familial Melanoma I: Primary and Secondary Preventative Behaviours. Dermatology 2021; 237:806-815. [PMID: 33588421 DOI: 10.1159/000513919] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing availability of panel testing for known high-penetrance familial melanoma genes has made it possible to improve risk awareness in those at greatest risk. Prior to wider implementation, the role of genetic testing in preventing melanoma, through influencing primary and secondary preventative behaviours, requires clarification. METHODS Database searches of PubMed, Embase, CINAHL, PsycINFO and the Cochrane Library were conducted for studies describing preventative behaviour outcomes in response to genetic testing for melanoma risk. Publications describing original research of any study type were screened for eligibility. RESULTS Eighteen publications describing 11 unique studies were reviewed. Outcomes assessed are based on health behaviour recommendations for those at increased risk: adherence to sun-protective behaviour (SPB); clinical skin examinations (CSE); skin self-examinations (SSE); and family discussion of risk. Overall, modest increases in adherence to primary prevention strategies of SPB were observed following genetic testing. Importantly, there were no net decreases in SPB found amongst non-carriers. For secondary preventative behaviour outcomes, including CSE and SSE, increases in post-test intentions and long-term adherence were reported across several subgroups in approximately half of the studies. While this increase reached significance in mutation carriers in some studies, one study reported a significant decline in annual CSE adherence of non-mutation carriers. CONCLUSIONS Evidence reviewed suggests that genetic testing has a modestly positive impact on preventative behaviour in high-risk individuals. Furthermore, improvements are observed regardless of mutation carrier status, although greater adherence is found in carriers. While additional studies of more diverse cohorts would be needed to inform clinical recommendations, the findings are encouraging and suggest that genetic testing for melanoma has a positive impact on preventative behaviours.
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Affiliation(s)
- Clare A Primiero
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Tatiane Yanes
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Anna Finnane
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia,
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia,
| | - Aideen M McInerney-Leo
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
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Nahar VK, Wilkerson AH, Pearlman RL, Ferris TS, Zardoost P, Payson SN, Aman I, Quadri SSA, Brodell RT. Skin cancer-related knowledge, attitudes, beliefs, and practices among the population in Gulf Cooperation Council countries: a systematic search and literature review. Arch Dermatol Res 2020; 312:533-544. [PMID: 32055931 DOI: 10.1007/s00403-020-02041-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/17/2020] [Accepted: 01/25/2020] [Indexed: 11/26/2022]
Abstract
Skin cancers are the most common malignancies diagnosed worldwide. In Gulf Cooperation Council (GCC) countries, skin cancer remains a significant health burden. Multiple studies have attempted to elucidate patient knowledge and attitudes regarding skin cancer risks and behavioral interventions to reduce risks. A systematic literature search of relevant articles was conducted in PubMed, ScienceDirect, and the Saudi Digital Library databases. A narrative analysis of relevant study results was conducted. A total of 12 studies were reviewed across GCC. These studies revealed common themes among GCC populations. Many study participants were aware that excess sun exposure represents a threat to health and increases cancer risk. Several studies reported sun exposure, with a mean of 19.13 h per week. More studies reported patients engaging in lower or no sunscreen use rather than regular sunscreen use. There are discrepancies in the understanding of sun exposure risk and risk mitigation practices among the study populations. Skin cancer poses a significant burden to patients in GCC countries and improved patient education will enhance population health.
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Affiliation(s)
- Vinayak K Nahar
- Department of Dermatology, School of Medicine, University of Mississippi Medical Center, 2500 North State Street-L216, Jackson, MS, 39216, USA.
- Department of Preventive Medicine, School of Medicine/John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Amanda H Wilkerson
- Department of Human Environmental Sciences, College of Human Environmental Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Ross L Pearlman
- Department of Dermatology, School of Medicine, University of Mississippi Medical Center, 2500 North State Street-L216, Jackson, MS, 39216, USA
| | - Taylor S Ferris
- Department of Dermatology, School of Medicine, University of Mississippi Medical Center, 2500 North State Street-L216, Jackson, MS, 39216, USA
| | - Pooya Zardoost
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, USA
| | - Shirley N Payson
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, USA
| | - Iram Aman
- Department of Preventive Medicine, School of Medicine/John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Syed Siraj A Quadri
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, USA
| | - Robert T Brodell
- Department of Dermatology, School of Medicine, University of Mississippi Medical Center, 2500 North State Street-L216, Jackson, MS, 39216, USA
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Stump TK, Aspinwall LG, Kohlmann W, Champine M, Hauglid J, Wu YP, Scott E, Cassidy P, Leachman SA. Genetic Test Reporting and Counseling for Melanoma Risk in Minors May Improve Sun Protection Without Inducing Distress. J Genet Couns 2018; 27:955-967. [PMID: 29349527 PMCID: PMC6039245 DOI: 10.1007/s10897-017-0185-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/27/2017] [Indexed: 11/28/2022]
Abstract
Genetic testing of minors is advised only for conditions in which benefits of early intervention outweigh potential psychological harms. This study investigated whether genetic counseling and test reporting for the CDKN2A/p16 mutation, which confers highly elevated melanoma risk, improved sun protection without inducing distress. Eighteen minors (Mage = 12.4, SD = 1.9) from melanoma-prone families completed measures of protective behavior and distress at baseline, 1 week (distress only), 1 month, and 1 year following test disclosure. Participants and their mothers were individually interviewed on the psychological and behavioral impact of genetic testing 1 month and 1 year post-disclosure. Carriers (n = 9) and noncarriers (n = 9) reported significantly fewer sunburns and a greater proportion reported sun protection adherence between baseline and 1 year post-disclosure; results did not vary by mutation status. Anxiety symptoms remained low post-disclosure, while depressive symptoms and cancer worry decreased. Child and parent interviews corroborated these findings. Mothers indicated that genetic testing was beneficial (100%) because it promoted risk awareness (90.9%) and sun protection (81.8%) without making their children scared (89.9%); several noted their child's greater independent practice of sun protection (45.4%). In this small initial study, minors undergoing CDKN2A/p16 genetic testing reported behavioral improvements and consistently low distress, suggesting such testing may be safely implemented early in life, allowing greater opportunity for risk-reducing lifestyle changes.
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Affiliation(s)
- Tammy K Stump
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.
- Department of Preventive Medicine, Northwestern University, 680 N. Lake Shore Dr., Suite 1500, Chicago, IL, 60611, USA.
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Jamie Hauglid
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Emily Scott
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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Wu YP, Aspinwall LG, Nagelhout E, Kohlmann W, Kaphingst KA, Homburger S, Perkins RD, Grossman D, Harding G, Cassidy P, Leachman SA. Development of an Educational Program Integrating Concepts of Genetic Risk and Preventive Strategies for Children with a Family History of Melanoma. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:774-781. [PMID: 27889875 PMCID: PMC5446308 DOI: 10.1007/s13187-016-1144-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Efforts to prevent melanoma, especially for those at elevated risk for the disease, should ideally begin during childhood. However, there are few preventive interventions targeting children who are at higher risk for melanoma due to a family history of the disease. Further, there are no educational interventions that aim to help these at-risk children understand their risk for melanoma and the ways in which preventive behaviors, such as sun protection, can mitigate their risk. The current paper describes a multidisciplinary team's process for creating a developmentally appropriate educational intervention about melanoma risk and prevention for children ages 8-17 years who have a family history of melanoma. Drawing from the fields of dermatology, health behavior change and education, genetic risk communication, science education, and graphic arts, the multimedia intervention created covers key learning points relevant to understanding melanoma, the role of DNA damage in melanoma development, inherited risk factors for melanoma, environmental factors causing DNA damage, and methods for preventing DNA damage, such as sun protective behaviors. Lessons learned during the development of the educational intervention, particularly relevant to multidisciplinary team interactions, are discussed. Implications for future testing and refinement of the novel educational content are also reviewed.
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Affiliation(s)
- Yelena P Wu
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA.
- Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4142, Salt Lake City, UT, 84112, USA.
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84112, USA
| | - Elizabeth Nagelhout
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4142, Salt Lake City, UT, 84112, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4142, Salt Lake City, UT, 84112, USA
- Department of Communication, University of Utah, 255 S Central Campus Drive, Room 2400, Salt Lake City, UT, 84112, USA
| | - Sheila Homburger
- Genetic Science Learning Center, University of Utah, 515 100 S, Salt Lake City, UT, 84102, USA
| | - Ryan D Perkins
- Genetic Science Learning Center, University of Utah, 515 100 S, Salt Lake City, UT, 84102, USA
| | - Douglas Grossman
- Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4142, Salt Lake City, UT, 84112, USA
- Department of Dermatology, University of Utah, 30 North 1900 East, 4A330, Salt Lake City, UT, 84132, USA
| | - Garrett Harding
- Huntsman Cancer Institute, 2000 Circle of Hope, Rm 4142, Salt Lake City, UT, 84112, USA
| | - Pamela Cassidy
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR, 97239, USA
| | - Sancy A Leachman
- Department of Dermatology and Knight Cancer Institute, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR, 97239, USA
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Smit AK, Newson AJ, Morton RL, Kimlin M, Keogh L, Law MH, Kirk J, Dobbinson S, Kanetsky PA, Fenton G, Allen M, Butow P, Dunlop K, Trevena L, Lo S, Savard J, Dawkins H, Wordsworth S, Jenkins M, Mann GJ, Cust AE. The melanoma genomics managing your risk study: A protocol for a randomized controlled trial evaluating the impact of personal genomic risk information on skin cancer prevention behaviors. Contemp Clin Trials 2018; 70:106-116. [PMID: 29802966 DOI: 10.1016/j.cct.2018.05.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Reducing ultraviolet radiation (UV) exposure and improving early detection may reduce melanoma incidence, mortality and health system costs. This study aims to evaluate the efficacy and cost-effectiveness of providing information on personal genomic risk of melanoma in reducing UV exposure at 12 months, according to low and high traditional risk. METHODS In this randomized controlled trial, participants (target sample = 892) will be recruited from the general population, and randomized (1:1 ratio, intervention versus control). Intervention arm participants provide a saliva sample, receive personalized melanoma genomic risk information, a genetic counselor phone call, and an educational booklet on melanoma prevention. Control arm participants receive only the educational booklet. Eligible participants are aged 18-69 years, have European ancestry and no personal history of melanoma. All participants will complete a questionnaire and wear a UV dosimeter to objectively measure their sun exposure at baseline, 1- and 12-month time-points, except 1-month UV dosimetry will be limited to ~250 participants. The primary outcome is total daily Standard Erythemal Doses at 12 months. Secondary outcomes include objectively measured UV exposure for specific time periods (e.g. midday hours), self-reported sun protection and skin-examination behaviors, psycho-social outcomes, and ethical considerations surrounding offering genomic testing at a population level. A within-trial and modelled economic evaluation will be undertaken from an Australian health system perspective to assess the intervention costs and outcomes. DISCUSSION This trial will inform the clinical and personal utility of introducing genomic testing into the health system for melanoma prevention and early detection at a population-level. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12617000691347.
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Affiliation(s)
- Amelia K Smit
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Melanoma Institute Australia, The University of Sydney, NSW 2006, Australia.
| | - Ainsley J Newson
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, NSW 2006, Australia
| | - Michael Kimlin
- University of the Sunshine Coast and Cancer Council Queensland, PO Box 201, Spring Hill, QLD 4004, Australia
| | - Louise Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Matthew H Law
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Locked Bag 2000, Brisbane, QLD 4029, Australia
| | - Judy Kirk
- Westmead Clinical School and Westmead Institute for Medical Research, Sydney Medical School, The University of Sydney, NSW 2006, Australia
| | - Suzanne Dobbinson
- Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Peter A Kanetsky
- H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, 4202 E Fowler Ave, Tampa, FL 33620, USA
| | - Georgina Fenton
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Martin Allen
- Electrical and Computer Engineering, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, The University of Sydney, NSW 2006, Australia
| | - Kate Dunlop
- The Centre for Genetics Education, NSW Health, Level 5 2c Herbert Street St Leonards, NSW 2065, Australia
| | - Lyndal Trevena
- Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, NSW 2006, Australia
| | - Jacqueline Savard
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Hugh Dawkins
- Office of Population Health Genomics, Public Health Division, Government of Western Australia, Level 3 C Block 189 Royal Street, East Perth, WA 6004, Australia
| | - Sarah Wordsworth
- Health Economics Research Centre, The University of Oxford, Oxford OX1 2JD, UK
| | - Mark Jenkins
- Centre for Epidemiology & Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, NSW 2006, Australia; Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, NSW 2006, Australia
| | - Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Melanoma Institute Australia, The University of Sydney, NSW 2006, Australia
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Aspinwall LG, Stump TK, Taber JM, Drummond DM, Kohlmann W, Champine M, Leachman SA. Genetic test reporting of CDKN2A provides informational and motivational benefits for managing melanoma risk. Transl Behav Med 2018; 8:29-43. [PMID: 29385581 PMCID: PMC6065541 DOI: 10.1093/tbm/ibx011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A CDKN2A/p16 mutation confers 28%-67% lifetime melanoma risk, a risk that may be moderated by ultraviolet radiation exposure. The aim of this study was to test whether melanoma genetic counseling and test disclosure conferred unique informational, motivational, or emotional benefits compared to family history-based counseling. Participants included were 114 unaffected members of melanoma-prone families, ages 16-69, 51.8% men, 65.8% with minor children or grandchildren. Carriers (n = 28) and noncarriers (n = 41) from families with a CDKN2A mutation were compared to no-test controls (n = 45) from melanoma-prone families without an identifiable CDKN2A mutation. All participants received equivalent counseling about melanoma risk and management; only CDKN2A participants received genetic test results. Using newly developed inventories, participants rated perceived costs and benefits for managing their own and their children's or grandchildren's melanoma risk 1 month and 1 year after counseling. Propensity scores controlled for baseline family differences. Compared to no-test controls, participants who received test results (carriers and noncarriers) reported feeling significantly more informed and prepared to manage their risk, and carriers reported greater motivation to reduce sun exposure. All groups reported low negative emotions about melanoma risk. Parents reported high levels of preparedness to manage children's risk regardless of group. Carrier parents reported greater (but moderate) worry about their children's risk than no-test control parents. Women, older, and more educated respondents reported greater informational and motivational benefits regardless of group. Genetic test results were perceived as more informative and motivating for personal sun protection efforts than equivalent counseling based on family history alone.
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Affiliation(s)
- Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Tammy K Stump
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Jennifer M Taber
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | | | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Marjan Champine
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Robinson J, Spring B. Personalized melanoma genomic risk information:perception of shared risk initiates sharing with family. Br J Dermatol 2017; 177:890-891. [DOI: 10.1111/bjd.15862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J.K. Robinson
- Department of Dermatology; Northwestern University Feinberg School of Medicine; Chicago IL U.S.A
| | - B. Spring
- Department of Preventive Medicine; Northwestern University Feinberg School of Medicine; Chicago IL U.S.A
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Smit A, Keogh L, Newson A, Butow P, Dunlop K, Morton R, Kirk J, Espinoza D, Cust A. Does personalized melanoma genomic risk information trigger conversations about skin cancer prevention and skin examination with family, friends and health professionals? Br J Dermatol 2017. [DOI: 10.1111/bjd.15744] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A.K. Smit
- Cancer Epidemiology and Prevention Research Sydney School of Public Health The University of Sydney Australia
- Centre for Values Ethics and the Law in Medicine Sydney School of Public Health The University of Sydney Australia
| | - L.A. Keogh
- Melbourne School of Population and Global Health The University of Melbourne Australia
| | - A.J. Newson
- Centre for Values Ethics and the Law in Medicine Sydney School of Public Health The University of Sydney Australia
| | - P.N. Butow
- Centre for Medical Psychology and Evidence‐based Decision‐making School of Psychology The University of Sydney Australia
| | - K. Dunlop
- The Centre for Genetics Education NSW Health Sydney Australia
| | - R.L. Morton
- NHMRC Clinical Trials Centre The University of Sydney Australia
- Melanoma Institute Australia The University of Sydney Australia
| | - J. Kirk
- Westmead Clinical School and Westmead Institute for Medical Research Sydney Medical School The University of Sydney Australia
| | - D. Espinoza
- NHMRC Clinical Trials Centre The University of Sydney Australia
| | - A.E. Cust
- Cancer Epidemiology and Prevention Research Sydney School of Public Health The University of Sydney Australia
- Melanoma Institute Australia The University of Sydney Australia
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Utz RL, Berg CA, Butner J. It’s A Family Affair: Reflections About Aging and Health Within a Family Context. THE GERONTOLOGIST 2016; 57:129-135. [DOI: 10.1093/geront/gnw081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/05/2016] [Indexed: 11/13/2022] Open
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