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Allen CG, Green RF, Dowling NF, Fairley TL, Khoury MJ. Understanding the Process of Family Cancer History Collection and Health Information Seeking. HEALTH EDUCATION & BEHAVIOR 2023; 50:572-585. [PMID: 36794801 PMCID: PMC10427738 DOI: 10.1177/10901981231152430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PROBLEM ADDRESSED To better understand the factors associated with family cancer history (FCH) information and cancer information seeking, we model the process an individual undergoes when assessing whether to gather FCH and seek cancer information and compare models by sociodemographics and family history of cancer. We used cross-sectional data from the Health Information National Trends Survey (HINTS 5, Cycle 2) and variables (e.g., emotion and self-efficacy) associated with the Theory of Motivated Information Management to assess the process of FCH gathering and information seeking. We completed path analysis to assess the process of FCH gathering and stratified path models. RESULTS Those who felt they could lower their chances of getting cancer (emotion) were more confident in their ability to complete FCH on a medical form (self-efficacy; B = 0.11, p < .0001) and more likely to have discussed FCH with family members (B = 0.07, p < .0001). Those who were more confident in their ability to complete a summary of their family history on a medical form were more likely to have discussed FCH with family members (B = 0.34, p < .0001) and seek other health information (B = 0.24, p < .0001). Stratified models showed differences in this process by age, race/ethnicity, and family history of cancer. IMPLICATIONS FOR PUBLIC HEALTH RESEARCH AND PRACTICE Tailoring outreach and education strategies to address differences in perceived ability to lower chances of getting cancer (emotion) and confidence in the ability to complete FCH (self-efficacy) could help encourage less engaged individuals to learn about their FCH and gather cancer information.
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Affiliation(s)
| | | | | | | | - Muin J. Khoury
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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2
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Kumerow MT, Rodriguez JL, Dai S, Kolor K, Rotunno M, Peipins LA. Prevalence of Americans reporting a family history of cancer indicative of increased cancer risk: Estimates from the 2015 National Health Interview Survey. Prev Med 2022; 159:107062. [PMID: 35460723 PMCID: PMC9162122 DOI: 10.1016/j.ypmed.2022.107062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 11/27/2022]
Abstract
The collection and evaluation of family health history in a clinical setting presents an opportunity to discuss cancer risk, tailor cancer screening recommendations, and identify people with an increased risk of carrying a pathogenic variant who may benefit from referral to genetic counseling and testing. National recommendations for breast and colorectal cancer screening indicate that men and women who have a first-degree relative affected with these types of cancers may benefit from talking to a healthcare provider about starting screening at an earlier age and other options for cancer prevention. The prevalence of reporting a first-degree relative who had cancer was assessed among adult respondents of the 2015 National Health Interview Survey who had never had cancer themselves (n = 27,999). We found 35.6% of adults reported having at least one first-degree relative with cancer at any site. Significant differences in reporting a family history of cancer were observed by sex, age, race/ethnicity, educational attainment, and census region. Nearly 5% of women under age 50 and 2.5% of adults under age 50 had at least one first-degree relative with breast cancer or colorectal cancer, respectively. We estimated that 5.8% of women had a family history of breast or ovarian cancer that may indicate increased genetic risk. A third of U.S. adults who have never had cancer report a family history of cancer in a first-degree relative. This finding underscores the importance of using family history to inform discussions about cancer risk and screening options between healthcare providers and their patients.
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Affiliation(s)
- Marie T Kumerow
- Tanaq Support Services, LLC, 3201 C St Site 602, Anchorage, AK 99503, USA.
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-4, Atlanta, GA 30341, USA.
| | - Shifan Dai
- Cyberdata Technologies, Inc., 455 Springpark Pl # 300, Herndon, VA 20701, USA.
| | - Katherine Kolor
- Office of Genomics and Precision Public Health, Centers for Disease Control and Prevention, 2500 Century Parkway NE, MS V25-5, Atlanta, GA 30345, USA.
| | - Melissa Rotunno
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr RM 4E548, Bethesda, MD 20892, USA.
| | - Lucy A Peipins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-4, Atlanta, GA 30341, USA.
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Abstract
Since the completion of the Human Genome Project, considerable progress has been made in translating knowledge about the genetic basis of disease risk and treatment response into clinical services and public health interventions that have greater precision. It is anticipated that more precision approaches to early detection, prevention, and treatment will be developed and will enhance equity in healthcare and outcomes among disparity populations. Reduced access to genomic medicine research, clinical services, and public health interventions has the potential to exacerbate disparities in genomic medicine. The purpose of this article is to describe these challenges to equity in genomic medicine and identify opportunities and future directions for addressing these issues. Efforts are needed to enhance access to genomic medicine research, clinical services, and public health interventions, and additional research that examines the clinical utility of precision medicine among disparity populations should be prioritized to ensure equity in genomic medicine. Expected final online publication date for the Annual Review of Genomics and Human Genetics, Volume 23 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA; .,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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Eisman AS, Brown KA, Chen ES, Sarkar IN. Clinical Note Section Detection Using a Hidden Markov Model of Unified Medical Language System Semantic Types. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2022; 2021:418-427. [PMID: 35308919 PMCID: PMC8861726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Clinical notes are a rich source of biomedical data for natural language processing (NLP). The identification of note sections represents a first step in creating portable NLP tools. Here, a system that used a heterogeneous hidden Markov model (HMM) was designed to identify seven note sections: (1) Medical History, (2) Medications, (3) Family and Social History, (4) Physical Exam, (5) Labs and Imaging, (6) Assessment and Plan, and (7) Review of Systems. Unified Medical Language System (UMLS) concepts were identified using MetaMap, and UMLS semantic type distributions for each section type were empirically determined. The UMLS semantic type distributions were used to train the HMM for identifying clinical note sections. The system was evaluated relative to a template boundary model using manually annotated notes from the Medical Information Mart for Intensive Care III. The results show promise for an approach to segment clinical notes into sections for subsequent NLP tasks.
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Affiliation(s)
- Aaron S Eisman
- Center for Biomedical Informatics, Brown University, Providence RI
- The Warren Alpert Medical School, Brown University, Providence, RI
| | | | - Elizabeth S Chen
- Center for Biomedical Informatics, Brown University, Providence RI
- The Warren Alpert Medical School, Brown University, Providence, RI
- School of Public Health, Brown University, Providence, RI
| | - Indra Neil Sarkar
- Center for Biomedical Informatics, Brown University, Providence RI
- The Warren Alpert Medical School, Brown University, Providence, RI
- School of Public Health, Brown University, Providence, RI
- Rhode Island Quality Institute, Providence, RI
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A Model for Examining Family Health History Awareness: Rethinking How to Increase Its Interfamilial and Clinical Utility and Transmission. Prof Case Manag 2022; 28:45-52. [DOI: 10.1097/ncm.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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6
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Ponathil A, Ozkan F, Bertrand J, Agnisarman S, Narasimha S, Welch B, Chalil Madathil K. An empirical study investigating the user acceptance of a virtual conversational agent interface for family health history collection among the geriatric population. Health Informatics J 2020; 26:2946-2966. [PMID: 32938275 DOI: 10.1177/1460458220955104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Critical for the early diagnosis of genetic disorders, a Family Health History (FHx) can be collected in several ways including electronic FHx tools, which aid easy editing and sharing by linking with other information management portals. The user acceptance of such systems is critical, especially among older adults experiencing motor and cognitive issues. This study investigated two types of FHx interfaces, standard and Virtual Conversational Agent (VCA), using 30 young (between 18 and 30) and 24 older participants (over 60). Workload, usability and performance data were collected. Even though participants required less time to complete three of five tasks on the standard interface, the VCA interface performed better in terms of subjective workload and usability. Additionally, 67% of the older adults preferred the VCA interface since it provided context-based guidance during the data collection process. The results from this study have implications for the use of virtual assistants in FHx and other areas of data collection.
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Allen C, Escoffery C, Haardörfer R, McBride C. Factors Influencing Not Perceiving Family Health History Assessments as Important: Opportunities to Improve Dissemination of Evidence-Based Population Screening for Cancer. Public Health Genomics 2019; 21:144-153. [DOI: 10.1159/000499125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/25/2019] [Indexed: 11/19/2022] Open
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Wu RR, Myers RA, Buchanan AH, Dimmock D, Fulda KG, Haller IV, Haga SB, Harry ML, McCarty C, Neuner J, Rakhra-Burris T, Sperber N, Voils CI, Ginsburg GS, Orlando LA. Effect of Sociodemographic Factors on Uptake of a Patient-Facing Information Technology Family Health History Risk Assessment Platform. Appl Clin Inform 2019; 10:180-188. [PMID: 30866001 PMCID: PMC6415985 DOI: 10.1055/s-0039-1679926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/18/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Investigate sociodemographic differences in the use of a patient-facing family health history (FHH)-based risk assessment platform. METHODS In this large multisite trial with a diverse patient population, we evaluated the relationship between sociodemographic factors and FHH health risk assessment uptake using an information technology (IT) platform. The entire study was administered online, including consent, baseline survey, and risk assessment completion. We used multivariate logistic regression to model effect of sociodemographic factors on study progression. Quality of FHH data entered as defined as relatives: (1) with age of onset reported on relevant conditions; (2) if deceased, with cause of death and (3) age of death reported; and (4) percentage of relatives with medical history marked as unknown was analyzed using grouped logistic fixed effect regression. RESULTS A total of 2,514 participants consented with a mean age of 57 and 10.4% minority. Multivariate modeling showed that progression through study stages was more likely for younger (p-value = 0.005), more educated (p-value = 0.004), non-Asian (p-value = 0.009), and female (p-value = 0.005) participants. Those with lower health literacy or information-seeking confidence were also less likely to complete the study. Most significant drop-out occurred during the risk assessment completion phase. Overall, quality of FHH data entered was high with condition's age of onset reported 87.85%, relative's cause of death 85.55% and age of death 93.76%, and relative's medical history marked as unknown 19.75% of the time. CONCLUSION A demographically diverse population was able to complete an IT-based risk assessment but there were differences in attrition by sociodemographic factors. More attention should be given to ensure end-user functionality of health IT and leverage electronic medical records to lessen patient burden.
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Affiliation(s)
- R. Ryanne Wu
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States
- Durham VA Cooperative Studies Program Epidemiology Center, Durham, North Carolina, United States
| | - Rachel A. Myers
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States
| | - Adam H. Buchanan
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania, United States
| | - David Dimmock
- Rady Children's Institute for Genomic Medicine, San Diego, California, United States
| | - Kimberly G. Fulda
- The North Texas Primary Care Practice-Based Research Network and Family Medicine, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Irina V. Haller
- Essentia Institute of Rural Health, Essentia, Duluth, Minnesota, United States
| | - Susanne B. Haga
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States
| | - Melissa L. Harry
- Essentia Institute of Rural Health, Essentia, Duluth, Minnesota, United States
| | - Catherine McCarty
- University of Minnesota Medical School, Duluth Campus, Duluth, Minnesota, United States
| | - Joan Neuner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Teji Rakhra-Burris
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States
| | - Nina Sperber
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, United States
- Durham VA Health Services & Development Service, Durham, North Carolina, United States
| | - Corrine I. Voils
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Geoffrey S. Ginsburg
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States
| | - Lori A. Orlando
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States
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Connors E, Selove R, Canedo J, Sanderson M, Hull P, Adams M, McDermott I, Barlow C, Johns-Porter D, McAfee C, Gilliam K, Miller O, Cox N, Fadden MK, King S, Tindle H. Improving Community Advisory Board Engagement in Precision Medicine Research to Reduce Health Disparities. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2019; 12:80-94. [PMID: 32832256 PMCID: PMC7442965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Community Advisory Boards (CABs) are used in efforts to reduce health disparities; however, there is little documentation in the literature regarding their use in precision medicine research. In this case study, an academic-CAB partnership developed a questionnaire and patient educational materials for two precision smoking cessation interventions that involved use of genetic or genetically-informed information. The community-engaged research (CEnR) literature provided a framework for enhancing benefits to CAB members involved in developing research documents for use with a low-income, ethnically diverse population of smokers.The academic partners integrated three CEnR strategies: 1) in-meeting statements acknowledging their desire to learn from community partners, 2) in-meeting written feedback to and from community partners, and 3) a survey to obtain CAB member feedback post-meetings. Strategies 1 and 2 yielded modifications to pertinent study materials, as well as suggestions for improving meeting operations that were then adopted, as appropriate, by the academic partners. The survey indicated that CAB members valued the meeting procedure changes which appeared to have contributed to improvements in attendance and satisfaction with the meetings. Further operationalization of relevant partnership constructs and development of tools for measuring these aspects of community-academic partnerships is warranted to support community engagement in precision medicine research studies.
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Affiliation(s)
| | | | | | | | | | - Marilyn Adams
- Meharry-Vanderbilt-TSU Cancer Partnership (MVTCP) Community Advisory Board
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Lin J, Marcum CS, Myers MF, Koehly LM. Racial differences in family health history knowledge of type 2 diabetes: exploring the role of interpersonal mechanisms. Transl Behav Med 2018; 8:540-549. [PMID: 29346616 DOI: 10.1093/tbm/ibx062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Collecting complete and accurate family health history is critical to preventing type 2 diabetes. Whether there are any racial difference in family health history knowledge of type 2 diabetes and whether such differences are related to interpersonal mechanisms remain unclear. We seek to identify the interpersonal mechanisms that give rise to discrepancies in family health history knowledge of type 2 diabetes in families of different racial backgrounds. We analyze informant-dyad consensus with respect to shared family history of type 2 diabetes in 127 informants of 45 families in the greater Cincinnati area (white: 28 families, 78 informants; black/African-American: 17 families, 49 informants). We first document a difference in informant-dyad consensus by race and then test whether this difference can be explained by interpersonal ties, particularly health communication. Compared with their white counterparts, dyads in families of black/African-American background are more likely to have an uneven distribution of knowledge, with one informant knowing and the other not knowing his/her family health history. The racial difference is explained by dyads in families of black/African-American background having fewer reciprocal health communication ties. While associated with informant-dyad consensus, education, kinship ties, and closeness ties do not account for the observed racial difference. Activating health communication is a key to improving family health history knowledge, especially in families of black/African-American background. Researchers and clinicians should leverage communication ties in the family network for better collection and utilization of family health history in preventive services.
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Affiliation(s)
- Jielu Lin
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Christopher S Marcum
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Melanie F Myers
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
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Ponathil A, Firat Ozkan N, Bertrand J, Welch B, Chalil Madathil K. New Approaches to Collecting Family Health History – A Preliminary Study Investigating the Efficacy of Conversational Systems to Collect Family Health History. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/1541931218621064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Knowing and compiling your family health information is an important, cost-effective and efficient way to help your doctor screen and monitor for risks of genomic diseases such as cancer. There are several ways to collect family health history, including the use of digital records. Digital records can be helpful for sharing and updating information among family members. However, minimal research has been conducted to compare the different data collection interfaces. This study focuses on evaluating the user’s performance and preference between a conversational interface that we developed and a traditional interface for compiling family health history. Using a within-subjects design, twenty participants were asked to perform several tasks using both platforms. Although the conversational interface required more clicks, participants reported lower workload, higher performance and greater ease-of-use with this platform, and preferred the guidance of the virtual assistant.
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Affiliation(s)
- Amal Ponathil
- Human-Systems Integration Laboratory, Clemson University
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12
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Manickam K, Buchanan AH, Schwartz MLB, Hallquist MLG, Williams JL, Rahm AK, Rocha H, Savatt JM, Evans AE, Butry LM, Lazzeri AL, Lindbuchler DM, Flansburg CN, Leeming R, Vogel VG, Lebo MS, Mason-Suares HM, Hoskinson DC, Abul-Husn NS, Dewey FE, Overton JD, Reid JG, Baras A, Willard HF, McCormick CZ, Krishnamurthy SB, Hartzel DN, Kost KA, Lavage DR, Sturm AC, Frisbie LR, Person TN, Metpally RP, Giovanni MA, Lowry LE, Leader JB, Ritchie MD, Carey DJ, Justice AE, Kirchner HL, Faucett WA, Williams MS, Ledbetter DH, Murray MF. Exome Sequencing-Based Screening for BRCA1/2 Expected Pathogenic Variants Among Adult Biobank Participants. JAMA Netw Open 2018; 1:e182140. [PMID: 30646163 PMCID: PMC6324494 DOI: 10.1001/jamanetworkopen.2018.2140] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Detection of disease-associated variants in the BRCA1 and BRCA2 (BRCA1/2) genes allows for cancer prevention and early diagnosis in high-risk individuals. OBJECTIVES To identify pathogenic and likely pathogenic (P/LP) BRCA1/2 variants in an unselected research cohort, and to characterize the features associated with P/LP variants. DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional study of adult volunteers (n = 50 726) who underwent exome sequencing at a single health care system (Geisinger Health System, Danville, Pennsylvania) from January 1, 2014, to March 1, 2016. Participants are part of the DiscovEHR cohort and were identified through the Geisinger MyCode Community Health Initiative. They consented to a research protocol that included sequencing and return of actionable test results. Clinical data from electronic health records and clinical visits were correlated with variants. Comparisons were made between those with (cases) and those without (controls) P/LP variants in BRCA1/2. MAIN OUTCOMES Prevalence of P/LP BRCA1/2 variants in cohort, proportion of variant carriers not previously ascertained through clinical testing, and personal and family history of relevant cancers among BRCA1/2 variant carriers and noncarriers. RESULTS Of the 50 726 health system patients who underwent exome sequencing, 50 459 (99.5%) had no expected pathogenic BRCA1/2 variants and 267 (0.5%) were BRCA1/2 carriers. Of the 267 cases (148 [55.4%] were women and 119 [44.6%] were men with a mean [range] age of 58.9 [23-90] years), 183 (68.5%) received clinically confirmed results in their electronic health record. Among the 267 participants with P/LP BRCA1/2 variants, 219 (82.0%) had no prior clinical testing, 95 (35.6%) had BRCA1 variants, and 172 (64.4%) had BRCA2 variants. Syndromic cancer diagnoses were present in 11 (47.8%) of the 23 deceased BRCA1/2 carriers and in 56 (20.9%) of all 267 BRCA1/2 carriers. Among women, 31 (20.9%) of 148 variant carriers had a personal history of breast cancer, compared with 1554 (5.2%) of 29 880 noncarriers (odds ratio [OR], 5.95; 95% CI, 3.88-9.13; P < .001). Ovarian cancer history was present in 15 (10.1%) of 148 variant carriers and in 195 (0.6%) of 29 880 variant noncarriers (OR, 18.30; 95% CI, 10.48-31.4; P < .001). Among 89 BRCA1/2 carriers without prior testing but with comprehensive personal and family history data, 44 (49.4%) did not meet published guidelines for clinical testing. CONCLUSIONS AND RELEVANCE This study found that compared with previous clinical care, exome sequencing-based screening identified 5 times as many individuals with P/LP BRCA1/2 variants. These findings suggest that genomic screening may identify BRCA1/2-associated cancer risk that might otherwise remain undetected within health care systems and may provide opportunities to reduce morbidity and mortality in patients.
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Affiliation(s)
- Kandamurugu Manickam
- Molecular and Human Genetics Department, Nationwide Children’s Hospital, Columbus, Ohio
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | | | | | | | | | - Heather Rocha
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Alyson E. Evans
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Loren M. Butry
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | | | | | | | - Victor G. Vogel
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Matthew S. Lebo
- Laboratory for Molecular Medicine, Partners HealthCare, Cambridge, Massachusetts
| | | | - Derick C. Hoskinson
- Laboratory for Molecular Medicine, Partners HealthCare, Cambridge, Massachusetts
| | | | | | | | | | - Aris Baras
- Regeneron Genetics Center, Tarrytown, New York
| | | | | | | | | | - Korey A. Kost
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Amy C. Sturm
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - T. Nate Person
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | | | - Lacy E. Lowry
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | - Marylyn D. Ritchie
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
- Center for Translational Bioinformatics, University of Pennsylvania, Philadelphia
| | - David J. Carey
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Anne E. Justice
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | | | | | | | - Michael F. Murray
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
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