1
|
Elsalti A, Darkhabani M, Alrifaai MA, Mahroum N. Celebrities and Medical Awareness-The Case of Celine Dion and Stiff-Person Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1936. [PMID: 36767301 PMCID: PMC9914970 DOI: 10.3390/ijerph20031936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
The positive role of celebrities in spreading important medical information and contributing to increasing public awareness regarding the diagnosis, treatment, and prevention of various medical conditions cannot be overemphasized. Interestingly and importantly at the same time, this impact is not related to the rarity of the disease, as very rare diseases are looked up by the public due to the fact that a celebrity suffers from this disorder. Therefore, if taken seriously and used to address the public in regard to critical medical conditions, such as screening for cancer or the importance of vaccines in fighting infections, celebrities could have a huge impact in this field. As previously shown in the medical literature, the recent announcement of the famous Canadian singer Celine Dion concerning her newly diagnosed stiff-person syndrome has influenced the public interest regarding the syndrome which manifested as an increased search volume related to the disorder as seen in Google Trends. In brief, in this short communication we aimed to address the phenomenon of celebrities' impact on public apprehension, revise the syndrome for the medical community, and emphasize taking advantage of such involvement of celebrities for improving the spread of highly important medical information for the public.
Collapse
|
2
|
Beidler LB, Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. Perceptions of Breast Cancer Risks Among Women Receiving Mammograph Screening. JAMA Netw Open 2023; 6:e2252209. [PMID: 36689223 PMCID: PMC9871800 DOI: 10.1001/jamanetworkopen.2022.52209] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/02/2022] [Indexed: 01/24/2023] Open
Abstract
Importance Breast density is an independent risk factor for breast cancer. Despite the proliferation of mandated written notifications about breast density following mammography, there is little understanding of how women perceive the relative breast cancer risk associated with breast density. Objective To assess women's perception of breast density compared with other breast cancer risks and explore their understanding of risk reduction. Design, Setting, and Participants This mixed-methods qualitative study used telephone surveys and semistructured interviews to investigate perceptions about breast cancer risk among a nationally representative, population-based sample of women. Eligible study participants were aged 40 to 76 years, reported having recently undergone mammography, had no history of prior breast cancer, and had heard of breast density. Survey participants who had been informed of their personal breast density were invited for a qualitative interview. Survey administration spanned July 1, 2019, to April 30, 2020, with 2306 women completing the survey. Qualitative interviews were conducted from February 1 to May 30, 2020. Main Outcomes and Measures Respondents compared the breast cancer risk associated with breast density with 5 other risk factors. Participants qualitatively described what they thought contributed to breast cancer risk and ways to reduce risk. Results Of the 2306 women who completed the survey, 1858 (166 [9%] Asian, 503 [27%] Black, 268 [14%] Hispanic, 792 [43%] White, and 128 [7%] other race or ethnicity; 358 [19%] aged 40-49 years, 906 [49%] aged 50-64 years, and 594 [32%] aged ≥65 years) completed the revised risk perception questions and were included in the analysis. Half of respondents thought breast density to be a greater risk than not having children (957 [52%]), having more than 1 alcoholic drink per day (975 [53%]), or having a prior breast biopsy (867 [48%]). Most respondents felt breast density was a lesser risk than having a first-degree relative with breast cancer (1706 [93%]) or being overweight or obese (1188 [65%]). Of the 61 women who were interviewed, 6 (10%) described breast density as contributing to breast cancer risk, and 43 (70%) emphasized family history as a breast cancer risk factor. Of the interviewed women, 17 (28%) stated they did not know whether it was possible to reduce their breast cancer risk. Conclusions and Relevance In this qualitative study of women of breast cancer screening age, family history was perceived as the primary breast cancer risk factor. Most interviewees did not identify breast density as a risk factor and did not feel confident about actions to mitigate breast cancer risk. Comprehensive education about breast cancer risks and prevention strategies is needed.
Collapse
Affiliation(s)
- Laura B. Beidler
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Nancy R. Kressin
- Section of General Internal Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts
| | | | - Tracy A. Battaglia
- Section of General Internal Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts
| | - Priscilla J. Slanetz
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Christine M. Gunn
- Dartmouth Cancer Center, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| |
Collapse
|
3
|
Gray SW, Ottesen RA, Currey M, Cristea M, Nikowitz J, Shehayeb S, Lozano V, Hom J, Kilburn J, Lopez LN, Wing S, Sosa E, Shen J, Morris M, Dilsizian B, Joseph T, Shen J, Adeimy C, Phillips T, Bahadini B, Niland JC. Leveraging an Informatics Approach to Identify an Unmet Clinical Need for BRCA1/ 2 Testing Among Patients With Ovarian Cancer. JCO Clin Cancer Inform 2022; 6:e2200034. [PMID: 36049148 PMCID: PMC9470148 DOI: 10.1200/cci.22.00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/31/2022] [Accepted: 07/18/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although BRCA1/2 testing in ovarian cancer improves outcomes, it is vastly underutilized. Scalable approaches are urgently needed to improve genomically guided care. METHODS We developed a Natural Language Processing (NLP) pipeline to extract electronic medical record information to identify recipients of BRCA testing. We applied the NLP pipeline to assess testing status in 308 patients with ovarian cancer receiving care at a National Cancer Institute Comprehensive Cancer Center (main campus [MC] and five affiliated clinical network sites [CNS]) from 2017 to 2019. We compared characteristics between (1) patients who had/had not received testing and (2) testing utilization by site. RESULTS We found high uptake of BRCA testing (approximately 78%) from 2017 to 2019 with no significant differences between the MC and CNS. We observed an increase in testing over time (67%-85%), higher uptake of testing among younger patients (mean age tested = 61 years v untested = 65 years, P = .01), and higher testing among Hispanic (84%) compared with White, Non-Hispanic (78%), and Asian (75%) patients (P = .006). Documentation of referral for an internal genetics consultation for BRCA pathogenic variant carriers was higher at the MC compared with the CNS (94% v 31%). CONCLUSION We were able to successfully use a novel NLP pipeline to assess use of BRCA testing among patients with ovarian cancer. Despite relatively high levels of BRCA testing at our institution, 22% of patients had no documentation of genetic testing and documentation of referral to genetics among BRCA carriers in the CNS was low. Given success of the NLP pipeline, such an informatics-based approach holds promise as a scalable solution to identify gaps in genetic testing to ensure optimal treatment interventions in a timely manner.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sam Wing
- Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, CA
| | | | - Jenny Shen
- The State University of New York at Stony Brook, Stony Brook, NY
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Biancovilli P, Makszin L, Amer F, Csongor A. Celebrities and Breast Cancer: A Multidimensional Quali-Quantitative Analysis of News Stories Shared on Social Media. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9676. [PMID: 35955028 PMCID: PMC9368231 DOI: 10.3390/ijerph19159676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
In 2020, breast cancer was the most frequent type of cancer in 158 countries. To advise the population about risk factors and the importance of preventive measures, celebrities can be of great help, acting as spokespersons for reliable scientific information. The goal of this study is to analyse the content of news stories about breast cancer shared on different social media, examining how stories with celebrity presence are constructed. We performed a quali-quantitative multidimensional analysis of news stories in English that addressed breast cancer on the following social media platforms: Facebook, Pinterest, Twitter and Reddit. We compared news stories with and without the presence of celebrities. Our sample consists of 1594 news stories that had at least 1000 total shares across all analysed social media; 262 news stories mention a celebrity (16.44%), while 1332 stories do not (83.56%). Nevertheless, the ones that feature celebrities are, as a rule, more shared. The percentage of stories with celebrities addressing breast cancer prevention is quite low (1.9%). The same can be said for mentions of scientific papers/specialist quotes (3.4%). This research may help outline some possible paths that healthcare organizations and communication professionals can take to improve breast cancer content available online.
Collapse
Affiliation(s)
| | - Lilla Makszin
- Institute of Bioanalysis, Medical School, University of Pécs, 7624 Pécs, Hungary
- Szentágothai Research Center, University of Pécs, 7624 Pécs, Hungary
| | - Faten Amer
- Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | - Alexandra Csongor
- Department of Languages for Biomedical Purposes and Communication, Medical School, University of Pécs, 7624 Pécs, Hungary
| |
Collapse
|
5
|
Douglas MP, Kumar A. Analyzing Precision Medicine Utilization with Real-World Data: A Scoping Review. J Pers Med 2022; 12:jpm12040557. [PMID: 35455673 PMCID: PMC9025578 DOI: 10.3390/jpm12040557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
Abstract
Precision medicine (PM), specifically genetic-based testing, is currently used in over 140,000 individual tests to inform the clinical management of disease. Though several databases (e.g., the NIH Genetic Testing Registry) demonstrate the availability of these sequencing-based tests, we do not currently understand the extent to which these tests are used. There exists a need to synthesize the body of real-world data (RWD) describing the use of sequencing-based tests to inform their appropriate use. To accomplish this, we performed a scoping review to examine what RWD sources have been used in studies of PM utilization between January 2015 and August 2021 to characterize the use of genome sequencing (GS), exome sequencing (ES), tumor sequencing (TS), next-generation sequencing-based panels (NGS), gene expression profiling (GEP), and pharmacogenomics (PGx) panels. We abstracted variables describing the use of these types of tests and performed a descriptive statistical analysis. We identified 440 articles in our search and included 72 articles in our study. Publications based on registry databases were the most common, followed by studies based on private insurer administrative claims. Slightly more than one-third (38%) used integrated datasets. Two thirds (67%) of the studies focused on the use of tests for oncological clinical applications. We summarize the RWD sources used in peer-reviewed literature on the use of PM. Our findings will help improve future study design by encouraging the use of centralized databases and registries to track the implementation and use of PM.
Collapse
Affiliation(s)
- Michael P. Douglas
- Center for Translational and Policy Research on Precision Medicine (TRANSPERS), Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA 94143, USA
- Correspondence: ; Tel.: +1-415-502-4025
| | - Anika Kumar
- School of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA;
| |
Collapse
|
6
|
Hospital-based ovarian cancer patient traceback program results in minimal genetic testing uptake. Gynecol Oncol 2022; 164:615-621. [PMID: 34998598 DOI: 10.1016/j.ygyno.2021.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the feasibility of hospital-based genetic counseling and testing (GC/T) Traceback for Ovarian Cancer (OC) patients, as proposed by the Division of Cancer Prevention and the Division of Cancer Control and Population Sciences, National Cancer Institute. METHODS Living patients with OC were sent a letter explaining the availability of guideline-supported GC/T for at least BRCA1/2 and surrogates of deceased patients were called on the telephone. Outcomes of contact attempts were systematically recorded and statistically described. RESULTS 598 Traceback-eligible OC patients diagnosed from 2006 to 2016 were identified (163 presumed-living and 435 deceased). Two living patients called our office and scheduled an appointment for GC/T after receiving a letter. For surrogates of prior patients, successful contact occurred in 25% of call attempts. Fourteen individuals (2 living patients and 12 surrogates) underwent genetic counseling. Of those 14, 10 individuals consented to genetic testing and 5 followed through with sample collection. None of these individuals had pathogenic variants (PVs). When surrogate call notes were reviewed, 58% reflected positive responses to contact, however 42% were noted to have negative or indifferent responses, which were most common among spouses. Total time spent for hospital-based Traceback was 109 h. CONCLUSIONS Overall, hospital-based Traceback via letter and telephone contact of surrogates is time-intensive and results in minimal uptake of GC/T. To practically execute this type of outreach program, health systems should consider collection of alternative contact information to allow for electronic communication of patient surrogates. Our study also underscores the importance of timely GC/T while patients are in active cancer care.
Collapse
|
7
|
Arslan B, Tazeoğlu D, Dağ A, Berkeşoğlu M, Özdemir AA. Is there an increasing trend of risk-reducing prophylactic mastectomy procedure in preventing breast cancer among women? Turk J Surg 2021; 37:347-354. [PMID: 35677477 PMCID: PMC9130946 DOI: 10.47717/turkjsurg.2021.4963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/12/2021] [Indexed: 11/23/2022]
Abstract
Objectives Prophylactic contralateral/bilateral mastectomy (PCM/PBM), as a risk-reducing mastectomy procedure, has a few evidence-based indica- tions; however, there is an increasing trend in the total number of operations globally. Worldwide famous actress Angelina Jolie was detected to have BRCA-1 mutation and underwent a prophylactic bilateral mastectomy in 2013. The procedure was perceived as 'lifesaving' worldwide, which eventually led to a significant increase in BRCA gene mutation analysis and PCM/PBM. In this study, it was aimed to evaluate our risk-reducing PCM/PBM results. Material and Methods Twenty-seven patients underwent risk-reducing PCM/PBM between 2010-2018, but only 22 patients were included into the study. A retrospective analysis was carried out on demographics, family history, preoperative diagnoses, pathological findings, mastectomy details, reconstructive procedures, neoadjuvant chemotherapy, BRCA analysis, educational status, and mastectomy indications. Results Surgical indications or major reasons for surgery were as follows: BRCA-1 mutation (n= 5), BRCA-2 mutation (n= 3), malignant-like areas in magnetic resonance imaging (n= 2), lobular carcinoma in situ (n= 3) and intense anxiety (n= 9). Eighteen patients (82%) underwent an additional re- constructive procedure via implantation or autologous tissue and four patients (18%) underwent mastectomy only. PCM/PBM by years was as: 2010 (n= 1), 2011 (n= 0), 2012 (n= 1), 2013 (n= 2), 2014 (n= 1), 2015 (n= 2), 2016 (n= 3), 2017 (n= 4), 2018 (n= 8), which represents the recently increasing trend. Conclusion Risk-reducing PCM/PBM was performed in 59.1% of the patients (n= 13) for a significant medical reason, whereas for distress about a relapse or a new disease on the contralateral breast on the remaining 40.9% of the patients (n= 9). Evidence in the literature shows that risk-reducing mastectomy does not affect survival, although it lowers breast cancer incidence. Close surveillance, cancer screening, and chemoprevention methods should have priority.
Collapse
Affiliation(s)
- Bilal Arslan
- Department of General Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Deniz Tazeoğlu
- Department of General Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ahmet Dağ
- Department of General Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Mustafa Berkeşoğlu
- Department of General Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Asena Ayça Özdemir
- Department of Biostatistics, Mersin University Faculty of Medicine, Mersin, Turkey
| |
Collapse
|
8
|
Jones T, Howard H, Freeman-Costin K, Creighton A, Wisdom-Chambers K, Underhill-Blazey M. Knowledge and perceptions of BRCA1/2 genetic testing and needs of diverse women with a personal or family history of breast cancer in South Florida. J Community Genet 2021; 12:415-429. [PMID: 33555545 PMCID: PMC8241944 DOI: 10.1007/s12687-021-00507-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022] Open
Abstract
The vast majority of (BRCA1/2) genetic testing has been conducted in White women, in particular Ashkenazi Jewish women, with limited information available for Black and Hispanic women. Understanding perspectives of those who are underserved is critical to developing interventions to support inclusive approaches to genetic testing. This qualitative study explored knowledge and perceptions of BRCA1/2 genetic testing among diverse women in South Florida. We also explored participants' information needs. Convenience sampling was used to recruit a diverse group of 15 women with a personal or family history of breast cancer. We conducted semi-structured interviews and used grounded theory method to analyze the data. Five themes were identified: (1) lacking awareness and knowledge of BRCA1/2 genetic testing and results among Black women, (2) perceiving BRCA1/2 genetic testing as beneficial to themselves and a way to be proactive about cancer risk, (3) perceiving BRCA1/2 genetic testing as beneficial to family members, (4) interactions with healthcare providers and the healthcare system that shape genetic testing experiences, and (5) information needs for reducing cancer risk and promoting health. Our findings suggest that diverse underserved women perceived genetic testing as beneficial to themselves and family members. Women needed more information about the BRCA genes and genetic testing, prevention strategies, and the latest breast cancer research. Healthcare providers, particularly nurse practitioners, need to engage diverse high-risk women in discussions about their cancer risk, address unmet information needs, and, in particular, educate Black women about the benefits of pursuing genetic testing.
Collapse
Affiliation(s)
- Tarsha Jones
- Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, USA.
| | - Heather Howard
- College for Design and Social Inquiry, Florida Atlantic University, Boca Raton, Florida, 33431, USA
| | - Katherine Freeman-Costin
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, 33431, USA
| | - Ana Creighton
- Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, USA
| | - Karen Wisdom-Chambers
- Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, USA
| | - Meghan Underhill-Blazey
- School of Nursing, University of Rochester, Rochester, NY, 14642, USA
- Dana Farber Cancer Institute, Boston, Massachusetts, 02215, USA
| |
Collapse
|
9
|
Grant P, Langlois S, Lynd LD, Austin JC, Elliott AM. Out-of-pocket and private pay in clinical genetic testing: A scoping review. Clin Genet 2021; 100:504-521. [PMID: 34080181 DOI: 10.1111/cge.14006] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 12/19/2022]
Abstract
Full coverage of the cost of clinical genetic testing is not always available through public or private insurance programs, or a public healthcare system. Consequently, some patients may be faced with the decision of whether to finance testing out-of-pocket (OOP), meet OOP expenses required by their insurer, or not proceed with testing. A scoping review was conducted to identify literature associated with patient OOP and private pay in clinical genetic testing. Seven databases (EMBASE, MEDLINE, CINAHL, PsychINFO, PAIS, the Cochrane Database of Systematic Reviews, and the JBI Evidence-Based Practice database) were searched, resulting in 83 unique publications included in the review. The presented evidence includes a descriptive analysis, followed by a narrative account of the extracted data. Results were divided into four groups according to clinical indication: (1) hereditary breast and ovarian cancer, (2) other hereditary cancers, (3) prenatal testing, (4) other clinical indications. The majority of studies focused on hereditary cancer and prenatal genetic testing. Overall trends indicated that OOP costs have fallen and payer coverage has improved, but OOP expenses continue to present a barrier to patients who do not qualify for full coverage.
Collapse
Affiliation(s)
- Peter Grant
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (BC), Canada
| | - Sylvie Langlois
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (BC), Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE), Department of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jehannine C Austin
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (BC), Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (BC), Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
10
|
Kühn F, Karsten MM, Kendel F, Feufel MA, Speiser D. Training courses on hereditary breast and ovarian cancer to strengthen cross-sectoral care in underserved areas. PATIENT EDUCATION AND COUNSELING 2021; 104:1431-1437. [PMID: 33162275 DOI: 10.1016/j.pec.2020.10.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/08/2020] [Accepted: 10/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To strengthen cross-sectoral care by disseminating specialized knowledge about hereditary breast and ovarian cancer across underserved areas. METHODS We report on a training course about genetic counseling and testing of hereditary breast and ovarian cancer patients for gynecologists from certified cancer centers. In total, 50 gynecologists attended the course which was offered once annually between 2017 and 2019. Before and after the course, participants were asked to answer a self-assessment questionnaire and completed the training with a multiple-choice test. The results of the self-assessments and knowledge tests were analyzed to steadily improve the training. RESULTS The self-assessments imply a perceived increase in certainty regarding the inclusion criteria for specialized genetic counseling, pedigree analysis, and contents of the initial consultation. Both the knowledge tests and self-assessments showed that participants had difficulties in interpreting and differentiating between age-specific and lifetime risks. CONCLUSION The courses successfully conveyed knowledge necessary to identify patients at risk and to provide timely genetic analyses even in rural areas. PRACTICE IMPLICATIONS The results are a promising basis for creating additional training courses addressing specialists in hospitals and gynecological practices. Further education of physicians might improve cross-sectoral cooperation and thereby enable specialized care supply in rural areas.
Collapse
Affiliation(s)
- Friedrich Kühn
- Charité - Universitätsmedizin Berlin, Department of Gynecology, Berlin, Germany
| | | | - Friederike Kendel
- Charité - Universitätsmedizin Berlin, Department of Gender in Medicine, Berlin, Germany
| | - Markus A Feufel
- Technische Universität Berlin, Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Berlin, Germany
| | - Dorothee Speiser
- Charité - Universitätsmedizin Berlin, Department of Gynecology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Hereditary Breast and Ovarian Cancer Center, Berlin, Germany.
| |
Collapse
|
11
|
Verdial FC, Bartek MA, Anderson BO, Javid SH. Genetic testing and surgical treatment after breast cancer diagnosis: Results from a national online cohort. J Surg Oncol 2021; 123:1504-1512. [PMID: 33735483 DOI: 10.1002/jso.26372] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/21/2020] [Accepted: 12/27/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Genetic testing for hereditary breast cancer has implications for breast cancer decision-making. We examined genetic testing rates, factors associated with testing, and the relationship between genetic testing and contralateral prophylactic mastectomy (CPM). METHODS Patients with breast cancer (2000-2015) from The Health of Women Study were identified and categorized as low, moderate, or high-likelihood of the genetic mutation using a previously published scale based on period-relevant national guidelines incorporating age and family history. Genetic testing and CPM rates were compared using univariate and multivariate logistic regression. RESULTS Among 4170 patients (median age 56-years), 38% were categorized as high-likelihood of having a genetic mutation. Among high-likelihood women, 67% underwent genetic testing, the odds of which were increased among women of higher-education and White-race (p < .001). Among 2028 patients reporting surgical treatment, 385 (19%) chose CPM. CPM rate was highest among mutation-positive women (41%), but 26% of women with negative tests still underwent CPM. Independent of test result, genetic testing increased the odds of CPM on multivariate analysis (adjusted-OR: 1.69; 95% CI: 1.29-2.22). CONCLUSIONS Genetic testing rates were higher among women at high-likelihood of mutation carriage, but one-third of these women were not tested. Racial disparities persisted, highlighting the need to improve testing in non-White populations. CPM rates were associated with mutation-carriage and genetic testing, but many women chose CPM despite negative testing, suggesting that well-educated women consider factors other than cancer mortality in selecting CPM.
Collapse
Affiliation(s)
- Francys C Verdial
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Matthew A Bartek
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Benjamin O Anderson
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Sara H Javid
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
12
|
Abstract
PURPOSE Testing for BRCA1/2 mutations has increased among privately insured women in the United States. However, little is known about testing rates or trends among women with Medicaid. We sought to determine whether BRCA1/2 testing rates differed between women with private insurance compared with women with Medicaid in a state where both insurance types cover the test, and to compare testing trends from 2011 to 2015. METHODS We conducted a retrospective cohort study of medical claims from January 2011 through June 2015. We included Massachusetts women aged 18-64 with private insurance or Medicaid and at least 12 months of continuous enrollment. We used multivariable linear regression to examine the association of insurance type, age, and time with testing rates. RESULTS Mean monthly BRCA1/2 testing rates were lower among women with Medicaid compared with those with private insurance. Among privately insured women, mean monthly rates rose from 9.3 per 100,000 in 2011 to 18.4 per 100,000 in 2015, while among Medicaid-insured women, rates increased from 3.7 to 14.7. There was no difference in the monthly rate of increase in both groups (P=0.07). In adjusted analyses, rates were lower among Medicaid-insured women (7 fewer tests per month than privately insured women, P<0.001), and differed by age, with women aged 44-54 most likely to receive testing and women 18-34 the least likely. CONCLUSION BRCA1/2 testing rates were lower among women insured by Medicaid compared with those with private insurance, though rates increased from 2011 to 2015 among both groups of women at a similar rate.
Collapse
|
13
|
Augustinsson A, Ellberg C, Kristoffersson U, Olsson H, Ehrencrona H. Variations in the Referral Pattern for Genetic Counseling of Patients with Early-Onset Breast Cancer: A Population-Based Study in Southern Sweden. Public Health Genomics 2020; 23:100-109. [PMID: 32640451 DOI: 10.1159/000508684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/05/2020] [Indexed: 11/19/2022] Open
Abstract
Swedish national breast cancer guidelines recommend that all women diagnosed with breast cancer (BC) at the age of 35 years or younger should be referred to their regional oncogenetic clinic for genetic counseling and testing, regardless of family history of cancer. The main objective of this study was to evaluate whether place of residence at BC diagnosis and treating hospital were associated with the fact that not all BC patients diagnosed at ≤35 years in the southern part of Sweden have attended genetic counseling and testing. Between 2000 and 2013, 279 women in the South Swedish Health Care Region were diagnosed with BC at ≤35 years. Information regarding place of residence at BC diagnosis, treating hospital, time of registration and first meeting at the Oncogenetic Clinic in Lund, and genetic testing was collected. With a follow-up period until August 2018, 64% were registered at the clinic (60% underwent genetic testing) and 36% were not. BC patients from 2 counties and from rural settings with a population of <10,000 inhabitants were significantly less likely to be registered at the clinic. Our results suggest that place of residence at BC diagnosis and treating hospital were associated with the probability of referral for genetic counseling and testing for women diagnosed with BC at ≤35 years in the South Swedish Health Care Region. We propose, as a generalizable finding, that further educational and outreach activities within the health care system and the community may be needed to ensure that all women diagnosed with early-onset BC receive proper genetic counseling.
Collapse
Affiliation(s)
- Annelie Augustinsson
- Department of Clinical Sciences in Lund, Cancer Epidemiology, Lund University, Lund, Sweden, .,Department of Clinical Sciences in Lund, Oncology and Pathology, Lund University, Lund, Sweden,
| | - Carolina Ellberg
- Department of Clinical Sciences in Lund, Cancer Epidemiology, Lund University, Lund, Sweden.,Department of Clinical Sciences in Lund, Oncology and Pathology, Lund University, Lund, Sweden
| | - Ulf Kristoffersson
- Department of Laboratory Medicine in Lund, Clinical Genetics, Lund University, Lund, Sweden.,Department of Clinical Genetics and Pathology, Laboratory Medicine, Region Skåne, Lund, Sweden
| | - Håkan Olsson
- Department of Clinical Sciences in Lund, Cancer Epidemiology, Lund University, Lund, Sweden.,Department of Clinical Sciences in Lund, Oncology and Pathology, Lund University, Lund, Sweden
| | - Hans Ehrencrona
- Department of Laboratory Medicine in Lund, Clinical Genetics, Lund University, Lund, Sweden.,Department of Clinical Genetics and Pathology, Laboratory Medicine, Region Skåne, Lund, Sweden
| |
Collapse
|
14
|
Adherence to National Comprehensive Cancer Network Guidelines for BRCA testing among high risk breast Cancer patients: a retrospective chart review study. Hered Cancer Clin Pract 2020; 18:13. [PMID: 32518611 PMCID: PMC7275608 DOI: 10.1186/s13053-020-00144-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/26/2020] [Indexed: 11/28/2022] Open
Abstract
Background Testing for BRCA variants can impact treatment decisions for breast cancer patients and affect surveillance and prevention strategies for both patients and their relatives. National Comprehensive Cancer Network (NCCN) guidelines recommend testing for patients at heightened risk of BRCA pathogenic variant. We examined the BRCA testing rate among high risk breast cancer patients treated in community oncology practices. Methods We conducted a retrospective medical chart review among community-based US oncologists using a physician panel approach. High risk breast cancer patients with a known family history of cancer and diagnosis with breast cancer at age ≥ 18 years between January 2013–October 2017 were included. We assessed the proportions of patients tested for BRCA variants in accordance with NCCN guidelines. Results Charts from 63 physicians, averaging 16 years of practice, were included; 97% were medical oncologists and 66.7% had a genetic counselor in their practice. We analyzed data for 410 randomly-selected patients with mean age of 52 years; 95% were female, 74% were White, and 19% had Ashkenazi Jewish ancestry. Among all patients, 94% were tested for BRCA variants. The testing rate ranged from 78 to 100% in various high risk groups; lower rates were observed among Black patients (91%), men (92%), and patients meeting NCCN criteria based on family history of male breast cancer (78%) and prostate cancer (87%). We observed a higher testing rate in patients treated by physicians with a genetic counselor in their practice (95% versus 91%). Conclusions Adherence to NCCN BRCA testing guidelines is high in this group of predominantly medical oncologists with extensive experience, with a high proportion having a genetic counselor in practice. Testing rates can be improved in patients with risk factors related to male relatives. High level of compliance to guidelines in a community setting is possible with a delivery model for genetic counseling and testing.
Collapse
|
15
|
Trends in Contralateral Prophylactic Mastectomy. Aesthetic Plast Surg 2020; 44:323-329. [PMID: 31853610 DOI: 10.1007/s00266-019-01582-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Many breast cancer patients remove their contralateral breast unaffected by cancer, commonly referred to as contralateral prophylactic mastectomy (CPM). CPM has been extensively studied and does not improve survival in patients without deleterious genetic mutation or lobular histology. Despite these limited indications, CPM rates have increased recently. We observed CPM trends in our county safety-net hospital. METHODS We performed a retrospective review of women treated for breast cancer who underwent bilateral mastectomy in our institution. RESULTS We analyzed 100 CPMs: 51% (n = 51) had bilateral breast MRI before CPM, 54% (n = 54) had genetic testing prior to CPM, and 56% (n = 30) had a deleterious genetic result. Another 12% (n = 12) had lobular histology as the primary determinant for CPM. Of patients without genetic mutation or lobular histology, 13% (n = 13) had suspicious MRI findings in the CPM side that drove the decision for CPM. Forty-seven percent (n = 47) had reconstructive surgery documented. CONCLUSION Only 42% (n = 42) of patients who underwent CPM had a documented justifiable medical reason. In the future, physician and patient education may decrease unindicated CPM. We also found that 13% of women without a medical indication chose CPM based on suspicious MRI findings, while only 8% of these MRI findings were malignant. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Collapse
|
16
|
Carroll NM, Blum‐Barnett E, Madrid SD, Jonas C, Janes K, Alvarado M, Bedoy R, Paolino V, Aziz N, McGlynn EA, Burnett‐Hartman AN. Demographic differences in the utilization of clinical and direct‐to‐consumer genetic testing. J Genet Couns 2019; 29:634-643. [DOI: 10.1002/jgc4.1193] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Nikki M. Carroll
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
| | | | - Sarah D. Madrid
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
| | - Cabell Jonas
- Mid‐Atlantic Permanente Research Institute Kaiser Permanente Mid‐Atlantic States Rockville MD USA
| | - Kristen Janes
- Kaiser Permanente Care Management Institute Oakland CA USA
| | - Monica Alvarado
- Southern California Permanente Medical Group Pasadena CA USA
| | - Ruth Bedoy
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
| | - Valerie Paolino
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
| | | | | | | |
Collapse
|
17
|
Martin AP, Pedra G, Downing J, Collins B, Godman B, Alfirevic A, Pirmohamed M, Lynn Greenhalgh K. Trends in BRCA testing and socioeconomic deprivation. Eur J Hum Genet 2019; 27:1351-1360. [PMID: 31053786 DOI: 10.1038/s41431-019-0424-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 03/19/2019] [Accepted: 04/06/2019] [Indexed: 12/20/2022] Open
Abstract
BRCA testing received much publicity following Angelina Jolie's editorial "My Medical Choice" in May 2013 and updated NICE clinical guidance (CG164) in June 2013. We assessed the effect of these two concurrent events on BRCA testing in one UK catchment area and relate this to socioeconomic deprivation. A database of 1393 patients who received BRCA testing was collated. This included individuals with breast/ovarian cancer, and those unaffected by cancer, where a relative has a ≥10% probability of carrying a BRCA variant which affects function. A segmented regression was conducted to estimate changes in testing. To examine the relative distribution of testing by deprivation, the deprivation status of patients who received testing was examined. Between April 2010 and March 2017, testing increased 11-fold and there was an 84% increase (P = 0.006) in BRCA1/2 testing in the month following both publications. In the pre-publication period, there was no statistically significant difference in testing between advantaged and disadvantaged areas (OR 1.21, 95% CI 0.99-1.48; P = 0.06). In the post-publication period helped by a larger sample size, the difference was statistically significant (OR 1.18, 95% CI 1.08-1.29; P = 0.0002) and of a similar magnitude to the pre-publication period. Testing increased following Jolie's editorial and NICE guidance update. However, further research is needed to examine differences in testing by the deprivation group which adjusts for confounders.
Collapse
Affiliation(s)
- Antony P Martin
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), Liverpool, UK. .,Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK.
| | - Gabriel Pedra
- Institute of Integrative Biology, University of Liverpool, Liverpool, UK
| | - Jennifer Downing
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), Liverpool, UK.,Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Brian Godman
- Liverpool Health Economics, University of Liverpool Management School, Liverpool, UK
| | - Ana Alfirevic
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), Liverpool, UK.,Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), Liverpool, UK.,Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | | |
Collapse
|
18
|
Psychosocial, attitudinal, and demographic correlates of cancer-related germline genetic testing in the 2017 Health Information National Trends Survey. J Community Genet 2019; 10:453-459. [PMID: 30835082 DOI: 10.1007/s12687-018-00405-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 12/27/2018] [Indexed: 12/24/2022] Open
Abstract
The study objective was to examine bivariate and multivariate associations among worry, perceptions, attitudes, sociodemographics, and uptake of cancer-related germline genetic testing. We used data from the Health Information National Trends Survey (cycle 5.1), administered (January-May 2017) to a nationally representative sample of non-institutionalized adults (n = 3285). Those who had "heard about genetic tests that determine how a disease can be treated" had a higher likelihood of Lynch syndrome and BRCA1/2 testing (aRR = 2.57, p < 0.01; aRR = 3.23, p < 0.04). Attitudinal and psychosocial variables were not associated with uptake. Future research should explore ways to educate the public about the potential use of genetics in treatment decision-making.
Collapse
|
19
|
Diviani N. On the Centrality of Information Appraisal in Health Literacy Research. Health Lit Res Pract 2019; 3:e21-e24. [PMID: 31294303 PMCID: PMC6608914 DOI: 10.3928/24748307-20181214-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nicola Diviani
- Address correspondence to Nicola Diviani, PhD, Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, Postfach 4466, 6002 Lucerne, Switzerland;
| |
Collapse
|
20
|
Silver MI, Klein W, Samimi G, Minasian L, Loud J, Roberts MC. Concordance with BRCA1/2 testing guidelines among women in The Health of Women (HOW) Study ®. Breast Cancer Res Treat 2019; 173:719-726. [PMID: 30413980 DOI: 10.1007/s10549-018-5035-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate factors associated with compliance to the National Comprehensive Cancer Network (NCCN) guidelines for BRCA1/2 testing and identify groups who are at risk of under- and over-use of BRCA1/2 testing. METHODS Data included 20,758 women from Dr. Susan Love Research Foundation's The Health of Women (HOW) Study®. Multinomial logistic regression was used to examine the association of socioeconomic and demographic characteristics with whether the woman was over-, under-, or appropriately tested for BRCA1/2 mutations, per 2015 NCCN guidelines. RESULTS 3894 women (18.8%) reported BRCA1/2 testing. 5628 (27.1%) women who met NCCN criteria for testing were not tested. Among women with a history of breast cancer, those without health insurance were more likely to be under-tested (OR 2.04, 95% CI 1.15-3.60) than those with managed care insurance, and higher education was associated with a lower likelihood of under-testing (Graduate/professional degree OR 0.71, 95% CI 0.55-0.91). CONCLUSION Almost 30% of women were under-tested, indicating that many high-risk women who may benefit from genetic testing are currently being missed. Without appropriate testing, providers are unable to tailor screening recommendations to those carrying mutations who are at highest risk. Patient and healthcare provider education and outreach targeted to low-income and under-served populations may assist in reducing under-testing.
Collapse
Affiliation(s)
- Michelle I Silver
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD, USA.
| | - William Klein
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Goli Samimi
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Lori Minasian
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Jennifer Loud
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD, USA
| | - Megan C Roberts
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| |
Collapse
|
21
|
Young AL, Butow PN, Rhodes P, Tucker KM, Williams R, Healey E, Wakefield CE. Talking across generations: Family communication about BRCA1
and BRCA2
genetic cancer risk. J Genet Couns 2019; 28:516-532. [DOI: 10.1002/jgc4.1055] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Alison Luk Young
- School of Psychology; The University of Sydney; Sydney NSW Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre; Sydney Children’s Hospital; Randwick Australia
| | - Phyllis N. Butow
- School of Psychology; The University of Sydney; Sydney NSW Australia
| | - Paul Rhodes
- School of Psychology; The University of Sydney; Sydney NSW Australia
| | - Katherine M. Tucker
- Prince of Wales Hereditary Cancer Centre; Prince of Wales Hospital; Randwick NSW Australia
- Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Randwick NSW Australia
| | - Rachel Williams
- Prince of Wales Hereditary Cancer Centre; Prince of Wales Hospital; Randwick NSW Australia
- Prince of Wales Clinical School, Faculty of Medicine; University of New South Wales; Randwick NSW Australia
| | - Emma Healey
- Illawarra Cancer Care Centre, Wollongong Hospital; Wollongong NSW Australia
| | - Claire E. Wakefield
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre; Sydney Children’s Hospital; Randwick Australia
- School of Women’s and Children’s Health; University of New South Wales; Sydney NSW Australia
| |
Collapse
|
22
|
Verma A, Nag S, Hasan Q, Priya Selvakumar V. Mainstreaming genetic counseling for BRCA testing into oncology clinics – Indian perspective. Indian J Cancer 2019; 56:S38-S47. [DOI: 10.4103/ijc.ijc_458_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
23
|
Abstract
Regulatory compliance in the direct-to-consumer genetic testing market is highly sophisticated as there are numerous federal, state, and ethical barriers to entry. In 2010, amid an underregulated market, 23andMe sought to do what few companies in the medical industry had attempted before-disregard the guidance and requests of the US Food and Drug Administration. This regulatory strategy effectively destined the company's Personal Genome Service for failure; however, the company changed course and has been granted several regulatory clearances. This exemplifies the importance of a healthy relationship with regulatory agencies, although challenges remain. The DTC industry continues to have a perplexing regulatory framework at both the federal and state level. There are also ethical concerns with the monetization of deidentified genetic health information, as genetic data have an inherent level of identifiability and are not fully protected by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule in these scenarios. Although some DTC tests are now cleared in the United States, the concern that a learned intermediary is needed for interpretation of results remains. The regulatory oversight of this market will need to continue to develop to ensure the protection of consumer health and privacy.
Collapse
Affiliation(s)
- Brendan Seward
- 1 Johns Hopkins University, Employee at Clarius Mobile Health Corp, Surrey, British Columbia, Canada
| |
Collapse
|
24
|
Gill J, Obley AJ, Prasad V. Direct-to-Consumer Genetic Testing: The Implications of the US FDA's First Marketing Authorization for BRCA Mutation Testing. JAMA 2018; 319:2377-2378. [PMID: 29800087 DOI: 10.1001/jama.2018.5330] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jennifer Gill
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland
| | - Adam J Obley
- Section of General Internal Medicine, Veterans Affairs Medical Center, Portland, Oregon
| | - Vinay Prasad
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland
- Center for Health Care Ethics, Oregon Health and Science University, Portland
| |
Collapse
|
25
|
Phillips CA, Barz Leahy A, Li Y, Schapira MM, Bailey LC, Merchant RM. Relationship Between State-Level Google Online Search Volume and Cancer Incidence in the United States: Retrospective Study. J Med Internet Res 2018; 20:e6. [PMID: 29311051 PMCID: PMC5778251 DOI: 10.2196/jmir.8870] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/18/2017] [Accepted: 10/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background In the United States, cancer is common, with high morbidity and mortality; cancer incidence varies between states. Online searches reflect public awareness, which could be driven by the underlying regional cancer epidemiology. Objective The objective of our study was to characterize the relationship between cancer incidence and online Google search volumes in the United States for 6 common cancers. A secondary objective was to evaluate the association of search activity with cancer-related public events and celebrity news coverage. Methods We performed a population-based, retrospective study of state-level cancer incidence from 2004 through 2013 reported by the Centers for Disease Control and Prevention for breast, prostate, colon, lung, and uterine cancers and leukemia compared to Google Trends (GT) relative search volume (RSV), a metric designed by Google to allow interest in search topics to be compared between regions. Participants included persons in the United States who searched for cancer terms on Google. The primary measures were the correlation between annual state-level cancer incidence and RSV as determined by Spearman correlation and linear regression with RSV and year as independent variables and cancer incidence as the dependent variable. Temporal associations between search activity and events raising public awareness such as cancer awareness months and cancer-related celebrity news were described. Results At the state level, RSV was significantly correlated to incidence for breast (r=.18, P=.001), prostate (r=–.27, P<.001), lung (r=.33, P<.001), and uterine cancers (r=.39, P<.001) and leukemia (r=.13, P=.003) but not colon cancer (r=–.02, P=.66). After adjusting for time, state-level RSV was positively correlated to cancer incidence for all cancers: breast (P<.001, 95% CI 0.06 to 0.19), prostate (P=.38, 95% CI –0.08 to 0.22), lung (P<.001, 95% CI 0.33 to 0.46), colon (P<.001, 95% CI 0.11 to 0.17), and uterine cancers (P<.001, 95% CI 0.07 to 0.12) and leukemia (P<.001, 95% CI 0.01 to 0.03). Temporal associations in GT were noted with breast cancer awareness month but not with other cancer awareness months and celebrity events. Conclusions Cancer incidence is correlated with online search volume at the state level. Search patterns were temporally associated with cancer awareness months and celebrity announcements. Online searches reflect public awareness. Advancing understanding of online search patterns could augment traditional epidemiologic surveillance, provide opportunities for targeted patient engagement, and allow public information campaigns to be evaluated in ways previously unable to be measured.
Collapse
Affiliation(s)
- Charles A Phillips
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Allison Barz Leahy
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Yimei Li
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Marilyn M Schapira
- Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - L Charles Bailey
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Raina M Merchant
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States.,Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
26
|
Mainstreaming genetics in palliative care: barriers and suggestions for clinical genetic services. J Community Genet 2017; 9:243-256. [PMID: 29159708 DOI: 10.1007/s12687-017-0345-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 11/07/2017] [Indexed: 01/20/2023] Open
Abstract
Palliative healthcare professionals (PHCPs) frequently do not refer their eligible patients for genetic testing. After the death of the affected individual, clinically relevant information for family members is lost. In previous research, PHCPs stated that the end-of-life setting is not appropriate to discuss genetic issues. It is unclear if this has changed due to increasing awareness of genetics in the media and efforts to mainstream genetic testing. Semi-structured interviews of PHCPs were analysed by thematic analysis. Seven PHCPs (four nurses, two consultants, and one clinical psychologist) were interviewed. Participants reported feeling unfamiliar with the role of clinical genetics services, and did not feel confident in addressing genetic issues with their patients. A lack of scientific knowledge and unawareness of existing infrastructure to support their patients were cited. Many stated that palliative patients are interested in exploring a potential hereditary component to their disease, and acknowledged the potential for psychological benefit for their patients and their families. Most stated that addressing genetics fits within their skill set, but expressed concern about issues of consent, logistical difficulties, and ethical dilemmas. These perceptions differ considerably from those reported in existing literature. Importantly, each participant stated that the potential benefits of addressing genetic issues outweighed the potential for harm in most cases. These results suggest a need for clinical genetics staff to develop closer links with their local PHCPs and to provide education. Clinical psychologists may also be a helpful resource to address PHCPs' concerns.
Collapse
|
27
|
Nabi H, Dorval M, Chiquette J, Simard J. Increased Use of BRCA Mutation Test in Unaffected Women Over the Period 2004-2014 in the U.S.: Further Evidence of the "Angelina Jolie Effect"? Am J Prev Med 2017; 53:e195-e196. [PMID: 29054246 DOI: 10.1016/j.amepre.2017.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 04/27/2017] [Accepted: 05/16/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Hermann Nabi
- Faculté de Pharmacie, Université Laval, Québec, QC, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada; INSERM U.1018, Centre de Recherche en Épidémiologie et Santé des Populations, Villejuif, France
| | - Michel Dorval
- Faculté de Pharmacie, Université Laval, Québec, QC, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada; Centre des maladies du sein Deschênes-Fabia, CHU de Québec, Hôpital du Saint-Sacrement, Québec, QC, Canada
| | - Jocelyne Chiquette
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada; Département de médecine familiale et de médecine d'urgence, Faculté de médecine de Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Jacques Simard
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada; Département de Médecine Moléculaire, Faculté de Médecine, Université Laval, Québec, QC, Canada
| |
Collapse
|
28
|
Trends in utilization and costs of BRCA testing among women aged 18-64 years in the United States, 2003-2014. Genet Med 2017; 20:428-434. [PMID: 28933789 PMCID: PMC8485755 DOI: 10.1038/gim.2017.118] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 06/12/2017] [Indexed: 11/08/2022] Open
Abstract
PurposeWe examined 12-year trends in BRCA testing rates and costs in the context of clinical guidelines, national policies, and other factors.MethodsWe estimated trends in BRCA testing rates and costs from 2003 to 2014 for women aged 18-64 years using private claims data and publicly reported revenues from the primary BRCA testing provider.ResultsThe percentage of women with zero out-of-pocket payments for BRCA testing increased during 2013-2014, after 7 years of general decline, coinciding with a clarification of Affordable Care Act coverage of BRCA genetic testing. Beginning in 2007, family history accounted for an increasing proportion of women with BRCA tests compared with personal history, coinciding with BRCA testing guidelines for primary care settings and direct-to-consumer advertising campaigns. During 2013-2014, BRCA testing rates based on claims grew at a faster rate than revenues, following 3 years of similar growth, consistent with increased marketplace competition. In 2013, BRCA testing rates based on claims increased 57%, compared with 11% average annual increases over the preceding 3 years, coinciding with celebrity publicity.ConclusionThe observed trends in BRCA testing rates and costs are consistent with possible effects of several factors, including the Affordable Care Act, clinical guidelines and celebrity publicity.
Collapse
|
29
|
Kolor K, Chen Z, Grosse SD, Rodriguez JL, Green RF, Dotson WD, Bowen MS, Lynch JA, Khoury MJ. BRCA Genetic Testing and Receipt of Preventive Interventions Among Women Aged 18-64 Years with Employer-Sponsored Health Insurance in Nonmetropolitan and Metropolitan Areas - United States, 2009-2014. MMWR. SURVEILLANCE SUMMARIES : MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES 2017; 66:1-11. [PMID: 28880857 PMCID: PMC5879728 DOI: 10.15585/mmwr.ss6615a1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PROBLEM/CONDITION Genetic testing for breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) gene mutations can identify women at increased risk for breast and ovarian cancer. These testing results can be used to select preventive interventions and guide treatment. Differences between nonmetropolitan and metropolitan populations in rates of BRCA testing and receipt of preventive interventions after testing have not previously been examined. PERIOD COVERED 2009-2014. DESCRIPTION OF SYSTEM Medical claims data from Truven Health Analytics MarketScan Commercial Claims and Encounters databases were used to estimate rates of BRCA testing and receipt of preventive interventions after BRCA testing among women aged 18-64 years with employer-sponsored health insurance in metropolitan and nonmetropolitan areas of the United States, both nationally and regionally. RESULTS From 2009 to 2014, BRCA testing rates per 100,000 women aged 18-64 years with employer-sponsored health insurance increased 2.3 times (102.7 to 237.8) in metropolitan areas and 3.0 times (64.8 to 191.3) in nonmetropolitan areas. The relative difference in BRCA testing rates between metropolitan and nonmetropolitan areas decreased from 37% in 2009 (102.7 versus 64.8) to 20% in 2014 (237.8 versus 191.3). The relative difference in BRCA testing rates between metropolitan and nonmetropolitan areas decreased more over time in younger women than in older women and decreased in all regions except the West. Receipt of preventive services 90 days after BRCA testing in metropolitan versus nonmetropolitan areas throughout the period varied by service: the percentage of women who received a mastectomy was similar, the percentage of women who received magnetic resonance imaging of the breast was lower in nonmetropolitan areas (as low as 5.8% in 2014 to as high as 8.2% in 2011) than metropolitan areas (as low as 7.3% in 2014 to as high as 10.3% in 2011), and the percentage of women who received mammography was lower in nonmetropolitan areas in earlier years but was similar in later years. INTERPRETATION Possible explanations for the 47% decrease in the relative difference in BRCA testing rates over the study period include increased access to genetic services in nonmetropolitan areas and increased demand nationally as a result of publicity. The relative differences in metropolitan and nonmetropolitan BRCA testing rates were smaller among women at younger ages compared with older ages. PUBLIC HEALTH ACTION Improved data sources and surveillance tools are needed to gather comprehensive data on BRCA testing in the United States, monitor adherence to evidence-based guidelines for BRCA testing, and assess receipt of preventive interventions for women with BRCA mutations. Programs can build on the recent decrease in geographic disparities in receipt of BRCA testing while simultaneously educating the public and health care providers about U.S. Preventive Services Task Force recommendations and other clinical guidelines for BRCA testing and counseling.
Collapse
Affiliation(s)
- Katherine Kolor
- Office of Public Health Genomics, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - Zhuo Chen
- Office of Public Health Genomics, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia.,CFO Leasing, Inc., Atlanta, Georgia.,Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Ridgely Fisk Green
- Office of Public Health Genomics, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia.,Carter Consulting, Inc., Atlanta, Georgia
| | - W David Dotson
- Office of Public Health Genomics, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - M Scott Bowen
- Office of Public Health Genomics, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| | - Julie A Lynch
- US Department of Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
| | - Muin J Khoury
- Office of Public Health Genomics, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
| |
Collapse
|
30
|
van der Giessen JAM, van Riel E, Velthuizen ME, van Dulmen AM, Ausems MGEM. Referral to cancer genetic counseling: do migrant status and patients' educational background matter? J Community Genet 2017; 8:303-310. [PMID: 28868568 PMCID: PMC5614888 DOI: 10.1007/s12687-017-0326-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/21/2017] [Indexed: 12/17/2022] Open
Abstract
Participation rates in cancer genetic counseling differ among populations, as patients with a lower educational background and migrant patients seem to have poorer access to it. We conducted a study to determine the present-day educational level and migrant status of counselees referred to cancer genetic counseling. We assessed personal characteristics and demographics of 731 newly referred counselees. Descriptive statistics were used to describe these characteristics. The results show that about 40% of the counselees had a high educational level and 89% were Dutch natives. Compared to the Dutch population, we found a significant difference in educational level (p = < 0.01) and migrant status (p = < 0.001). This suggests disparities in cancer genetic counseling and as a result of that, suboptimal care for vulnerable groups. Limited health literacy is likely to pose a particular challenge to cancer genetic counseling for counselees with a lower education or a migrant background. Our study points to considerable scope for improvement in referring vulnerable groups of patients for cancer genetic counseling.
Collapse
Affiliation(s)
- J A M van der Giessen
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands
| | - E van Riel
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands
| | - M E Velthuizen
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands
| | - A M van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.,Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - M G E M Ausems
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands.
| |
Collapse
|
31
|
Ricker C. DE LAS FAMILIAS CON SÍNDROMES A LOS GENES. LAS PRIMERAS CARACTERIZACIONES CLÍNICAS Y GENÉTICAS DE DOS SÍNDROMES HEREDITARIOS CON PREDISPOSICIÓN AL CÁNCER: ¿CUÁL FUE EL COMIENZO? REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
32
|
Ricker C. FROM FAMILIES SYNDROMES TO GENES… THE FIRST CLINICAL AND GENETIC CHARACTERIZATIONS OF HEREDITARY SYNDROMES PREDISPOSING TO CANCER: WHAT WAS THE BEGINNING? REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|