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Hong YR, Yadav S, Wang R, Vadaparampil S, Bian J, George TJ, Braithwaite D. Genetic Testing for Cancer Risk and Perceived Importance of Genetic Information Among US Population by Race and Ethnicity: a Cross-sectional Study. J Racial Ethn Health Disparities 2024; 11:382-394. [PMID: 36689121 PMCID: PMC9870197 DOI: 10.1007/s40615-023-01526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Genetic testing can help determine the risk of many cancers and guide cancer prevention and treatment plans. Despite increasing concern about disparities in precision cancer medicine, public knowledge and cancer genetic testing by race and ethnicity have not been well investigated. METHODS We analyzed data from the 2020 Health Information National Trends Survey in 2022. Self-reported cancer genetic testing (e.g., Lynch syndrome, BRCA1/2) knowledge and utilization were compared by race and ethnicity. Perceived importance of genetic information for cancer care (prevention, detection, and treatment) was also examined in relation to the uptake of cancer genetic testing. Multivariable logistic regression models were employed to examine factors associated with knowledge and genetic testing to calculate predicted probability of undergoing genetic testing by race and ethnicity. RESULTS Of 3551 study participants, 37.8% reported having heard of genetic testing for cancer risk and 3.9% stated that they underwent cancer genetic testing. Being non-Hispanic Black (OR=0.47, 95% CI=0.30-0.75) or Hispanic (OR=0.56, CI=0.35-0.90) was associated with lower odds of genetic testing knowledge. Although Hispanic or non-Hispanic Black respondents were more likely to perceive higher importance of genetic information versus non-Hispanic Whites, they had a lower predicted probability of cancer genetic testing. CONCLUSION Non-Hispanic Black and Hispanic adults had lower knowledge and were less likely to undergo cancer genetic testing than non-Hispanic Whites. Further research is needed on sources of genetic testing information for racial and ethnic minorities and the barriers to accessing genetic testing to inform the development of effective cancer risk genetic testing promotion.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, PO Box 100195, Gainesville, FL, 32610, USA.
- UF Health Cancer Center, Gainesville, USA.
| | - Sandhya Yadav
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, PO Box 100195, Gainesville, FL, 32610, USA
| | - Ruixuan Wang
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, PO Box 100195, Gainesville, FL, 32610, USA
| | - Susan Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, USA
- Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Gainesville, USA
| | - Jiang Bian
- UF Health Cancer Center, Gainesville, USA
- Department of Health Outcomes and Biomedical informatics, College of Medicine, University of Florida, Gainesville, USA
| | - Thomas J George
- UF Health Cancer Center, Gainesville, USA
- Department of Medicine, Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, USA
| | - Dejana Braithwaite
- UF Health Cancer Center, Gainesville, USA
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
- Department of Surgery, College of Medicine, University of Florida, Gainesville, USA
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Alkhatib KY, Filipas DK, Briggs L, Frego N, Koelker M, Lipsitz SR, Pierorazio PM, Rebbeck T, Kilbridge K, Kibel AS, Trinh QD, Rana HQ, Cole AP. Racial differences in knowledge, attitudes, and sources of information about germline cancer genetic testing in the U.S.A.: An analysis of the health information National Trends Survey System. Prev Med 2024; 178:107779. [PMID: 37967620 DOI: 10.1016/j.ypmed.2023.107779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE To understand racial disparities in germline cancer genetic testing and the role of prior knowledge, attitudes, and sources of information. METHODS A cross-sectional analysis of the Health Information National Trends Survey 5 (HINTS 5) was conducted between February 24th and June 15th, 2020. The study aimed to investigate knowledge and receipt of genetic testing, attitudes toward the importance of genetic testing in preventing, detecting, and treating cancer, and information sources of genetic testing in the United States of America. RESULTS Non-Hispanic Black (NHB) and Hispanic race/ethnicity were associated with lower odds of being informed about genetic testing, whereas those of NHB race were more likely to endorse the importance of genetic testing in cancer prevention and treatment. Regarding sources of information about genetic testing: Non-Hispanic Asians were less likely to be informed about genetic testing from television (Mean Predicted Probability (MPP) 0.38 95%CI; 0.21-0.55, (Adjusted Risk Difference) ARD vs. Non-Hispanic White (NHW); -0.228, p = 0.01), NHB were less likely to report being informed about genetic testing from social media (MPP 0.27 95%CI; 0.20-0.34, ARD vs. NHW; -0.139, p < 0.01). CONCLUSIONS NHB and Hispanic groups face unequal access to information about genetic testing. There are significant race-based differences in information sources. These differences could be used to promote equitable access to cancer genetic testing.
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Affiliation(s)
- Khalid Y Alkhatib
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics (Penn LDI), Wharton, University of Pennsylvania, Philadelphia, PA, USA.
| | - Dejan K Filipas
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Logan Briggs
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urologic Surgery, Mayo Clinic, Phoenix, AZ.
| | - Nicola Frego
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy.
| | - Mara Koelker
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Stuart R Lipsitz
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Phillip M Pierorazio
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics (Penn LDI), Wharton, University of Pennsylvania, Philadelphia, PA, USA.
| | - Tim Rebbeck
- Division of Cancer Genetics and Prevention and Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Kerry Kilbridge
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Department of Urology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Adam S Kibel
- Department of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Quoc-Dien Trinh
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Huma Q Rana
- Division of Cancer Genetics and Prevention and Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Alexander P Cole
- Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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He M, Guan J, Li H, Dong Y, Zhu X, Sun J, Gao S, Zhi S, Ai Ni BHLQM, Sun J. Genetic testing decision-making experiences within families of colorectal cancer patients: A qualitative study. Eur J Oncol Nurs 2023; 66:102417. [PMID: 37741145 DOI: 10.1016/j.ejon.2023.102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/05/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE Genetic testing is the gold standard for the diagnosis of hereditary colorectal cancer syndromes but is currently inadequate and nonideal. The decision-making processes regarding genetic testing are even less well known. The present study aims to explore the decision-making experience of genetic testing for colorectal cancer patients and their family members. METHOD A descriptive qualitative study was employed. Data were collected using individual semi-structured interviews with 5 colorectal cancer patients and 20 family members from November 2020 to April 2021. Interviews were transcribed and analysed using inductive content analysis. RESULTS Four categories were identified: 1) the source of information for genetic testing, 2) the differentiated attitudes towards genetic testing, 3) genetic testing decisional needs, and 4) the factors influencing genetic testing decision-making. Colorectal cancer patients and their families engaged in two distinct pathways to genetic testing decisions: direct decision-making and indirect decision-making. Throughout these processes, due to the limited source of information, they had information needs that were met and facilitated genetic testing decision-making. CONCLUSIONS Colorectal cancer patients and family members need knowledge related to genetic testing, but they have limited access to information, which prevents them from making informed decisions. Providing decision aid interventions and informational support are significant steps towards addressing the support needs of this population.
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Affiliation(s)
- Meng He
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Jingjing Guan
- The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China.
| | - Huanhuan Li
- Clinical Nursing Department, Naval Medical University, 800 Xiang Yin Road, Yangpu District, Shanghai, 200433, China.
| | - Yueyang Dong
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Xiangning Zhu
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Juanjuan Sun
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Shizheng Gao
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Shengze Zhi
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Bu He Li Qian Mu Ai Ni
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
| | - Jiao Sun
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
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Factors Associated with the Uptake of Genetic Testing for Cancer Risks: A Pathway Analysis Using the Health Information National Trends Survey Data. Life (Basel) 2022; 12:life12122024. [PMID: 36556389 PMCID: PMC9786267 DOI: 10.3390/life12122024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/24/2022] [Accepted: 12/01/2022] [Indexed: 12/11/2022] Open
Abstract
Our study aimed to identify pathways from the source of information to the uptake of cancer genetic testing, with consideration of intermediate variables including perceptional, attitudinal and psychosocial factors. We used the Health Information National Trends Survey (2020 database) and constructed a structural equation model for pathway analysis (using SPSS version 24). Variables for socio-demographic, lifestyle and health information were also collected and used for confounding adjustment. A total of 2941 participants were analyzed (68.5%, non-Hispanic white; 59.7%, females; 58 years, median age; and 142 (4.8%) had undertaken genetic testing for cancer risk previously). Our pathway analysis found that only information from particular sources (i.e., healthcare providers and genetic counsellors) had positive and significant effects on people’s perceptions of cancer regarding its prevention, detection and treatment (standardized β range, 0.15−0.31, all p-values < 0.01). Following the paths, these perceptional variables (cancer prevention, detection and treatment) showed considerable positive impacts on the uptake of genetic testing (standardized β (95% CIs): 0.25 (0.20, 0.30), 0.28 (0.23, 0.33) and 0.12 (0.06, 0.17), respectively). Pathways involving attitudinal and psychosocial factors showed much smaller or insignificant effects on the uptake of genetic testing. Our study brings several novel perspectives to the behavior model and may underpin certain issues regarding cancer risk genetic testing.
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Roberts MC, Foss KS, Henderson GE, Powell SN, Saylor KW, Weck KE, Milko LV. Public Interest in Population Genetic Screening for Cancer Risk. Front Genet 2022; 13:886640. [PMID: 35938028 PMCID: PMC9354961 DOI: 10.3389/fgene.2022.886640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023] Open
Abstract
An emerging role for DNA sequencing is to identify people at risk for an inherited cancer syndrome in order to prevent or ameliorate the manifestation of symptoms. Two cancer syndromes, Hereditary Breast and Ovarian Cancer and Lynch Syndrome meet the “Tier 1” evidence threshold established by the Centers for Disease Control and Prevention (CDC) for routine testing of patients with a personal or family history of cancer. Advancements in genomic medicine have accelerated public health pilot programs for these highly medically actionable conditions. In this brief report, we provide descriptive statistics from a survey of 746 US respondents from a Qualtrics panel about the public’s awareness of genetic testing, interest in learning about their cancer risk, and likelihood of participating in a population genetic screening (PGS) test. Approximately of half the respondents were aware of genetic testing for inherited cancer risk (n = 377/745, 50.6%) and would choose to learn about their cancer risk (n-309/635, 48.7%). Characteristics of those interested in learning about their cancer risk differed by educational attainment, age, income, insurance status, having a primary care doctor, being aware of genetic testing, and likelihood of sharing information with family (p < 0.05). A sizeable majority of the respondents who were interested in about learning their cancer risk also said that they were likely to participate in a PGS test that involved a clinical appointment and blood draw, but no out-of-pocket cost (n = 255/309, 82.5%). Reasons for not wanting to participate included not finding test results interesting or important, concerns about costs, and feeling afraid to know the results. Overall, our results suggest that engaging and educating the general population about the benefits of learning about an inherited cancer predisposition may be an important strategy to address recruitment barriers to PGS.
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Affiliation(s)
- Megan C Roberts
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, United States
| | - Kimberly S Foss
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gail E Henderson
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sabrina N Powell
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Katherine W Saylor
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Karen E Weck
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Laura V Milko
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Makhnoon S, Maki KG, Yu R, Peterson SK, Shete S. Are beliefs about the importance of genetics for cancer prevention and early detection associated with high risk cancer genetic testing in the U.S. Population? Prev Med Rep 2022; 27:101781. [PMID: 35378849 PMCID: PMC8976149 DOI: 10.1016/j.pmedr.2022.101781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/18/2022] [Accepted: 03/26/2022] [Indexed: 11/10/2022] Open
Abstract
Public attitudes towards germline genetic testing for inherited cancers have been found to be generally positive. Past research demonstrated that diverse causal beliefs and contextual factors are associated with uptake of genetic testing. However, it is unclear how beliefs about genetically informed cancer prevention and early detection ultimately shape testing behaviors. We used data from the National Health Information National Trends Survey (HINTS 5 Cycle 4) to evaluate these beliefs and the relationship between beliefs related to cancer genetics and participation in cancer genetic testing. Overall, 5.24% of the total weighted sample underwent cancer genetic testing, of whom 70.5% (n = 141) had no personal history of cancer, whereas others had a personal diagnosis of breast, ovarian, or colorectal cancer (23.0%), or other cancers (6.5%). In adjusted multivariable analysis, testing was positively associated with personal history of breast, ovarian, or colorectal cancer (OR = 28.37, 95% CI: 10.19–79.04), female sex (OR = 2.97, 95% CI: 1.41–6.26), having high cancer worry (OR = 4.78, 95%: 2.19–10.45), and negatively associated with being Hispanic (OR = 0.37, 95%: 0.16–0.86) or non-Hispanic Asian (OR = 0.12, 95% CI: 0.04–0.33). Belief in the importance of genetics for early detection of cancer was associated with testing (OR = 18.03, 95% CI: 4.07–79.79), whereas belief in the importance of genetics for cancer prevention was not. The association between testing and belief about the importance of genetics for early detection of cancer, but not cancer prevention, is a surprising finding that warrants further research. Better understanding of these beliefs and their potential impact on test uptake may inform population genetic testing efforts.
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Turbitt E, Roberts MC, Taber JM, Waters EA, McNeel TS, Biesecker BB, Klein WMP. Genetic counseling, genetic testing, and risk perceptions for breast and colorectal cancer: Results from the 2015 National Health Interview Survey. Prev Med 2019; 123:12-19. [PMID: 30817954 PMCID: PMC7321923 DOI: 10.1016/j.ypmed.2019.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 02/16/2019] [Accepted: 02/23/2019] [Indexed: 11/19/2022]
Abstract
We examined what proportion of the U.S. population with no personal cancer history reported receiving either genetic counseling or genetic testing for cancer risk, and also the association of these behaviors with cancer risk perceptions. We used data from the 2015 National Health Interview Survey. Objective relative risk scores for breast (women) and colorectal (men and women) cancer risk were generated for individuals without a personal history of cancer. Participants' risk perceptions were compared with their objective relative risk. Of 12,631 women, 1.2% reported receiving genetic counseling and 0.8% genetic testing for hereditary breast cancer risk. Of 15,085 men and women, 0.8% reported receiving genetic counseling and 0.3% genetic testing for hereditary colorectal cancer risk. Higher breast cancer risk perception was associated with genetic counseling (OR: 4.31, 95%CI: 2.56, 7.26) and testing (OR: 3.56, 95%CI: 1.80, 7.03). Similarly, higher perception of colorectal cancer risk was associated with genetic counseling (OR: 5.04, 95%CI: 2.57, 9.89) and testing (OR: 5.92, 95%CI: 2.40, 14.63). A higher proportion of individuals with colorectal cancer risk perceptions concordant with their objective risk (vs. discordant) had undergone genetic counseling or testing for colorectal cancer risk. Concordant risk perceptions for breast cancer were not associated with breast cancer genetic counseling or testing. Given frequent dialogue about implementing population level programs involving genetic services for cancer risk, policy makers and investigators should consider the role of risk perceptions in the effectiveness and design of such programs and potential strategies for addressing inaccuracies in risk perceptions.
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Affiliation(s)
- Erin Turbitt
- National Human Genome Research Institute, Bethesda, MD, United States of America; University of Technology Sydney, NSW, Australia.
| | - Megan C Roberts
- National Cancer Institute, Rockville, MD, United States of America
| | | | - Erika A Waters
- Washington University School of Medicine in St. Louis, St Louis, MO, United States of America
| | - Timothy S McNeel
- Information Management Services, Inc., Calverton, MD, United States of America
| | - Barbara B Biesecker
- Research Triangle Institute, International, Washington, DC, United States of America
| | - William M P Klein
- National Human Genome Research Institute, Bethesda, MD, United States of America; National Cancer Institute, Rockville, MD, United States of America
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