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Leachman SA, Latour E, Detweiler-Bedell B, Detweiler-Bedell JB, Zell A, Wenzel E, Stoos E, Nelson JH, Wiedrick J, Berry EG, Lange J, Etzioni R, Lapidus JA. Melanoma literacy among the general population of three western US states. Pigment Cell Melanoma Res 2023; 36:481-500. [PMID: 37574711 DOI: 10.1111/pcmr.13106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 08/15/2023]
Abstract
Melanoma is a significant cause of cancer death, despite being detectable without specialized or invasive technologies. Understanding barriers to preventive behaviors such as skin self-examination (SSE) could help to define interventions for increasing the frequency of early detection. To determine melanoma knowledge and beliefs across three high-incidence US states, 15,000 surveys were sent to a population-representative sample. We aimed to assess (1) melanoma literacy (i.e., knowledge about melanoma risks, attitudes, and preventive behaviors) and (2) self-reported SSE and its association with melanoma literacy, self-efficacy, and belief in the benefits of SSE. Of 2326 respondents, only 21.2% provided responses indicating high knowledge of melanoma, and 62.8% reported performing an SSE at any time in their lives. Only 38.3% and 7.3% reported being "fairly" or "very" confident about doing SSE, respectively. SSE performance among respondents was most strongly associated with higher melanoma knowledge, higher self-efficacy, and personal history of melanoma. Melanoma literacy among survey respondents was modest, with greater literacy associated with a higher likelihood of reported preventive behavior. This assessment establishes a baseline and provides guidance for public health campaigns designed to increase prevention and early detection of this lethal cancer.
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Affiliation(s)
- Sancy A Leachman
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
- Melanoma & Skin Cancer Program, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Emile Latour
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Adrienne Zell
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth Wenzel
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth Stoos
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
- Melanoma & Skin Cancer Program, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jacob H Nelson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jack Wiedrick
- Biostatistics and Design Program, Oregon Health & Science University, Portland, Oregon, USA
- Oregon Health & Science University-Portland State University (OHSU-PSU) School of Public Health, Portland, Oregon, USA
| | - Elizabeth G Berry
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
- Melanoma & Skin Cancer Program, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jane Lange
- Melanoma & Skin Cancer Program, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
- Center for Early Detection Advanced Research, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Group Health Research Institute, Seattle, Washington, USA
| | - Jodi A Lapidus
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, Oregon, USA
- Biostatistics and Design Program, Oregon Health & Science University, Portland, Oregon, USA
- Oregon Health & Science University-Portland State University (OHSU-PSU) School of Public Health, Portland, Oregon, USA
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Pauley K, Khan A, Kohlmann W, Jeter J. Considerations for Germline Testing in Melanoma: Updates in Behavioral Change and Pancreatic Surveillance for Carriers of CDKN2A Pathogenic Variants. Front Oncol 2022; 12:837057. [PMID: 35372037 PMCID: PMC8967159 DOI: 10.3389/fonc.2022.837057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/23/2022] [Indexed: 01/13/2023] Open
Abstract
The largest proportion of hereditary melanoma cases are due to pathogenic variants (PVs) in the CDKN2A/p16 gene, which account for 20%-40% of familial melanomas and confer up to a 30%-70% lifetime risk for melanoma in individuals with these variants. In addition, PVs in the CDKN2A gene also increase risk for pancreatic cancer (~5-24% lifetime risk). Individuals with PVs in the CDKN2A gene also tend to have an earlier onset of cancer. Despite these known risks, uptake of germline testing has been limited in the past, largely due to perceptions of limited benefit for patients. Prevention recommendations have been developed for individuals with CDKN2A PVs as well the providers who care for them. On the patient level, behavioral modifications regarding melanoma prevention such as wearing sunscreen, limiting prolonged sun exposure and practicing general sun safety can help reduce risks. Germline testing can provide motivation for some individuals to adhere to these lifestyle changes. On the provider level, pancreatic cancer surveillance for individuals with CDKN2A PVs has been increasingly endorsed by expert consensus, although the efficacy of these surveillance methods remains under study. This review summarizes the updated surveillance guidelines for individuals with CDKN2A PVs and explores the impact of genetic counseling and testing in influencing behavioral changes in these individuals.
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Affiliation(s)
- Kristen Pauley
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Ambreen Khan
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Wendy Kohlmann
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Joanne Jeter
- Department of Internal Medicine, Huntsman Cancer Institute, Salt Lake City, UT, United States
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Primiero CA, Yanes T, Finnane A, Soyer HP, McInerney-Leo AM. A Systematic Review on the Impact of Genetic Testing for Familial Melanoma I: Primary and Secondary Preventative Behaviours. Dermatology 2021; 237:806-815. [PMID: 33588421 DOI: 10.1159/000513919] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing availability of panel testing for known high-penetrance familial melanoma genes has made it possible to improve risk awareness in those at greatest risk. Prior to wider implementation, the role of genetic testing in preventing melanoma, through influencing primary and secondary preventative behaviours, requires clarification. METHODS Database searches of PubMed, Embase, CINAHL, PsycINFO and the Cochrane Library were conducted for studies describing preventative behaviour outcomes in response to genetic testing for melanoma risk. Publications describing original research of any study type were screened for eligibility. RESULTS Eighteen publications describing 11 unique studies were reviewed. Outcomes assessed are based on health behaviour recommendations for those at increased risk: adherence to sun-protective behaviour (SPB); clinical skin examinations (CSE); skin self-examinations (SSE); and family discussion of risk. Overall, modest increases in adherence to primary prevention strategies of SPB were observed following genetic testing. Importantly, there were no net decreases in SPB found amongst non-carriers. For secondary preventative behaviour outcomes, including CSE and SSE, increases in post-test intentions and long-term adherence were reported across several subgroups in approximately half of the studies. While this increase reached significance in mutation carriers in some studies, one study reported a significant decline in annual CSE adherence of non-mutation carriers. CONCLUSIONS Evidence reviewed suggests that genetic testing has a modestly positive impact on preventative behaviour in high-risk individuals. Furthermore, improvements are observed regardless of mutation carrier status, although greater adherence is found in carriers. While additional studies of more diverse cohorts would be needed to inform clinical recommendations, the findings are encouraging and suggest that genetic testing for melanoma has a positive impact on preventative behaviours.
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Affiliation(s)
- Clare A Primiero
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Tatiane Yanes
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Anna Finnane
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia,
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia,
| | - Aideen M McInerney-Leo
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
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Taber JM, Aspinwall LG, Drummond DM, Stump TK, Kohlmann W, Champine M, Cassidy P, Leachman SA. Priority of Risk (But Not Perceived Magnitude of Risk) Predicts Improved Sun-Protection Behavior Following Genetic Counseling for Familial Melanoma. Ann Behav Med 2021; 55:24-40. [PMID: 32415830 PMCID: PMC7880221 DOI: 10.1093/abm/kaaa028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Understanding multiple components of risk perceptions is important because perceived risk predicts engagement in prevention behaviors. PURPOSE To examine how multiple components of risk perceptions (perceived magnitude of and worry about risk, prioritization of the management of one's risk) changed following genetic counseling with or without test reporting, and to examine which of these components prospectively predicted improvements in sun-protection behavior 1 year later. METHODS A prospective, nonrandomized study design was used. Participants were 114 unaffected members of melanoma-prone families who (i) underwent genetic testing for a CDKN2A/p16 mutation (n = 69) or (ii) were at comparably elevated risk based on family history and underwent genetic counseling but not testing (no-test controls, n = 45). Participants reported risk perception components and sun-protection behavior at baseline, immediately following counseling, and 1 month and 1 year after counseling. RESULTS Factor analysis indicated three risk components. Carriers reported increased perceived magnitude and priority of risk, but not cancer worry. No-test controls showed no changes in any risk perception. Among noncarriers, priority of risk remained high at all assessments, whereas magnitude of risk and cancer worry decreased. Of the three risk components, greater priority of risk uniquely predicted improved self-reported sun protection 1 year post-counseling. CONCLUSIONS Priority of risk (i) seems to be a component of risk perceptions distinguishable from magnitude of risk and cancer worry, (ii) may be an important predictor of daily prevention behavior, and (iii) remained elevated 1 year following genetic counseling only for participants who received a positive melanoma genetic test result.
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Affiliation(s)
- Jennifer M Taber
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, UT
| | | | - Tammy K Stump
- Department of Preventive Medicine, Northwestern University, Evanston, IL
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Marjan Champine
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Wu YP, Parsons BG, Aspinwall LG, Hay JL, Boucher KM, Caputo H, Mooney R, Grossman D, Leachman SA. Parent and child perspectives on perceived barriers to child sun protection and their association with sun protection strategies among children of melanoma survivors. Pediatr Dermatol 2019; 36:317-323. [PMID: 30895676 PMCID: PMC6525049 DOI: 10.1111/pde.13796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Children with an elevated familial risk for melanoma inconsistently implement sun protection behaviors that could mitigate their melanoma risk. Little is known about perceived barriers to child sun protection among this at-risk group and their parents, and the extent to which perceived barriers are associated with child sun protection. The goal of this study was to examine, among children with a family history of melanoma, the frequency with which children and their parents reported barriers to child sun protection and the extent to which barriers were associated with reported use of sun protection among children. METHODS Children with a family history of melanoma and their parents completed questionnaires assessing perceived barriers and reported child use of sun protection. RESULTS Common barriers to child sun protection included being bothered by implementing the behavior or forgetting. A greater number of perceived barriers were associated with less frequent child use of sunscreen, long-sleeved shirts, long pants, and shade. CONCLUSIONS Children at elevated risk for melanoma due to a family history of the disease and their parents perceive multiple barriers to sun protection that are associated with children's use of these melanoma preventive behaviors. Sun protection interventions for this at-risk population could provide families with specific strategies to address common barriers to implementing child sun protection.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, Utah.,Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, Utah
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City, New York
| | | | | | - Ryan Mooney
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Douglas Grossman
- Department of Dermatology, University of Utah, Salt Lake City, Utah.,Huntsman Cancer Institute, Salt Lake City, Utah
| | - Sancy A Leachman
- Department of Dermatology & Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
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Frieser MJ, Wilson S, Vrieze S. Behavioral impact of return of genetic test results for complex disease: Systematic review and meta-analysis. Health Psychol 2018; 37:1134-1144. [PMID: 30307272 DOI: 10.1037/hea0000683] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Advances in genomewide association studies have made possible the return of genetic risk results for complex diseases. Two concerns about these results are (a) negative psychological consequences and (b) viewing probabilistic results as deterministic, leading to misinterpretation and inappropriate decisions. The present study evaluates these concerns through a meta-analytic review of existing literature. METHOD Seventeen genetic testing studies of complex disease, including 1,171 participants and reporting 195 effects, 104 of which were unadjusted for covariates, were meta-analyzed under a random effects model. Diseases included Alzheimer's, cardiovascular and coronary heart disease, lung cancer, melanoma, thrombophilia, and type II diabetes. Six domains of behavioral-psychological reactions were examined. RESULTS Carriers showed significantly increased self-reported behavior change compared to noncarriers when assessed 6 months or later after results return (Hedges's g = .36, p = .019). CONCLUSIONS Return of genetic testing results for complex disease does not strongly impact self-reported negative behavior or psychological function of at-risk individuals. Return of results does appear to moderately increase self-reported healthy behavior in carriers, although research on objectively observed behavior change is needed. This is a growing area of research, with preliminary results suggesting potential positive implications of genetic testing for complex disease on behavior change. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | - Sylia Wilson
- Department of Psychology, University of Minnesota, Minneapolis
| | - Scott Vrieze
- Department of Psychology, University of Minnesota, Minneapolis
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Aspinwall LG, Stump TK, Taber JM, Drummond DM, Kohlmann W, Champine M, Leachman SA. Genetic test reporting of CDKN2A provides informational and motivational benefits for managing melanoma risk. Transl Behav Med 2018; 8:29-43. [PMID: 29385581 PMCID: PMC6065541 DOI: 10.1093/tbm/ibx011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A CDKN2A/p16 mutation confers 28%-67% lifetime melanoma risk, a risk that may be moderated by ultraviolet radiation exposure. The aim of this study was to test whether melanoma genetic counseling and test disclosure conferred unique informational, motivational, or emotional benefits compared to family history-based counseling. Participants included were 114 unaffected members of melanoma-prone families, ages 16-69, 51.8% men, 65.8% with minor children or grandchildren. Carriers (n = 28) and noncarriers (n = 41) from families with a CDKN2A mutation were compared to no-test controls (n = 45) from melanoma-prone families without an identifiable CDKN2A mutation. All participants received equivalent counseling about melanoma risk and management; only CDKN2A participants received genetic test results. Using newly developed inventories, participants rated perceived costs and benefits for managing their own and their children's or grandchildren's melanoma risk 1 month and 1 year after counseling. Propensity scores controlled for baseline family differences. Compared to no-test controls, participants who received test results (carriers and noncarriers) reported feeling significantly more informed and prepared to manage their risk, and carriers reported greater motivation to reduce sun exposure. All groups reported low negative emotions about melanoma risk. Parents reported high levels of preparedness to manage children's risk regardless of group. Carrier parents reported greater (but moderate) worry about their children's risk than no-test control parents. Women, older, and more educated respondents reported greater informational and motivational benefits regardless of group. Genetic test results were perceived as more informative and motivating for personal sun protection efforts than equivalent counseling based on family history alone.
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Affiliation(s)
- Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Tammy K Stump
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Jennifer M Taber
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | | | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Marjan Champine
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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8
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Fogel AL, Jaju PD, Li S, Halpern-Felsher B, Tang JY, Sarin KY. Factors influencing and modifying the decision to pursue genetic testing for skin cancer risk. J Am Acad Dermatol 2017; 76:829-835.e1. [PMID: 28087134 DOI: 10.1016/j.jaad.2016.11.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 10/18/2016] [Accepted: 11/20/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Across cancers, the decision to pursue genetic testing is influenced more by subjective than objective factors. However, skin cancer, which is more prevalent, visual, and multifactorial than many other malignancies, may offer different motivations for pursuing such testing. OBJECTIVES The primary objective was to determine factors influencing the decision to receive genetic testing for skin cancer risk. A secondary objective was to assess the impact of priming with health questions on the decision to receive testing. METHODS We distributed anonymous online surveys through ResearchMatch.org to assess participant health, demographics, motivations, and interest in pursuing genetic testing for skin cancer risk. Two surveys with identical questions but different question ordering were used to assess the secondary objective. RESULTS We received 3783 responses (64% response rate), and 85.8% desired testing. Subjective factors, including curiosity, perceptions of skin cancer, and anxiety, were the most statistically significant determinants of the decision to pursue testing (P < .001), followed by history of sun exposure (odds ratio 1.85, P < .01) and history of skin cancer (odds ratio 0.5, P = .01). Age and family history of skin cancer did not influence this decision. Participants increasingly chose testing if first queried about health behaviors (P < .0001). LIMITATIONS The decision to pursue hypothetical testing may differ from in-clinic decision-making. Self-selected, online participants may differ from the general population. Surveys may be subject to response bias. CONCLUSION The decision to pursue genetic testing for skin cancer is primarily determined by subjective factors, such as anxiety and curiosity. Health factors, including skin cancer history, also influenced decision-making. Priming with consideration of objective health factors can increase the desire to pursue testing.
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Affiliation(s)
- Alexander L Fogel
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Prajakta D Jaju
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Shufeng Li
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Bonnie Halpern-Felsher
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University School of Medicine, Stanford, California
| | - Jean Y Tang
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University School of Medicine, Stanford, California.
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9
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Wu YP, Aspinwall LG, Conn BM, Stump T, Grahmann B, Leachman SA. A systematic review of interventions to improve adherence to melanoma preventive behaviors for individuals at elevated risk. Prev Med 2016; 88:153-67. [PMID: 27090434 PMCID: PMC4902721 DOI: 10.1016/j.ypmed.2016.04.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/07/2016] [Accepted: 04/12/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES To examine the effectiveness of behavioral interventions for melanoma prevention targeted to individuals at elevated risk due to personal and/or family history. METHODS Through literature searches in 5 search databases (through July 2014), 20 articles describing 14 unique interventions focused on melanoma prevention among individuals at elevated risk for the disease were identified. Interventions targeting only patients undergoing active treatment for melanoma were excluded. RESULTS The average study quality was moderate. The majority of interventions (6 out of 9, 66% of studies) led to improvements in one or more photoprotective behaviors, particularly for improvements in use of protective clothing (3 out of 5, 60% of studies), and frequency and/or thoroughness of skin self-examinations (9 out of 12, 75%). Fewer interventions (5 out of 14, 36%) targeted uptake of total body skin examinations (60% led to improvements). Also, fewer interventions targeted all three preventive behaviors (5 out of 14, 36%). CONCLUSIONS Findings suggest that future interventions should aim to improve adherence across multiple preventive behaviors, over a longer time period (past 8months post-intervention), and target high-risk children. Studies should include adequate sample sizes to investigate moderators and mediators of intervention effectiveness. Interventions may be strengthened by new techniques, such as incorporating family members (e.g., to improve thoroughness of skin self-examinations) and eHealth technology.
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Affiliation(s)
- Yelena P Wu
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, USA; Huntsman Cancer Institute, USA.
| | - Lisa G Aspinwall
- Huntsman Cancer Institute, USA; Department of Psychology, University of Utah, USA
| | - Bridgid M Conn
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, USA
| | - Tammy Stump
- Department of Psychology, University of Utah, USA
| | - Bridget Grahmann
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, USA
| | - Sancy A Leachman
- Huntsman Cancer Institute, USA; Department of Dermatology, Oregon Health & Science University, USA
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Wu YP, Aspinwall LG, Michaelis TC, Stump T, Kohlmann WG, Leachman SA. Discussion of photoprotection, screening, and risk behaviors with children and grandchildren after melanoma genetic testing. J Community Genet 2016; 7:21-31. [PMID: 26099287 PMCID: PMC4715817 DOI: 10.1007/s12687-015-0243-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 06/04/2015] [Indexed: 12/20/2022] Open
Abstract
The purpose of the current study was to examine changes in frequency of discussion about melanoma preventive behaviors among adults who received melanoma genetic test reporting and counseling and their children and grandchildren, correspondence of frequency of discussion with intentions, and content of discussions. Participants received CDKN2A/p16 testing and counseling (N = 24, 46 % p16-positive). Discussions about preventive behaviors were assessed before testing and 1 and 6 months post-testing. Intentions to discuss preventive behaviors and perceived preparedness to discuss risk were assessed post-testing. Open-ended questions assessed content of reported discussions. Discussion of preventive behaviors declined following test reporting, with more rapid decline reported by noncarriers. There was a large gap between the percentage of participants who intended to discuss preventive behaviors and who then reported discussions 1 and 6 months after counseling. Participants felt prepared to discuss melanoma risk but also suggested resources to facilitate discussions. Genetic test reporting and counseling alone did not sustain discussions about preventive behaviors for a hereditary cancer with children and grandchildren. The gap between intentions to have discussions and reported discussions has implications for augmentation of counseling to support at-risk families' discussions about preventive behaviors.
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Affiliation(s)
- Yelena P Wu
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA.
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, 380 South 1530 East, Salt Lake City, UT, 84112, USA
| | - Timothy C Michaelis
- School of Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Tammy Stump
- Department of Psychology, University of Utah, 380 South 1530 East, Salt Lake City, UT, 84112, USA
| | - Wendy G Kohlmann
- Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health and Science University, 3303 Southwest Bond Avenue, Portland, OR, 97239, USA
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Fogel AL, Sarin K. The digital age of melanoma management: detection and diagnostics. Melanoma Manag 2015; 2:383-391. [PMID: 30190865 PMCID: PMC6094706 DOI: 10.2217/mmt.15.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
New technologies are increasingly impacting the way melanoma is detected and diagnosed. Devices, software and diagnostics abound, ranging from smartphone applications that purport to predict which lesions are likely to be malignant, to genomic analysis of low-stage melanomas to predict metastatic risk. The purpose of this review is to concisely update practitioners on the research behind the latest tools available for melanoma detection and diagnosis, as well as the implications of these technologies for melanoma management.
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Affiliation(s)
- Alexander L Fogel
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Kavita Sarin
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway St, Pavilion B, 4th FL, MC 5338, Redwood City, CA 94063, USA
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12
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Taber JM, Aspinwall LG. Framing recommendations to promote prevention behaviors among people at high risk: A simulation study of responses to melanoma genetic test reporting. J Genet Couns 2015; 24:771-82. [PMID: 25582532 DOI: 10.1007/s10897-014-9808-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
Abstract
A CDKN2A/p16 mutation confers 76 % lifetime risk of developing melanoma to US residents, and high-risk individuals are counseled to use sunscreen. Generally, for patients at population risk, gain framing more effectively promotes prevention behaviors; however, it is unknown whether loss frames might more effectively promote behavioral intentions and perceived control over disease risk among high-risk patients. Undergraduates (N = 146) underwent a simulated genetic counseling and test reporting session for hereditary melanoma. Participants watched a video of a genetic counselor providing information in which genetic risk of melanoma (Low: 15 %; High: 76 %) and framed recommendations to use sunscreen (Loss: Risk may increase by 15 % if don't use sunscreen; Gain: Risk may decrease by 15 % if use sunscreen) were manipulated. Controlling for baseline sunscreen use, high-risk participants given loss frames reported greater beliefs that sunscreen would reduce risk than high-risk participants given gain frames. Further, high-risk participants with fair skin tended to report greater intentions to use sunscreen when given loss frames versus gain frames. Perceived control over risk mediated the effect of message frame and disease risk on intentions to use sunscreen. When counseling patients with elevated cancer risk, genetic counselors may consider framing prevention behavioral recommendations in terms of potential losses.
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Affiliation(s)
- Jennifer M Taber
- Department of Psychology, University of Utah, 380 S. 1530 E., Room 502, Salt Lake City, UT, 84112, US
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, 380 S. 1530 E., Room 502, Salt Lake City, UT, 84112, US.
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Aspinwall LG, Stump TK, Taber JM, Kohlmann W, Leaf SL, Leachman SA. Impact of melanoma genetic test reporting on perceived control over melanoma prevention. J Behav Med 2015; 38:754-65. [PMID: 25822116 PMCID: PMC4568125 DOI: 10.1007/s10865-015-9631-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 03/18/2015] [Indexed: 11/29/2022]
Abstract
To determine whether receiving melanoma genetic test results undermines perceived control over melanoma prevention, control-related beliefs were examined among 60 adults from melanoma-prone families receiving CDKN2A/p16 test results (27 unaffected noncarriers, 15 unaffected carriers, 18 affected carriers; response rate at 2 years = 64.9 % of eligible respondents). Multilevel modeling of perceived control ratings over a 2-year period revealed significant variation in individual trajectories: most participants showed increases (45 %) or no change (38.3 %), while 16.7 % showed decreases. At the group level, noncarriers reported sustained increases through the 2-year follow-up (ps < .05); unaffected carriers reported significant short-term increases (ps < .05); and affected carriers reported no change. Participants in all groups continued to rate photoprotection as highly effective in reducing melanoma risk and reported decreased beliefs that carrying the p16 mutation would inevitably lead to the development of melanoma. Qualitative responses immediately following counseling and test reporting corroborated these findings, as 93 % indicated it was possible to either prevent (64.9 %) or decrease the likelihood (28.1 %) of future melanomas. Thus, genetic test reporting does not generally undermine perceived control over melanoma prevention, though variability in response to positive results warrants future study.
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Affiliation(s)
- Lisa G Aspinwall
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84112-0251, USA.
| | - Tammy K Stump
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84112-0251, USA
| | - Jennifer M Taber
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84112-0251, USA
| | | | - Samantha L Leaf
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84112-0251, USA
- ISA Group, Alexandria, VA, USA
| | - Sancy A Leachman
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Oregon Health and Science University, Portland, OR, USA
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14
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Common genetic risk for melanoma encourages preventive behavior change. J Pers Med 2015; 5:36-49. [PMID: 25695399 PMCID: PMC4384058 DOI: 10.3390/jpm5010036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/12/2015] [Accepted: 02/13/2015] [Indexed: 11/21/2022] Open
Abstract
There is currently great interest in using genetic risk estimates for common disease in personalized healthcare. Here we assess melanoma risk-related preventive behavioral change in the context of the Coriell Personalized Medicine Collaborative (CPMC). As part of on-going reporting activities within the project, participants received a personalized risk assessment including information related to their own self-reported family history of melanoma and a genetic risk variant showing a moderate effect size (1.7, 3.0 respectively for heterozygous and homozygous individuals). Participants who opted to view their report were sent an optional outcome survey assessing risk perception and behavioral change in the months that followed. Participants that report family history risk, genetic risk, or both risk factors for melanoma were significantly more likely to increase skin cancer preventive behaviors when compared to participants with neither risk factor (ORs = 2.04, 2.79, 4.06 and p-values = 0.02, 2.86 × 10−5, 4.67 × 10−5, respectively), and we found the relationship between risk information and behavior to be partially mediated by anxiety. Genomic risk assessments appear to encourage positive behavioral change in a manner that is complementary to family history risk information and therefore may represent a useful addition to standard of care for melanoma prevention.
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15
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Fitzpatrick L, Hay JL. Barriers to risk-understanding and risk-reduction behaviors among individuals with a family history of melanoma. Melanoma Manag 2014; 1:185-191. [PMID: 30190823 DOI: 10.2217/mmt.14.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Family members of melanoma patients are often called upon to provide support, ranging from monetary to medical assistance. Consanguineal relatives of melanoma patients are also at greater risk of developing the disease themselves. However, as a group, they have limited understanding of their melanoma risk and they demonstrate inadequate primary and secondary prevention behaviors. The optimal intervention strategies for improving the consistent use of such behaviors (i.e., improving rates of sun-protection behaviors and screening) remains unclear, necessitating further research.
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Affiliation(s)
- Laura Fitzpatrick
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.,Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Jennifer L Hay
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.,Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY 10022, USA.,Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.,Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY 10022, USA
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16
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Fogel AL, Azizi N, Tang J, Sarin KY. Dermatologic applications of direct-to-consumer genomic analysis. J Am Acad Dermatol 2014; 71:993-5. [PMID: 25437956 DOI: 10.1016/j.jaad.2014.04.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 04/27/2014] [Accepted: 04/30/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Alexander L Fogel
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Nason Azizi
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Jean Tang
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University School of Medicine, Stanford, California.
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17
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Avril MF, Bahadoran P, Cabaret O, Caron O, de la Fouchardière A, Demenais F, Desjardins L, Frébourg T, Hammel P, Leccia MT, Lesueur F, Mahé E, Martin L, Maubec E, Remenieras A, Richard S, Robert C, Soufir N, Stoppa-Lyonnet D, Thomas L, Vabres P, Bressac-de Paillerets B. [Recommendations for genetic testing and management of individuals genetically at-risk of cutaneous melanoma]. Ann Dermatol Venereol 2014; 142:26-36. [PMID: 25600792 DOI: 10.1016/j.annder.2014.09.606] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/08/2014] [Accepted: 09/01/2014] [Indexed: 11/19/2022]
Abstract
Cutaneous melanoma is a multifactorial disease resulting from both environmental and genetic factors. Five susceptibility genes have been identified over the past years, comprising high-risk susceptibility genes (CDKN2A, CDK4, and BAP1 genes) and intermediate-risk susceptibility genes (MITF, and MC1R genes). The aim of this expert consensus was to define clinical contexts justifying genetic analyses, to describe the conduct of these analyses, and to propose surveillance recommendations. Given the regulatory constraints, it is recommended that dermatologists work in tandem with a geneticist. Genetic analysis may be prescribed when at least two episodes of histologically proven invasive cutaneous melanoma have been diagnosed before the age of 75 years in two 1st or 2nd degree relatives or in the same individual. The occurrence in the same individual or in a relative of invasive cutaneous melanoma with ocular melanoma, pancreatic cancer, renal cancer, mesothelioma or a central nervous system tumour are also indications for genetic testing. Management is based upon properly managed photoprotection and dermatological monitoring according to genetic status. Finally, depending on the mutated gene and the familial history, associated tumour risks require specific management (e.g. ocular melanoma, pancreatic cancer). Due to the rapid progress in genetics, these recommendations will need to be updated regularly.
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Affiliation(s)
- M-F Avril
- Service de dermatologie, groupe hospitalier Cochin-Saint-Vincent-de-Paul, AP-HP, pavillon Tarnier, 89, rue d'Assas, 75006 Paris, France
| | - P Bahadoran
- Inserm U895, service de dermatologie, hôpital Archet 2, CHU, 151, route Saint-Antoine-Ginestiere, BP 79, 06200 Nice cedex 3, France
| | - O Cabaret
- Service de génétique, département de biologie et pathologie médicales, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - O Caron
- Consultation d'oncogénétique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - A de la Fouchardière
- Département de biopathologie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - F Demenais
- Inserm, UMR946, variabilité génétique et maladies humaines, fondation Jean-Dausset, CEPH, 27, rue Juliette-Dodu, 75010 Paris, France
| | - L Desjardins
- Service d'ophtalmologie, institut Curie, 26, rue d'Ulm, 75231 Paris cedex 05, France
| | - T Frébourg
- Inserm U1079, service de génétique, CHU de Rouen, IRIB, faculté de médecine et de pharmacie, 22, boulevard Gambetta, 76183 Rouen cedex, France
| | - P Hammel
- Service de gastro-entérologie-pancréatologie, hôpital Beaujon, AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy cedex, France
| | - M-T Leccia
- Service de dermatologie, CHU Michallon, BP 217, 38043 Grenoble cedex 9, France
| | - F Lesueur
- Inserm U900, équipe épidémiologie génétique des cancers, institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - E Mahé
- Service de dermatologie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95107 Argenteuil cedex, France
| | - L Martin
- Service de dermatologie, CHU d'Angers, université d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - E Maubec
- Inserm, UMR946, variabilité génétique et maladies humaines, fondation Jean-Dausset, CEPH, 27, rue Juliette-Dodu, 75010 Paris, France; Service de dermatologie, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Remenieras
- Département d'oncologie génétique, institut Paoli-Calmettes, 232, boulevard Saint-Marguerite, 13273 Marseille cedex 9, France
| | - S Richard
- Service d'urologie, hôpital Bicêtre, Centre expert national cancers rares INCa PREDIR, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | - C Robert
- Service de dermatologie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - N Soufir
- Inserm U976, laboratoire de génétique moléculaire, unité fonctionnelle de génétique, hôpital Xavier-Bichat-Claude-Bernard, AP-HP, Paris 7 université, 75018 Paris, France
| | - D Stoppa-Lyonnet
- Inserm U830, service de génétique, département de biologie des tumeurs, institut Curie, 26, rue d'Ulm, 75231 Paris cedex 05, France
| | - L Thomas
- Service de dermatologie, centre hospitalier Lyon Sud, université Lyon 1, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - P Vabres
- Service de dermatologie, CHU de Dijon, BP 77908, 21079 Dijon cedex, France
| | - B Bressac-de Paillerets
- Service de génétique, département de biologie et pathologie médicales, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.
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18
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Aspinwall LG, Taber JM, Kohlmann W, Leaf SL, Leachman SA. Unaffected family members report improvements in daily routine sun protection 2 years following melanoma genetic testing. Genet Med 2014; 16:846-53. [PMID: 24763292 PMCID: PMC4209010 DOI: 10.1038/gim.2014.37] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/19/2014] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Reducing ultraviolet radiation exposure may decrease melanoma risk in the hereditary melanoma setting. It is unknown whether genetic counseling and test reporting of CDKN2A/p16 mutation status promote long-term compliance with photoprotection recommendations, especially in unaffected mutation carriers. METHODS This study evaluated changes 2 years following melanoma genetic testing in self-reported practice of sun protection (sunscreen, photoprotective clothing, and ultraviolet radiation avoidance) among 37 members of two CDKN2A/p16 kindreds (10 unaffected carriers, 11 affected carriers, and 16 unaffected noncarriers; response rate = 64.9% of eligible participants). RESULTS Multivariate profile analysis indicated that all three participant groups reported increased daily routine practice of sun protection 2 years following melanoma genetic testing (P < 0.02), with 96.9% reporting that at least one sun protection behavior was part of their daily routine, up from 78.1% at baseline (P < 0.015). Unaffected carriers (P < 0.024) and unaffected noncarriers (P < 0.027) reported significantly more frequent use of photoprotective clothing. Affected carriers maintained adherence to all sun protection behaviors. Reported sunburns in the past 6 months decreased significantly (P < 0.018). CONCLUSION Members of high-risk families reported increased daily routine sun protection and decreased sunburns 2 years following melanoma genetic testing, with no net decline in sun protection following negative test results. Thus, genetic testing and counseling may motivate sustained improvements in prevention behaviors.
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19
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Ascierto PA, Grimaldi AM, Anderson AC, Bifulco C, Cochran A, Garbe C, Eggermont AM, Faries M, Ferrone S, Gershenwald JE, Gajewski TF, Halaban R, Hodi FS, Kefford R, Kirkwood JM, Larkin J, Leachman S, Maio M, Marais R, Masucci G, Melero I, Palmieri G, Puzanov I, Ribas A, Saenger Y, Schilling B, Seliger B, Stroncek D, Sullivan R, Testori A, Wang E, Ciliberto G, Mozzillo N, Marincola FM, Thurin M. Future perspectives in melanoma research: meeting report from the "Melanoma Bridge", Napoli, December 5th-8th 2013. J Transl Med 2014; 12:277. [PMID: 25348889 PMCID: PMC4232645 DOI: 10.1186/s12967-014-0277-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 09/23/2014] [Indexed: 12/28/2022] Open
Abstract
The fourth "Melanoma Bridge Meeting" took place in Naples, December 5 to 8th, 2013. The four topics discussed at this meeting were: Diagnosis and New Procedures, Molecular Advances and Combination Therapies, News in Immunotherapy, and Tumor Microenvironment and Biomarkers.
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Affiliation(s)
- Paolo A Ascierto
- />Istituto Nazionale Tumori, Fondazione “G. Pascale”, Napoli, Italy
| | | | | | - Carlo Bifulco
- />Translational Molecular Pathology, Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR USA
| | - Alistair Cochran
- />Departments of Pathology and Laboratory Medicine and Surgery, David Geffen School of Medicine at University of California Los Angeles (UCLA), John Wayne Cancer Institute, Santa Monica, CA USA
| | - Claus Garbe
- />Center for Dermato Oncology, Department of Dermatology, University of Tübingen, Tübingen, Germany
| | | | - Mark Faries
- />Donald L. Morton Melanoma Research Program, John Wayne Cancer Institute, Santa Monica, CA USA
| | - Soldano Ferrone
- />Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Jeffrey E Gershenwald
- />Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Thomas F Gajewski
- />Departments of Medicine and of Pathology, Immunology and Cancer Program, The University of Chicago Medicine, Chicago, IL USA
| | - Ruth Halaban
- />Department of Dermatology, Yale University School of Medicine, New Haven, CT USA
| | - F Stephen Hodi
- />Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA USA
| | - Richard Kefford
- />Westmead Institute for Cancer Research, Westmead Millennium Institute and Melanoma Institute Australia, University of Sydney, Sydney, NSW Australia
| | - John M Kirkwood
- />Division of Hematology/Oncology, Departments of Medicine, Dermatology, and Translational Science, University of Pittsburgh School of Medicine and Melanoma Program of the Pittsburgh Cancer Institute, Pittsburgh, PA USA
| | - James Larkin
- />Royal Marsden NHS Foundation Trust, London, UK
| | - Sancy Leachman
- />Department of Dermatology, Oregon Health Sciences University, Portland, OR USA
| | - Michele Maio
- />Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Richard Marais
- />Molecular Oncology Group, The Paterson Institute for Cancer Research, Wilmslow Road, Manchester, M20 4BX UK
| | - Giuseppe Masucci
- />Department of Oncology-Pathology, The Karolinska Hospital, Stockholm, Sweden
| | - Ignacio Melero
- />Centro de Investigación Médica Aplicada, Clinica Universidad de Navarra, Pamplona, Navarra Spain
| | - Giuseppe Palmieri
- />Unit of Cancer Genetics, Institute of Biomolecular Chemistry, National Research Council, Sassari, Italy
| | - Igor Puzanov
- />Vanderbilt University Medical Center, Nashville, TN USA
| | - Antoni Ribas
- />Tumor Immunology Program, Jonsson Comprehensive Cancer Center (JCCC), David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA USA
| | - Yvonne Saenger
- />Division of Hematology and Oncology, Tisch Cancer Institute, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Bastian Schilling
- />Department of Dermatology, University Hospital, West German Cancer Center, University Duisburg-Essen, Essen, Germany
- />German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Barbara Seliger
- />Martin Luther University Halle-Wittenberg, Institute of Medical Immunology, Halle, Germany
| | - David Stroncek
- />Cell Processing Section, Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, MD USA
| | - Ryan Sullivan
- />Center for Melanoma, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA USA
| | | | - Ena Wang
- />Division Chief of Translational Medicine, Sidra Medical and Research Centre, Doha, Qatar
| | | | - Nicola Mozzillo
- />Istituto Nazionale Tumori, Fondazione “G. Pascale”, Napoli, Italy
| | | | - Magdalena Thurin
- />Cancer Diagnosis Program, National Cancer Institute, NIH, Bethesda, MD USA
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Aspinwall LG, Taber JM, Kohlmann W, Leaf SL, Leachman SA. Perceived risk following melanoma genetic testing: a 2-year prospective study distinguishing subjective estimates from recall. J Genet Couns 2014; 23:421-37. [PMID: 24322567 PMCID: PMC4028391 DOI: 10.1007/s10897-013-9676-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 11/21/2013] [Indexed: 12/20/2022]
Abstract
A major goal of predictive genetic testing is to alert people to their risk before illness onset; however, little is known about how risk perceptions change following genetic testing and whether information is recalled accurately over time. In the United States, a CDKN2A/p16 mutation confers 76 % lifetime risk of melanoma. Following genetic counseling and test reporting, subjective risk estimates and recall of counselor-provided risk estimates were assessed 5 times over the next 2 years among 60 adult members of 2 extended CDKN2A/p16 kindreds. No sustained changes from baseline in risk perceptions were reported. Unaffected carriers (n = 15) consistently reported significantly lower subjective risk estimates (46 %) than they were actually given (76 %, p < 0.001) or recalled having been given (60 %, p < 0.001). Noncarriers' (n = 27) risk estimates decreased following results disclosure, but rebounded, with both subjective and recalled estimates subsequently exceeding what they were told by the counselor (both ps < 0.001). Affected carriers' (n = 18) risk estimates for developing a new melanoma corresponded well to counselor-provided information (p = 0.362). For all 3 patient groups, results were consistent across multiple risk measures and remained similar when demographic, phenotypic, and baseline behavioral contributors to melanoma risk were statistically controlled. These findings are consistent with other studies of risk perception, but additional studies of more diverse populations are needed to understand the reasons behind both the persistence of initial risk estimates and their divergence from information provided by the counselor during genetic counseling. Additionally, determining whether holding subjective risk perceptions that differ from counselor-provided information ultimately affects adherence to management recommendations will help guide the presentation of risk information in genetic counseling practice.
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Affiliation(s)
- Lisa G Aspinwall
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84112-0251, USA,
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21
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Abstract
Families that have several relatives with melanoma, multiple primary melanomas in one individual, younger than average ages of melanoma onset, and/or the presence of both pancreatic cancer and melanoma may be suggestive of a hereditary melanoma syndrome and are candidates for genetic counseling and risk assessment. Genetic counseling for hereditary melanoma presents many complexities. Only a minority of hereditary melanoma cases have been attributed to a single genetic factor, CDKN2A. Both the frequency and the penetrance of CDKN2A mutations has been shown to be dependent on multiple factors. The clinical utility of genetic testing for hereditary melanoma families is debatable because CDKN2A status may not impact medical management in patients with melanoma. No standard medical management guidelines exist for families with CDKN2A mutations; however, family history of melanoma and pancreatic cancer may warrant further discussion. Clinicians should discuss the clinical and psychological implications before genetic testing. Genetic counseling and pretest education regarding melanoma risk factors provides an opportunity to increase knowledge and understanding of melanoma risk, while addressing psychological risks and concerns.
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22
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Aspinwall LG, Taber JM, Leaf SL, Kohlmann W, Leachman SA. Melanoma genetic counseling and test reporting improve screening adherence among unaffected carriers 2 years later. Cancer Epidemiol Biomarkers Prev 2013; 22:1687-97. [PMID: 23950214 PMCID: PMC3837428 DOI: 10.1158/1055-9965.epi-13-0422] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A major goal of predictive genetic testing for melanoma is to promote early detection to reduce mortality. This study evaluated the long-term impact of melanoma genetic test reporting and counseling on screening adherence. METHODS This study assessed adherence to recommendations for annual total body skin examinations (TBSE) and monthly skin self-examinations (SSE) among 37 members of Utah CDKN2A/p16 kindreds (10 unaffected carriers, 11 affected carriers, and 16 unaffected noncarriers; response rate = 64.9% of eligible participants). RESULTS Two years following test reporting, adherence to annual TBSE among unaffected carriers increased from 40% to 70%. However, unaffected noncarriers' adherence decreased from 56% to 13%. Affected carriers reported TBSEs at both assessments (91% and 82%, respectively). Monthly SSE frequency remained highly variable in all patient groups: at 2 years, 29.7% reported monthly SSEs, 27.0% reported more frequent self-examinations, and 43.2% reported underscreening. However, SSE quality improved significantly: participants checked more body sites at 2 years than at baseline, especially feet, shoulders, legs, and genitals. Perceived logistic barriers to TBSEs (e.g., expensive, inconvenient) and SSEs (hard to remember, time-consuming) predicted lower adherence. CONCLUSIONS Unaffected carriers reported increased TBSE adherence and thoroughness of SSEs 2 years following melanoma genetic test reporting, suggesting clinical benefit in this modest sample. Unaffected noncarriers reported comparable gains in SSE thoroughness, but decreased TBSEs. IMPACT Melanoma genetic counseling and test reporting may improve adherence among unaffected carrier members of p16 families. Further interventions to reduce logistic barriers and to promote continued screening adherence among unaffected noncarrier family members may be needed.
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Affiliation(s)
| | | | | | | | - Sancy A. Leachman
- Department of Dermatology, University of Utah
- Huntsman Cancer Institute
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23
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Abstract
Many hereditary cancer predisposition syndromes are associated with cutaneous findings, both benign and malignant. Dermatological examination and histopathology, when combined with a thorough personal and family medical history, play an important role in the diagnosis of cancer predisposition syndromes. Skin findings are an important diagnostic tool for a variety of cancer syndromes, including Cowden syndrome, Birt-Hogg-Dubé, hereditary leiomyomatosis renal cell carcinoma, and others. This article focuses on the phenotype, medical management, and genetic testing for 4 hereditary cancer syndromes that include cutaneous findings: hereditary melanoma, basal cell nevus syndrome, neurofibromatosis type 1, and neurofibromatosis type 2.
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24
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Bränström R, Kasparian NA, Affleck P, Tibben A, Chang YM, Azizi E, Baron-Epel O, Bergman W, Chan M, Davies J, Ingvar C, Kanetsky PA, van Leeuwen E, Olsson H, Gruis NA, Brandberg Y, Newton-Bishop J. Perceptions of genetic research and testing among members of families with an increased risk of malignant melanoma. Eur J Cancer 2012; 48:3052-62. [PMID: 22726816 DOI: 10.1016/j.ejca.2012.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 04/04/2012] [Accepted: 05/14/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Several melanoma susceptibility genes have been identified. As part of the international genetic research programme of the GenoMEL consortiums research on genetic mutations in melanoma families, the aim of this study was to examine family members' views about their risk of melanoma, gene testing and genetic research. METHODS Self-report data were gathered using online and paper-based surveys available in four languages among 312 individuals (62% from Europe, 18% from Australia, 13% from the United States of America (USA) and 7% from Israel). RESULTS Fifty three percent had been diagnosed with a melanoma, and 12% had a positive susceptibility gene test result. Respondents with many moles and freckles were more likely to perceive themselves at risk for developing melanoma (odds ratio [OR](Freckles)=2.24 with 95% confidence interval [CI]=1.18-4.26; OR(Many moles)=6.92, 95%CI=2.37-20.23). Respondents who had received a non-informative (negative) genetic test result were much less likely to perceive themselves at increased risk (OR=0.17, 95% CI=0.04-0.73). Safe-guards were perceived as important to protect genetic information, but there was also support for the storage and exchange of such information. Overall, respondents were in favour of genetic testing, even if current knowledge about melanoma risk genes is still limited. Contrary to previous studies, participants reported that a non-informative (negative) genetic test result, although not necessarily indicative of lower risk of melanoma, would be likely to reduce their practise of preventive behaviours. CONCLUSIONS Participants were influenced by their phenotype and test results in risk estimations. They expressed positive views on genetic research and towards genetic testing, but reported that a non-informative (negative) test result might be associated with an (erroneous) perception of reduced risk and fewer preventive behaviours. These results highlight the urgency of improving the quality of genetic counselling and increasing the effectiveness of communication regarding genetic test results.
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Affiliation(s)
- Richard Bränström
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
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25
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Abstract
PURPOSE Genetic testing of minors is controversial, as ethical considerations depend on multiple aspects of the particular disease and familial context. For melanoma, there is a well-established and avoidable environmental influence and a documented benefit of early detection. METHODS We surveyed 61 CDKN2A/p16 mutation-tested adults from two kindreds about their attitudes toward genetic testing of minors immediately posttesting and 2 years later. RESULTS Overall, 86.9% expressed support of melanoma genetic testing of minors, with the importance of risk awareness (77.4%) and the likelihood of improved prevention and screening behaviors (69.8%) as the most frequently cited potential benefits. Among mutation carriers, 82.6% wanted genetic testing for their own children. These preferences remained stable over a 2-year period. Most respondents (62.3%) favored complete involvement of their children in genetic counseling and test reporting; 19.7% suggested that children be tested but not informed of the results. Concerns about inducing psychological distress or compromising children's decision autonomy were infrequently cited. Testing preferences did not vary by respondent age, gender, or melanoma history. CONCLUSION Respondents strongly supported melanoma genetic testing of minors, with most citing improved health behavior as a likely outcome. We discuss options for melanoma genetic counseling and testing of minors.
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Aspinwall LG, Taber JM, Leaf SL, Kohlmann W, Leachman SA. Genetic testing for hereditary melanoma and pancreatic cancer: a longitudinal study of psychological outcome. Psychooncology 2011; 22:276-89. [PMID: 23382133 DOI: 10.1002/pon.2080] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 08/26/2011] [Accepted: 08/27/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE CDKN2A/p16 mutations confer 76% lifetime risk of melanoma and up to 17% lifetime risk of pancreatic cancer. Our objective was to determine the short- and long-term impact of CDKN2A/p16 genetic counseling and test reporting on psychological distress, cancer worry, and perceived costs and benefits of testing. METHODS Prospective changes in anxiety, depression, and cancer worry following CDKN2A/p16 counseling and test reporting were evaluated at multiple assessments over 2 years among 60 adult members of melanoma-prone families; 37 participants completed the 2-year follow-up. Quantitative and qualitative assessments of the costs and benefits of testing were carried out. Outcomes were evaluated among unaffected noncarriers (n = 27), unaffected carriers (n = 15), and affected carriers (n = 18). RESULTS Reported anxiety and depression were low. For carriers and noncarriers, anxiety decreased significantly throughout the 2-year period, whereas depression and melanoma worry showed short-term decreases. Worry about pancreatic cancer was low and decreased significantly. In all groups, test-related distress and uncertainty were low, regret was absent, and positive experiences were high. All participants (>93% at each assessment) reported at least one perceived benefit of genetic testing; only 15.9% listed any negative aspect. Carriers reported increased knowledge about melanoma risk and prevention (78.3%) and increased prevention and screening behaviors for self and family (65.2%). Noncarriers reported increased knowledge (95.2%) and emotional benefits (71.4%). CONCLUSION Among US participants familiar with their hereditary melanoma risk through prior epidemiological research participation, CDKN2A/p16 genetic testing provides multiple perceived benefits to both carriers and noncarriers without inducing distress in general or worry about melanoma or pancreatic cancer.
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Affiliation(s)
- Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.
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