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Matalon DR, Zepeda-Mendoza CJ, Aarabi M, Brown K, Fullerton SM, Kaur S, Quintero-Rivera F, Vatta M. Clinical, technical, and environmental biases influencing equitable access to clinical genetics/genomics testing: A points to consider statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2023; 25:100812. [PMID: 37058144 DOI: 10.1016/j.gim.2023.100812] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 04/15/2023] Open
Affiliation(s)
- Dena R Matalon
- Division of Medical Genetics, Department of Pediatrics, Stanford Medicine, Stanford University, Stanford, CA
| | - Cinthya J Zepeda-Mendoza
- Divisions of Hematopathology and Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Mahmoud Aarabi
- UPMC Medical Genetics and Genomics Laboratories, UPMC Magee-Womens Hospital, Pittsburgh, PA; Departments of Pathology and Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Stephanie M Fullerton
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Department of Bioethics & Humanities, University of Washington School of Medicine, Seattle, WA
| | - Shagun Kaur
- Department of Child Health, Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Fabiola Quintero-Rivera
- Division of Genetic and Genomic Medicine, Departments of Pathology, Laboratory Medicine, and Pediatrics, University of California Irvine, Irvine, CA
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Santos CSD, Kishi RGB, Costa DLGD, Silva DSDD, Narciso TRF, Avó LRDSD, Germano CMR, Sandes KA, Acosta AX, Melo DG. Identificação de doenças genéticas na Atenção Primária à Saúde. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2020. [DOI: 10.5712/rbmfc15(42)2347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Problema: Embora individualmente raras, somadas, as doenças genéticas têm prevalência global estimada de 31,5 a 73,0 por 1.000 indivíduos. Além disto, doenças genéticas e defeitos congênitos representam a segunda causa de mortalidade infantil no Brasil. Diante deste cenário, foi instituída a Política Nacional de Atenção Integral às Pessoas com Doenças Raras no Sistema Único de Saúde. Esta política prevê funções específicas para Atenção Primária à Saúde (APS) que incluem diagnóstico precoce e mapeamento de pessoas com ou sob-risco de desenvolver doenças genéticas raras e/ou defeitos congênitos para encaminhamento regulado. Essa experiência objetivou colaborar com o desenvolvimento de métodos para o reconhecimento de indivíduos com ou sob-risco de desenvolver doenças genéticas na APS. Métodos: Através de visitas domiciliares e por meio do preenchimento de uma ficha específica, realizou-se busca ativa de casos de doença genética e/ou defeito congênito em uma amostra probabilística aleatória, representativa de uma Unidade de Saúde da Família de um município brasileiro de porte médio. Resultados: Foram investigados 295 domicílios, totalizando 1.160 indivíduos e 238 casais. A média de filhos por casal foi de 2,7, a frequência de consanguinidade foi 3,8% e de abortamento espontâneo foi 8,7%. Foram identificadas 29 pessoas (2,5%) com doenças congênitas, 11 (0,9%) com deficiências auditivas, 10 (0,9%) com deficiência mental e 6 (0,5%) com déficits visuais importantes. Atraso no desenvolvimento neuropsicomotor foi relatado em 8,8% das crianças e adolescentes. Doze indivíduos (1%) possuíam câncer e 9,6% relataram história familiar positiva para câncer. Conclusão: Os profissionais da APS estão em posição privilegiada para identificar e organizar uma rede de cuidados para indivíduos com doenças genéticas e/ou defeitos congênitos. A utilização sistemática de instrumentos que facilitem o reconhecimento de fatores de risco e de situações suspeitas pode ser uma estratégia útil a ser incorporada pela APS.
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Flória-Santos M, Lopes-Júnior LC, Alvarenga LDM, Ribeiro MS, Ferraz VEDF, Nascimento LC, Pereira-da-Silva G. Self-reported cancer family history is a useful tool for identification of individuals at risk of hereditary cancer predisposition syndrome at primary care centers in middle-income settings: a longitudinal study. Genet Mol Biol 2016; 39:178-83. [PMID: 27275666 PMCID: PMC4910551 DOI: 10.1590/1678-4685-gmb-2014-0362] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/11/2016] [Indexed: 11/21/2022] Open
Abstract
Analysis of cancer family history (CFH) offers a low-cost genetic tool to identify
familial cancer predisposition. In middle-income settings, the scarcity of individual
records and database-linked records hinders the assessment of self-reported CFH
consistency as an indicator of familial cancer predisposition. We used self-reported
CFH to identify those families at risk for hereditary cancer syndromes in
community-based primary care centers of a low-income Brazilian area. We also
evaluated the consistency of the information collected by reassessing CFH five years
later. We interviewed 390 families and constructed their pedigrees for genetic cancer
risk assessment. We found 125 families affected by cancer, 35.2% with moderate to
high risk of familial susceptibility to cancer, a number that represents a relatively
high prevalence of potential hereditary cancer syndromes in the overall study sample.
Upon reassessment of CFH in 14/20 families that were previously identified as having
at least one first-degree and one second-degree relative affected by cancer, and
presented moderate to high risk for developing cancer, 90% of initial pedigrees were
confirmed. These results demonstrate the reliability of self-reports as a means of
early identification of healthy individuals at risk, encouraging the wider use of
this method in low- and middle-income primary care settings.
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Affiliation(s)
- Milena Flória-Santos
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Luís Carlos Lopes-Júnior
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Larissa de Melo Alvarenga
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Mayara Segundo Ribeiro
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Lucila Castanheira Nascimento
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Gabriela Pereira-da-Silva
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Endevelt R, Goren I, Sela T, Shalev V. Family history intake: a challenge to personalized approaches in health promotion and disease prevention. Isr J Health Policy Res 2015; 4:60. [PMID: 26609359 PMCID: PMC4659160 DOI: 10.1186/s13584-015-0055-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 11/13/2015] [Indexed: 02/05/2023] Open
Abstract
Background Family history is considered an essential, obligatory part of the primary physician’s intake interview. Including coded FH in a unified medical file can save expensive genetic tests and detect the early onset of diseases in young people who are not recommended to be screened routinely. The objectives of this study are to explore the frequency and point in time of recording the coded family history (FH) as a first step to increasing awareness of the importance of such information. Methods All ICD-9 coded diagnoses of familial histories of disease (ICD-9 coded V16.0 – V19.8), including diseases related to gender, age, and indications of chronic diseases, were collected from the electronic medical records of patients ages 18 and above in Israel’s Maccabi Health Care system. The study was carried out in 2012 on the basis of coded data for 1.9 million Maccabi members, which were collected from 2004 through 2011. Results Of the Maccabi members (the second biggest HMO in Israel covering 2 million people), only 10 % had FH coded documentation. FH was significantly more frequent for females than for males (13.5 % vise 10.1 %) and increased with age. About 10 % of the FH documentation occurred before any disease was diagnosed. The most frequent FH documentation was observed for cardiovascular disease, hypertension, and diabetes. In the case of cancer FH was more frequent in females, whereas in the case of males it was cardiovascular disease. Discussion Family history is an easy tool and need to be coded and implimented in most visits in order to get the best information of the potential health and disease of the patients. Conclusions FH frequency is very low and varies with gender and age. The literature suggests that implementing it routinely in primary care will improve health care. Further research is needed to identify the factors that impede primary care givers from complying with FH guidelines.
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Affiliation(s)
- Ronit Endevelt
- University of Haifa, Welfare and Health Faculty, School of Public Health, Haifa, Israel ; Maccabi Health Care Services, Tel Aviv, Israel ; Nutrition Department, Health Ministry, Jerusalem, Israel
| | - Iris Goren
- Maccabi Health Care Services, Tel Aviv, Israel
| | - Tal Sela
- Maccabi Health Care Services, Tel Aviv, Israel
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Senier L, Shields M, Lee R, Nicoll L, Falzon D, Wiecek E. Community-Based Family Health History Education: The Role of State Health Agencies in Engaging Medically Underserved Populations in Understanding Genomics and Risk of Chronic Disease. Healthcare (Basel) 2015; 3:995-1017. [PMID: 27417809 PMCID: PMC4934627 DOI: 10.3390/healthcare3040995] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/05/2015] [Accepted: 10/14/2015] [Indexed: 12/22/2022] Open
Abstract
Although family health history (FHH) collection has been recognized as an influential method for assessing a person's risk of chronic disease, studies have shown that people who are low-income, from racial and ethnic minorities, and poorly educated are less likely to collect their FHH or share it with a medical professional. Programs to raise public awareness about the importance of FHH have conventionally targeted patients in primary care clinics or in the general community, but few efforts have been made to coordinate educational efforts across settings. This paper describes a project by the Connecticut Department of Public Health's Genomics Office to disseminate training materials about FHH as broadly as possible, by engaging partners in multiple settings: a local health department, a community health center, and two advocacy organizations that serve minority and immigrant populations. We used a mixed methods program evaluation to examine the efficacy of the FHH program and to assess barriers in integrating it into the groups' regular programming. Our findings highlight how a state health department can promote FHH education among underserved communities.
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Affiliation(s)
- Laura Senier
- Department of Sociology and Anthropology, Northeastern University, 360 Huntington Ave Boston, MA 02115, USA.
- Department of Health Sciences, Northeastern University, 360 Huntington Ave Boston, MA 02115, USA.
| | - Michael Shields
- Department of Sociology and Anthropology, Northeastern University, 360 Huntington Ave Boston, MA 02115, USA.
| | - Rachael Lee
- Department of Sociology and Anthropology, Northeastern University, 360 Huntington Ave Boston, MA 02115, USA.
| | - Lauren Nicoll
- Department of Sociology and Anthropology, Northeastern University, 360 Huntington Ave Boston, MA 02115, USA.
| | - Danielle Falzon
- Department of Sociology and Anthropology, Northeastern University, 360 Huntington Ave Boston, MA 02115, USA.
| | - Elyssa Wiecek
- School of Pharmacy, Northeastern University, 140 Fenway, 360 Huntington Ave Boston, MA 02115, USA.
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The potential of microRNAs in personalized medicine against cancers. BIOMED RESEARCH INTERNATIONAL 2014; 2014:642916. [PMID: 25243170 PMCID: PMC4163464 DOI: 10.1155/2014/642916] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 08/06/2014] [Indexed: 02/06/2023]
Abstract
MicroRNAs orchestrate the expression of the genome and impact many, if not all, cellular processes. Their deregulation is thus often causative of human malignancies, including cancers. Numerous studies have implicated microRNAs in the different steps of tumorigenesis including initiation, progression, metastasis, and resistance to chemo/radiotherapies. Thus, microRNAs constitute appealing targets for novel anticancer therapeutic strategies aimed at restoring their expression or function. As microRNAs are present in a variety of human cancer types, microRNA profiles can be used as tumor-specific signatures to detect various cancers (diagnosis), to predict their outcome (prognosis), and to monitor their treatment (theranosis). In this review, we present the different aspects of microRNA biology that make them remarkable molecules in the emerging field of personalized medicine against cancers and provide several examples of their industrial exploitation.
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