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Limoges J, Chiu P, Dordunoo D, Puddester R, Pike A, Wonsiak T, Zakher B, Carlsson L, Mussell JK. Nursing strategies to address health disparities in genomic informed care: a scoping review. JBI Evid Synth 2024:02174543-990000000-00356. [PMID: 39258479 DOI: 10.11124/jbies-24-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVE The objective of this review was to map the available global evidence on strategies that nurses can use to facilitate genomics-informed health care to address health disparities to inform the development of a research and action agenda. INTRODUCTION The integration of genomics into health care is improving patient outcomes through better prevention, diagnostics, and treatment; however, scholars have noted concerns with widening health disparities. Nurses work across the health system and can address health disparities from a clinical, research, education, policy, and leadership perspective. To do this, a comprehensive understanding of existing genomics-informed strategies is required. INCLUSION CRITERIA Published (qualitative, quantitative, mixed methods studies, systematic and literature reviews and text and opinion papers) and unpublished (gray) literature that focuses on genomics-informed nursing strategies to address health disparities over the last 10 years were included. No limitations were placed on language. METHODS The review was conducted in accordance with the JBI methodology for scoping reviews. A search was undertaken on May 25, 2023, across 5 databases: MEDLINE (Ovid), Embase, Cochrane Library (Ovid), APA PsycINFO (EBSCOhost), and CINAHL (EBSCOhost). Gray literature was searched through websites, including the International Society of Nurses in Genetics and the Global Genomics Nursing Alliance. Abstracts, titles, and full texts were screened by 2 or more independent reviewers. Data were extracted using a data extraction tool. The coded data were analyzed by 2 or more independent reviewers using conventional content analysis and the summarized results are presented using descriptive statistics and evidence tables. RESULTS In total, we screened 818 records and 31 were included in the review. The majority of papers were published in either 2019 (n=5, 16%), 2020 (n=5, 16%), or 2021 (n=5, 16%). Most papers came from the United States (n=25, 81%) followed by the Netherlands (n=3, 10%), United Kingdom (n=1, 3%), Tanzania (n=1, 3%) and written from a global perspective (n=1, 3%). Nearly half the papers discussed cancer-related conditions (n=14, 45%) and most of the others did not specify a disease or condition (n=12, 30%). In terms of population, nurse clinicians were mentioned the most frequently (n=16, 52%) followed by nurse researchers, scholars, or scientists (n=8, 26%). The patient population varied, with African American patients or communities (n=7, 23%) and racial or ethnic minorities (n=6, 19%) discussed most frequently. The majority of equity issues focused on inequitable access to genetic and genomics health services amongst ethnic and racial groups (n=14, 45%), individuals with lower educational attainment or health literacy (n=6, 19%), individuals with lower socioeconomic status (n=3, 10%), migrants (n=3, 10%), individuals with lack of insurance coverage (n=2, 6%), individuals living in rural or remote areas (n=1, 3%) individuals of older age (n=1, 3%). Root causes contributing to health disparity issues varied at the patient, provider, and system levels. Strategies were grouped into 2 categories: those to prepare the nursing workforce and those nurses can implement in practice. We further categorized the strategies by domains of practice, including clinical practice, education, research, policy advocacy, and leadership. Papers that mentioned strategies focused on preparing the nursing workforce were largely related to the education domain (n=16, 52%), while papers that mentioned strategies that nurses can implement were mostly related to clinical practice (n=19, 61%). CONCLUSIONS Nurses in all domains of practice can draw on the identified strategies to address health disparities related to genomics in health care. We found a notable lack of intervention and evaluation studies exploring the impact on health and equity outcomes. Additional research informed by implementation science and that measures health outcomes is needed to identify best practices. SUPPLEMENTAL DIGITAL CONTENT A French-language version of the abstract of this review is available as Supplemental Digital Content [http://links.lww.com/SRX/A65].
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Affiliation(s)
- Jacqueline Limoges
- Athabasca University, Edmonton, AB, Canada
- Ontario Cancer Research Ethics Board, Toronto, ON, Canada
| | | | - Dzifa Dordunoo
- Faculty of Health Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Rebecca Puddester
- Memorial University of Newfoundland, Faculty of Nursing, St. John's, NL, Canada
| | - April Pike
- Memorial University of Newfoundland, Faculty of Nursing, St. John's, NL, Canada
| | - Tessa Wonsiak
- Faculty of Health Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Bernadette Zakher
- University of Victoria Collaborative for Evidence Informed Healthcare: A JBI Centre of Excellence, Victoria, BC, Canada
| | | | - Jessica K Mussell
- University of Victoria Collaborative for Evidence Informed Healthcare: A JBI Centre of Excellence, Victoria, BC, Canada
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McCrary JM, Van Valckenborgh E, Poirel HA, de Putter R, van Rooij J, Horgan D, Dierks ML, Antonova O, Brunet J, Chirita-Emandi A, Colas C, Dalmas M, Ehrencrona H, Grima C, Janavičius R, Klink B, Koczok K, Krajc M, Lace B, Leitsalu L, Mistrik M, Paneque M, Primorac D, Roetzer KM, Ronez J, Slámová L, Spanou E, Stamatopoulos K, Stoklosa T, Strang-Karlsson S, Szakszon K, Szczałuba K, Turner J, van Dooren MF, van Zelst-Stams WAG, Vassallo LM, Wadt KAW, Žigman T, Ripperger T, Genuardi M, Van den Bulcke M, Bergmann AK. Genetic counselling legislation and practice in cancer in EU Member States. Eur J Public Health 2024; 34:666-675. [PMID: 38905592 PMCID: PMC11293827 DOI: 10.1093/eurpub/ckae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Somatic and germline genetic alterations are significant drivers of cancer. Increasing integration of new technologies which profile these alterations requires timely, equitable and high-quality genetic counselling to facilitate accurate diagnoses and informed decision-making by patients and their families in preventive and clinical settings. This article aims to provide an overview of genetic counselling legislation and practice across European Union (EU) Member States to serve as a foundation for future European recommendations and action. METHODS National legislative databases of all 27 Member States were searched using terms relevant to genetic counselling, translated as appropriate. Interviews with relevant experts from each Member State were conducted to validate legislative search results and provide detailed insights into genetic counselling practice in each country. RESULTS Genetic counselling is included in national legislative documents of 22 of 27 Member States, with substantial variation in legal mechanisms and prescribed details (i.e. the 'who, what, when and where' of counselling). Practice is similarly varied. Workforce capacity (25 of 27 Member States) and genetic literacy (all Member States) were common reported barriers. Recognition and/or better integration of genetic counsellors and updated legislation and were most commonly noted as the 'most important change' which would improve practice. CONCLUSIONS This review highlights substantial variability in genetic counselling across EU Member States, as well as common barriers notwithstanding this variation. Future recommendations and action should focus on addressing literacy and capacity challenges through legislative, regulatory and/or strategic approaches at EU, national, regional and/or local levels.
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Affiliation(s)
- J Matt McCrary
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Els Van Valckenborgh
- Cancer Centre, , Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Hélène A Poirel
- Cancer Centre, , Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Robin de Putter
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Jeroen van Rooij
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Denis Horgan
- European Alliance for Personalised Medicine, Brussels, Belgium
| | - Marie-Luise Dierks
- Institute for Epidemiology, Social Medicine, and Health System Research, Hannover Medical School, Hannover, Germany
| | - Olga Antonova
- Department of Medical Genetics, Medical University of Sofia, Sofia, Bulgaria
| | - Joan Brunet
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBGI, Girona, Spain
| | - Adela Chirita-Emandi
- Department of Microscopic Morphology, Genetics Discipline, Center of Genomic Medicine, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
- Regional Center of Medical Genetics Timis, Clinical Emergency Hospital for Children “Louis Turcanu”, part of ERN ITHACA, Timisoara, Romania
| | - Chrystelle Colas
- Département de Génétique, Institut Curie, Paris, France
- INSERM U830, Université Paris Cité, Paris, France
| | | | - Hans Ehrencrona
- Department of Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skane, Lund, Sweden
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | | | - Ramūnas Janavičius
- Faculty of Medicine, Department of Human and Medical Genetics, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania
- State Research Institute Center for Innovative Medicine, Vilnius, Lithuania
| | - Barbara Klink
- National Center of Genetics, Laboratoire National de Santé, Dudelange, Luxembourg
| | - Katalin Koczok
- Department of Laboratory Medicine, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
| | - Mateja Krajc
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Baiba Lace
- Riga East Clinical University, Riga, Latvia
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Liis Leitsalu
- Institute of Genomics, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
- Genetics and Personalized Medicine Clinic, Tartu University Hospital, Tartu, Estonia
| | - Martin Mistrik
- Department of Medical Genetics, Unilabs, Spišská Nová Ves, Slovakia
| | - Milena Paneque
- CGPP—Centre for Predictive and Preventive Genetics, Institute for Molecular and Cell Biology (IBMC), Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
- ICBAS—School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Dragan Primorac
- St Catherine Specialty Hospital, Zagreb, Croatia
- Medical School, University of Split, Split, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Medical School, University of Rijeka, Rijeka, Croatia
- Medical School REGIOMED, Coburg, Germany
- Eberly College of Science, The Pennsylvania State University, University Park, PA, USA
- The Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT, USA
- Department of Paediatrics, University Hospital Center Zagreb and University of Zagreb School of Medicine, Zagreb, Croatia
| | - Katharina M Roetzer
- Labdia Labordiagnostik, Vienna, Austria
- St Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Joelle Ronez
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Lucie Slámová
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Elena Spanou
- Clinical Genetics Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Tomasz Stoklosa
- Department of Tumor Biology and Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Sonja Strang-Karlsson
- Department of Clinical Genetics, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katalin Szakszon
- Institute of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Krzysztof Szczałuba
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Jacqueline Turner
- Clinical Genetics Centre for Ophthalmology, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Marieke F van Dooren
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Karin A W Wadt
- Department of Clinical Genetics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tamara Žigman
- Department of Paediatrics, University Hospital Center Zagreb and University of Zagreb School of Medicine, Zagreb, Croatia
| | - Tim Ripperger
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Maurizio Genuardi
- Sezione di Medicina Genomica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Genetica Medica, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marc Van den Bulcke
- Cancer Centre, , Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Youngs A, Forman A, Elms M, Kohut K, Hlaing MT, Short J, Hanson H, Snape K. Digital innovation for cancer risk assessment allows large-scale service redevelopment of regional cancer genetics service delivery. Fam Cancer 2024:10.1007/s10689-024-00407-x. [PMID: 38954285 DOI: 10.1007/s10689-024-00407-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/01/2024] [Indexed: 07/04/2024]
Abstract
Family-history assessment can identify individuals above population-risk for cancer to enable targeted Screening, Prevention and Early Detection (SPED). The online patient-facing cancer Family History Questionnaire Service (cFHQS) is a digitalised, resource efficient tool for family history data capture to facilitate this. The capturing of digital data from cFHQS allows for data interrogation of patients referred to Clinical Genetics for the purposes of service improvement. Digital data from 4,044 cFHQS respondents over a three-year period was collected and interrogated with respect to the number and type of familial tumour diagnoses to enable service improvement and streamlining of referral pathways. 81% of colorectal and 71% of breast screening assessments were population- or moderate-risk. Most patients who completed cFHQS reported more than one diagnosis of cancer/tumour/polyps in their family. 2.5% of family history assessment patients had a second indication that required assessment that would have been missed if single tumour type assessment was undertaken. Implementation of an innovative, digital family history data collection pathway has allowed large scale interrogation of referral patterns and assessment outcomes to enable service development. The high volume of inappropriate referrals to Clinical Genetics for population and moderate risk patients highlighted the need for dedicated secondary care pathway provision for these patients. The use of cFHQS streamlined family history assessment allows for redistribution of resources to improve equity and access to genetic cancer risk assessment.
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Affiliation(s)
- Alice Youngs
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England
| | - Andrea Forman
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England
| | - Marisa Elms
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England
| | - Kelly Kohut
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England
| | - Min Theik Hlaing
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England
| | - John Short
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England
| | - Helen Hanson
- Peninsula Clinical Genetics Service, Royal Devon University Healthcare NHS Foundation Trust, EX1 2ED, Exeter, England
| | - Katie Snape
- South West Thames Centre for Genomics, St George's University Hospitals NHS Foundation Trust, SW17 0QT, London, England.
- St George's University, London, UK.
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Aboleil-Zoubi O, Gafni-Amsalem C, Peled-Perets L, Mamluk E, Tamir L, Hakrosh S, Kurtzman S, Chervinsky E, Aalimi U, Husam B, Khayat M, Baram-Tsabari A, Shalev SA. The effect of a prior e-learning tool on genetic counseling outcomes in diverse ethnic couples with abnormal Down syndrome screening tests: A randomized controlled trial. J Genet Couns 2024; 33:666-676. [PMID: 37632224 DOI: 10.1002/jgc4.1774] [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: 05/26/2021] [Revised: 07/10/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
Genetic counseling (GC) following abnormal Down syndrome (DS) screening tests aims to ensure learning of complex medical concepts and discussion of counselees' personal desires. Pre-GC use of electronic learning tools (e-learning tools) can facilitate GC sessions by allowing more time for dialogue rather than learning medical and genetic concepts, enabling greater focus on the counselee's decisional, psychological, and personal needs. Few studies have investigated such tools for DS screening tests and those who have focused on screening uptake rather than abnormal results and implications. This study evaluated prenatal GC outcomes following implementation of an e-learning tool utilizing an educational animated movie for couples of varied ethnic backgrounds in northern Israel, with abnormal DS screening tests. E-learning tool impact was assessed as knowledge level, informed choices, satisfaction with the intervention and GC process, the state of anxiety and duration of the GC meeting. The 321 study participants were randomized to three groups: animation movie, booklet, and control. All participants had been asked to complete pre- and post-counseling questionnaires. Outcome scores were compared between the research groups. Results showed increased knowledge level in general among participants in the animation group; among minority participants, the highest knowledge level was in the animation group. Anxiety levels and informed choices were not statistically different among the groups. However, watching the animation, Jewish ethnicity, good level of genetic literacy, and academic degree were significant predictors of informed choice, and those who watched the animation were three times more likely to make an informed choice than the control group. Our findings suggest that this e-learning tool is efficient and acceptable for the general population. Special attention is needed for minorities with lower genetic literacy and education.
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Affiliation(s)
- Olfat Aboleil-Zoubi
- The Genetics Institute Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Chen Gafni-Amsalem
- The Genetics Institute Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Efrat Mamluk
- The Genetics Institute Emek Medical Center, Afula, Israel
| | - Liron Tamir
- The Genetics Institute Emek Medical Center, Afula, Israel
| | - Shadia Hakrosh
- The Genetics Institute Emek Medical Center, Afula, Israel
| | | | | | - Ula Aalimi
- The Genetics Institute Emek Medical Center, Afula, Israel
| | - Bashir Husam
- The Genetics Institute Emek Medical Center, Afula, Israel
| | - Morad Khayat
- The Genetics Institute Emek Medical Center, Afula, Israel
| | - Ayelet Baram-Tsabari
- Faculty of Education in Science and Technology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Stavit A Shalev
- The Genetics Institute Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Coulombe F, Laberge AM. The Need to Consider Context: A Systematic Review of Factors Involved in the Consent Process for Genetic Tests from the Perspective of Patients. AJOB Empir Bioeth 2024; 15:93-107. [PMID: 38189769 DOI: 10.1080/23294515.2023.2297935] [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] [Indexed: 01/09/2024]
Abstract
Background: Informed consent for genetic tests is a well-established practice. It should be based on good quality information and in keeping with the patient's values. Existing informed consent assessment tools assess knowledge and values. Nevertheless, there is no consensus on what specific elements need to be discussed or considered in the consent process for genetic tests.Methods: We performed a systematic review to identify all factors involved in the decision-making and consent process about genetic testing, from the perspective of patients. Through public databases, we identified studies reporting factors that influence the decision to accept or decline genetic testing. Studies were included if they reported the perspective of patients or at-risk individuals. All articles were thematically coded.Results: 1989 articles were reviewed: 70 met inclusion criteria and 12 additional articles were identified through the references of included studies. Coding of the 82 articles led to the identification of 45 factors involved in decision-making and consent, which were initially divided into three domains: in favor of, against or with an undetermined influence on genetic testing. Each factor was also divided into three subdomains relating to the informed choice concept: knowledge, values or other. The factors in the "other" subdomain were all related to the context of testing (e.g. timing, cost, influence of family members, etc), and were present in all three domains.Conclusions: We describe the network of factors contributing to decision-making and consent process and identify the context of genetic testing as a third component to influence this process. Future studies should consider the evaluation of contextual factors as an important and relevant component of the consent and decision-making process about genetic tests. Based on these results, we plan to develop and test a more comprehensive tool to assess informed consent for genetic testing.
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Affiliation(s)
- Frédéric Coulombe
- Medical Genetics, McGill University Health Center and McGill University, Montreal, Canada
| | - Anne-Marie Laberge
- Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montreal, Canada
- Bioethics Program, School of Public Health, Université de Montréal, Montreal, Canada
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Kabeya V, Puthussery S, Furmanski A. Barriers and facilitators to genetic testing for breast and ovarian cancer amongst Black African women in Luton (UK). J Genet Couns 2024; 33:425-444. [PMID: 37403830 DOI: 10.1002/jgc4.1742] [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: 11/24/2021] [Revised: 04/22/2023] [Accepted: 05/28/2023] [Indexed: 07/06/2023]
Abstract
Evidence suggests that although Black African women have the lowest incidence of breast and ovarian cancer, they have the highest mortality rate and low rates of uptake for cancer screening services for these conditions in the United Kingdom (UK). This study aimed to explore the perceived barriers and facilitators to genetic testing for breast and ovarian cancer amongst Black African women in Luton (UK). We conducted a qualitative study that included one face-to-face and five telephone focus group discussions. Consistent with the health belief model, a focus group discussion guide was developed. A total of 24 participants, aged 23-57 who self-identified as Black African women and who were English speakers residing in Luton, took part in the focus group discussions. Purposive and snowballing sampling were used to recruit the participants for this study. The focus group discussions were recorded, transcribed per verbatim, coded and analyzed using an inductive thematic analysis approach, and the findings were classified. Nine themes emerged from the narratives obtained including six barriers and three facilitators. Barriers to genetic testing included (1) Cost and affordability, (2) Lack of knowledge, awareness, and family health history knowledge, (3) Language barrier, immigration, and distrust in western healthcare services, (4) Fear, (5) Cultural, religious, and intergenerational views and perceptions, and (6) Eligibility for genetic testing for the BRCA1/2 pathogenic variants and a lack of referral to specialist genetic clinics. Facilitators to genetic testing included (7) Availability of tests cost-free under the National Health Service (NHS) (8) Family members' health and (9) Awareness and education on genetic testing. The barriers and facilitators identified could enable policy makers and healthcare services alike to gain a better understanding of the factors influencing Black African women's decision-making process toward genetic testing. Ultimately, this work can inform interventions aiming to increase the uptake of genetic testing among this group.
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Affiliation(s)
- Valencia Kabeya
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Anna Furmanski
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Singh DN, Daripelli S, Elamin Bushara MO, Polevoy GG, Prasanna M. Genetic Testing for Successful Cancer Treatment. Cureus 2023; 15:e49889. [PMID: 38179395 PMCID: PMC10765765 DOI: 10.7759/cureus.49889] [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] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Cancer genetic testing is a revolutionary medical approach that involves the assessment of genetic markers in asymptomatic individuals to predict their future susceptibility to cancer. This paradigm shift in early detection and intervention has the potential to profoundly alter our strategies for cancer prevention and treatment. One pivotal area where genetic testing can have a significant impact is among families with a hereditary predisposition to cancer. Recent research has seen a surge in the exploration of how individuals perceive their cancer risk within the realm of cancer genetics. This proactive approach to genetic testing allows healthcare professionals to identify family members who may carry the same cancer-related genetic mutations, empowering them to make informed decisions regarding their healthcare and cancer risk management. Genetic testing for cancer-related disorders has significantly improved in accuracy and affordability, potentially revolutionizing monitoring and treatment methods. The expanding knowledge of genetic mutations associated with cancer susceptibility has driven significant progress in cancer therapy. Identifying numerous major cancer susceptibility genes has propelled predictive genetic testing, providing individuals with valuable insights into their genetic predisposition to cancer. While perceived risk plays a vital role in genetic counseling, it is equally essential to offer comprehensive information about the advantages and potential risks associated with genetic testing. Ensuring that individuals have a clear understanding of the benefits and potential drawbacks of genetic testing is imperative for making informed healthcare decisions. In our comprehensive review, researchers explored several critical aspects of genetic testing in the context of cancer, including awareness and knowledge, the communication of cancer genetic risk, genetic testing for inherited cancer syndromes, and the challenges and limitations linked to genetic testing. Through this examination, we aim to illuminate the transformative potential of genetic testing in cancer prevention and treatment.
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Affiliation(s)
- Desh Nidhi Singh
- Microbiology, Rama Medical College Hospital & Research Centre, Kanpur, IND
| | - Sushma Daripelli
- Anatomy, Government Medical College (GMC) Jangaon, Jangaon, IND
- Anatomy, Gandhi Medical College, Hyderabad, IND
- Anatomy, All India Institute of Medical Sciences, Bibinagar, Bibinagar, IND
| | | | | | - Muthu Prasanna
- Pharmaceutics and Pharmaceutical Biotechnology, Surya School of Pharmacy, Surya Group of Educational Institutions, Villupuram, IND
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Watt L, Li M, Bladon S, Martin GP, White C, Majeed-Ariss R. Use of SARC services by victims of sexual violence: Auditing the ethnicity of Saint Mary's Sexual Assault Referral Centre's clients. J Forensic Leg Med 2023; 99:102593. [PMID: 37734254 DOI: 10.1016/j.jflm.2023.102593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Saint Mary's Sexual Assault Referral Centre (SARC) in Manchester provides services to adults and children who have suffered sexual assault. The ethnic composition of those who attended the centre was audited in 2001 and 2003 to measure how well it serves different ethnic groups. This paper provides an updated audit using 2019 data. METHODOLOGY Census data for Greater Manchester, and data from the Crime Survey of England and Wales (CSEW) showing rates of sexual assault for different ethnic groups, were used to predict the ethnic composition of sexual assault victims in Greater Manchester. These predicted figures were then compared with the ethnic composition of Saint Mary's SARC 2019 client base to measure how well the SARC is serving different groups. This comparison was repeated using data from the 2001 SARC client base to explore change over time. RESULTS The analysis shows that South Asians and Chinese individuals are underrepresented in the SARC client base, and that this issue has become more pronounced over time. Every other group is overrepresented. CONCLUSION The underrepresentation of South Asian and Chinese clients at Saint Mary's SARC is concerning. Making the service more accessible to those from these ethnic groups should be a priority for the centre.
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Affiliation(s)
- Laura Watt
- Department of Sociology, Manchester Metropolitan University, Manchester, United Kingdom
| | - Mingze Li
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sian Bladon
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Catherine White
- University of Manchester, Manchester, United Kingdom; Institute for Addressing Strangulation Sexual Offences, Manchester, United Kingdom
| | - Rabiya Majeed-Ariss
- University of Manchester, Manchester, United Kingdom; Saint Mary's Sexual Assault Referral Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
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Marsh L, Mendoza M, Tatsugawa Z, Pineda E, Markovic D, Holschneider CH, Zakhour M. A Community Health Worker Model to Support Hereditary Cancer Risk Assessment and Genetic Testing. Obstet Gynecol 2023; 142:699-707. [PMID: 37535963 DOI: 10.1097/aog.0000000000005292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/01/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To evaluate the effects of a community health worker-supported hereditary cancer risk-assessment and genetic testing program in a safety-net hospital serving more than 70% medically underserved patients. METHODS This community health worker pilot program began in January 2020 at women's health clinics by administering original National Comprehensive Cancer Network (NCCN)-based questionnaires. Patients meeting high-risk criteria were offered video-based genetic education and testing, notified of results using telehealth, and offered indicated counseling. We compared the rate of genetic counseling and testing in the first 18 months of the pilot program with that in the prior 18 months. RESULTS In the first 18 months of the pilot program, 940 patients were screened through the community health worker program: 196 were identified as high-risk, 103 patients were tested, and pathogenic variants were identified in 10 (9.7%), two of whom had a personal cancer history. In addition, 73 patients were tested per usual practice by a certified genetic counselor: pathogenic variants were identified in 16 (21.9%), 11 (68.8%) of whom had a personal cancer history. In the 18 months before the program, 68 patients underwent genetic testing with a certified genetic counselor, pathogenic variants were identified in 16 (23.5%), 13 (81.3%) of whom had a personal cancer history. The community health worker program led to a significant increase in testing among unaffected patients based on family history alone (odds ratio [OR] 7.0; 95% CI 3.7-13.2; P <.001), paralleled by a respective significant increase in the identification of pathogenic variants (OR 4.33; 95% CI 1.0-18.9; P =.051). CONCLUSION This pilot program demonstrates the feasibility of a community health worker-supported program, using self-administered questionnaires and telehealth-based genetic services in a primarily medically underserved population. This program improved the detection of unaffected high-risk patients based on family history, increasing the volume of tests performed for this indication. Programs of this type may improve family history-based hereditary cancer testing in medically underserved patients, further enabling cancer-prevention strategies.
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Affiliation(s)
- Leah Marsh
- Department of Obstetrics and Gynecology, Olive View-UCLA Medical Center, and the David Geffen School of Medicine at UCLA and the UCLA Clinical and Translational Science Institute, University of California, Los Angeles, Los Angeles, California; and Corewell Health West, Grand Rapids, Michigan
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10
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Mapoko BSE, Ndi KC, Tabola L, Mouaye V, Douanla P, Nsangou N, Nkeng G, Vanvolkenburgh C, Dzekem B, Huo D, Ndom P, Olopade O. Feasibility of cancer genetic counselling and screening in Cameroon: perceived benefits and barriers. Ecancermedicalscience 2023; 17:1588. [PMID: 37799957 PMCID: PMC10550300 DOI: 10.3332/ecancer.2023.1588] [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: 11/27/2022] [Indexed: 10/07/2023] Open
Abstract
Because there was no genetic testing service in Cameroon, we assessed the acceptance, perceived benefits and barriers and willingness to pay for genetic cancer screening in Cameroon amongst patients with cancers. We carried out a hospital-based, cross-sectional study on adult cancer patients at the Yaoundé General Hospital and the non-Governmental Organisation Solidarity Chemotherapy between February 1, 2021, and December 31, 2021. This was a convenience sampling that included all consenting patients. Qualitative and quantitative data were analysed by Epi info version 7 and SPSS version 20. Our study included 160 (87.5% females) cancer patients, whose ages ranged from 20 to 82 years, with a mean of 49.9 ± 13.0 years. Only 11.9% had undergone some form of genetic counselling or information sessions, and most found this to be helpful in terms of increased knowledge and prevention strategies (13, 68.4%). Almost all participants (156, 97.5%) stated they will like their relatives to undergo genetic counselling. Of these, 151 (94.4%) expressed their desire for their relatives to discuss their cancer risk with a specialist. Perceived benefits of genetic testing included cancer prevention (108, 67.5%) and motivation of self-examination (81, 50.6%). Prominent possible barriers included the cost (129, 80.6%), unavailability of equipment (49, 30.6%) and anticipated anxiety (40, 25.0%). However, a majority of the participants (156, 97.5%) were willing to test for genetic mutations. One hundred and thirty-five (84.4%) participants were willing to pay for genetic testing, with the majority of them (71.8%) ready to pay between $16.7 and $100. Almost all of the participants expressed their willingness to receive cancer genetic counselling and testing but the cost became the main barrier. This pilot study will serve as a guide to the processes of establishing a cancer risk assessment clinic in Cameroon.
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Affiliation(s)
- Berthe Sabine Esson Mapoko
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
- National Cancer Control Committee, Yaoundé 99322, Cameroon
| | - Kenn Chi Ndi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Lionel Tabola
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Vanessa Mouaye
- National Cancer Control Committee, Yaoundé 99322, Cameroon
| | - Pelagie Douanla
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Nasser Nsangou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Glenda Nkeng
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Carmen Vanvolkenburgh
- Center for Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Bonaventure Dzekem
- Center for Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Dezheng Huo
- Center for Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Paul Ndom
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
- National Cancer Control Committee, Yaoundé 99322, Cameroon
| | - Olufunmilayo Olopade
- Center for Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
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Lahiri S, Pirzadeh-Miller S, Moriarty K, Kubiliun N. Implementation of a Population-Based Cancer Family History Screening Program for Lynch Syndrome. Cancer Control 2023; 30:10732748231175011. [PMID: 37161761 DOI: 10.1177/10732748231175011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVES Lynch syndrome increases risks for colorectal and other cancers. Though published Lynch syndrome cancer risk-management guidelines are effective for risk-reduction, the condition remains under-recognized. The Cancer Genetics Program at an academic medical center implemented a population-based cancer family history screening program, Detecting Unaffected Individuals with Lynch syndrome, to aid in identification of individuals with Lynch syndrome. METHODS In this retrospective cohort study, simple cancer family history screening questionnaires were used to identify those at risk for Lynch syndrome. Program navigators triaged and educated those who screened positive about hereditary cancer, and genetic counseling and testing services, offering genetic counseling if eligible. Genetic counseling was provided primarily via telephone. Genetic counselors performed hereditary cancer risk assessment and offered genetic testing via hereditary cancer panels to those eligible. Remote service delivery models via telephone genetic counseling and at-home saliva testing were used to increase access to medical genetics services. RESULTS This program screened 212,827 individuals, over half of whom were considered underserved, and identified 133 clinically actionable genetic variants associated with hereditary cancer. Of these, 47 (35%) were associated with Lynch syndrome while notably, 70 (53%) were not associated with hereditary colorectal cancer. Of 3,344 patients offered genetic counseling after initial triage, 2,441 (73%) elected to schedule the appointment and 1,775 individuals (73%) completed genetic counseling. Among underserved patients, telephone genetic counseling completion rates were significantly higher than in-person appointment completion rates (P < .05). While remote service delivery improved appointment completion rates, challenges with genetic test completion using at-home saliva sample collection kits were observed, with 242 of 1592 individuals (15%) not completing testing. CONCLUSION Population-based cancer family history screening and navigation can help identify individuals with hereditary cancer syndromes across diverse patient populations, but logistics of certain downstream service delivery models can impact outcomes.
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Affiliation(s)
- Sayoni Lahiri
- Department of Cancer Genetics, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Kelsey Moriarty
- Department of Cancer Genetics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nisa Kubiliun
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
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12
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Psychological factors and the uptake of preventative measures in BRCA1/2 pathogenic variant carriers: results of a prospective cohort study. Hered Cancer Clin Pract 2022; 20:38. [PMID: 36536421 PMCID: PMC9761978 DOI: 10.1186/s13053-022-00244-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Women carrying BRCA1/2 pathogenic variants are exposed to elevated risks of developing breast cancer (BC) and are faced by a complex decision-making process on preventative measures, i.e., risk-reducing mastectomy (RRM), and intensified breast surveillance (IBS). In this prospective cohort study we investigated the effect of anxiety, personality factors and coping styles on the decision-making process on risk management options in women with pathogenic variants in BRCA1/2. METHODS Breast cancer unaffected and affected women with a pathogenic variant in the BRCA1 or BRCA2 gene were psychologically evaluated immediately before (T0), 6 to 8 weeks (T1) and 6 to 8 months (T2) after the disclosure of their genetic test results. Uptake of RRM and IBS was assessed at T2. Psychological data were gathered using questionnaires on risk perception, personality factors, coping styles, decisional conflict, depression and anxiety, including the Hospital Anxiety and Depression Scale (HADS). We performed tests on statistical significance and fitted a logistic regression based on significance level. RESULTS A total of 98 women were included in the analysis. Baseline anxiety levels in women opting for RRM were high but decreased over time, while they increased in women opting for intensified breast surveillance (IBS). Elevated levels of anxiety after genetic test result disclosure (T1) were associated with the decision to undergo RRM (p < 0.01; OR = 1.2, 95% CI = 1.05-1.42), while personal BC history and personality factors seemed to be less relevant. CONCLUSIONS Considering psychosocial factors influencing the decision-making process of women with pathogenic variants in BRCA1/2 may help improving their genetic and psychological counselling. When opting for IBS they may profit from additional medical and psychological counselling. TRIAL REGISTRATION Retrospectively registered at the German Clinical Trials Register under DRKS00027566 on January 13, 2022.
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13
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Guan Y, Pathak S, Ballard D, Veluswamy JK, McCullough LE, McBride CM, Gornick MC. Testing a deliberative democracy method with citizens of African ancestry to weigh pros and cons of targeted screening for hereditary breast and ovarian cancer risk. Front Public Health 2022; 10:984926. [PMID: 36424974 PMCID: PMC9679525 DOI: 10.3389/fpubh.2022.984926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022] Open
Abstract
Background Democratic deliberation (DD), a strategy to foster co-learning among researchers and communities, could be applied to gain informed public input on health policies relating to genomic translation. Purpose We evaluated the quality of DD for gaining informed community perspectives regarding targeting communities of African Ancestry (AAn) for Hereditary Breast and Ovarian Cancer (HBOC) screening in Georgia. Methods We audiotaped a 2.5 day conference conducted via zoom in March 2021 to examine indicators of deliberation quality based on three principles: (1) inclusivity (diverse viewpoints based on participants' demographics, cancer history, and civic engagement), (2) consideration of factual information (balanced and unbiased expert testimonies, participant perceived helpfulness), and (3) deliberation (speaking opportunities, adoption of a societal perspective on the issue, reasoned justification of ideas, and participant satisfaction). Results We recruited 24 participants who reflected the diversity of views and life experiences of citizens of AAn living in Georgia. The expert testimony development process we undertook for creating balanced factual information was endorsed by experts' feedback. Deliberation process evaluation showed that while participation varied (average number of statements = 24, range: 3-62), all participants contributed. Participants were able to apply expert information and take a societal perspective to deliberate on the pros and cons of targeting individuals of AAn for HBOC screening in Georgia. Conclusions The rigorous process of public engagement using deliberative democracy approach can successfully engage a citizenry with diverse and well-informed views, do so in a relatively short time frame and yield perspectives based on high quality discussion.
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Affiliation(s)
- Yue Guan
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Sarita Pathak
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Denise Ballard
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | | | - Lauren E. McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Colleen M. McBride
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Michele C. Gornick
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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14
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Lima SM, Nazareth M, Schmitt KM, Reyes A, Fleck E, Schwartz GK, Terry MB, Hillyer GC. Interest in genetic testing and risk-reducing behavioral changes: results from a community health assessment in New York City. J Community Genet 2022; 13:605-617. [PMID: 36227532 DOI: 10.1007/s12687-022-00610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/29/2022] [Indexed: 11/25/2022] Open
Abstract
Risk-based genetic tests are often used to determine cancer risk, when to initiate screening, and frequency of screening, but rely on interest in genetic testing. We examined overall interest in genetic testing for cancer risk assessment and willingness to change behavior, and whether these are affected by demographic or socioeconomic factors.We conducted a community needs health survey in 2019 among primary care and cancer patients, family members and community members in New York City. We used univariable analysis and relative risk regression to examine interest in genetic cancer risk testing and willingness to modify lifestyle behaviors in response to an informative genetic test.Of the 1225 participants, 74.0% (n = 906) expressed interest in having a genetic test to assess cancer risk. Interest in genetic testing was high across all demographic and socioeconomic groups; reported interest in genetic testing by group ranged from 65.0 (participants aged 65 years and older) to 83.6% (participants below federal poverty level). Among the 906 participants that reported interest in genetic testing, 79.6% were willing to change eating habits, 66.5% to change exercise habits, and 49.5% to lose weight in response to an informative genetic test result.Our study reveals that interest in genetic testing for cancer risk is high among patients and community members and is high across demographic and socioeconomic groups, as is the reported willingness to change behavior. Based on these results, we recommend that population-based genetic testing may result in greater reduction cancer risk, particularly among minoritized groups.
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Affiliation(s)
- Sarah M Lima
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY, USA
| | - Meaghan Nazareth
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY, USA
| | - Karen M Schmitt
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Division of Community and Population Health, New York Presbyterian Hospital, New York, NY, USA
| | - Andria Reyes
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Elaine Fleck
- Division of Community and Population Health, New York Presbyterian Hospital, New York, NY, USA
| | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Hematology and Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Mary Beth Terry
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Grace C Hillyer
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA.
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15
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Weise N, Shaya J, Javier-Desloges J, Cheng HH, Madlensky L, McKay RR. Disparities in germline testing among racial minorities with prostate cancer. Prostate Cancer Prostatic Dis 2022; 25:403-410. [PMID: 34775478 PMCID: PMC8590439 DOI: 10.1038/s41391-021-00469-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 12/14/2022]
Abstract
Germline testing is becoming increasingly relevant in prostate cancer (PCa) screening, prognosis, and management. A subset of patients with PCa harbor pathogenic/likely pathogenic variants (P/LPVs) in genes mediating DNA-repair processes, and these P/LPVs have implications for cancer screening, treatment, and cascade testing. As a result, it is recommended that all men with high-risk localized and metastatic PCa undergo routine germline testing. As more PCa patients undergo germline testing, it is important that clinicians and genetics experts recognize current disparities in germline testing rates among racial/ethnic minorities in the United States. The reasons for these disparities are multiple and require similarly manifold consideration to close the germline testing gap and reduce inequities in PCa screening, management, and treatment.
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Affiliation(s)
- Nicole Weise
- University of California San Diego, San Diego, CA, USA
| | - Justin Shaya
- University of California San Diego, San Diego, CA, USA
| | | | - Heather H Cheng
- University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Rana R McKay
- University of California San Diego, San Diego, CA, USA.
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16
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Investigating disparity in access to Australian clinical genetic health services for Aboriginal and Torres Strait Islander people. Nat Commun 2022; 13:4966. [PMID: 36002448 PMCID: PMC9400572 DOI: 10.1038/s41467-022-32707-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 08/11/2022] [Indexed: 11/08/2022] Open
Abstract
Globally, there is a recognised need that all populations should be able to access the benefits of genomics and precision medicine. However, achieving this remains constrained by a paucity of data that quantifies access to clinical genomics, particularly amongst Indigenous populations. Using administrative data from clinical genetic health services across three Australian jurisdictions (states/territories), we investigate disparities in the scheduling and attendance of appointments among Aboriginal and/or Torres Strait Islander people, compared to non-Indigenous people. For 14,870 appointments scheduled between 2014-2018, adjusted Multivariate Poisson Regression models revealed that Aboriginal and/or Torres Strait Islander people were scheduled fewer appointments (IRR 0.73 [0.68-0.80], <0.001) and attended at lower rates (IRR 0.85 [0.78-0.93], <0.001). Within this population, adults, females, remote residents, and those presenting in relation to cancer or prenatal indications experienced the greatest disparity in access. These results provide important baseline data related to disparities in access to clinical genomics in Australia.
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Bednar EM, Nitecki R, Krause KJ, Rauh-Hain JA. Interventions to improve delivery of cancer genetics services in the United States: A scoping review. Genet Med 2022; 24:1176-1186. [PMID: 35389342 DOI: 10.1016/j.gim.2022.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Interventions that decrease barriers and improve clinical processes can increase patient access to guideline-recommended cancer genetics services. We sought to identify and describe interventions to improve patient receipt of guideline-recommended cancer genetics services in the United States. METHODS We performed a comprehensive search in Ovid MEDLINE and Embase, Scopus, and Web of Science from January 1, 2000 to February 12, 2020. Eligible articles reported interventions to improve the identification, referral, genetic counseling (GC), and genetic testing (GT) of patients in the United States. We independently screened titles and abstracts and reviewed full-text articles. Data were synthesized by grouping articles by clinical process. RESULTS Of 44 included articles, 17 targeted identification of eligible patients, 14 targeted referral, 15 targeted GC, and 16 targeted GT. Patient identification interventions included universal tumor testing and screening of medical/family history. Referral interventions included medical record system adaptations, standardizing processes, and provider notifications. GC interventions included supplemental patient education, integrated GC within oncology clinics, appointment coordination, and alternative service delivery models. One article directly targeted the GT process by implementing provider-coordinated testing. CONCLUSION This scoping review identified and described interventions to improve US patients' access to and receipt of guideline-recommended cancer genetics services.
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Affiliation(s)
- Erica M Bednar
- Cancer Prevention and Control Platform, Moon Shots Program, The University of Texas MD Anderson Cancer Center, Houston, TX; Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Roni Nitecki
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Van der Merwe NC, Combrink HM, Ntaita KS, Oosthuizen J. Prevalence of Clinically Relevant Germline BRCA Variants in a Large Unselected South African Breast and Ovarian Cancer Cohort: A Public Sector Experience. Front Genet 2022; 13:834265. [PMID: 35464868 PMCID: PMC9024354 DOI: 10.3389/fgene.2022.834265] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/23/2022] [Indexed: 01/14/2023] Open
Abstract
Breast cancer is a multifaceted disease that currently represents a leading cause of death in women worldwide. Over the past two decades (1998–2020), the National Health Laboratory Service’s Human Genetics Laboratory in central South Africa screened more than 2,974 breast and/or ovarian cancer patients for abnormalities characteristic of the widely known familial breast cancer genes, Breast Cancer gene 1 (BRCA1) and Breast Cancer gene 2 (BRCA2). Patients were stratified according to the presence of family history, age at onset, stage of the disease, ethnicity and mutation status relative to BRCA1/2. Collectively, 481 actionable (likely-to pathogenic) variants were detected in this cohort among the different ethnic/racial groups. A combination of old (pre-2014) and new (post-2014) laboratory techniques was used to identify these variants. Additionally, targeted genotyping was performed as translational research revealed the first three recurrent South African pathogenic variants, namely BRCA1 c.1374del (legacy name 1493delC), BRCA1 c.2641G>T (legacy name E881X) and BRCA2 c.7934del (legacy name 8162delG). This initial flagship study resulted in a cost-effective diagnostic test that enabled screening of a particular ethnic group for these variants. Since then, various non-Afrikaner frequent variants were identified that were proven to represent recurrent variants. These include BRCA2 c.5771_5774del (legacy name 5999del4) and BRCA2 c.582G>A, both Black African founder mutations. By performing innovative translational research, medical science in South Africa can adopt first-world technologies into its healthcare context as a developing country. Over the past two decades, the progress made in the public sector enabled a pivotal shift away from population-directed genetic testing to the screening of potentially all breast and ovarian cancer patients, irrespective of ethnicity, family history or immunohistochemical status. The modifications over the years complied with international standards and guidelines aimed at universal healthcare for all. This article shares all the cohort stratifications and the likely-to pathogenic variants detected.
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Affiliation(s)
- Nerina C. Van der Merwe
- Division of Human Genetics, National Health Laboratory Service, Bloemfontein, South Africa
- Division of Human Genetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- *Correspondence: Nerina C. Van der Merwe,
| | - Herkulaas MvE Combrink
- Economic and Management Sciences, University of the Free State, Bloemfontein, South Africa
- Interdisciplinary Centre for Digital Futures, University of the Free State, Bloemfontein, South Africa
| | - Kholiwe S. Ntaita
- Division of Human Genetics, National Health Laboratory Service, Bloemfontein, South Africa
- Division of Human Genetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Jaco Oosthuizen
- Division of Human Genetics, National Health Laboratory Service, Bloemfontein, South Africa
- Division of Human Genetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Dharwadkar P, Greenan G, Stoffel EM, Burstein E, Pirzadeh-Miller S, Lahiri S, Mauer C, Singal AG, Murphy CC. Racial and Ethnic Disparities in Germline Genetic Testing of Patients With Young-Onset Colorectal Cancer. Clin Gastroenterol Hepatol 2022; 20:353-361.e3. [PMID: 33359728 PMCID: PMC8222407 DOI: 10.1016/j.cgh.2020.12.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Up to 20% of younger patients (age <50 years) diagnosed with colorectal cancer (CRC) have germline mutations in cancer susceptibility genes. Germline genetic testing may guide clinical management and facilitate earlier intervention in affected relatives. Few studies have characterized differences in genetic testing by race/ethnicity. METHODS We identified young adults (age 18-49 years) diagnosed with CRC between 2009 and 2017 in 2 health systems in Dallas, TX. We evaluated referral to genetic counseling, attendance at genetic counseling appointments, and receipt of germline genetic testing by race/ethnicity. RESULTS Of 385 patients with young-onset CRC (median age at diagnosis 44.4 years), 176 (45.7%) were Hispanic, 98 (25.4%) non-Hispanic Black, and 111 (28.8%) non-Hispanic White. Most patients (76.9%) received immunohistochemistry (IHC) for mismatch repair proteins, and there was no difference in receipt of IHC by race/ethnicity. However, a lower proportion of Black patients were referred to genetic counseling (50.0% vs White patients 54.1% vs Hispanic patients 65.9%; P = .02) and attended genetic counseling appointments (61.2% vs 81.7% White patients vs 86.2% Hispanic patients; P < .01). Of 141 patients receiving genetic testing, 38 (27.0%) had a pathogenic or likely pathogenic variant in a cancer susceptibility gene. An additional 33 patients (23.4%) had variants of uncertain significance, of which 84.8% occurred in racial/ethnic minorities. CONCLUSIONS In a diverse population of patients diagnosed with young-onset CRC, we observed racial/ethnic differences in referral to and receipt of germline genetic testing. Our findings underscore the importance of universal genetic testing to address racial/ethnic disparities in young-onset CRC.
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Affiliation(s)
- Pooja Dharwadkar
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Garrett Greenan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elena M Stoffel
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ezra Burstein
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | | | - Sayoni Lahiri
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Caitlin Mauer
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas; Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Caitlin C Murphy
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas; Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
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20
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Bazarbashi S, Su WP, Wong SW, Singarachari RA, Rawal S, Volkova MI, Bastos DA. A Narrative Review of Implementing Precision Oncology in Metastatic Castration-Resistant Prostate Cancer in Emerging Countries. Oncol Ther 2021; 9:311-327. [PMID: 34236692 PMCID: PMC8593077 DOI: 10.1007/s40487-021-00160-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/14/2021] [Indexed: 02/08/2023] Open
Abstract
The therapeutic landscape of metastatic castration-resistant prostate cancer (mCRPC) has evolved considerably with the introduction of newer agents, such as poly-ADP ribose polymerase (PARP) inhibitors targeting DNA damage repair mutations. Combining and sequencing novel and existing therapies appropriately is necessary for optimizing the management of mCRPC and ensuring better treatment outcomes. The purpose of this review is to provide evidence-based answers to key clinical questions on treatment selection, treatment sequencing patterns, and factors influencing treatment decisions in the management of mCRPC in the era of PARP inhibitors. This article can also serve as a comprehensive guide to clinicians for optimizing genetic testing and counseling and management of patients with mCRPC. Although the PROfound study has validated the concept of PARP sensitivity across multiple genes associated with homologous recombination repair (HRR) in mCRPC and highlighted the importance of genomic testing in this at-risk patient population, it still remains unclear how patients with rarer HRR mutations will respond to PARP inhibitors. Therefore, real-world data obtained through registry-based randomized controlled trials in the future may help produce robust scientific evidence for supporting optimal clinician decision-making in the management of mCRPC.
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Affiliation(s)
- Shouki Bazarbashi
- Oncology, King Faisal Specialist Hospital and Research Center, Alzahrawi Street, Riyadh, 11211, Saudi Arabia.
| | - Wen-Pin Su
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, No. 35, Rd. Xiao-Tong, Tainan, Taiwan
- Departments of Oncology and Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 35, Rd. Xiao-Tong, Tainan, Taiwan
| | - Siew W Wong
- Medical Oncology, The Cancer Centre, Orchard Road, Singapore, 238859, Singapore
| | - Ramanujam A Singarachari
- Division of Oncology and Hematology, Department of Internal Medicine, Sheikh Khalifa Medical City, Karamah Street, Abu Dhabi, UAE
| | - Sudhir Rawal
- Uro-Oncology, Rajev Gandhi Cancer Institute & Research Centre, Rohini, New Delhi, India
| | - Maria I Volkova
- Oncourology, N.N. Blokhin Cancer Center, Kashirskoye shosse, 24, Moscow, 115478, Russia
| | - Diogo A Bastos
- Oncology, Hospital Sirio-Libanês, 91 Adma Jafet street, São Paulo, Brazil
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21
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Uebergang E, Best S, de Silva MG, Finlay K. Understanding genomic health information: how to meet the needs of the culturally and linguistically diverse community-a mixed methods study. J Community Genet 2021; 12:549-557. [PMID: 34185265 PMCID: PMC8554909 DOI: 10.1007/s12687-021-00537-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 06/15/2021] [Indexed: 11/28/2022] Open
Abstract
Clinical genomic testing, analysis of your entire genetic material for healthcare purposes, is a complex topic for various medical specialities. Although Australia is a multicultural society, most genomic resources are produced in English which can make understanding challenging for people from culturally and linguistically diverse (CALD) backgrounds. A mixed methods approach explored the views of healthcare interpreters and people from CALD backgrounds to identify knowledge gaps and inform the provision of more equitable services. Eighteen healthcare interpreters completed a survey from two public hospitals in Melbourne. Descriptive data analysis informed the four pilot interviews with individuals from CALD backgrounds identified through online advertisements. Interpreters revealed variable satisfaction with patient understanding of genomic concepts and suggested that basic training and resources on genomics would help facilitate interpretation. Three themes arose from the pilot interviews: (1) cultural factors; (2) perceptions of genomics; and (3) language barriers and complex terminology. Resources that consider cultural differences and language barriers will help to ensure people from CALD backgrounds are adequately informed about genomic testing. The pilot interviews will inform future in-depth studies of the views of people from the CALD community.
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Affiliation(s)
- Eloise Uebergang
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Stephanie Best
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
| | - Michelle G de Silva
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Victorian Clinical Genetics Services, Melbourne, VIC, Australia
| | - Keri Finlay
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genetic Support Network of Victoria, Melbourne, VIC, Australia
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22
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Aizuddin AN, Ramdzan AR, Syed Omar SA, Mahmud Z, Latiff ZA, Amat S, Teik KW, Siew CG, Rais H, Aljunid SM. Genetic Testing for Cancer Risk: Is the Community Willing to Pay for It? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8752. [PMID: 34444499 PMCID: PMC8392682 DOI: 10.3390/ijerph18168752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
With the increasing number of cancer cases worldwide, genetic testing for familiar cancers seems inevitable, yet little is known on population interest and the monetary value for cancer genetic risk information. The current study aimed to determine the willingness to undergo and pay for cancer genetic testing among the Malaysian population. A self-administered questionnaire was distributed to cancer patients and their family members in the oncology and daycare units in several government hospitals. Of 641 respondents (354 patients, 287 family members), 267 (41.7%) were willing to undergo cancer genetic testing. The median that respondents were willing to pay was USD 48.31 (MYR 200.00) IQR USD 96.91 (MYR 400), while 143 (22.3%) respondents were willing to pay a shared cost with the insurance company. Regression analysis identified independent positive predictors of willingness to pay as respondent's status as a family member, high education level, and willingness to undergo cancer genetic testing in general, while in patients, female gender and high level of education were identified as independent positive predictors. Generally, the population needs more information to undergo and pay for cancer genetic testing. This will increase the utilization of the services offered, and with cost-sharing practices with the provider, it can be implemented population-wide.
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Affiliation(s)
- Azimatun Noor Aizuddin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Abdul Rahman Ramdzan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia;
- Department of Public Health Medicine, University of Malaysia Sabah, Jalan UMS, Kota Kinabalu 88400, Malaysia
| | - Sharifah Azween Syed Omar
- Faculty of Education, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; (S.A.S.O.); (Z.M.); (S.A.)
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Zuria Mahmud
- Faculty of Education, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; (S.A.S.O.); (Z.M.); (S.A.)
| | - Zarina A. Latiff
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Salleh Amat
- Faculty of Education, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia; (S.A.S.O.); (Z.M.); (S.A.)
| | - Keng Wee Teik
- Genetic Department, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur 50586, Malaysia; (K.W.T.); (C.G.S.)
| | - Ch’ng Gaik Siew
- Genetic Department, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur 50586, Malaysia; (K.W.T.); (C.G.S.)
| | - Haniza Rais
- Department of Education Psychology & Counseling, International Islamic University Malaysia, Jalan Gombak, Selangor 53100, Malaysia;
| | - Syed Mohamed Aljunid
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia;
- Department of Health Policy and Management, Kuwait University, 320 St, Hawally 13110, Kuwait
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23
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Patient ethnicity and cascade genetic testing: a descriptive study of a publicly funded hereditary cancer program. Fam Cancer 2021; 21:369-374. [PMID: 34232459 DOI: 10.1007/s10689-021-00270-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Cascade genetic testing for hereditary cancer is highly accurate and cost-effective for identifying individuals at high risk for cancer; however, not all eligible people utilize this service. While sociodemographic factors related to the uptake of cascade genetic testing, such as age and sex, have been fairly well described in the literature, there is limited data available regarding patient ethnicity. We analyzed four years of testing data for this factor, as well as sex, age and genes tested. The patients were seen by the Hereditary Cancer Program of BC Cancer, which serves the entire population of British Columbia and Yukon, Canada. Patient ethnicity was compared to the 2016 Census data from the same region. Fisher's exact test was conducted to explore the cascade genetic testing uptakes. Chi-square test was used to compare the major ethnicity groups to Census data. There was significant variability in the uptake of cascade genetic testing in the three largest population groups (p < 0.05), with individuals of European ethnic origin overrepresented, individuals of Asian ethnic origin modestly underrepresented, and individuals of North American Indigenous origin considerably underrepresented for cascade genetic testing. The proportions represented compared to those expected from census data were significantly different for these three largest groups (p < 0.01). The majority of cascade genetic tests were for BRCA1/BRCA2 (58.8%), followed by 16.9% for Lynch syndrome genes. Most patients were female (70%), and the mean age of patients was 49 years old. This study provides further insight into uptake of cascade genetic testing by patient ethnicity. Examining patient ethnicity and cascade genetic testing rates helps to identify underserved populations. Our analysis highlights significant underrepresentation of North American Indigenous individuals for hereditary cancer cascade genetic testing, and helps recognize the need for development of culturally-safe alternatives to outreach and service promotion.
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24
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Systematic development of a training program for healthcare professionals to improve communication about breast cancer genetic counseling with low health literate patients. Fam Cancer 2021; 19:281-290. [PMID: 32323055 PMCID: PMC7497313 DOI: 10.1007/s10689-020-00176-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is a disproportionate underuse of genetic testing in breast cancer patients from lower education or migrant background. Within these groups, communication about referral to genetic counseling appears challenging due to limited health literacy and cultural barriers. Our aim was to develop and evaluate a training program for healthcare professionals (breast surgeons and specialized nurses), to increase effective communication. We systematically developed a blended training program based on patients’ and healthcare professionals’ needs and preferences. Prior to the training, we assessed awareness, knowledge and self-efficacy of healthcare professionals. Acceptability and usefulness of the training program were assessed directly after the training. Healthcare professionals (n = 65) from 17 hospitals showed moderate to high awareness and knowledge about the prevalence and impact of limited health literacy. They were aware of cultural factors that influence communication. However, they did not feel confident in recognizing limited health literacy and their self-efficacy to communicate effectively with these patients was low. The training program was rated as acceptable and useful. Healthcare professionals lack confidence to effectively communicate with patients with limited health literacy or migrant background. The training program offers opportunities to improve communication about referral to breast cancer genetic counseling.
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25
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McAlarnen L, Stearns K, Uyar D. Challenges of Genomic Testing for Hereditary Breast and Ovarian Cancers. Appl Clin Genet 2021; 14:1-9. [PMID: 33488111 PMCID: PMC7814235 DOI: 10.2147/tacg.s245021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/26/2020] [Indexed: 12/18/2022] Open
Abstract
Completion of genetic testing is increasingly important for the complex care of patients with suspected hereditary breast and ovarian cancers (HBOC) and their at-risk family members. Identification of individuals with pathogenic variants has implications for targeted treatment recommendations, risk reduction strategies, increased surveillance recommendations, as well as the genetic testing of family members, known as cascade testing or screening. Due to advances in technology and decreasing costs, what was once single-gene genetic testing has evolved into large-scale multi-gene panel genomic testing. As germline genomic testing for HBOC becomes more and more available, it is important to identify the challenges that are associated with its use. In this manuscript, we review the current issues faced by germline genomic testing for HBOC which include effectively managing the marked increases in genetic referrals, interpreting the vast amount of information yielded by newer testing methods such as next generation sequencing (NGS), recognizing the need for better cascade screening strategies, potential exacerbation of health disparities and improving support for patients navigating the emotional impact related to positive, negative and indeterminate testing results.
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Affiliation(s)
- Lindsey McAlarnen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kristen Stearns
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Denise Uyar
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
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26
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Sobering AK, Li D, Beighley JS, Carey JC, Donald T, Elsea SH, Figueroa KP, Gerdts J, Hamlet A, Mirzaa GM, Nelson B, Pulst SM, Smith JL, Tassone F, Toriello HV, Walker RH, Yearwood KR, Bhoj EJ. Experiences with offering pro bono medical genetics services in the West Indies: Benefits to patients, physicians, and the community. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:1030-1041. [PMID: 33274544 DOI: 10.1002/ajmg.c.31871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
We describe our experiences with organizing pro bono medical genetics and neurology outreach programs on several different resource-limited islands in the West Indies. Due to geographic isolation, small population sizes, and socioeconomic disparities, most Caribbean islands lack medical services for managing, diagnosing, and counseling individuals with genetic disorders. From 2015 to 2019, we organized 2-3 clinics per year on various islands in the Caribbean. We also organized a week-long clinic to provide evaluations for children suspected of having autism spectrum disorder. Consultations for over 100 different individuals with suspected genetic disorders were performed in clinics or during home visits following referral by locally registered physicians. When possible, follow-up visits were attempted. When available and appropriate, clinical samples were shipped to collaborating laboratories for molecular analysis. Laboratory tests included karyotyping, cytogenomic microarray analysis, exome sequencing, triplet repeat expansion testing, blood amino acid level determination, biochemical assaying, and metabolomic profiling. We believe that significant contributions to healthcare by genetics professionals can be made even if availability is limited. Visiting geneticists may help by providing continuing medical education seminars. Clinical teaching rounds help to inform local physicians regarding the management of genetic disorders with the aim of generating awareness of genetic conditions. Even when only periodically available, a visiting geneticist may benefit affected individuals, their families, their local physicians, and the community at large.
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Affiliation(s)
- Andrew K Sobering
- Department of Biochemistry, St. George's University School of Medicine, St. George's, Grenada.,Windward Islands Research and Education Foundation, True Blue, St. George's, Grenada
| | - Dong Li
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer S Beighley
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - John C Carey
- Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Tyhiesia Donald
- Grenada General Hospital, Pediatrics Ward, St. George's, Grenada.,Clinical Teaching Unit, St. George's University School of Medicine, St. George's, Grenada
| | - Sarah H Elsea
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Karla P Figueroa
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer Gerdts
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Andre Hamlet
- Grenada General Hospital, Pediatrics Ward, St. George's, Grenada.,Clinical Teaching Unit, St. George's University School of Medicine, St. George's, Grenada
| | - Ghayda M Mirzaa
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Beverly Nelson
- Clinical Teaching Unit, St. George's University School of Medicine, St. George's, Grenada
| | - Stefan M Pulst
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Janice L Smith
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, University of California Davis, School of Medicine, Sacramento, California, USA.,MIND Institute, University of California Davis Medical Center, Sacramento, California, USA
| | - Helga V Toriello
- Department of Pediatrics/Human Development College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.,Department of Neurology, Mount Sinai School of Medicine, New York City, New York, USA
| | | | - Elizabeth J Bhoj
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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27
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Lumpkins CY, Philp A, Nelson KL, Miller LM, Greiner KA. A road map for the future: An exploration of attitudes, perceptions, and beliefs among African Americans to tailor health promotion of cancer-related genetic counseling and testing. J Genet Couns 2020; 29:518-529. [PMID: 32291871 DOI: 10.1002/jgc4.1277] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/30/2023]
Abstract
African Americans (AA), the second largest racial/ethnic minority group in the United States (US), carry the largest mortality burden of cancer compared with other racial/ethnic groups (Cancer Facts & Figures for African Americans, 2019-2021, American Cancer Society).One solution to address this disparity is through cancer-related genetic counseling and testing (CGT). Although CGT is utilized among the general population, it remains underutilized among AA populations. Community-engaged and community-driven health promotion programs within faith-based organizations (FBOs) have been successfully implemented and delivered among AA populations (Israel et al., American Journal of Public Health, 100, 2010, 2094). FBOs are well positioned for cancer-related health promotion and equipped as conduits of health education and information distribution for cancer prevention. In the present pilot study, a community-based participatory approach (CBPR) was used to collect exploratory data on attitudes, perceptions, and beliefs toward CGT and uptake among an AA sample in the Midwest. Focus groups were conducted in two churches where respondents (N=34) answered a pre-focus group survey prior to a discussion. Respondents were largely unaware of CGT and thought of testing as primarily for ancestral discovery and not for an inheritable disease. Themes identified through qualitative analysis included emotional experiences with cancer; perception of cancer risk; different pictures of genetic testing; other things to worry about; trust in the healthcare system/faith in God and the healthcare system; and ideas and insights regarding promotion of CGT. These primary themes showed participants' perceptions of CGT were shaped by their experiences with cancer, faith, faith communities/FBOs, and cost and access to CGT. Overall, participants within these organizations had positive perceptions about the church as a conduit of genetic testing information but had mixed opinions about the rationale for completing CGT. These findings have implications for genetic counselors, medical providers, and health promotion personnel as to how AA faith populations view CGT and the utility of FBOs as promoters of CGT information.
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Affiliation(s)
- Crystal Y Lumpkins
- Department of Family Medicine and Community Health, University of Kansas Medical Center, School of Medicine, Kansas City, Kansas
| | - Alisdair Philp
- Department of Internal Medicine, University of Kansas Medical Center, School of Medicine, Kansas City, Kansas
| | - Katherine L Nelson
- Department of Internal Medicine, University of Kansas Medical Center, School of Medicine, Kansas City, Kansas
| | - Lynn M Miller
- Faith Works Connecting for a Healthy Community Advisory Board, Kansas City, Kansas
| | - Keith Allen Greiner
- Department of Family Medicine and Community Health, University of Kansas Medical Center, School of Medicine, Kansas City, Kansas
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28
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Bradbury AR, Egleston BL, Patrick-Miller LJ, Rustgi N, Brandt A, Brower J, DiGiovanni L, Fetzer D, Berkelbach C, Long JM, Powers J, Stopfer JE, Domchek SM. Longitudinal outcomes with cancer multigene panel testing in previously tested BRCA1/2 negative patients. Clin Genet 2020; 97:601-609. [PMID: 32022897 PMCID: PMC9984207 DOI: 10.1111/cge.13716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/07/2020] [Accepted: 01/23/2020] [Indexed: 01/04/2023]
Abstract
Although multigene panel testing (MGPT) is increasingly utilized in clinical practice, there remain limited data on patient-reported outcomes. BRCA 1/2 negative patients were contacted and offered MGPT. Patients completed pre- and posttest counseling, and surveys assessing cognitive, affective and behavioral outcomes at baseline, postdisclosure and 6 and 12 months. Of 317 eligible BRCA1/2 negative patients who discussed the study with research staff, 249 (79%) enrolled. Decliners were more likely to be older, non-White, and recruited by mail or email. Ninety-five percent of enrolled patients proceeded with MGPT. There were no significant changes in anxiety, depression, cancer specific distress or uncertainty postdisclosure. There were significant but small increases in knowledge, cancer-specific distress and depression at 6-12 months. Uncertainty declined over time. Those with a VUS had significant decreases in uncertainty but also small increases in cancer specific distress at 6 and 12 months. Among those with a positive result, medical management recommendations changed in 26% of cases and 2.6% of all tested. Most BRCA1/2 negative patients have favorable psychosocial outcomes after receipt of MGPT results, although small increases in depression and cancer-specific worry may exist and may vary by result. Medical management changed in few patients.
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Affiliation(s)
- Angela R. Bradbury
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian L. Egleston
- Fox Chase Cancer Center, Temple University Health System, Biostatistics and Bioinformatics Facility, Philadelphia, Pennsylvania, USA
| | - Linda J. Patrick-Miller
- Division of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Neil Rustgi
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amanda Brandt
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jamie Brower
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura DiGiovanni
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dominique Fetzer
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Berkelbach
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica M. Long
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacquelyn Powers
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jill E. Stopfer
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susan M. Domchek
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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29
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McKinney LP, Gerbi GB, Caplan LS, Claridy MD, Rivers BM. Predictors of genetic beliefs toward cancer risk perceptions among adults in the United States: Implications for prevention or early detection. J Genet Couns 2020; 29:494-504. [PMID: 32103577 DOI: 10.1002/jgc4.1228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The objective of this study is to assess predictors of genetic beliefs toward cancer risk perceptions among adults, aged 18 years and over, in the United States (US). Data were obtained from the National Cancer Institute's (NCI) Health Information National Trends Survey 2014 (HINTS) 4 Cycle 4. Bivariate and multivariable logistic regression analyses were conducted to assess factors associated with an individual's beliefs about genetic and cancer risk perceptions. The results showed that African Americans, Non-White Hispanics, Non-Hispanic Asians, individuals with a high school education or less, and annual household incomes less than $20,000 and do not believe that health behaviors play some role in determining whether a person will develop cancer was significantly less likely to report that genetics plays at least some role in whether a person will develop cancer. Findings of this study provide an opportunity for genetic counselors to address beliefs about genetics and cancer risk perceptions among minority populations and promote health equity.
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Affiliation(s)
- Lawrence P McKinney
- Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA, USA.,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Gemechu B Gerbi
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Lee S Caplan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Mechelle D Claridy
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Brian M Rivers
- Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA, USA.,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
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30
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Carroll NM, Blum‐Barnett E, Madrid SD, Jonas C, Janes K, Alvarado M, Bedoy R, Paolino V, Aziz N, McGlynn EA, Burnett‐Hartman AN. Demographic differences in the utilization of clinical and direct‐to‐consumer genetic testing. J Genet Couns 2019; 29:634-643. [DOI: 10.1002/jgc4.1193] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Nikki M. Carroll
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
| | | | - Sarah D. Madrid
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
| | - Cabell Jonas
- Mid‐Atlantic Permanente Research Institute Kaiser Permanente Mid‐Atlantic States Rockville MD USA
| | - Kristen Janes
- Kaiser Permanente Care Management Institute Oakland CA USA
| | - Monica Alvarado
- Southern California Permanente Medical Group Pasadena CA USA
| | - Ruth Bedoy
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
| | - Valerie Paolino
- Institute for Health Research Kaiser Permanente Colorado Aurora CO USA
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Smith D, Newton P, Berlin J, Barrett S. A community approach to engaging Gypsy and Travellers’ in cancer services. Health Promot Int 2019; 35:1094-1105. [DOI: 10.1093/heapro/daz103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Abstract
While cancer outcomes in the UK have improved, inequalities remain with poorer and some ethnic minority populations experiencing lower survival rates. Research has addressed Gypsies’ and Travellers’ cancer-related beliefs, experiences and practices as part of wider studies but this is the first study in the UK to specifically focus on cancer. Findings suggest that health beliefs and practices are shaped by historical and contemporary social processes and the marginal position of Gypsies and Travellers in the UK society can result in a preference for seeking information and support from within the community. Starting from a health assets perspective, findings indicate that the structure of social relations in Gypsy and Traveller communities could be more widely utilized in health promotion programmes. Developing and extending techniques employed by Gypsy and Traveller Non-governmental Organisations such as community-based interventions and the use of lay health advisers, could be an effective method of health promotion by raising knowledge of cancer, engaging community members in preventative programmes and encouraging earlier access to services.
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Affiliation(s)
- David Smith
- Faculty of Health, Education Medicine and Social Care at Anglia Ruskin University, Chelmsford, Essex, UK
| | - Paul Newton
- Faculty of Education and Health at the University of Greenwich
| | | | - Shirley Barrett
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Vrinten C, Gallagher A, Waller J, Marlow LAV. Cancer stigma and cancer screening attendance: a population based survey in England. BMC Cancer 2019; 19:566. [PMID: 31185949 PMCID: PMC6561035 DOI: 10.1186/s12885-019-5787-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/31/2019] [Indexed: 02/07/2023] Open
Abstract
Background Cancer-related stigma attracts considerable research interest, but few studies have examined stigmatisation in the healthy population. Qualitative studies suggest that stigma can discourage people from attending cancer screening. We aimed to quantify the prevalence and socio-demographic patterning of cancer stigma in the general population and to explore its association with cancer screening attendance. Methods In 2016, 1916 adults aged 18–70 years took part in home-based interviews in England. Measures assessed demographic characteristics, self-reported screening uptake for cervical (n = 681), breast (n = 326) and colorectal cancer (n = 371), and cancer stigma. Cancer stigma was measured with the validated Cancer Stigma Scale which assesses six subdomains (Severity, Personal Responsibility, Awkwardness, Avoidance, Policy Opposition, and Financial Discrimination), from which a mean score was calculated. Logistic regression analyses examined the association between cancer stigma and having been screened as recommended versus not. Results Levels of cancer stigma were low, but varied across the six subdomains. Items regarding the severity of a cancer diagnosis attracted the highest levels of agreement (30–51%), followed by statements about the acceptability of making financial decisions on the basis of a cancer diagnosis such as allowing banks to refuse a mortgage (16–31%) and policy opposition statements such as not having a responsibility to provide the best possible care for cancer patients (10–17%). A similar proportion anticipated feeling awkward around someone with cancer (10–17%). Only 8–11% agreed with personal responsibility statements, such as that a person with cancer is to blame for their condition, while 4–5% of adults anticipated avoiding someone with cancer. Stigma was significantly higher in men (p < .05) and in those from ethnic minority backgrounds (p < .001). Higher cancer stigma was associated with not being screened as recommended for all three screening programmes (cervical: adjusted OR 1.59, 95% CI 1.15–2.20; breast: adjusted OR = 1.97, 95% CI 1.17–3.32; colorectal: adjusted OR = 1.59, 95% CI 1.06–2.38). Conclusions Cancer stigma is generally low, but some aspects of stigma are more prevalent than others. Stigma is more prevalent in certain population subgroups and is negatively associated with cancer screening uptake. These benchmark findings may help track and reduce cancer stigma over time. Electronic supplementary material The online version of this article (10.1186/s12885-019-5787-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotte Vrinten
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK.
| | - Ailish Gallagher
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Jo Waller
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Laura A V Marlow
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
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Kahn RM, Gordhandas S, Maddy BP, Baltich Nelson B, Askin G, Christos PJ, Caputo TA, Chapman-Davis E, Holcomb K, Frey MK. Universal endometrial cancer tumor typing: How much has immunohistochemistry, microsatellite instability, and MLH1 methylation improved the diagnosis of Lynch syndrome across the population? Cancer 2019; 125:3172-3183. [PMID: 31150123 DOI: 10.1002/cncr.32203] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Universal tumor testing for defective DNA mismatch repair (MMR) is recommended for all women diagnosed with endometrial cancer to identify those with underlying Lynch syndrome. However, the effectiveness of these screening methods in identifying individuals with Lynch syndrome across the population has not been well studied. The aim of this study was to evaluate outcomes of MMR immunohistochemistry (IHC), mutL homolog 1 (MLH1) methylation, and microsatellite instability (MSI) analysis among patients with endometrial cancer. METHODS A complete systematic search of online databases (PubMed, EMBASE, MEDLINE, and the Cochrane Library) for 1990-2018 was performed. A DerSimonian-Laird random effects model meta-analysis was used to estimate the weighted prevalence of Lynch syndrome diagnoses. RESULTS The comprehensive search produced 4400 publications. Twenty-nine peer-reviewed studies met the inclusion criteria. Patients with endometrial cancer (n = 6649) were identified, and 206 (3%) were confirmed to have Lynch syndrome through germline genetic testing after positive universal tumor molecular screening. Among 5917 patients who underwent tumor IHC, 28% had abnormal staining. Among 3140 patients who underwent MSI analysis, 31% had MSI. Among patients with endometrial cancer, the weighted prevalence of Lynch syndrome germline mutations was 15% (95% confidence interval [CI], 11%-18%) with deficient IHC staining and 19% (95% CI, 13%-26%) with a positive MSI analysis. Among 1159 patients who exhibited a loss of MLH1 staining, 143 (13.7%) were found to be MLH1 methylation-negative among those who underwent methylation testing, and 32 demonstrated a germline MLH1 mutation (2.8% of all absent MLH1 staining cases and 22.4% of all MLH1 methylation-negative cases). Forty-three percent of patients with endometrial cancer who were diagnosed with Lynch syndrome via tumor typing would have been missed by family history-based screening alone. CONCLUSIONS Despite the widespread implementation of universal tumor testing in endometrial cancer, data regarding testing results remain limited. This study provides predictive values that will help practitioners to evaluate abnormal results in the context of Lynch syndrome and aid them in patient counseling.
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Affiliation(s)
- Ryan M Kahn
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Sushmita Gordhandas
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Brandon Paul Maddy
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Becky Baltich Nelson
- Department of Information Technologies and Services, Weill Cornell Medical College, New York, New York
| | - Gulce Askin
- Clinical and Translational Science Center, Department of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, New York
| | - Paul J Christos
- Clinical and Translational Science Center, Department of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, New York
| | - Thomas A Caputo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Eloise Chapman-Davis
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Kevin Holcomb
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Melissa K Frey
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
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Cheung FY, Pratt R, Shire A, Bigalke L, Ahmed Z, Zierhut H. Developing culturally informed genetic services for the Somali immigrants in Minnesota. J Genet Couns 2019; 28:887-896. [PMID: 31058411 DOI: 10.1002/jgc4.1131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/30/2019] [Indexed: 12/12/2022]
Abstract
Misinformation and distrust often prevent individuals from minority communities to seek adequate healthcare, including genetic services. Immigrants appear to be further burdened by factors that negatively impact their health outcomes and little is known about their experience with genetic services. We sought to identify attitudes and perception of genetic services in one immigrant group, the Somali community of Minnesota and to establish a culturally informed framework for caring for members. A qualitative study comprised of 11 semi-structured key informant interviews was conducted and analyzed using a thematic approach. Main themes emerged from the analysis fell within one of four major topics: (a) Somali views and perspective on genetics and healthcare, (b) barriers to uptake of genetic services, (c) facilitators to uptake of genetic services, and (d) perspective on genetic service delivery subtypes. Somali views and perspective on genetics are often framed by religious and cultural values. These values, at times, conflicted with those common in the American healthcare system. Supports for different genetic service delivery subtypes also varied, ranging from little to no support in prenatal screening to generally positive support for pharmacogenetic testing. Future studies should prioritize topics with support and ways to better provide genetic counseling services within the Somali community.
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Affiliation(s)
- Fook Yee Cheung
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Abdirashid Shire
- Health and Research Institute for Somali Americans Inc. (HeRISA), Rochester, Minnesota
| | - Lauren Bigalke
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Zahra Ahmed
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota
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Middleton A, Milne R, Thorogood A, Kleiderman E, Niemiec E, Prainsack B, Farley L, Bevan P, Steed C, Smith J, Vears D, Atutornu J, Howard HC, Morley KI. Attitudes of publics who are unwilling to donate DNA data for research. Eur J Med Genet 2019; 62:316-323. [PMID: 30476628 PMCID: PMC6582635 DOI: 10.1016/j.ejmg.2018.11.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 12/17/2022]
Abstract
With the use of genetic technology, researchers have the potential to inform medical diagnoses and treatment in actionable ways. Accurate variant interpretation is a necessary condition for the utility of genetic technology to unfold. This relies on the ability to access large genomic datasets so that comparisons can be made between variants of interest. This can only be successful if DNA and medical data are donated by large numbers of people to 'research', including clinical, non-profit and for-profit research initiatives, in order to be accessed by scientists and clinicians worldwide. The objective of the 'Your DNA, Your Say' global survey is to explore public attitudes, values and opinions towards willingness to donate and concerns regarding the donation of one's personal data for use by others. Using a representative sample of 8967 English-speaking publics from the UK, the USA, Canada and Australia, we explore the characteristics of people who are unwilling (n = 1426) to donate their DNA and medical information, together with an exploration of their reasons. Understanding this perspective is important for making sense of the interaction between science and society. It also helps to focus engagement initiatives on the issues of concern to some publics.
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Affiliation(s)
- Anna Middleton
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK; Faculty of Education, University of Cambridge, Cambridge, UK.
| | - Richard Milne
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK; Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Adrian Thorogood
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Erika Kleiderman
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Emilia Niemiec
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Barbara Prainsack
- Department of Political Science, University of Vienna, Austria; Department of Global Health & Social Medicine, King's College London, UK
| | - Lauren Farley
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK
| | - Paul Bevan
- Web Team, Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Claire Steed
- Web Team, Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - James Smith
- Web Team, Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Danya Vears
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Melbourne Law School, The University of Melbourne, Melbourne, Australia; Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia
| | - Jerome Atutornu
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK; Faculty of Education, University of Cambridge, Cambridge, UK; School of Health Sciences, University of Suffolk, Ipswich, UK
| | - Heidi C Howard
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK; Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Katherine I Morley
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK; Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, Melbourne, Australia
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Evidence of Differences and Discrimination in the Delivery of Care: Colorectal Screening in Healthy People and in the Care and Surveillance of Patients with Inflammatory Bowel Disease. GASTROINTESTINAL DISORDERS 2019. [DOI: 10.3390/gidisord1020020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: In this review the management of colorectal disease will be investigated as an exemplar of common practice in the UK in an attempt to identify factors responsible for the more general experiences of patients from ethnic minorities. Within this field such populations have a lower uptake of cancer screening programmes and their experience of day-to-day care for chronic gastrointestinal disorders is poor. Study design: PubMed and Google Scholar were reviewed in 2016 to identify publications concerning colorectal screening in patients with inflammatory bowel disease and healthy communities. Methods: Data were extracted from each paper and the references exploded to identify other potential reports. Results: It is reported that barriers exist both at individual and access levels but little has been done to overcome these. There have been a number of suggestions as to how to provide equitable access, but there is a clear need to ensure that these are evidence based and have been tested and shown to be effective in clinical trials. Conclusions: Clearly, current systems of surveillance and screening will only make a difference if they provide effective and acceptable services to all potential clients. Most programmes fail to address the specific risks and anxieties of minority groups, which are thought to be poorly compliant. This review considers those factors that may play a part and suggests approaches that could overcome these deficiencies. Some clues as to these factors may come from work with patients with chronic disorders.
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Hinchcliff EM, Bednar EM, Lu KH, Rauh-Hain JA. Disparities in gynecologic cancer genetics evaluation. Gynecol Oncol 2019; 153:184-191. [PMID: 30711300 PMCID: PMC6430691 DOI: 10.1016/j.ygyno.2019.01.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 01/14/2023]
Abstract
An estimated 2-5% of endometrial cancers and 15-20% of high-grade, non-mucinous epithelial ovarian cancers have an underlying hereditary cause. Appropriate risk assessment, genetic counseling, and germline genetic testing for cancer predisposition genes in both gynecologic cancer patients and their at-risk relatives is essential for effective delivery of tailored cancer treatment and cancer prevention. However, significant disparities exist within medically underserved and minority populations in the United States regarding awareness of, access to, and use of genetic services. The objectives of this review are to summarize the literature on genetic counseling and genetic testing of gynecologic cancer patients, the cascade genetic testing of their families following the identification of a germline mutation associated with susceptibility to cancer, to highlight disparities between populations, and to present some potential remedies.
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Affiliation(s)
- Emily M Hinchcliff
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Erica M Bednar
- The Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The Cancer Prevention and Control Platform, Moon Shots™ Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - J Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA; Department of Health Services Research, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
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Roberts MC, Mensah GA, Khoury MJ. Leveraging Implementation Science to Address Health Disparities in Genomic Medicine: Examples from the Field. Ethn Dis 2019; 29:187-192. [PMID: 30906168 DOI: 10.18865/ed.29.s1.187] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The integration of genomic data into screening, prevention, diagnosis, and treatment for clinical and public health practices has been slow and challenging. Implementation science can be applied in tackling the barriers and challenges as well as exploring opportunities and best practices for integrating genomic data into routine clinical and public health practice.In this article, we define the state of disparities in genomic medicine and focus predominantly on late-stage research findings. We use case studies from genetic testing for cardiovascular diseases (familial hypercholesterolemia) and cancer (Lynch syndrome and hereditary breast and ovarian cancer syndrome) in high-risk populations to consider current disparities and related barriers in turning genomic advances into population health impact to advance health equity. Finally, we address how implementation science can address these translational barriers and we discuss the strategic importance of collaborative multi-stakeholder approaches that engage public health agencies, professional societies, academic health and research centers, community clinics, and patients and their families to work collectively to improve population health and reduce or eliminate health inequities.
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Affiliation(s)
- Megan C Roberts
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia
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Millan M, Smith D. A Comparative Sociology of Gypsy Traveller Health in the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E379. [PMID: 30699997 PMCID: PMC6388580 DOI: 10.3390/ijerph16030379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 01/12/2023]
Abstract
This paper presents findings from a series of health-related studies undertaken between 2012 and 2017 with Romany Gypsies and Irish Travellers living in different locations and in various forms of accommodation in southern England. These set out to develop a sociological understanding of the factors impacting on the health and wellbeing of members of those communities and to consider the extent health status is shaped by ethno-cultural and/or socioeconomic factors, and the interplay and direction of causal processes between them. The relative influences of cultural and structural factors in generating health inequalities have important implications for engaging marginalised populations in health services and preventative programmes. This paper will present survey and qualitative data on Gypsies' and Travellers' health beliefs and practices to understand how those beliefs and practices have developed in different social contexts as responses to deeper social mechanisms, and share commonalities with other marginalised and excluded social groups. In policy terms this indicates the need for health interventions that are applied proportionate to the level of disadvantage experienced thus ensuring equality and fairness while accounting for diversity and difference.
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Affiliation(s)
- Miranda Millan
- Faculty of Education and Health, University of Greenwich, London SE9 2UG, UK.
| | - David Smith
- DAVID SMITH Reader in Social Policy, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, Essex CM1 1SQ, UK.
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Hauser D, Obeng AO, Fei K, Ramos MA, Horowitz CR. Views Of Primary Care Providers On Testing Patients For Genetic Risks For Common Chronic Diseases. Health Aff (Millwood) 2019; 37:793-800. [PMID: 29733703 DOI: 10.1377/hlthaff.2017.1548] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We surveyed 488 primary care providers in community and academic practices in New York City in the period 2014-16 about their views on genetic testing for chronic diseases. The majority of the providers, most of whom were current or recent physicians in training, had had formal genetics education and had positive views of the utility of genetic testing. However, they felt unprepared to work with patients at high risk for genetic conditions and were not confident about interpreting test results. Many were concerned that genetic testing might lead to insurance discrimination and lacked trust in companies that offer genetic tests. These findings point to some of the attitudes and knowledge gaps among the providers that should be considered in the clinical implementation of genomic medicine for chronic conditions. Enhanced training, guidelines, clinical tools, and awareness of patient protections might support the effective adoption of genomic medicine by primary care providers.
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Affiliation(s)
- Diane Hauser
- Diane Hauser ( ) is a senior associate in the Institute for Family Health and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai, both in New York City
| | - Aniwaa Owusu Obeng
- Aniwaa Owusu Obeng is an assistant professor in the Charles Bronfman Institute for Personalized Medicine and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai, and the clinical pharmacogenomics coordinator in the Pharmacy Department at Mount Sinai Hospital
| | - Kezhen Fei
- Kezhen Fei is a biostatistician in the Department of Population Health Science and Policy and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai
| | - Michelle A Ramos
- Michelle A. Ramos is a program manager in the Department of Population Health Science and Policy and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai
| | - Carol R Horowitz
- Carol R. Horowitz is a professor in the Department of Population Health Science and Policy and in the Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai
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Machirori M, Patch C, Metcalfe A. Black and Minority Ethnic women's decision-making for risk reduction strategies after BRCA testing: Use of context and knowledge. Eur J Med Genet 2018; 62:376-384. [PMID: 30550831 DOI: 10.1016/j.ejmg.2018.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/30/2018] [Accepted: 12/08/2018] [Indexed: 12/14/2022]
Abstract
Within the field of breast cancer care, women concerned about their family history are offered genetic testing and subsequent treatment options based on several factors which include but are not limited to personal and family cancer disease histories and clinical guidelines. Discussions around decision-making in genetics in Black and Minority Ethnic (BME) groups are rarely documented in literature, and information regarding interactions with genetics services is usually discussed and linked to lack of scientific knowledge. As such, counselling sessions based only on scientific and medical information miss out the many reasons participants consider in making health decisions, information which can be used to encourage BME women to engage in cancer genetics services. 10 BME women with a mixed personal and family history of breast and ovarian cancer backgrounds, were interviewed in a study exploring issues of knowledge about familial breast cancer syndromes, to understand how they created and used familial knowledge for health decisions, with a particular focus on attitudes towards risk reducing strategies. Study results show that our participants are not unique in the ways they make decisions towards the use of cancer genetics and risk reduction strategies and as such, there are no specific ethnically defined pathways for decision-making. Our participants demonstrated mixed biomedical, social and individual cultural reasons for their decision-making towards risk reduction surgeries and treatment options which are similar to women from different ethnicities and are individual rather than group-specific. Narratives about suspicion of scientific utility of genetic knowledge, the perceived predictive value of mutations for future cancers or the origin of mutations and family disease patterns feature heavily in how participants evaluated genetic information and treatment decisions. The diversity of results shows that our participants are interested in engaging with genetic information but use multiple sources for evaluating the extent of involvement in genetic services and the place of genetic information and treatment options for themselves and their families. Genetic information is considered within various bio-social scenarios before decision-making for risk reduction is undertaken. BME women are shown to undertake evaluative processes which clinicians are encouraged to explore for better patient support. Continuing to focus on links between superficial and un-representative meanings of ethnicity, ethnic identity and attitudes and behaviours by only searching for differences between ethnic groups, are unhelpful in further understanding how women from those diverse backgrounds make decisions towards risk reduction interventions. Future research must find ways of investigating and understanding populations in ways that are not focussed solely on ethnic differences but on how meaning is created out of social circumstances and experiences.
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Affiliation(s)
- Mavis Machirori
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, United Kingdom.
| | - Christine Patch
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, United Kingdom
| | - Alison Metcalfe
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, United Kingdom; Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom
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Towards Cultural Competence in the Genomic Age: a Review of Current Health Care Provider Educational Trainings and Interventions. CURRENT GENETIC MEDICINE REPORTS 2018. [DOI: 10.1007/s40142-018-0150-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Sanghavi K, Moses I, Moses D, Gordon A, Chyr L, Bodurtha J. Family health history and genetic services-the East Baltimore community stakeholder interview project. J Community Genet 2018; 10:219-227. [PMID: 30171451 DOI: 10.1007/s12687-018-0379-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 08/23/2018] [Indexed: 12/30/2022] Open
Abstract
Discussion of family health history (FH) has the potential to be a communication tool within families and with health providers to stimulate health promotion related to many chronic conditions, including those with genetic implications for prevention, screening, diagnosis, treatment. Diverse communities with disparities in health outcomes may require different approaches to engage individuals and families in the evolving areas of genetic risk communication, assessment, and services. This work was a partnership of a local urban agency and academic genetics professionals to increase understanding of community concerns and preferences related to FH and genetic awareness. Thirty community stakeholders in the East Baltimore area participated in structured interviews conducted by community members. We identified key themes on family health history FH, risk assessment, and genetic services. Forty-three percent (18/27) of community stakeholders thought families in East Baltimore did not discuss family health history FH with doctors. Stakeholders recognized the benefits and challenges of potential actions based on genetic risk assessment and the multiple competing priorities of families. FH awareness with community engagement and genetics education were the major needs identified by the participants. Research undertaken in active collaboration with community partners can provide enhanced consumer perspectives on the importance of family health history and its potential connections to health promotion and prevention activities.
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Affiliation(s)
- Kunal Sanghavi
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA.
| | - Ivy Moses
- Johns Hopkins Hospital, Baltimore, MD, USA
- Jesus' Stop Restoration, Inc., Baltimore, MD, USA
| | - DuWade Moses
- Jesus' Stop Restoration, Inc., Baltimore, MD, USA
| | - Adelaide Gordon
- Chapel Hill School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Linda Chyr
- Maryland Department of Health, Office of Health Services, Maryland Medicaid, Baltimore, MD, USA
| | - Joann Bodurtha
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Carlo MI, Giri VN, Paller CJ, Abida W, Alumkal JJ, Beer TM, Beltran H, George DJ, Heath EI, Higano CS, McKay RR, Morgans AK, Patnaik A, Ryan CJ, Schaeffer EM, Stadler WM, Taplin ME, Kauff ND, Vinson J, Antonarakis ES, Cheng HH. Evolving Intersection Between Inherited Cancer Genetics and Therapeutic Clinical Trials in Prostate Cancer: A White Paper From the Germline Genetics Working Group of the Prostate Cancer Clinical Trials Consortium. JCO Precis Oncol 2018; 2018. [PMID: 30761386 DOI: 10.1200/po.18.00060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose Advances in germline genetics, and related therapeutic opportunities, present new opportunities and challenges in prostate cancer. The Prostate Cancer Clinical Trials Consortium Germline Genetics Working Group was established to address genetic testing for men with prostate cancer, especially those with advanced disease undergoing testing for treatment-related objectives and clinical trials. Methods The Prostate Cancer Clinical Trials Consortium Germline Genetics Working Group met monthly to discuss the current state of genetic testing of men with prostate cancer for therapeutic or clinical trial purposes. We assessed current institutional practices, developed a framework to address unique challenges in this population, and identified areas of future research. Results Genetic testing practices in men with prostate cancer vary across institutions; however, there were several areas of agreement. The group recognized the clinical benefits of expanding germline genetic testing, beyond cancer risk assessment, for the goal of treatment selection or clinical trial eligibility determination. Genetic testing for treatment selection should ensure patients receive appropriate pretest education and consent and occur under auspices of a research study whenever feasible. Providers offering genetic testing should be able to interpret results and recommend post-test genetic counseling for patients. When performing tumor (somatic) genomic profiling, providers should discuss the potential for uncovering germline mutations and recommend appropriate genetic counseling. In addition, family members may benefit from cascade testing and early cancer screening and prevention strategies. Conclusion As germline genetic testing is incorporated into practice, further development is needed in establishing prompt testing for time-sensitive treatment decisions, integrating cascade testing for family, ensuring equitable access to testing, and elucidating the role of less-characterized germline DNA damage repair genes, individual gene-level biologic consequences, and treatment response prediction in advanced disease.
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Affiliation(s)
- Maria I Carlo
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Veda N Giri
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Channing J Paller
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Wassim Abida
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Celestia S Higano
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Alicia K Morgans
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Charles J Ryan
- University of California San Francisco, San Francisco, CA
| | | | | | | | | | - Jacob Vinson
- Prostate Cancer Clinical Trials Consortium, New York, NY
| | | | - Heather H Cheng
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
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47
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Apathy NC, Menser T, Keeran LM, Ford EW, Harle CA, Huerta TR. Trends and Gaps in Awareness of Direct-to-Consumer Genetic Tests From 2007 to 2014. Am J Prev Med 2018; 54:806-813. [PMID: 29656919 DOI: 10.1016/j.amepre.2018.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/30/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Direct-to-consumer genetic tests for inherited disease risks have gained recent approvals from the Food and Drug Administration, and interest in these tests has continued to grow. Broad use of these tests coupled with planning and discussion with health providers regarding genetic risks and potential protective behavior changes have been proposed as preventive tools to reduce health disparities and improve equity in health outcomes. However, awareness of direct-to-consumer genetic testing has historically demonstrated differences by education, income, and race; these disparities could jeopardize potential benefits by limiting access and use. METHODS The national survey data from the Health Information National Trends Survey was analyzed to understand how overall awareness of direct-to-consumer genetic testing and disparities in awareness across sociodemographic groups have changed since 2007. RESULTS The findings showed persistent disparities, as well as a widening gap in awareness between Hispanics and non-Hispanic whites (OR2007 =1.52, OR2014 =0.58, pchange =0.0056), despite overall increases in awareness over time. CONCLUSIONS Given these findings, policies regulating direct-to-consumer genetic tests should prioritize equitable distribution of benefits by including provisions that counteract prevailing disparities in awareness.
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Affiliation(s)
- Nate C Apathy
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Lindsay M Keeran
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio
| | - Eric W Ford
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher A Harle
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio; Department of Biomedical Informatics, Ohio State University, Columbus, Ohio.
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Smith CE, Fullerton SM, Dookeran KA, Hampel H, Tin A, Maruthur NM, Schisler JC, Henderson JA, Tucker KL, Ordovás JM. Using Genetic Technologies To Reduce, Rather Than Widen, Health Disparities. Health Aff (Millwood) 2018; 35:1367-73. [PMID: 27503959 DOI: 10.1377/hlthaff.2015.1476] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Evidence shows that both biological and nonbiological factors contribute to health disparities. Genetics, in particular, plays a part in how common diseases manifest themselves. Today, unprecedented advances in genetically based diagnoses and treatments provide opportunities for personalized medicine. However, disadvantaged groups may lack access to these advances, and treatments based on research on non-Hispanic whites might not be generalizable to members of minority groups. Unless genetic technologies become universally accessible, existing disparities could be widened. Addressing this issue will require integrated strategies, including expanding genetic research, improving genetic literacy, and enhancing access to genetic technologies among minority populations in a way that avoids harms such as stigmatization.
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Affiliation(s)
- Caren E Smith
- Caren E. Smith is a scientist in the Nutrition and Genomics Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, in Boston, Massachusetts
| | - Stephanie M Fullerton
- Stephanie M. Fullerton is an associate professor in the Department of Bioethics and Humanities at the University of Washington, in Seattle
| | - Keith A Dookeran
- Keith A. Dookeran is an assistant professor in the Division of Epidemiology and Biostatistics, School of Public Health, at the University of Illinois at Chicago and chair and CEO of the Cancer Foundation for Minority and Underserved Populations, also in Chicago
| | - Heather Hampel
- Heather Hampel is a professor in the Division of Human Genetics at the Ohio State University Comprehensive Cancer Center, in Columbus
| | - Adrienne Tin
- Adrienne Tin is an assistant scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Nisa M Maruthur
- Nisa M. Maruthur is an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, and the Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins University
| | - Jonathan C Schisler
- Jonathan C. Schisler is an assistant professor in the Department of Pharmacology at the University of North Carolina at Chapel Hill
| | - Jeffrey A Henderson
- Jeffrey A. Henderson is president and CEO of the Black Hills Center for American Indian Health, in Rapid City, South Dakota
| | - Katherine L Tucker
- Katherine L. Tucker is a professor in clinical laboratory and nutritional sciences at the University of Massachusetts, in Lowell
| | - José M Ordovás
- José M. Ordovás is director of the Nutrition and Genomics Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University
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49
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Kam S, Bylstra Y, Forrest L, Macciocca I, Foo R. Experience of Asian males communicating cardiac genetic risk within the family. J Community Genet 2018; 9:293-303. [PMID: 29308542 DOI: 10.1007/s12687-017-0352-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/09/2017] [Accepted: 12/18/2017] [Indexed: 11/24/2022] Open
Abstract
The genetic nature of an inherited cardiac condition (ICC) places first- and second-degree relatives at risk of cardiac complications and sudden death, even in the absence of symptoms. Communication of cardiac genetic risk information allows at-risk relatives to clarify, manage, and potentially prevent ICC-associated risks through cardiac screening. Literature regarding family communication of genetic risk information are predominantly based on Western populations, with limited insight into the Asian experience. This qualitative exploratory study provides a male perspective into the communication of ICC risks within families in Singapore. Eight male participants with clinically diagnosed cardiomyopathy, who had all received genetic counseling, were recruited. A phenomenological perspective was used to identify emergent themes from semi-structured interviews. In this study, most participants recalled their healthcare professional's emphasis on family communication. Notably, participants revealed that at-risk relatives were not accessing screening, and many described family members as currently asymptomatic and "healthy." These findings coincide with documented Asian beliefs regarding perceptions of health, which have important implications for the provision of genetic counseling support within Asian communities, especially in facilitating family communication such that at-risk relatives are informed about their ICC risks and available management options.
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Affiliation(s)
- Sylvia Kam
- POLARIS @ SingHealth, Singapore Health Services, 20 College Road, The Academia, Discovery Tower, Level 10, Singapore, 169856, Singapore.
- Department of Paediatrics, The University of Melbourne, Reception Level 2, West Building, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.
| | - Yasmin Bylstra
- SingHealth Duke-NUS Institute of Precision Medicine, Level 9, National Heart Centre, 5 Hospital Drive, Singapore, 169609, Singapore
- Inherited Cardiac Conditions Clinic, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Laura Forrest
- Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Ivan Macciocca
- Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, 4th Floor, Royal Children's Hospital, Flemington Road, Parkville, VIC, 3052, Australia
| | - Roger Foo
- Cardiovascular Research Institute, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, 119228, Singapore
- Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 8, MD6, 14 Medical Drive, Singapore, 117599, Singapore
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50
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Rana HQ, Cochrane SR, Hiller E, Akindele RN, Nibecker CM, Svoboda LA, Cronin AM, Garber JE, Lathan CS. A comparison of cancer risk assessment and testing outcomes in patients from underserved vs. tertiary care settings. J Community Genet 2017; 9:233-241. [PMID: 29151150 DOI: 10.1007/s12687-017-0347-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 11/07/2017] [Indexed: 01/29/2023] Open
Abstract
In cancer genetics, technological advances (next generation sequencing) and the expansion of genetic test options have resulted in lowered costs and increased access to genetic testing. Despite this, the majority of patients utilizing cancer genetics services lack diversity of gender, ethnicity, and socioeconomic status. Through retrospective chart review, we compared outcomes of cancer genetics consultations at a tertiary cancer center and a Federally Qualified Health Center (FQHC) (58 tertiary and 23 FQHC patients) from 2013 to 2015. The two groups differed in race, ethnicity, use of translator services, and type of insurance coverage. There were also significant differences in completeness of family history information, with more missing information about relatives in the FQHC group. In spite of these differences, genetic testing rates among those offered testing were comparable across the two groups with 74% of tertiary patients and 60% of FQHC patients completing testing. Implementation of community-based cancer genetics outreach clinics represents an opportunity to improve access to genetic counseling services, but more research is needed to develop effective counseling models for diverse patient populations.
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Affiliation(s)
- Huma Q Rana
- Center for Cancer Genetics and Prevention, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave DA 1122, Boston, MA, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Sarah R Cochrane
- Center for Cancer Genetics and Prevention, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave DA 1122, Boston, MA, USA
| | - Elaine Hiller
- Center for Cancer Genetics and Prevention, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave DA 1122, Boston, MA, USA
| | - Ruth N Akindele
- Center for Cancer Genetics and Prevention, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave DA 1122, Boston, MA, USA
| | - Callie M Nibecker
- Center for Cancer Genetics and Prevention, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave DA 1122, Boston, MA, USA
| | - Ludmila A Svoboda
- Center for Cancer Genetics and Prevention, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave DA 1122, Boston, MA, USA
| | - Angel M Cronin
- Center for Cancer Genetics and Prevention, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave DA 1122, Boston, MA, USA
| | - Judy E Garber
- Center for Cancer Genetics and Prevention, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave DA 1122, Boston, MA, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Christopher S Lathan
- Center for Cancer Genetics and Prevention, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave DA 1122, Boston, MA, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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