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Ramirez Leon D, Martinez D, Rivera Rivera J, Fuzzell L, Vadaparampil S, Rogers H, Gabram S, Snyder C, Guan Y. Assessing interventions promoting the uptake of cancer-related genomic services within the Latino community: A scoping review using the RE-AIM framework. Cancer Med 2024; 13:e7440. [PMID: 38989639 PMCID: PMC11237879 DOI: 10.1002/cam4.7440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 06/11/2024] [Accepted: 06/18/2024] [Indexed: 07/12/2024] Open
Abstract
Cancer genomic services (CGS) can support genetic risk-stratified cancer prevention and treatment. Racial/ethnic minority groups are less likely to access and utilize CGS compared with non-Hispanic Whites. Little research has described characteristics of interventions targeted at CGS among Latinos. This scoping review aimed to (1) describe interventions promoting uptake of CGS among Latinos in the United States and Latin America, (2) describe intervention adaptations for Latino participants, and (3) summarize intervention implementation factors suggested by reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. We conducted a search in English and Spanish of literature published between 2005 and 2022 across PubMed and Latin American and Caribbean Health Sciences Literature databases. Sixteen of 2344 papers met the inclusion criteria of the analysis. Efforts to promote CGS among Latino communities were limited in the US and lower in Latin America. This review highlights the need for in-depth exploration of acculturation-informed interventions and better reporting on implementation factors to enhance their scalability across diverse settings.
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Affiliation(s)
- Dayanna Ramirez Leon
- Department of Behavioral, Social, and Health Education SciencesRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
| | - Denise Martinez
- Department of Behavioral, Social, and Health Education SciencesRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
| | - Jessica Rivera Rivera
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Lindsay Fuzzell
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Susan Vadaparampil
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Hannah Rogers
- Woodruff Health Sciences Center LibraryEmory UniversityAtlantaGeorgiaUSA
| | - Sheryl Gabram
- Georgia Center for Oncology Research and EducationAtlantaGeorgiaUSA
| | - Cindy Snyder
- Georgia Center for Oncology Research and EducationAtlantaGeorgiaUSA
| | - Yue Guan
- Department of Behavioral, Social, and Health Education SciencesRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
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Hunter JE, Riddle L, Joseph G, Amendola LM, Gilmore MJ, Zepp JM, Shuster E, Bulkley JE, Muessig KR, Anderson KP, Goddard KAB, Wilfond BS, Leo MC. Most people share genetic test results with relatives even if the findings are normal: Family communication in a diverse population. Genet Med 2023; 25:100923. [PMID: 37421176 PMCID: PMC10766857 DOI: 10.1016/j.gim.2023.100923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023] Open
Abstract
PURPOSE With increasing utilization of genetic testing, sharing genetic information can become part of general family health communication while providing biological relatives with important information about their own genetic risk. Importantly, little is known about motivations for and barriers to family communication of genetic information in historically underserved populations. METHODS Using mixed methods, we explored patient experiences with family communication in a study population of English- and Spanish-speaking adults aged 18 to 49 years, enriched for participants from historically underserved backgrounds. Risk screening for hereditary cancer guided genetic testing for cancer risk genes and other medically actionable findings. RESULTS Most participants overall (91%), including most with normal findings (89%), shared or planned to share their results with relatives. Common motivations for sharing results were to give relatives information about their genetic risk and because the participant thought the results were interesting. Reasons for not sharing were limited contact with relatives, perceptions of limited clinical utility for relatives, and concern that discussion of genetic information was stigmatized or taboo. CONCLUSION Results demonstrate high rates of sharing genetic information, indicate motivations for sharing go beyond facilitating genetic testing for relatives, and suggest general willingness to share genetic information as part of family health communication.
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Affiliation(s)
- Jessica Ezzell Hunter
- Genomics, Ethics, and Translational Research Program, RTI International, Research Triangle Park, NC; Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR.
| | - Leslie Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA
| | | | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | | | - Joanna E Bulkley
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | - Katherine P Anderson
- Department of Family Medicine, Ambulatory Care Services, Denver Health, Denver, CO
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, OR
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR
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Iltis AS, Rolf L, Yaeger L, Goodman MS, DuBois JM. Attitudes and beliefs regarding race-targeted genetic testing of Black people: A systematic review. J Genet Couns 2023; 32:435-461. [PMID: 36644818 PMCID: PMC10349658 DOI: 10.1002/jgc4.1653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 01/17/2023]
Abstract
Geographical ancestry has been associated with an increased risk of various genetic conditions. Race and ethnicity often have been used as proxies for geographical ancestry. Despite numerous problems associated with the crude reliance on race and ethnicity as proxies for geographical ancestry, some genetic testing in the clinical, research, and employment settings has been and continues to be race- or ethnicity-based. Race-based or race-targeted genetic testing refers to genetic testing offered only or primarily to people of particular racial or ethnic groups because of presumed differences among groups. One current example is APOL1 testing of Black kidney donors. Race-based genetic testing raises numerous ethical and policy questions. Given the ongoing reliance on the Black race in genetic testing, it is important to understand the views of people who identify as Black or are identified as Black (including African American, Afro-Caribbean, and Hispanic Black) regarding race-based genetic testing that targets Black people because of their race. We conducted a systematic review of studies and reports of stakeholder-engaged projects that examined how people who identify as or are identified as Black perceive genetic testing that specifically presumes genetic differences exist among racial groups or uses race as a surrogate for ancestral genetic variation and targets Black people. Our review identified 14 studies that explicitly studied this question and another 13 that implicitly or tacitly studied this matter. We found four main factors that contribute to a positive attitude toward race-targeted genetic testing (facilitators) and eight main factors that are associated with concerns regarding race-targeted genetic testing (barriers). This review fills an important gap. These findings should inform future genetic research and the policies and practices developed in clinical, research, public health, or other settings regarding genetic testing.
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Affiliation(s)
| | - Liz Rolf
- Washington University in St. Louis School of Medicine
| | - Lauren Yaeger
- Washington University in St. Louis School of Medicine
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Lee R, Frick M, Joseph G, Guerra C, Stewart S, Kaplan C, Dixit N, Tsoh JY, Flores S, Pasick RJ. Research to reduce inequities in cancer risk services: Insights for remote genetic counseling in a pandemic and beyond. J Genet Couns 2021; 30:1292-1297. [PMID: 34687478 PMCID: PMC8657358 DOI: 10.1002/jgc4.1525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Robin Lee
- University of California, San Francisco, San Francisco, California, USA
| | - Miya Frick
- University of California, San Francisco, San Francisco, California, USA
| | - Galen Joseph
- University of California, San Francisco, San Francisco, California, USA
| | - Claudia Guerra
- University of California, San Francisco, San Francisco, California, USA
| | - Susan Stewart
- University of California, Davis, Davis, California, USA
| | - Celia Kaplan
- University of California, San Francisco, San Francisco, California, USA
| | - Niharika Dixit
- University of California, San Francisco, San Francisco, California, USA
| | - Janice Y Tsoh
- University of California, San Francisco, San Francisco, California, USA
| | - Selena Flores
- University of California, San Francisco, San Francisco, California, USA
| | - Rena J Pasick
- University of California, San Francisco, San Francisco, California, USA
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Guan Y, McBride CM, Rogers H, Zhao J, Allen CG, Escoffery C. Initiatives to Scale Up and Expand Reach of Cancer Genomic Services Outside of Specialty Clinical Settings: A Systematic Review. Am J Prev Med 2021; 60:e85-e94. [PMID: 33168338 PMCID: PMC7855907 DOI: 10.1016/j.amepre.2020.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/27/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT This systematic review aims to (1) characterize strategies used to identify individuals at increased risk for hereditary breast and ovarian cancer syndrome and Lynch syndrome outside of oncology and clinical genetic settings, (2) describe the extent to which these strategies have extended the reach of genetic services to underserved target populations, and (3) summarize indicators of the potential scalability of these strategies. EVIDENCE ACQUISITION Investigators searched PubMed, EMBASE, and PsycINFO for manuscripts published from October 2005 to August 2019. Eligible manuscripts were those published in English, those that described strategies to identify those at risk for hereditary breast and ovarian cancer syndrome or Lynch syndrome, those implemented outside of an oncology or genetic specialty clinic, and those that included measures of cancer genetic services uptake. This study assessed strategies used to increase the reach of genetic risk screening and counseling services. Each study was evaluated using the 16-item quality assessment tool, and results were reported according to the PRISMA guidelines. EVIDENCE SYNTHESIS Of the 16 eligible studies, 11 were conducted in clinical settings and 5 in public health settings. Regardless of setting, most (63%, 10/16) used brief screening tools to identify people with a family history suggestive of hereditary breast and ovarian cancer syndrome or Lynch syndrome. When reported, genetic risk screening reach (range =11%-100%) and genetic counseling reach (range =11%-100%) varied widely across studies. Strategies implemented in public health settings appeared to be more successful (median counseling reach=65%) than those implemented in clinical settings (median counseling reach=26%). Most studies did not describe fundamental components relevant for broad scalability. CONCLUSIONS Efforts to expand cancer genomic services are limited outside of traditional oncology and genetic clinics. This is a missed opportunity because evidence thus far suggests that these efforts can be successful in expanding the reach of genetic services with the potential to reduce health inequities in access. This review highlights the need for accelerating research that applies evidence-based implementation strategies and frameworks along with process evaluation to understand barriers and facilitators to scalability of strategies with high reach.
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Affiliation(s)
- Yue Guan
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | - Colleen M McBride
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Hannah Rogers
- Woodruff Health Sciences Center Library, Emory University, Atlanta, Georgia
| | - Jingsong Zhao
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Caitlin G Allen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Differences in referral patterns based on race for women at high-risk for ovarian cancer in the southeast: Results from a Gynecologic Cancer Risk Assessment Clinic. Gynecol Oncol 2019; 154:379-382. [PMID: 31196574 DOI: 10.1016/j.ygyno.2019.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare referral patterns, genetic testing and pathogenic variant rates in Black women (BW) and White women (WW) in a large academic Gynecologic Cancer Risk Assessment Clinic (GCRAC). METHODS Cross sectional study of an IRB-approved prospective, cohort study from a GCRAC. Data evaluated included: age, race, referral provider specialty and indication, genetic testing frequency, as well as frequency and types of pathogenic variants. RESULTS 588 WW and 57 BW were evaluated from 1/2010-12/2015. Although approximately one-third of BW and WW were referred for family history alone, referral indications varied. BW were more likely referred for a known pathogenic variant (20.0% vs. 6.2%) although less likely referred for a personal history of ovarian cancer (24.0% vs. 46.8%; p = 0.0023). While gynecologic oncologists referred most patients (BW 43.6% vs. WW 63.0%), BW were more likely to be referred by surgical oncologist (23.0% vs. 12.8%) or genetic counselor (12.8% vs. 5.9%) than WW (p = 0.0234). Referral from non-OBGYN primary care providers was <3% in both groups. Genetic testing rates were similar in both races (82.4% vs. 85.5%). Rates of BRCA1 mutations (12.7% vs. 11.5%) were similar; however, BW had more BRCA2 mutations (21.3% vs. 9.5%; p = 0.0194). CONCLUSIONS Since BW are more likely to be referred by surgical oncology or genetics counselor, breast clinics might be an entry point to ensure genetic counseling and testing. Continued efforts to increase awareness regarding the importance of patient referral at the primary care level may help identify the subset of women not currently undergoing counseling and testing.
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Barrington DA, Champion ML, Boitano TKL, Walters-Haygood CL, Farmer MB, Alvarez RD, Estes JM, Leath CA. Characteristics of African American women at high-risk for ovarian cancer in the southeast: Results from a Gynecologic Cancer Risk Assessment Clinic. Gynecol Oncol 2018; 149:337-340. [PMID: 29486991 DOI: 10.1016/j.ygyno.2018.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/05/2018] [Accepted: 02/18/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Describe patient characteristics in African American (AA) women seen for gynecologic cancer related genetic counseling at a large southeastern comprehensive cancer center. METHODS We reviewed an IRB approved, prospective observational cohort of patients from a Gynecologic Cancer Risk Assessment Clinic. Data evaluated included personal cancer history, family history, frequency of genetic testing, frequency/type of genetic mutations, and frequency of surgical intervention. Standard statistical statistics were utilized. RESULTS 1227 patients were evaluated from 2003 to 2015, of which 95 (7.7%) were AA. Sixteen patients had a personal history of ovarian cancer. 21 women (22%) underwent genetic counseling only; subsequent genetic testing was not recommended based on absence of risk factors. Of the seventy-four AA patients in whom genetic testing was recommended, sixty-six (69.5%) completed testing. Of women tested, 37 (56%) had abnormal results. Eight and 14 patients had pathogenic variants in BRCA1 and BRCA2, respectively. Two were found to have pathogenic PALB2 variants; one had a pathogenic ATM variant and one constitutional MLH1 epimutation case was identified. Eleven had BRCA variants of uncertain significance. Of the patients with abnormal testing, six of 22 women with pathogenic BRCA variants underwent risk-reducing salpingo-oophorectomy (RRSO). CONCLUSIONS Our study demonstrates that in a region where AAs represent 27% of the population, the proportion of AA patients referred to a Gynecologic Cancer Risk Assessment Clinic remains low. Pathogenic variant and variant of uncertain significance rates were high in patients tested, likely representing a selection bias of high-risk patients. Endeavors should continue to identify minorities at risk for ovarian cancer and institute measures to provide thorough genetic counseling and testing.
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Affiliation(s)
- David A Barrington
- University of Alabama at Birmingham, Department of Obstetrics & Gynecology, United States
| | - Macie L Champion
- University of Alabama at Birmingham, Department of Obstetrics & Gynecology, United States
| | - Teresa K L Boitano
- University of Alabama at Birmingham, Department of Obstetrics & Gynecology, United States
| | | | - Meagan B Farmer
- University of Alabama at Birmingham, Department of Medical Genetics, United States
| | - Ronald D Alvarez
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States
| | - Jacob M Estes
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States
| | - Charles A Leath
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States.
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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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Stewart SL, Kaplan CP, Lee R, Joseph G, Karliner L, Livaudais-Toman J, Pasick RJ. Validation of an Efficient Screening Tool to Identify Low-Income Women at High Risk for Hereditary Breast Cancer. Public Health Genomics 2016; 19:342-351. [PMID: 27788513 DOI: 10.1159/000452095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/28/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND/AIMS We compared the 6-Point Scale, a screening tool to identify low-income women for referral to genetic counseling, with genetic counselors' (GCs') recommendation and the Referral Screening Tool (RST). METHODS RST and 6-Point Scale scores were computed for 2 samples: (1) S1, public hospital mammography clinic patients in 2006-2010 (n = 744), classified by GCs as high risk (meriting referral to counseling) or not high risk, and (2) S2, primary care patients enrolled in an education intervention study in 2011-2012 (n = 1,425). Sensitivity, specificity, and area under the ROC curve (AUROC) were computed for the 6-Point Scale score versus GC and RST classification as high risk. RESULTS The 6-Point Scale had low sensitivity (0.27, 95% confidence interval [CI] 0.21-0.34) but high specificity (0.97, 95% CI 0.95-0.99) and AUROC (0.85, 95% CI 0.81-0.90) versus GC classification, and high sensitivity (S1: 0.90, 95% CI 0.79-1.00; S2: 0.94, 95% CI 0.87-0.97), specificity (S1: 0.95, 95% CI 0.93-0.97; S2: 0.94, 95% CI 0.93-0.96), and AUROC (S1: 0.98, 95% CI 0.96-0.99; S2: 0.98, 95% CI 0.98-0.99) versus the RST. CONCLUSION The 6-Point Scale compared favorably with the RST, a validated instrument, and is potentially useful as a simple tool for administration in a safety net setting, requiring minimal time investment by primary care physicians and their staff and no financial investment in tablet computers or software.
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Affiliation(s)
- Susan L Stewart
- University of California, Davis Division of Biostatistics, Sacramento, CA, USA
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10
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Pasick RJ, Joseph G, Stewart S, Kaplan C, Lee R, Luce J, Davis S, Marquez T, Nguyen T, Guerra C. Effective Referral of Low-Income Women at Risk for Hereditary Breast and Ovarian Cancer to Genetic Counseling: A Randomized Delayed Intervention Control Trial. Am J Public Health 2016; 106:1842-8. [PMID: 27552275 DOI: 10.2105/ajph.2016.303312] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To determine the effectiveness of a statewide telephone service in identifying low-income women at risk for hereditary breast and ovarian cancer and referring them to free genetic counseling. METHODS From June 2010 through August 2011, eligible callers to California's toll-free breast and cervical cancer telephone service were screened for their family histories of breast and ovarian cancer. High-risk women were identified and called for a baseline survey and randomization to an immediate offer of genetic counseling or a mailed brochure on how to obtain counseling. Clinic records were used to assess receipt of genetic counseling after 2 months. RESULTS Among 1212 eligible callers, 709 (58.5%) agreed to answer family history questions; 102 (14%) were at high risk (25% Hispanic, 46% White, 10% Black, 16% Asian, 3% of other racial/ethnic backgrounds). Of the high-risk women offered an immediate appointment, 39% received counseling during the intervention period, as compared with 4.5% of those receiving the brochure. CONCLUSIONS A public health approach to the rare but serious risk of hereditary breast and ovarian cancer can be successful when integrated into the efforts of existing safety net organizations.
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Affiliation(s)
- Rena J Pasick
- Rena J. Pasick, Celia Kaplan, Tung Nguyen, and Claudia Guerra are with the Department of Medicine, Division of General Internal Medicine, University of California, San Francisco. Galen Joseph is with the Department of Anthropology, History, and Social Medicine, University of California, San Francisco. Susan Stewart is with the Division of Biostatistics, University of California, Davis. Robin Lee is with the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco. Judith Luce is with the Department of Medicine, Division of Hematology and Oncology, San Francisco General Hospital, University of California, San Francisco. Sharon Davis and Titas Marquez are with the Cancer Prevention Institute of California, Fremont
| | - Galen Joseph
- Rena J. Pasick, Celia Kaplan, Tung Nguyen, and Claudia Guerra are with the Department of Medicine, Division of General Internal Medicine, University of California, San Francisco. Galen Joseph is with the Department of Anthropology, History, and Social Medicine, University of California, San Francisco. Susan Stewart is with the Division of Biostatistics, University of California, Davis. Robin Lee is with the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco. Judith Luce is with the Department of Medicine, Division of Hematology and Oncology, San Francisco General Hospital, University of California, San Francisco. Sharon Davis and Titas Marquez are with the Cancer Prevention Institute of California, Fremont
| | - Susan Stewart
- Rena J. Pasick, Celia Kaplan, Tung Nguyen, and Claudia Guerra are with the Department of Medicine, Division of General Internal Medicine, University of California, San Francisco. Galen Joseph is with the Department of Anthropology, History, and Social Medicine, University of California, San Francisco. Susan Stewart is with the Division of Biostatistics, University of California, Davis. Robin Lee is with the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco. Judith Luce is with the Department of Medicine, Division of Hematology and Oncology, San Francisco General Hospital, University of California, San Francisco. Sharon Davis and Titas Marquez are with the Cancer Prevention Institute of California, Fremont
| | - Celia Kaplan
- Rena J. Pasick, Celia Kaplan, Tung Nguyen, and Claudia Guerra are with the Department of Medicine, Division of General Internal Medicine, University of California, San Francisco. Galen Joseph is with the Department of Anthropology, History, and Social Medicine, University of California, San Francisco. Susan Stewart is with the Division of Biostatistics, University of California, Davis. Robin Lee is with the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco. Judith Luce is with the Department of Medicine, Division of Hematology and Oncology, San Francisco General Hospital, University of California, San Francisco. Sharon Davis and Titas Marquez are with the Cancer Prevention Institute of California, Fremont
| | - Robin Lee
- Rena J. Pasick, Celia Kaplan, Tung Nguyen, and Claudia Guerra are with the Department of Medicine, Division of General Internal Medicine, University of California, San Francisco. Galen Joseph is with the Department of Anthropology, History, and Social Medicine, University of California, San Francisco. Susan Stewart is with the Division of Biostatistics, University of California, Davis. Robin Lee is with the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco. Judith Luce is with the Department of Medicine, Division of Hematology and Oncology, San Francisco General Hospital, University of California, San Francisco. Sharon Davis and Titas Marquez are with the Cancer Prevention Institute of California, Fremont
| | - Judith Luce
- Rena J. Pasick, Celia Kaplan, Tung Nguyen, and Claudia Guerra are with the Department of Medicine, Division of General Internal Medicine, University of California, San Francisco. Galen Joseph is with the Department of Anthropology, History, and Social Medicine, University of California, San Francisco. Susan Stewart is with the Division of Biostatistics, University of California, Davis. Robin Lee is with the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco. Judith Luce is with the Department of Medicine, Division of Hematology and Oncology, San Francisco General Hospital, University of California, San Francisco. Sharon Davis and Titas Marquez are with the Cancer Prevention Institute of California, Fremont
| | - Sharon Davis
- Rena J. Pasick, Celia Kaplan, Tung Nguyen, and Claudia Guerra are with the Department of Medicine, Division of General Internal Medicine, University of California, San Francisco. Galen Joseph is with the Department of Anthropology, History, and Social Medicine, University of California, San Francisco. Susan Stewart is with the Division of Biostatistics, University of California, Davis. Robin Lee is with the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco. Judith Luce is with the Department of Medicine, Division of Hematology and Oncology, San Francisco General Hospital, University of California, San Francisco. Sharon Davis and Titas Marquez are with the Cancer Prevention Institute of California, Fremont
| | - Titas Marquez
- Rena J. Pasick, Celia Kaplan, Tung Nguyen, and Claudia Guerra are with the Department of Medicine, Division of General Internal Medicine, University of California, San Francisco. Galen Joseph is with the Department of Anthropology, History, and Social Medicine, University of California, San Francisco. Susan Stewart is with the Division of Biostatistics, University of California, Davis. Robin Lee is with the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco. Judith Luce is with the Department of Medicine, Division of Hematology and Oncology, San Francisco General Hospital, University of California, San Francisco. Sharon Davis and Titas Marquez are with the Cancer Prevention Institute of California, Fremont
| | - Tung Nguyen
- Rena J. Pasick, Celia Kaplan, Tung Nguyen, and Claudia Guerra are with the Department of Medicine, Division of General Internal Medicine, University of California, San Francisco. Galen Joseph is with the Department of Anthropology, History, and Social Medicine, University of California, San Francisco. Susan Stewart is with the Division of Biostatistics, University of California, Davis. Robin Lee is with the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco. Judith Luce is with the Department of Medicine, Division of Hematology and Oncology, San Francisco General Hospital, University of California, San Francisco. Sharon Davis and Titas Marquez are with the Cancer Prevention Institute of California, Fremont
| | - Claudia Guerra
- Rena J. Pasick, Celia Kaplan, Tung Nguyen, and Claudia Guerra are with the Department of Medicine, Division of General Internal Medicine, University of California, San Francisco. Galen Joseph is with the Department of Anthropology, History, and Social Medicine, University of California, San Francisco. Susan Stewart is with the Division of Biostatistics, University of California, Davis. Robin Lee is with the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco. Judith Luce is with the Department of Medicine, Division of Hematology and Oncology, San Francisco General Hospital, University of California, San Francisco. Sharon Davis and Titas Marquez are with the Cancer Prevention Institute of California, Fremont
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Abstract
African American women have a lower lifetime incidence of breast cancer than white/Caucasian Americans yet have a higher risk of breast cancer mortality. African American women are also more likely to be diagnosed with breast cancer at young ages, and they have higher risk for the biologically more aggressive triple-negative breast cancers. These features are also more common among women from western, sub-Saharan Africa who share ancestry with African Americans, and this prompts questions regarding an association between African ancestry and inherited susceptibility for certain patterns of mammary carcinogenesis.
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Affiliation(s)
- Lisa A Newman
- Breast Care Center, University of Michigan Comprehensive Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48167, USA.
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Joseph G, Guerra C. To worry or not to worry: breast cancer genetic counseling communication with low-income Latina immigrants. J Community Genet 2014; 6:63-76. [PMID: 25148879 DOI: 10.1007/s12687-014-0202-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022] Open
Abstract
The purpose of this pilot study was to describe communication practices during hereditary breast cancer genetic counseling (GC) with low-income immigrant Latina patients in a public hospital setting. We utilized qualitative ethnographic methods, including direct observation of GC appointments with Latina patients at a public hospital offering free GC and BRCA testing and in-depth qualitative interviews with patients after they had received their BRCA genetic test results. Twenty-five patients participated; 20 were observed during genetic counseling appointments, and ten participated in interviews after BRCA testing with six participating in both observations and an interview. Analyses of qualitative data from observation field notes and interviews identified both strengths and limitations of current communication practices within the following themes: (1) family health history communication, (2) education regarding genes and genetics and patient information needs, (3) the purpose of the genetic test, (4) genetic test results and cancer risk, (5) building rapport and providing support, and (6) medical interpretation for monolingual Spanish speakers. As access to cancer GC expands in the public safety net settings and for the diverse populations they serve, it is critical to ensure effective communication in order for patients, whether or not they have a BRCA mutation, to understand the nature of their cancer risk and recommended methods of screening and prevention. Intervention strategies that address both structural constraints and patient-provider communication are needed to improve GC communication with immigrant Latinas, especially monolingual Spanish speakers.
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Affiliation(s)
- Galen Joseph
- Department of Anthropology, History and Social Medicine, University of California, San Francisco, 1450 Third Street, San Francisco, CA, 94158, USA,
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13
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Fehniger J, Lin F, Beattie MS, Joseph G, Kaplan C. Family Communication of
BRCA1/2
Results and Family Uptake of
BRCA1/2
Testing in a Diverse Population of
BRCA1/2
Carriers. J Genet Couns 2013; 22:603-12. [DOI: 10.1007/s10897-013-9592-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 04/09/2013] [Indexed: 01/31/2023]
Affiliation(s)
- Julia Fehniger
- Cancer Risk ProgramUniversity of California, San FranciscoSan FranciscoCAUSA
- University of Michigan Medical SchoolAnn ArborMIUSA
| | - Feng Lin
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Mary S. Beattie
- Cancer Risk ProgramUniversity of California, San FranciscoSan FranciscoCAUSA
- Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Galen Joseph
- Department of Anthropology, History, and Social MedicineUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Celia Kaplan
- Department of MedicineUniversity of California, San FranciscoSan FranciscoCAUSA
- University of California, San FranciscoBox 0856, 3333 California StreetSan FranciscoCA94143USA
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14
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Mays D, Sharff ME, DeMarco TA, Williams B, Beck B, Sheppard VB, Peshkin BN, Eng-Wong J, Tercyak KP. Outcomes of a systems-level intervention offering breast cancer risk assessments to low-income underserved women. Fam Cancer 2013; 11:493-502. [PMID: 22711611 DOI: 10.1007/s10689-012-9541-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Hereditary breast and ovarian cancer risk assessments (CRAs) are underutilized by low-income and racial/ethnic minority women, potentially exacerbating cancer-related disparities observed within these populations. We deployed and evaluated a systems-level intervention designed to identify patients potentially at-risk for hereditary breast/ovarian cancer, refer them for CRAs, and facilitate CRA utilization at an urban community-based breast health care center. Cancer family history forms were completed by patients seen at the center during an 18-month period and reviewed by staff for CRA eligibility against published referral criteria. A patient navigator educated eligible patients about the benefits of CRA, navigating interested patients to this service. CRA-specific patient interest and utilization outcomes are reported. In total, 94.7 % of all patients (n = 2,436) completed forms and 65 patients (2.7 %) met CRA eligibility criteria. Most eligible patients (72.3 %) were interested in CRA. Interested patients had a greater risk for hereditary breast/ovarian cancer (i.e., more affected relatives, greater objective risk scores) than uninterested patients: 57.4 % scheduled a CRA appointment and 51.9 % of scheduled patients utilized CRAs. Patients scheduling a CRA were contacted in less time and required fewer follow-up contacts by the patient navigator, and were more likely to be African American, than those who declined a CRA or were lost to follow-up (all p's ≤ .05). The systems-level intervention successfully identified patients eligible for CRA and linked interested and at-risk patients with CRA resources. More intensive patient navigation addressing the unique barriers encountered within this population may be required to enhance utilization.
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Affiliation(s)
- Darren Mays
- Division of Health Outcomes and Health Behaviors, Department of Oncology, Lombardi Comprehensive Cancer, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
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15
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Mannis GN, Fehniger JE, Creasman JS, Jacoby VL, Beattie MS. Risk-reducing salpingo-oophorectomy and ovarian cancer screening in 1077 women after BRCA testing. JAMA Intern Med 2013; 173:96-103. [PMID: 23247828 PMCID: PMC4989513 DOI: 10.1001/2013.jamainternmed.962] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND For women at potentially increased risk for ovarian cancer, data regarding screening and risk reduction are limited. Previous studies have reported on the behaviors of BRCA mutation carriers, but less is known about the behaviors of non- BRCA carriers. We surveyed a large cohort of women after BRCA testing to identify the prevalence and posttest predictors of risk-reducing and screening interventions. METHODS A median of 3.7 years after BRCA testing, 1447 women who received genetic counseling and BRCA testing at 2 hospital sites were surveyed, with a 77.6% response rate. We analyzed data from 1077 survey respondents. We performed univariate and multivariate logistic regression analyses to identify predictors of risk-reducing salpingo-oophorectomy (RRSO), screening transvaginal ultrasonography (TVUS), and screening serum cancer antigen 125 (CA-125). RESULTS Among the respondents, 201 women (18.7%) received positive test results for a deleterious mutation, 103 women (9.6%) received true-negative results, and 773 women (71.8%) received uninformative results. Overall, 19.1% of eligible women underwent RRSO and 39.6% used screening procedures. A positive BRCA result predicted RRSO (odds ratio [OR], 28.1; 95% CI, 16.2-48.6), TVUS (9.5 [4.3-21.0]), and serum CA-125 (13.0 [5.5-29.0]). Similarly, a true-negative BRCA result reduced the OR for RRSO (0.1 [0.0-0.6]), TVUS (0.2 [0.1-0.5]), and serum CA-125 (0.3 [0.1-0.7]). Of the 71.8% of women who received uninformative results after BRCA testing, 12.3% subsequently underwent RRSO, 33.8% reported ever having undergone screening serum CA-125 since BRCA testing, and 37.3% reported ever having undergone screening TVUS since BRCA testing. CONCLUSIONS Results of BRCA testing strongly predict RRSO and ovarian cancer screening. Use of RRSO and ovarian screening was reported in a sizable percentage of non- BRCA carriers despite insufficient data to determine the effectiveness of these interventions.
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Affiliation(s)
- Gabriel N Mannis
- Division of Hematology/Oncology, Department of Internal Medicine, University of California, San Francisco, 505 Parnassus Ave, Room M1286, San Francisco, CA 94117, USA.
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Chieng WS, Lee SC. Discrepancy between initial high expression of interest in clinical cancer genetic testing and actual low uptake in an Asian population. Genet Test Mol Biomarkers 2012; 16:785-93. [PMID: 22536849 DOI: 10.1089/gtmb.2011.0268] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIMS Little is known about the acceptance of clinical cancer genetic testing in Asians. We surveyed the attitudes and perceived motivators and barriers to genetic testing immediately after genetic counseling in at-risk patients for hereditary cancer in a cancer genetics clinic in Singapore, and compared the responses of actual test acceptors and decliners. RESULTS Three hundred seventeen patients participated, including 199 cancer-affected and 118 cancer-free probands or family members. Overall, 70% of patients expressed an initial willingness to be tested, and most did not perceive major barriers. However, only 69/199 (35%) of cancer-affected probands were actually tested. There was no significant difference in age, education, marital status, or initial expression of negative feelings toward genetic information between the test acceptors and decliners, although the decliners were more likely to have indicated a wish not to be tested (22% vs. 4%, p<0.001) and cited cost as a barrier (32% vs. 12%, p=0.002). The most common actual reasons against testing were cost (60%), not wanting to bear the emotional burden of genetic information (16%), and the perception that the medical management will not change (16%). CONCLUSION A significant discrepancy exists between an initial high interest in testing and actual low uptake. Health programs that address cost issues and education to correct misperceptions may improve genetic information utilization.
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Affiliation(s)
- Wei-Shieng Chieng
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
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17
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Kardashian A, Fehniger J, Creasman J, Cheung E, Beattie MS. A Pilot study of the Sharing Risk Information Tool (ShaRIT) for Families with Hereditary Breast and Ovarian Cancer Syndrome. Hered Cancer Clin Pract 2012; 10:4. [PMID: 22494806 PMCID: PMC3351367 DOI: 10.1186/1897-4287-10-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 04/12/2012] [Indexed: 12/17/2022] Open
Abstract
Background Individuals who carry deleterious BRCA mutations face significantly elevated risks of breast, ovarian, and other cancers. These individuals are also responsible for informing relatives of their increased risk for carrying the family BRCA mutation. Few interventions have been developed to facilitate this family communication process. Methods We developed the Sharing Risk Information Tool (ShaRIT), a personalized educational intervention, to support BRCA carriers as they discuss BRCA positive results and their implications with relatives. We conducted a pilot study of 19 BRCA carriers identified through the University of California San Francisco Cancer Risk Program. Our study had two aims: 1) to assess the feasibility and acceptability of ShaRIT, and 2) describe characteristics associated with increased family communication and BRCA testing. Participants in our study were divided into two groups: those who had not received ShaRIT as part of their genetic counseling protocol (control group, n = 10) and those who received ShaRIT (n = 9). Results All 9 women who received ShaRIT reported that it was a useful resource. Characteristics associated with increased sharing and testing included: female gender, degree of relationship, and frequency of communication. Increased pedigree knowledge showed a trend toward higher rates of sharing. Conclusions Both participants and genetic counselors considered ShaRIT a well-received, comprehensive tool for disseminating individual risk information and clinical care guidelines to Hereditary Breast and Ovarian Cancer Syndrome families. Because of this, ShaRIT has been incorporated as standard of care at our institution. In the future we hope to evaluate the effects of ShaRIT on family communication and family testing in larger populations of BRCA positive families.
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Affiliation(s)
- Ani Kardashian
- University of California San Francisco Cancer Risk Program, 94115 San Francisco, CA, USA.
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18
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Beattie MS, Wang G, Phillips KA. Differences in US healthcare coverage policies in BRCA testing and potential implications. Per Med 2012; 9:5-8. [PMID: 29783285 DOI: 10.2217/pme.11.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Mary S Beattie
- University of California, San Francisco, 1635 Divisadero St, Suite 600, San Francisco, CA 94115, USA.
| | - Grace Wang
- Center for Translational & Policy Research on Personalized Medicine (TRANSPERS), University of California, San Francisco, 3333 California St, Suite 420, Box 613, San Francisco, CA 94118, USA
| | - Kathryn A Phillips
- Center for Translational & Policy Research on Personalized Medicine (TRANSPERS), University of California, San Francisco, 3333 California St, Suite 420, Box 613, San Francisco, CA 94118, USA
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19
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Surveillance of survivors: Follow-up after risk-reducing salpingo-oophorectomy in BRCA 1/2 mutation carriers. Gynecol Oncol 2011; 122:339-43. [DOI: 10.1016/j.ygyno.2011.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 03/31/2011] [Accepted: 04/02/2011] [Indexed: 11/23/2022]
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20
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Case studies in the co-production of populations and genetics: The making of ‘at risk populations’ in BRCA genetics. BIOSOCIETIES 2010. [DOI: 10.1057/biosoc.2010.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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21
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Cheung EL, Olson AD, Yu TM, Han PZ, Beattie MS. Communication of BRCA results and family testing in 1,103 high-risk women. Cancer Epidemiol Biomarkers Prev 2010; 19:2211-9. [PMID: 20699375 DOI: 10.1158/1055-9965.epi-10-0325] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Genetic testing for hereditary cancer risk has implications for individuals and families. This study of women at risk of hereditary breast and ovarian cancer examines communication of BRCA results and subsequent genetic testing in the family. METHODS We surveyed 1,103 female BRCA testers at two hospitals, querying for communication of results and testing in relatives. RESULTS Ninety-seven percent of participants communicated BRCA results with at least one relative. Communication was negatively associated with older age [odds ratio (OR), 0.66 per decade; 95% confidence interval, (95% CI), 0.4-0.9], Asian race (OR, 0.18; 95% CI, 0.06-0.5), and testing at the public hospital versus the cancer center (OR, 0.19; 95% CI, 0.07-0.5). Communication was positively associated with increased knowledge of hereditary breast and ovarian cancer screening and risk reduction recommendations (OR, 1.9; 95% CI, 1.1-3.4) and increased satisfaction with the decision to BRCA test (OR, 2.6; 95% CI, 1.6-4.0). Seventy-five percent of BRCA-positive participants reported that at least one relative pursued genetic testing. Family testing was negatively associated with Asian race (OR, 0.15; 95% CI, 0.02-0.8) and positively associated with increased socioeconomic status (OR, 1.4; 95% CI, 1.1-1.7) and increased satisfaction with decision (OR, 2.1; 95% CI, 1.1-4.1). CONCLUSION Despite high overall rates of communicating BRCA results, underserved and some minority women seem less likely to inform relatives of their BRCA status or have relatives test for a known family mutation. Satisfaction with the decision to BRCA test is positively associated with both outcomes. IMPACT This study identified several novel predictors of family communication and family genetic testing in a large population of high-risk women. This work can inform clinicians interested in improving family communication regarding cancer predisposition testing.
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Joseph G, Beattie MS, Lee R, Braithwaite D, Wilcox C, Metrikin M, Lamvik K, Luce J. Pre-counseling education for low literacy women at risk of Hereditary Breast and Ovarian Cancer (HBOC): patient experiences using the Cancer Risk Education Intervention Tool (CREdIT). J Genet Couns 2010; 19:447-62. [PMID: 20490636 PMCID: PMC2944955 DOI: 10.1007/s10897-010-9303-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 04/07/2010] [Indexed: 12/03/2022]
Abstract
The Cancer Risk Education Intervention Tool (CREdIT) is a computer-based (non-interactive) slide presentation designed to educate low-literacy, and ethnically and racially diverse public hospital patients at risk of Hereditary Breast and Ovarian Cancer (HBOC) about genetics. To qualitatively evaluate participants’ experience with and perceptions of a genetic education program as an adjunct to genetic counseling, we conducted direct observations of the intervention, semi-structured in person interviews with 11 women who viewed CREdIT, and post-counseling questionnaires with the two participating genetic counselors. Five themes emerged from the analysis of interviews: (1) genetic counseling and testing for breast/ovarian cancer was a new concept; (2) CREdIT’s story format was particularly appealing; (3) changes in participants’ perceived risk for breast cancer varied; (4) some misunderstandings about individual risk and heredity persisted after CREdIT and counseling; (5) the context for viewing CREdIT shaped responses to the presentation. Observations demonstrated ways to make the information provided in CREdIT and by genetic counselors more consistent. In a post-session counselor questionnaire, counselors’ rating of the patient’s preparedness before the session was significantly higher for patients who viewed CREdIT prior to their appointments than for other patients. This novel educational tool fills a gap in HBOC education by tailoring information to women of lower literacy and diverse ethnic/racial backgrounds. The tool was well received by interview participants and counselors alike. Further study is needed to examine the varied effects of CREdIT on risk perception. In addition, the implementation of CREdIT in diverse clinical settings and the cultural adaptation of CREdIT to specific populations reflect important areas for future work.
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Affiliation(s)
- Galen Joseph
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco, San Francisco, CA 94143 - 0128, USA.
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Beattie MS, Crawford B, Lin F, Vittinghoff E, Ziegler J. Uptake, time course, and predictors of risk-reducing surgeries in BRCA carriers. Genet Test Mol Biomarkers 2009; 13:51-6. [PMID: 19309274 DOI: 10.1089/gtmb.2008.0067] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION AND AIMS For women who carry BRCA mutations, risk-reducing surgeries are an option to decrease breast and ovarian cancer risk. This study aims to determine the uptake, time course, and predictors of risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO) in BRCA carriers. RESULTS In 272 female carriers, followed for a median of 3.7 years, 23% of those eligible chose RRM, and 51% percent chose RRSO. Among BRCA carriers who chose these procedures, median time to both RRM and RRSO was approximately 4 months after learning of BRCA-positive results. Predictors of RRM were as follows: age below 60 years (hazard ratio 1.8, p=0.04), prior breast cancer (hazard ratio 2.4, p=0.0004), and RRSO (hazard ratio 7.2, p<0.0001). Predictors of RRSO were as follows: age below 60 years (hazard ratio 3.6, p=0.006), prior breast cancer (hazard ratio 1.8, p=0.002), and RRM (hazard ratio 5.4, p<0.0001). CONCLUSIONS Many women who undergo BRCA testing use these results to make clinical decisions; those who choose risk-reducing surgeries typically do so within months of receiving BRCA-positive results. Predictors of risk-reducing surgery uptake include the following: age below 60 years, prior breast cancer, and utilization of another risk-reducing surgery. Future research directions include examining other preventive and screening options in BRCA carriers as well as studying motivations for choosing or declining risk-reducing surgeries.
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Affiliation(s)
- Mary S Beattie
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
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24
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Smith J, Baer L, Blank S, Dilawari A, Carapetyan K, Alvear M, Utate M, Curtin J, Muggia F. A screening and prevention programme serving an ethnically diverse population of women at high risk of developing breast and/or ovarian cancer. Ecancermedicalscience 2009; 3:123. [PMID: 22275995 PMCID: PMC3224011 DOI: 10.3332/ecancer.2008.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION We describe a screening and prevention programme primarily targeting under-served minority women at high risk of breast and/or ovarian cancer. Women attending this Bellevue Hospital Center (BHC) Clinic were either self-referred from a variety of special outreach programmes or referred internally by medical professionals caring for relatives or friends. Our objective was to delineate referral sources and preliminary risk-assessment findings in relation to demographic features in this population. METHODS Following a detailed family and personal history intake and physical examination, each woman on her initial visit is categorized into a low (standard) risk, high-risk or indeterminate-risk group. Women found to be at high risk of developing breast and/or ovarian cancers are referred for further testing, additional screening measures, or participation in chemoprevention trials. All other women are counselled concerning follow-up and lifestyle issues. RESULT Between 2003 and 2007, 171 women for whom complete information was obtained were analysed. Thirty-four of the women were Caucasians (19.8%) and 137 (80.2%) were ethnically diverse minority women. Sixty-two (36.2%) were found to be at high risk with a median age of 42 years. The majority of the high-risk women were referred to the clinic by medical professionals (58%), most of whom were from within the BHC health care system. In fact, one-fourth of the referrals were women who carried a diagnosis of cancer, mostly arising in the breast, and who were concerned with risks to other family members. Trends in genetic testing results indicate fewer mutations among high-risk Asians than among other ethnicities. CONCLUSION Accurate risk assessments and implementation of screening and prevention measures have been challenging during the first few years of operation. Nevertheless, the need for providing consultation from internal referrals and the potential for genetic and psychosocial research in an ethnically diverse population are powerful incentives for continuing to evolve these services.
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Affiliation(s)
- J Smith
- Department of Medical Oncology, New York University, USA
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25
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Beattie MS, Crawford B, Lin F, Vittinghoff E, Ziegler J. Uptake, Time Course, and Predictors of Risk-Reducing Surgeries inBRCACarriers. ACTA ACUST UNITED AC 2009. [DOI: 10.1089/gte.2008.0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Simon MS, Petrucelli N. Hereditary breast and ovarian cancer syndrome : the impact of race on uptake of genetic counseling and testing. Methods Mol Biol 2009; 471:487-500. [PMID: 19109796 DOI: 10.1007/978-1-59745-416-2_25] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Breast cancer is a significant cause of morbidity and mortality in the United States. Although breast cancer is more common among White American (WA) women, incidence rates are higher among young African American (AA) women. Approximately 5-10% of all breast cancer can be accounted for by germline mutations in the breast cancer (BRCA)1 and BRCA2 genes responsible for hereditary breast and ovarian cancer (HBOC) syndrome. Although genetic counseling (GC) and genetic testing (GT) for HBOC have become widely accepted by the WA population, cancer genetic services are underused among AA. Many investigators have evaluated a wide spectrum of BRCA1 and BRCA2 mutations in the AA and African population with the possible identification of African founder mutations. Barriers to GC and GT include lack of knowledge and/or negative attitudes regarding genetics and genetics research, and concerns regarding the potential for racial discrimination. It is important for future research to focus on ways in which to eliminate barriers to GC and GT to alleviate disparity in the use of genetic services among high-risk AA women.
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Affiliation(s)
- Michael S Simon
- Division of Hematology and Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
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27
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Kim DH, Crawford B, Ziegler J, Beattie MS. Prevalence and characteristics of pancreatic cancer in families with BRCA1 and BRCA2 mutations. Fam Cancer 2008; 8:153-8. [PMID: 18855126 DOI: 10.1007/s10689-008-9220-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 09/24/2008] [Indexed: 02/06/2023]
Abstract
A growing body of research describes cancers other than breast and ovarian in families with BRCA1/2 mutations, but the prevalence and characteristics of pancreatic cancer in these families has not been well described. This study was designed to: (1) estimate the prevalence of pancreatic cancer in BRCA1/2 positive families; (2) ascertain age of onset and gender distribution of pancreatic cancer in this cohort; and (3) compare age and gender characteristics of pancreatic cancer in BRCA1/2 positive families with those of the general population. Within the UCSF Cancer Risk Program cohort, 24/219 (11.0%) BRCA1 and 17/156 (10.9%) BRCA2 families had at least 1 individual with pancreatic cancer. In the 24 BRCA1 families, median age of diagnosis was 59 (range 45-80) in males, and 68 (range 38-87) in females (male:female ratio = 2.00). In the 17 BRCA2 families, median age of diagnosis was 67 (range 39-78) in males and 59 (range 46-81) in females (male:female ratio = 1.11). The SEER database, which describes cancer characteristics in a representative sample of the US population, reports a median age of 70 in males and 74 in females (male:female ratio = 0.96) over the same time period. Additionally, mean ages of diagnosis of pancreatic cancer in BRCA1/2 families differ significantly from the SEER mean (P = 0.0014 for BRCA1 and P = 0.011 for BRCA2 by unpaired t-test). Our findings suggest that families with early onset pancreatic cancer and features of hereditary breast and ovarian cancer should be considered for BRCA1/2 testing.
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Affiliation(s)
- Daniel H Kim
- School of Medicine, University of California San Francisco, San Francisco, CA 94115, USA
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28
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Schillinger D, Dohan D. Genetic testing for vulnerable populations: what kinds of communication we need and do not need. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2008; 8:12-14. [PMID: 18726772 DOI: 10.1080/15265160802248393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Dean Schillinger
- University of California, San Francisco, Center for Vulnerable Populations, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
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29
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"Are you at risk for hereditary breast cancer?": development of a personal risk assessment tool for hereditary breast and ovarian cancer. J Genet Couns 2008; 17:64-78. [PMID: 18181014 DOI: 10.1007/s10897-007-9125-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 09/19/2007] [Indexed: 12/24/2022]
Abstract
Identification of risk for the hereditary breast and ovarian cancer syndrome (HBOC) is important, as research has demonstrated the benefits of risk-reducing interventions for women with or at risk for this disorder. Knowledge among women regarding risk factors for hereditary breast cancer and the existence of cancer genetics services appears limited. The goal of this project was to develop a tool to broaden women's awareness regarding their potential risk for HBOC. A formal instructional design process was used to develop a brochure to facilitate recognition of HBOC risk among women attending a no-cost breast and cervical cancer screening clinic. Brochure development was guided by gathering feedback from potential users early and often. The resulting brochure included four parts: (1) a brief description of the impact of hereditary breast cancer risk on one's health; (2) a personal and family history collection table; (3) a series of questions enabling the user to self-assess HBOC risk; (4) a list of resources for women at risk for HBOC. User feedback indicated that the brochure was easy to use. The project demonstrated that women can self-evaluate their risk for HBOC. Future work will evaluate this tool among a broader population of women.
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30
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Lubitz RJ, Komaromy M, Crawford B, Beattie M, Lee R, Luce J, Ziegler J. Development and Pilot Evaluation of Novel Genetic Educational Materials Designed for an Underserved Patient Population. ACTA ACUST UNITED AC 2007; 11:276-90. [DOI: 10.1089/gte.2007.0012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rebecca Jean Lubitz
- University of California, Berkeley—University of California, San Francisco Joint Medical Program, and Ontario, Canada
| | - Miriam Komaromy
- University of California San Francisco, Cancer Risk Program, UCSF Comprehensive Cancer Center, San Francisco, California
| | - Beth Crawford
- University of California San Francisco, Cancer Risk Program, UCSF Comprehensive Cancer Center, San Francisco, California
| | - Mary Beattie
- University of California San Francisco, Cancer Risk Program, UCSF Comprehensive Cancer Center, San Francisco, California
| | - Robin Lee
- University of California San Francisco, Cancer Risk Program, UCSF Comprehensive Cancer Center, San Francisco, California
| | - Judith Luce
- Breast Clinic, Division of Hematology-Oncology San Francisco General Hospital, San Francisco, California
| | - John Ziegler
- University of California San Francisco, Cancer Risk Program, UCSF Comprehensive Cancer Center, San Francisco, California
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31
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Hayanga AJ, Newman LA. Investigating the phenotypes and genotypes of breast cancer in women with African ancestry: the need for more genetic epidemiology. Surg Clin North Am 2007; 87:551-68, xii. [PMID: 17498544 DOI: 10.1016/j.suc.2007.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Disparities in incidence, mortality, and age of onset of breast cancer between women of African ancestry and women of other racial/ethnic backgrounds are poorly understood. A more comprehensive elaboration of genetic variants that occur in African women may facilitate a better understanding of the disease in African American women and explain the role of genetic admixture on the variation in the expression of the disease. Large-scale, population-based databases that document the cancer burden of Africa are lacking because of financial and infrastructural limitations. The development of such programs would represent an important cancer control and research strategy.
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Affiliation(s)
- Awori J Hayanga
- Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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