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Wang H, Chen LS, Hsiao HY, Hsiao SC, Han T, Chang E, Assoumou B, Wang JHY. Chinese American and Non-Hispanic White Breast Cancer Patients' Knowledge and Use of BRCA Testing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3384. [PMID: 36834079 PMCID: PMC9959522 DOI: 10.3390/ijerph20043384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer among Chinese American women. Knowing the BRCA1 and BRCA2 (BRCA1/2) gene mutation status can improve breast cancer patients' health outcomes by guiding targeted treatment towards preventing breast cancer recurrence and other BRCA-related cancers. Nevertheless, it is unclear if there is a disparity in knowledge and use of BRCA testing among Chinese American breast cancer patients. This cross-sectional study investigated the possible presence of differences in the knowledge and the use of BRCA testing between Chinese American and Non-Hispanic White (NHW) breast cancer patients. We surveyed 45 Chinese American and 48 NHW adult breast cancer patients who had been diagnosed with breast cancer within the previous two years through telephone interviews. The results showed that race was not statistically related to the use of BRCA testing. BRCA testing utilization was associated with family history (p < 0.05) and age (p < 0.05). However, Chinese American participants' understanding of BRCA testing was significantly lower than that of NHW participants (p = 0.030). Our findings suggest that a disparity exists in BRCA testing knowledge between Chinese American and NHW breast cancer patients. Genetic education and counseling are needed to improve BRCA testing knowledge and uptake among Chinese American breast cancer patients.
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Affiliation(s)
- Haocen Wang
- School of Nursing, Purdue University, West Lafayette, IN 47907, USA
- Department of Health Behavior, Texas A&M University, College Station, TX 77843, USA
| | - Lei-Shih Chen
- Department of Health Behavior, Texas A&M University, College Station, TX 77843, USA
| | - Hsin-Yi Hsiao
- Department of Social Work, Tzu Chi University, Hualien 97074, Taiwan
| | - Suh Chen Hsiao
- Department of Adult Mental Health and Wellness, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
| | - Tian Han
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Emily Chang
- Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Bertille Assoumou
- Department of Health Behavior, Texas A&M University, College Station, TX 77843, USA
- Department of Surgery, University of Nevada, Las Vegas, NV 89154, USA
| | - Judy Huei-Yu Wang
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
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2
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Conley CC, Rivera Rivera JN, Castro-Figueroa EM, Moreno L, Dutil J, García JD, Ricker C, Quinn GP, Soliman H, Vadaparampil ST. Provider discussion of genetic counseling among high-risk Spanish-preferring Latina breast cancer survivors. Transl Behav Med 2022; 12:900-908. [PMID: 36205471 PMCID: PMC9540969 DOI: 10.1093/tbm/ibac031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Among high-risk breast cancer (BC) survivors, genetic counseling (GC) and genetic testing (GT) may inform cascade testing and risk management. Compared to non-Hispanic White BC survivors, Spanish-preferring Latina BC survivors are less likely to report discussing GC with a healthcare provider. However, few studies have examined Latinas' experiences with GC/GT, particularly outside of the mainland USA. This study aimed to compare frequency of provider discussion of GC between Spanish-preferring Latina BC survivors living in Florida (FL) and Puerto Rico (PR). We conducted secondary data analysis of baseline assessments from a randomized pilot of an educational intervention for Spanish-preferring Latina BC survivors. Participants (N = 52) were GC/GT-naive, but met clinical criteria for GC/GT referral. Participants self-reported sociodemographic, clinical, and cultural variables, including previous provider discussion of GC. Descriptive statistics characterized frequency of GC discussion. Logistic regression examined the relationships between sociodemographic, clinical, and cultural characteristics and GC discussion. Only 31% of participants reported previous GC discussion. More participants from PR reported having GC discussions (43% vs. 21% in the mainland USA). In multivariable analyses, greater likelihood of GC discussion was associated with PR (vs. mainland USA) residence (odds ratio [OR] = 6.00, p = .03), older age at baseline (OR = 1.19, p = .04), and younger age at BC diagnosis (OR = 0.80, p = .03). Few high-risk Spanish-preferring Latina BC survivors in the mainland USA and PR had discussed GC with their providers. These results highlight a gap in the implementation of evidence-based genetics guidelines. Provider-directed interventions may be needed to increase uptake of GC/GT among Latina BC survivors.
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Affiliation(s)
- Claire C Conley
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA
| | | | | | | | - Julie Dutil
- Ponce Health Sciences University, Ponce 00716, Puerto Rico
| | | | - Charité Ricker
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA
| | - Gwendolyn P Quinn
- Grossman School of Medicine, New York University, New York, NY 10016, USA
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Vadaparampil ST, Moreno Botero L, Fuzzell L, Garcia J, Jandorf L, Hurtado-de-Mendoza A, Campos-Galvan C, Peshkin BN, Schwartz MD, Lopez K, Ricker C, Fiallos K, Quinn GP, Graves KD. Development and pilot testing of a training for bilingual community education professionals about hereditary breast and ovarian cancer among Latinas: ÁRBOLES Familiares. Transl Behav Med 2021; 12:6320107. [PMID: 34255089 DOI: 10.1093/tbm/ibab093] [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] [Indexed: 11/14/2022] Open
Abstract
Cancer health disparities remain a significant problem in the USA, compounded by lack of access to care, language barriers and systemic biases in health care. These disparities are particularly evident in areas such as genetics/genomics. For example, Latinas at high risk for hereditary breast and ovarian cancer (HBOC) have extremely low rates of genetic counseling/testing. Long-standing barriers and inequities in access to services such as genetic counseling and testing require innovative solutions. One solution can involve training community outreach and education professionals (CORE-Ps) to bridge the gap between underserved communities and genetic specialists. We sought to develop and pilot test a training program for English-Spanish bilingual CORE-Ps to reduce disparities in access to and uptake of genetic services among Latino populations. Guided by Adult Learning Theory and with input from multiple stakeholders, we developed ÁRBOLES Familiares (Family Trees), an in-person and online training program for bilingual CORE-Ps to facilitate identification, referral, and navigation of Latinas to genetic counseling/testing. We conducted a pilot test of 24 CORE-Ps recruited from across the United States and assessed knowledge, genetic literacy, and self-efficacy at baseline and follow-up. At follow-up, participants in the pilot with complete baseline and follow-up data (N = 15) demonstrated significant improvements in HBOC knowledge, genetic literacy, self-efficacy and reports of fewer barriers to identify/navigate Latinas (ps < .05). Qualitative assessment identified ways to improve the training curriculum. Pilot results suggest ÁRBOLES is a promising approach for training CORE-Ps to identify and refer high-risk Latinas to genetic services. Next steps involve further refinement of ÁRBOLES, development of an online toolkit, and adaptation for virtual delivery.
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Affiliation(s)
- Susan T Vadaparampil
- Moffitt Cancer Center, Tampa, FL, USA.,Office of Community Outreach, Engagement, and Equity, Moffitt Cancer Center, Tampa, FL, USA
| | | | | | | | - Lina Jandorf
- Icahn School of Medicine, Department of Population Health Science and Policy, New York, NY, USA
| | - Alejandra Hurtado-de-Mendoza
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Beth N Peshkin
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Marc D Schwartz
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Katherine Lopez
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Charité Ricker
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Katie Fiallos
- Johns Hopkins University Kimmel Cancer Center, Baltimore, MD, USA
| | | | - Kristi D Graves
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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Almeida R, Lopez-Macha A, Dugatkin T, Joseph G, Duron Y, Hurtado de Mendoza A, D. Graves K, Fejerman L. Community research collaboration to develop a promotores-based hereditary breast cancer education program for Spanish-speaking Latinas. HEALTH EDUCATION RESEARCH 2021; 36:319-336. [PMID: 34113985 PMCID: PMC9115327 DOI: 10.1093/her/cyab011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Indexed: 06/12/2023]
Abstract
Breast cancer (BC) is the most common cancer in Latinas and the leading cause of cancer death. Latinas tend to be diagnosed at later stages, receive poorer quality care and have a higher risk of mortality than non-Latina White (NLW) women. Among women with a genetic predisposition to hereditary BC, genetic counseling can be beneficial. Latinas participate in genetic counseling at lower rates than NLW women. The goal of this study was to develop comprehensive, culturally appropriate materials for community health educators (promotores)-led hereditary BC education program for Spanish-speaking Latinas. We developed the curriculum through feedback from 7 focus groups, with a total of 68 participants (35 promotores and 33 community members). We used a mixed-methods approach that relied on quantitative analysis of survey questions and qualitative content analysis of the focus groups transcripts. Pre and post promotores' training survey responses suggested improvement in the promotores' cancer-related knowledge. Themes that emerged from the qualitative analyses were (i) barriers to health education and/or care; (ii) importance of educating the Latino community about BC and genetics and (iii) role of the promotores. Future research will further evaluate the impact of the program in promotores' knowledge and community members' screening behaviors.
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Affiliation(s)
| | | | | | - Galen Joseph
- University of California, San Francisco, CA, USA
| | | | | | | | - Laura Fejerman
- University of California, San Francisco, CA, USA
- University of California, Davis, San Francisco, CA, USA
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5
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Design of a study to implement population-based risk assessment for hereditary cancer genetic testing in primary care. Contemp Clin Trials 2020; 101:106257. [PMID: 33373667 DOI: 10.1016/j.cct.2020.106257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/24/2022]
Abstract
Identifying patients with high genetic risk for cancer has important clinical ramifications, but hereditary cancer risk is often not identified because of testing barriers at both the provider and patient level. It is unknown how to best implement appropriate genetic testing and follow-up care into an operating primary care clinic. Implementation studies to date have been conducted in high resourced facilities under optimal conditions, often not at the clinic level. This study aims to compare and evaluate two population-wide engagement strategies for identifying members of a primary care clinic's population with a family or personal history of cancer and offering high-risk individuals genetic testing for cancer susceptibility mutations. The two engagement strategies are: 1) point of care screening (POC), conducted when a patient is scheduled for an appointment and 2) direct patient engagement (DPE), where outreach provides the patient an opportunity to complete screening online on their own time. The study will identify changes, problems, and inefficiencies in clinical flow during and after the implementation of risk assessment and genomic testing for cancer risk across primary care clinics. It will also evaluate the effects of the two engagement strategies on patient, provider, and clinic leader outcomes, including perceptions of benefits, harms, and satisfaction with the engagement strategy and process of cancer risk assessment and genetic testing, across gender, racial/ethnic, socioeconomic, and genetic literacy divides. Finally, the study will evaluate the cost-effectiveness and budget impact of each engagement strategy.
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Lynce F, Schlam I, Geng X, Peshkin BN, Friedman S, Dutil J, Nahleh Z, Campos C, Ricker C, Rodriguez P, Denduluri N, Ahn J, Isaacs C, Graves KD. BRCA1/2 mutations and risk-reducing bilateral salpingo-oophorectomy among Latinas: The UPTAKE study. J Genet Couns 2020; 30:383-393. [PMID: 33010199 PMCID: PMC10064975 DOI: 10.1002/jgc4.1322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 11/08/2022]
Abstract
Bilateral salpingo-oophorectomy (BSO) is a risk management approach with strong evidence of mortality reduction for women with germline mutations in the tumor suppressor genes BRCA1 and BRCA2 (BRCA1/2). Few studies to date have evaluated uptake of BSO in women from diverse racial and ethnic backgrounds who carry BRCA1/2 mutations. The objective of the UPTAKE study was to explore rates and predictors of risk-reducing BSO among Latinas affected and unaffected with breast cancer who had a deleterious BRCA1/2 mutation. We recruited 100 Latina women with deleterious BRCA1/2 mutations from community hospitals, academic health systems, community, and advocacy organizations. Women completed interviews in Spanish or English. We obtained copies of genetic test reports for participants who provided signed medical release. After performing threefold cross-validation LASSO for variable selection, we used multiple logistic regression to identify demographic and clinical predictors of BSO. Among 100 participants, 68 had undergone BSO at the time of interview. Of these 68, 35 were US-born (61% of all US-born participants) and 33 were not (77% of the non-US-born participants). Among Latinas with BRCA1/2 mutations, older age (p = 0.004), personal history of breast cancer (p = 0.003), higher income (p = 0.002), and not having a full-time job (p = 0.027) were identified as variables significantly associated with uptake of BSO. Results suggest a high rate of uptake of risk-reducing BSO among a sample of Latinas with BRCA1/2 mutations living in the US. We document factors associated with BSO uptake in a diverse sample of women. Relevant to genetic counseling, our findings identify possible targets for supporting Latinas' decision-making about BSO following receipt of a positive BRCA1/2 test.
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Affiliation(s)
- Filipa Lynce
- Lombardi Comprehensive Cancer Center and Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA.,Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ilana Schlam
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Xue Geng
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Beth N Peshkin
- Lombardi Comprehensive Cancer Center and Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
| | - Sue Friedman
- Force - Facing Our Risk of Cancer Empowered, Tampa, FL, USA
| | - Julie Dutil
- Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
| | | | | | - Charité Ricker
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Patricia Rodriguez
- Virginia Cancer Specialists, Arlington, VA, USA.,US Oncology Network, Virginia, VA, USA
| | - Neelima Denduluri
- Virginia Cancer Specialists, Arlington, VA, USA.,US Oncology Network, Virginia, VA, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center and Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
| | - Kristi D Graves
- Lombardi Comprehensive Cancer Center and Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC, USA
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7
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Schapira MM, Faghri A, Jacobs EA, Fletcher KE, Ganschow PS, Gil D, Smallwood AJ, Walker CM, Neuner JM. Communication and Shared Decision Making in the Breast Cancer Treatment Consultation: A Comparative Analysis of English- and Spanish-Speaking Patients. MDM Policy Pract 2019; 4:2381468319881651. [PMID: 31696154 PMCID: PMC6820186 DOI: 10.1177/2381468319881651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/10/2019] [Indexed: 12/17/2022] Open
Abstract
Background. Communication in the breast cancer treatment consultation is complex. Language barriers may increase the challenge of achieving patient-centered communication and effective shared decision making. Design. We conducted a prospective cohort study among Spanish- and English-speaking women with stage 0 to 3 breast cancer in two urban medical centers in the Midwestern United States. Patient centeredness of care and decisional conflict were compared between Spanish- and English-speaking participants using the Interpersonal Processes of Care (IPC) and Decision Conflict Scale (DCS), respectively. Clinician behaviors of shared decision making were assessed from consultation audio-recordings using the 12-item Observing Patient Involvement in Decision Making (OPTION) scale. Multivariate regression analyses were conducted to control for differences in baseline characteristics and clinician specialty. Results. Fifteen Spanish-speaking and 35 English-speaking patients were enrolled in the study. IPC scores (median, interquartile range [IQR]) were higher (less patient centered) in Spanish- versus English-speaking participants in the domains of lack of clarity (2.5, 1-3 v. 1.5, 1-2), P = 0.028; perceived discrimination (1.1, 1-1 v. 1.0, 1-1), P = 0.047; and disrespectful office staff (1.25, 1-2 v. 1.0, 1-1), P < 0.0005 (Wilcoxon rank-sum test). OPTION scores (median, IQR) were lower in Spanish- versus English-speaking participants (21.9, 17.7-27.1 v. 31.3, 26.6-39.6), P = 0.001 (Wilcoxon rank-sum test). In multivariate analysis, statistically significant differences persisted in the IPC lack of clarity and disrespectful office staff between Spanish- and English-speaking groups. Conclusions. Our findings highlight challenges in cancer communication for Spanish-speaking patients, particularly with respect to perceived patient centeredness of communication. Further cross-cultural studies are needed to ensure effective communication and shared decision making in the cancer consultation.
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Affiliation(s)
- Marilyn M Schapira
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Arshia Faghri
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Denise Gil
- Rush University Medical Center, Chicago, Illinois
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Patient Knowledge and Attitudes towards Genetic Testing in Parkinson's Disease Subjects with Deep Brain Stimulation. PARKINSONS DISEASE 2019; 2019:3494609. [PMID: 31143438 PMCID: PMC6501170 DOI: 10.1155/2019/3494609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/15/2019] [Accepted: 04/01/2019] [Indexed: 11/29/2022]
Abstract
Objectives As genetic testing is becoming more widely commercially available for Parkinson's disease (PD) and may have implications regarding clinical outcomes for deep brain stimulation (DBS) and other therapies, we aimed to determine patient knowledge and attitudes towards genetic testing. Methods A sample of 88 PD subjects with bilateral STN-DBS completed a Genetic Attitudes Questionnaire (GAQ). Knowledge and attitudes towards genetic testing were assessed. Results The mean percent of correct responses regarding genetic testing knowledge was 58.5%. Nearly 90% of subjects were unfamiliar with Genetic Information Nondiscrimination Act (GINA). The most important reasons subjects cited in deciding whether to undergo genetic testing included (1) to be a candidate for clinical trials if positive, (2) to learn that they do not carry a mutation, and (3) because a healthcare provider had recommended it. Individuals who influence decision-making include spouses and children. About 88% of subjects would share results with spouses, children, and siblings. Discussion These results reveal that there is a major knowledge gap regarding genetic testing in PD and the implications of testing results on treatment, work, insurance, and privacy. Also, subjects would mainly seek genetic testing to participate in clinical trials, with spouses and children being the key stakeholders in decision-making.
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Hann KEJ, Freeman M, Fraser L, Waller J, Sanderson SC, Rahman B, Side L, Gessler S, Lanceley A. Awareness, knowledge, perceptions, and attitudes towards genetic testing for cancer risk among ethnic minority groups: a systematic review. BMC Public Health 2017; 17:503. [PMID: 28545429 PMCID: PMC5445407 DOI: 10.1186/s12889-017-4375-8] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/07/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Genetic testing for risk of hereditary cancer can help patients to make important decisions about prevention or early detection. US and UK studies show that people from ethnic minority groups are less likely to receive genetic testing. It is important to understand various groups' awareness of genetic testing and its acceptability to avoid further disparities in health care. This review aims to identify and detail awareness, knowledge, perceptions, and attitudes towards genetic counselling/testing for cancer risk prediction in ethnic minority groups. METHODS A search was carried out in PsycInfo, CINAHL, Embase and MEDLINE. Search terms referred to ethnicity, genetic testing/counselling, cancer, awareness, knowledge, attitudes, and perceptions. Quantitative and qualitative studies, written in English, and published between 2000 and 2015, were included. RESULTS Forty-one studies were selected for review: 39 from the US, and two from Australia. Results revealed low awareness and knowledge of genetic counselling/testing for cancer susceptibility amongst ethnic minority groups including African Americans, Asian Americans, and Hispanics. Attitudes towards genetic testing were generally positive; perceived benefits included positive implications for personal health and being able to inform family. However, negative attitudes were also evident, particularly the anticipated emotional impact of test results, and concerns about confidentiality, stigma, and discrimination. Chinese Australian groups were less studied, but of interest was a finding from qualitative research indicating that different views of who close family members are could impact on reported family history of cancer, which could in turn impact a risk assessment. CONCLUSION Interventions are needed to increase awareness and knowledge of genetic testing for cancer risk and to reduce the perceived stigma and taboo surrounding the topic of cancer in ethnic minority groups. More detailed research is needed in countries other than the US and across a broader spectrum of ethnic minority groups to develop effective culturally sensitive approaches for cancer prevention.
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Affiliation(s)
- Katie E J Hann
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Madeleine Freeman
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Lindsay Fraser
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Saskia C Sanderson
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Belinda Rahman
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Lucy Side
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Sue Gessler
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK
| | - Anne Lanceley
- Department of Women's Cancer, EGA UCL Institute for Women's Health, University College London, London, UK.
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Insights into BRCA1/2 Genetic Counseling from Ethnically Diverse Latina Breast Cancer Survivors. J Genet Couns 2017; 26:1221-1237. [DOI: 10.1007/s10897-017-0096-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 03/22/2017] [Indexed: 01/29/2023]
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11
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Sandberg JC, Rodriguez G, Howard TD, Quandt SA, Arcury TA. "He Beat You in the Blood": Knowledge and Beliefs About the Transmission of Traits Among Latinos from Mexico and Central America. J Immigr Minor Health 2017; 19:170-178. [PMID: 26660317 PMCID: PMC4903094 DOI: 10.1007/s10903-015-0311-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Genomic literacy is becoming increasingly important. Knowledge about how Latinos from Mexico and Central America (MCA) think and speak about how traits are shared by family members is needed. Semi-structured in-depth interviews were conducted with 16 MCA Latino men and women. Interviews elicited detailed information about participant beliefs and knowledge about intergenerational trait transmission, genes and genetics. Transcripts were systematically analyzed. Most participants had familiarity with the role of genes. Knowledge about gene function was limited. Participants used "blood talk" to discuss awareness that traits are transmitted between generations and to express that blood itself plays a crucial role often, but not necessarily, in conjunction with genes or DNA to transmit traits. Health educators need to directly address potential confusion about blood's role in the transmission of traits. Culturally and linguistically appropriate materials are needed to present genetic and genomic information to MCA Latinos.
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Affiliation(s)
- Joanne C Sandberg
- Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Guadalupe Rodriguez
- Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Timothy D Howard
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Sara A Quandt
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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12
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Clinical Cancer Genetics Disparities among Latinos. J Genet Couns 2016; 26:379-386. [PMID: 27957667 DOI: 10.1007/s10897-016-0051-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
The three major hereditary cancer syndromes in Latinos (Hereditary Breast and Ovarian Cancer, Familial Adenomatous Polyposis and Lynch Syndrome) have been shown to exhibit geographic disparities by country of origin suggesting admixture-based disparities. A solid infrastructure of clinical genetics geared towards diagnosis and prevention could aid in reducing the mortality of these cancer syndromes in Latinos. Currently, clinical cancer genetic services in Latin America are scarce. Moreover, limited studies have investigated the mutational spectrum of these cancer syndromes in Latinos resulting in gaps in personalized medicine affecting diagnosis, treatment and prevention. The following commentary discusses available genotype and clinical information on hereditary cancer in Latinos and highlights the limited access for cancer genetic services in Latin America including barriers to genetic testing and alternatives for providing better access to genetic services. In this review, we discuss the status of clinical genetic cancer services for both US Latinos and those Latinos living in Latin America.
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13
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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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14
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Peshkin BN, Kelly S, Nusbaum RH, Similuk M, DeMarco TA, Hooker GW, Valdimarsdottir HB, Forman AD, Joines JR, Davis C, McCormick SR, McKinnon W, Graves KD, Isaacs C, Garber J, Wood M, Jandorf L, Schwartz MD. Patient Perceptions of Telephone vs. In-Person BRCA1/BRCA2 Genetic Counseling. J Genet Couns 2016; 25:472-82. [PMID: 26455498 PMCID: PMC4829475 DOI: 10.1007/s10897-015-9897-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
Abstract
Telephone genetic counseling (TC) for hereditary breast/ovarian cancer risk has been associated with positive outcomes in high risk women. However, little is known about how patients perceive TC. As part of a randomized trial of TC versus usual care (UC; in-person genetic counseling), we compared high risk women's perceptions of: (1) overall satisfaction with genetic counseling; (2) convenience; (3) attentiveness during the session; (4) counselor effectiveness in providing support; and (5) counselor ability to recognize emotional responses during the session. Among the 554 participants (TC, N = 272; UC, N = 282), delivery mode was not associated with self-reported satisfaction. However, TC participants found counseling significantly more convenient than UC participants (OR = 4.78, 95 % CI = 3.32, 6.89) while also perceiving lower levels of support (OR = 0.56, 95 % CI = 0.40-0.80) and emotional recognition (OR = 0.53, 95 % CI = 0.37-0.76). In exploratory analyses, we found that non-Hispanic white participants reported higher counselor support in UC than in TC (69.4 % vs. 52.8 %; OR = 3.06, 95 % CI = 1.39-6.74), while minority women perceived less support in UC vs. TC (58.3 % vs. 38.7 %; OR = 0.80, 95 % CI = 0.39-1.65). We discuss potential research and practice implications of these findings which may further improve the effectiveness and utilization of TC.
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Affiliation(s)
- Beth N Peshkin
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
| | - Scott Kelly
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
| | | | - Morgan Similuk
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Tiffani A DeMarco
- Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA, USA
| | | | - Heiddis B Valdimarsdottir
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Reyjavik University, Reyjavik, Iceland
| | - Andrea D Forman
- Department of Clinical Genetics, Risk Assessment Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jessica Rispoli Joines
- Department of Medicine, Division of Hematology/Oncology, Marlene and Stewart Greenebaum Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - Claire Davis
- Joan H. Marks Graduate Program in Human Genetics, Sarah Lawrence College, Yonkers, NY, USA
| | - Shelley R McCormick
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Wendy McKinnon
- Familial Cancer Program, University of Vermont Cancer Center, Burlington, VT, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Claudine Isaacs
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Judy Garber
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Marie Wood
- Familial Cancer Program, University of Vermont Cancer Center, Burlington, VT, USA
| | - Lina Jandorf
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marc D Schwartz
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
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15
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Targeted Ovarian Cancer Education for Hispanic Women: A Pilot Program in Arizona. J Community Health 2015; 41:619-25. [DOI: 10.1007/s10900-015-0137-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Scherr CL, Vasquez E, Quinn GP, Vadaparampil ST. Genetic counseling for hereditary breast and ovarian cancer among Puerto Rican women living in the United States. Rev Recent Clin Trials 2014; 9:245-253. [PMID: 25626062 PMCID: PMC4530991 DOI: 10.2174/1574887110666150127110314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/02/2014] [Accepted: 12/08/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Little is known about barriers to Hereditary Breast and Ovarian Cancer (HBOC) genetic counseling among Puerto Rican women. OBJECTIVE This study reviews existing literature to identify individual, interpersonal, and systems level factors that may impact the use of HBOC genetic services among Puerto Rican women living in the United States. METHODS A systematic search of articles published between the years 1995-2014 was performed in PubMed and ISI Web of Science. Additionally, the bibliography of relevant articles was reviewed for additional potential articles. RESULTS Individual level barriers most frequently identified included: a lack of knowledge or awareness about HBOC or genetic counseling and testing, and facilitators included high levels of interest in genetic counseling/genetic testing. Interpersonal level barriers included worry about knowing a family member's risk, and conversely, a facilitator was the ability to help family members. Systems level barriers included concerns about the cost, having competing life demands, whereas facilitators included holding private insurance. CONCLUSION Puerto Rican women are a unique ethnic minority group with specific perceptions, beliefs and levels of education about genetic counseling and testing for HBOC. Addressing individual, interpersonal and systems level factors unique to this group may improve knowledge and awareness. Policy and structural changes may be needed to improve system level barriers.
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17
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Pal T, Vadaparampil ST. Genetic risk assessments in individuals at high risk for inherited breast cancer in the breast oncology care setting. Cancer Control 2013; 19:255-66. [PMID: 23037493 DOI: 10.1177/107327481201900402] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND It has become increasingly common to consider BRCA mutation status when determining optimal cancer risk management and treatment options in order to improve patient outcomes. Knowledge about the risk for hereditary cancer at or as close as possible to the time of diagnosis allows patients access to the most risk reduction options available. METHODS This paper illustrates the role of genetic risk assessment for hereditary breast cancer, using hereditary breast and ovarian cancer (HBOC) syndrome as a model due to germline mutations in the BRCA1 and BRCA2. Specifically, the value of genetic counseling and testing for HBOC across the cancer prevention and control continuum is outlined as it pertains to breast cancer. RESULTS In recognition of the importance of risk assessment for hereditary breast cancer, leading health professional organizations have developed specific guidelines and recommendations to providers for identification of women at increased risk for carrying a BRCA mutation. CONCLUSIONS Institutional efforts specific to genetic counseling and testing have resulted in the implementation of a model driven by physician recommendation as a referral system for high-risk breast cancer patients. Establishing an infrastructure to support research, education, and outreach initiatives focused on BRCA genetic counseling and testing will provide information that can improve the delivery of cancer genetics services.
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Affiliation(s)
- Tuya Pal
- Population Sciences Department of Cancer Epidemiology, Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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18
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August EM, Quinn GP, Perales R, Closser Z, Dutil J, Puig M, Vadaparampil ST. Important considerations for recruiting women to cancer genetics studies in Puerto Rico. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:105-11. [PMID: 21866412 PMCID: PMC4528373 DOI: 10.1007/s13187-011-0265-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
A goal of the Minority Institution/Cancer Center Partnership between the Ponce School of Medicine in Puerto Rico and the H. Lee Moffitt Cancer Center & Research Institute in Florida is to provide cross-cultural training in cancer research. This is achieved through a collaborative summer exchange program, which provides US students with an opportunity to conduct research in Puerto Rico. As part of this program, students recruited participants and collected data for a study to enhance the understanding of sociocultural factors among Puerto Rican women regarding genetic testing for hereditary breast/ovarian cancer. Limited studies have examined cancer genetics issues among Latinos, particularly those specific to the various Latino subgroups, such as Puerto Ricans. As a result of the student training experience, culturally appropriate strategies for the recruitment of women in Puerto Rico have been identified. These recommendations can inform the design of cancer research projects and interventions targeting the Puerto Rican population.
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Affiliation(s)
- Euna M August
- Health Outcomes & Behavior Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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19
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Gwede CK, Castro E, Brandon TH, McIntyre J, Meade CD, Munoz-Antonia T, Simmons VN, Vadaparampil ST, Jimenez J, Quinn GP. Developing strategies for reducing cancer disparities via cross-institutional collaboration: outreach efforts for the partnership between the Ponce School of Medicine and the Moffitt Cancer Center. Health Promot Pract 2011; 13:807-15. [PMID: 22167362 DOI: 10.1177/1524839911404227] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The disproportionate burden of cancer among U.S. Hispanics is well documented. Historically, epidemiologic data on U.S. Hispanics and cancer have aggregated all Hispanics as one homogeneous group without appreciating the diversity of this population with regard to nativity (nationality/geographic origin). The authors report on the initial efforts of a collaborative academic institutional partnership between a minority-serving institution and a National Cancer Institute-designated cancer center to address cancer health disparities in two Hispanic communities in Puerto Rico and Florida. This article outlines the joint Outreach Program's initial collaborative strategies and activities in community outreach, cancer education, and research that mutually benefit both the Ponce (Puerto Rico) and Tampa (Florida) Hispanic communities. This partnership program used innovative multipronged community-engagement strategies in the two communities to reduce cancer health disparities. Specific projects and lessons learned from three outreach/cancer education projects and two pilot research projects are discussed. The challenges of balancing service and research agendas in communities with disparate levels of resources and infrastructure are summarized to inform future initiatives in this partnership, as well as serve as an example for similar minority-serving institution/cancer center partnerships to reduce cancer health disparities.
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Affiliation(s)
- Clement K Gwede
- H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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20
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Vadaparampil ST, Quinn GP, Dutil J, Puig M, Malo TL, McIntyre J, Perales R, August EM, Closser Z. A pilot study of knowledge and interest of genetic counseling and testing for hereditary breast and ovarian cancer syndrome among Puerto Rican women. J Community Genet 2011; 2:211-21. [PMID: 22109874 DOI: 10.1007/s12687-011-0058-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 06/30/2011] [Indexed: 12/31/2022] Open
Abstract
This study explored baseline levels of knowledge and attitude toward genetic testing (GT) for hereditary breast and ovarian cancer among Puerto Rican women. A secondary aim was to evaluate whether these factors differed between respondents in Puerto Rico and Tampa. Puerto Rican women with a personal or family history of breast or ovarian cancer who live in Puerto Rico (n = 25) and Tampa (n = 20) were interviewed. Both groups were interested in obtaining GT; women living in Puerto Rico were more likely to report they would get GT within 6 months (p = 0.005). The most commonly cited barrier was cost; the most commonly cited facilitator was provider recommendation. There was no difference in overall knowledge between Tampa (M = 5.15, SD = 1.63) and Puerto Rico (M = 5.00, SD = 1.87) participants (p = 0.78). Involving health care providers in recruitment and highlighting that GT may be available at minimal or no cost in the USA and Puerto Rico may facilitate participation.
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Affiliation(s)
- Susan T Vadaparampil
- Health Outcomes and Behavior Program, Moffitt Cancer Center, 12902 Magnolia Drive, MRC CANCONT, Tampa, FL, 33612, USA,
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21
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Quinn GP, McIntyre JQ, Vadaparampil ST. Challenges in recruiting Mexican women for cancer genetics research. J Community Genet 2011; 2:43-7. [PMID: 22109723 PMCID: PMC3186020 DOI: 10.1007/s12687-010-0032-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022] Open
Abstract
Hispanic women often have low participation rates in cancer genetics research. Additionally, Hispanic sub-ethnicities may have varying accrual rates based on unique cultural factors. Hispanic women were recruited through flyers placed in the Tampa Bay Community to participate in an interview about knowledge of hereditary breast and ovarian cancer. The study goal was to recruit 20 women from each Hispanic sub-ethnicity: Puerto Rican, Mexican, and Cuban. This article reports on the difficulty in recruiting Mexican women. One hundred forty-three women called the study hotline to inquire about participation. Seventy-six callers were ineligible for the study. Thirty-four percent (n = 26) of ineligibles were Mexican women; within this group, 62% (n = 16) were unable to participate because they did not know the cancer site of their first degree relative. Inclusion criteria requiring knowledge of family history of cancer for behavioral research may be too stringent. The socio-cultural norms of Mexican families may not include discussions of cancer specifics. This study demonstrates Mexican women may have limited knowledge about their family history of cancer. Considerations of these knowledge limitations should be built into cancer genetics-related research. Referral criteria to assess the risk of hereditary breast and ovarian cancer by cancer genetics professionals are predicated on the patient providing details about cancer within multiple generations of family members, thus, posing a barrier for Mexican women who may have limited knowledge of their family history of cancer.
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Affiliation(s)
- Gwendolyn P Quinn
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, 33612, USA,
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22
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Vadaparampil ST, McIntyre J, Quinn GP. Awareness, perceptions, and provider recommendation related to genetic testing for hereditary breast cancer risk among at-risk Hispanic women: similarities and variations by sub-ethnicity. J Genet Couns 2010; 19:618-29. [PMID: 20798982 DOI: 10.1007/s10897-010-9316-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 07/23/2010] [Indexed: 10/19/2022]
Abstract
This study explored awareness of risk factors for hereditary breast and ovarian cancer (HBOC), awareness, knowledge and concerns about genetic testing, and preference for how to have genetic testing recommended by a care provider among at-risk Hispanic women. Differences in these factors among Mexican, Cuban, and Puerto Rican women were also examined. Women with a personal or family history of breast or ovarian cancer from the Tampa Bay Area participated in a qualitative interview (N = 53). Data were analyzed using a combination of open and axial coding with a grounded theory approach. Study participants in all groups reported: being aware that family history was a breast cancer risk factor, limited knowledge of genetic testing, fear of test results, concerns about children's risks, and no physician referral for genetic testing. Noteworthy sub-ethnic differences included preferences for physician recommendation and information about genetic testing. This study provides important preliminary information about areas related to HBOC that require additional education in the Hispanic community as a whole and by sub-ethnicity.
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Affiliation(s)
- Susan T Vadaparampil
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL 33612, USA.
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