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Lacson JCA, Sutton SK, Kim Y, Roetzheim RG, Vadaparampil ST, Soto-Torres B, Kanetsky PA. Predictors of correct recall of genetic risk information among Hispanic individuals in Florida and Puerto Rico. PATIENT EDUCATION AND COUNSELING 2023; 117:107978. [PMID: 37708699 PMCID: PMC10872848 DOI: 10.1016/j.pec.2023.107978] [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: 06/20/2023] [Revised: 09/03/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To identify predictors of genetic risk recall and examine whether recall influences adoption of skin cancer preventive behaviors among Hispanic individuals. METHODS Hispanic participants randomized to intervention arms (n = 463) of a precision prevention trial were provided MC1R risk information (average, higher) and asked to recall their risk after 3 and 9 months. Predictors of recall (correct versus did not recall/misremembered) were determined by backwards stepwise logistic regression. Intervention effects on preventive behaviors were estimated within strata of 3-month recall. RESULTS Age inversely predicted correct recall in both risk groups (average: OR3-months(3)= 0.97, 95%CI:0.94-1.01, OR9-months(9)= 0.96, 95%CI:0.93-0.99; higher: OR3 = 0.98, 95%CI:0.95-1.01, OR9 = 0.98, 95%CI:0.95-1.00). Education positively predicted recall among participants at average risk (OR3 =1.64, 95%CI:1.06-2.63, OR9 =1.73, 95%CI:1.12-2.81). Darker untanned skin color inversely predicted recall among participants at higher risk (OR3 =0.68, 95%CI:0.45-0.99, OR9 =0.74, 95%CI:0.50-1.09). Intervention effects for routine sunscreen use and undergoing a clinical skin exam were stronger among participants at higher risk who correctly recalled at 3 months than those who did not recall/misremembered. CONCLUSIONS Younger age, higher education, and lighter untanned skin color predicted correct recall. Better recall may improve skin cancer prevention outcomes. PRACTICE IMPLICATIONS Additional strategies are needed to boost recall among Hispanic individuals who are older, less educated, and darker-skinned.
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Affiliation(s)
- John Charles A Lacson
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Richard G Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Susan T Vadaparampil
- Department of Health and Behavioral Outcomes, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
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Lacson JCA, Soto-Torres B, Sutton SK, Doyle SH, Kim Y, Roetzheim RG, Vadaparampil ST, Kanetsky PA. Skin cancer prevention behaviors, beliefs, distress, and worry among hispanics in Florida and Puerto Rico. BMC Public Health 2023; 23:2234. [PMID: 37957686 PMCID: PMC10644628 DOI: 10.1186/s12889-023-17039-y] [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: 06/07/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Incidence of skin cancer has been increasing among U.S. Hispanics, who often are diagnosed with larger lesions and at later stage disease. Behaviors to decrease exposure to ultraviolet radiation can reduce risk of skin cancer. We describe skin cancer prevention behaviors and psychosocial variables among Hispanic participants recruited into a skin cancer prevention trial. METHODS Self-reported Hispanic participants from eight primary care clinics in Tampa, Florida and Ponce, Puerto Rico were recruited into a randomized controlled prevention trial. Information on demographics, sun-related behaviors, and psychosocial variables were collected before intervention materials were provided. Multivariable regression models were used to compare baseline sun-related behaviors and psychosocial variables across groups defined by geographic location and language preference. RESULTS Participants reported low levels of intentional outdoor tanning, weekday and weekend sun exposure, and very low levels of indoor tanning. However, only a minority of participants practiced sun-protective behaviors often or always, and about 30% experienced a sunburn in the past year. Participants had low levels of recent worry and concern about skin cancer, modest levels of perceived risk and severity, and high levels of response efficacy and self-efficacy. When comparing across groups defined by geographic location and language preference, English-preferring Tampa residents (hereafter referred to as Tampeños) had the highest proportion who were sunburned (35.9%) and tended toward more risky behavior but also had higher protective behavior than did Spanish-preferring Tampeños or Puerto Ricans. Spanish-preferring Puerto Ricans had higher recent concern about skin cancer, comparative chance of getting skin cancer, and response efficacy compared to either English- or Spanish-preferring Tampeños. Spanish-preferring Tampeños had the highest levels of familism and recent distress about skin cancer. CONCLUSIONS Our results mirror previous observations of low levels of sun-protective behavior among U.S. Hispanics compelling the need for culturally appropriate and translated awareness campaigns targeted to this population. Because Hispanics in Tampa and Puerto Rico reported modest levels of perceived risk and severity, and high levels of response efficacy and self-efficacy, interventions aiming to improve skin cancer prevention activities that are anchored in Protection Motivation Theory may be particularly effective in this population subgroup.
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Affiliation(s)
- John Charles A Lacson
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Dr., MRC 213, Tampa, FL, 33612, US
| | | | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, US
| | - Scarlet H Doyle
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Dr., MRC 213, Tampa, FL, 33612, US
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, US
| | - Richard G Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, US
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, US
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Dr., MRC 213, Tampa, FL, 33612, US.
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Crowder SL, Buro AW, Lacson JCA, Del Rio J, Kim Y, Roetzheim RG, Sutton SK, Vadaparampil ST, Soto-Torres B, Stern M, Kanetsky PA. Qualitative assessment of uptake retention and evaluation of prevention materials for skin cancer among Hispanics. PATIENT EDUCATION AND COUNSELING 2023; 112:107742. [PMID: 37028174 PMCID: PMC10164708 DOI: 10.1016/j.pec.2023.107742] [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: 01/19/2023] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Examine retention and evaluation of incorporating melanocortin-1 receptor genetic risk information materials in a skin cancer prevention intervention conducted in Hispanics living near Tampa, Florida and Ponce, Puerto Rico. METHODS Two researchers applied thematic content analysis to identify major themes of open-ended responses (n = 1689) from 489 participants. RESULTS Five major thematic categories emerged: 1) intervention comments; 2) tips and tricks; 3) cancer prevention; 4) general information; and 5) risk factors and genetics. Responses captured under intervention comments (e.g., information was clear, easy to understand) and tips and tricks for sun protection (e.g., using sunscreen, wearing protective clothing) were most frequent. Participants noted the importance of conducting skin exams professionally or at home. English-preferring Tampa residents stated their individual risk factors, especially race and/or ethnicity, more frequently than Ponce residents and Spanish-preferring Tampa residents. Ponce residents were more likely to comment on wanting to share intervention materials with family and friends. CONCLUSION Findings suggest Hispanic participants implemented sun safety activities.
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Affiliation(s)
- Sylvia L Crowder
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA
| | - Acadia W Buro
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA
| | - John Charles A Lacson
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA
| | - Jocelyn Del Rio
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Richard G Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA
| | | | - Marilyn Stern
- Department of Child and Family Studies, University of South Florida, Tampa, USA
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA.
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Gómez-Trillos S, Graves KD, Fiallos K, Schwartz MD, Peshkin BN, Hamilton H, Sheppard VB, Vadaparampil ST, Campos C, Cupertino AP, Alzamora MC, Lynce F, Hurtado-de-Mendoza A. Cultural adaptations to a telephone genetic counseling protocol and booklet for Latina breast cancer survivors at risk for hereditary breast and ovarian cancer. Transl Behav Med 2023; 13:297-308. [PMID: 36694918 PMCID: PMC10182423 DOI: 10.1093/tbm/ibac106] [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] [Indexed: 01/26/2023] Open
Abstract
Telephone genetic counseling (TGC) is accepted as standard clinical care for people seeking hereditary cancer risk assessment. TGC has been shown to be non-inferior to in-person genetic counseling, but trials have been conducted with a predominantly highly educated, non-Hispanic White population. This article describes the process of culturally adapting a TGC protocol and visual aid booklet for Spanish-preferring Latina breast cancer survivors at risk for hereditary breast and ovarian cancers. The adaptation process included two phases. Phase 1 involved a review of the literature and recommendations from an expert team including community partners. Phase 2 included interviews and a pilot with the target population (n = 14) to collect feedback about the adapted protocol and booklet following steps from the Learner Verification and Revision Framework. We describe the adaptation process and report the main adaptations following the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions (FRAME). Adaptations in Phase 1 were responsive to the target population needs and characteristics (e.g., delivered in Spanish at an appropriate health literacy level, addressing knowledge gaps, targeting cultural values). Phase 2 interviews were crucial to refine details (e.g., selecting words) and to add components to address GCT barriers (e.g., saliva sample video). Cultural adaptations to evidence-based TGC protocols can increase the fit and quality of care for historically underserved populations. As TGC visits become routine in clinical care, it is crucial to consider the needs of diverse communities to adequately promote equity and justice in cancer care.
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Affiliation(s)
- Sara Gómez-Trillos
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Kristi D Graves
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Katie Fiallos
- Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marc D Schwartz
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Beth N Peshkin
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Heidi Hamilton
- Department of Linguistics, Georgetown University, Washington, DC, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University, VA, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Ana Paula Cupertino
- School of Medicine and Dentistry, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Maria C Alzamora
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center/Georgetown University Hospital, Washington, DC, USA
| | | | - Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
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5
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Clark NM, Roberts EA, Fedorenko C, Sun Q, Dubard-Gault M, Handford C, Yung R, Cheng HH, Sham JG, Norquist BM, Flanagan MR. Genetic Testing Among Patients with High-Risk Breast, Ovarian, Pancreatic, and Prostate Cancers. Ann Surg Oncol 2023; 30:1312-1326. [PMID: 36335273 DOI: 10.1245/s10434-022-12755-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The National Comprehensive Cancer Network recommends genetic testing in patients with potentially hereditary breast, ovarian, pancreatic, and prostate cancers (HBOPP). Knowledge of genetic mutations impacts decisions about screening and treatment. METHODS A retrospective cohort study of 28,586 HBOPP patients diagnosed from 2013 to 2019 was conducted using a linked administrative-cancer database in the Seattle-Puget Sound SEER area. Guideline-concordant testing (GCT) was assessed annually according to guideline updates. Frequency of testing according to patient/cancer characteristics was evaluated using chi-squared tests, and factors associated with receipt of genetic testing were identified using multivariable logistic regression. RESULTS Testing occurred in 17% of HBOPP patients, increasing from 9% in 2013 to 21% in 2019 (p < 0.001). Ovarian cancer had the highest testing (40%) and prostate cancer the lowest (4%). Age < 50, female sex, non-Hispanic White race, commercial insurance, urban location, family history of HBOPP, and triple negative breast cancer (TNBC) were associated with increased testing (all p < 0.05). GCT increased from 38% in 2013 to 44% in 2019, and was highest for early age at breast cancer diagnosis, TNBC, male breast cancer, and breast cancer with family history of HBOPP (all > 70% in 2019), and lowest for metastatic prostate cancer (6%). CONCLUSIONS The frequency of genetic testing for HBOPP cancer has increased over time. Though GCT is high for breast cancer, there are gaps in concordance among patients with other cancers. Increasing provider and patient education, genetic counseling, and insurance coverage for testing among HBOPP patients may improve guideline adherence.
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Affiliation(s)
- Nina M Clark
- Department of Surgery, University of Washington, Seattle, USA
| | - Emma A Roberts
- University of Washington School of Medicine, Seattle, USA
| | - Catherine Fedorenko
- Hutchinson Institute for Cancer Outcomes Research Fred Hutchinson Cancer Center, Seattle, USA
| | - Qin Sun
- Hutchinson Institute for Cancer Outcomes Research Fred Hutchinson Cancer Center, Seattle, USA
| | - Marianne Dubard-Gault
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, USA.,Fred Hutchinson Cancer Center, Seattle, USA
| | | | - Rachel Yung
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.,Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, USA
| | - Heather H Cheng
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.,Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, USA
| | - Jonathan G Sham
- Department of Surgery, University of Washington, Seattle, USA.,Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, USA
| | - Barbara M Norquist
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
| | - Meghan R Flanagan
- Department of Surgery, University of Washington, Seattle, USA. .,Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, USA.
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Rivera Rivera JN, Conley CC, Castro-Figueroa EM, Moreno L, Dutil J, García JD, Ricker C, Quinn GP, Soliman H, Vadaparampil ST. Behavioral beliefs about genetic counseling among high-risk Latina breast cancer survivors in Florida and Puerto Rico. Cancer Med 2023; 12:4701-4706. [PMID: 35941731 PMCID: PMC9972095 DOI: 10.1002/cam4.5111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022] Open
Abstract
Compared with non-Hispanic White women, Latina women are less likely to receive genetic counseling (GC) and testing (GT) following BC diagnosis. This study used secondary data analysis to explore beliefs about GC among Latina BC survivors in and outside the US mainland. GC/GT-naïve, high-risk, Spanish-preferring Latina BC survivors (n = 52) in FL and PR completed the Behavioral Beliefs about GC scale. Participants reported high positive beliefs about GC (M = 4.19, SD = 0.92); the majority agreed that GC was beneficial to understand cancer risk (90%) and promote discussion (87%) in their family. Participants reported low-to-moderate scores for barriers (Ms = 1.53-3.40; SDs = 0.59-0.90). The most frequently endorsed barriers were desire for additional GC information (M = 3.44; SD = 0.90), and GC logistic concerns (M = 2.71; SD = 0.80). No statistically significant differences for barriers and benefits scales were identified by place of residence (all ps ≥ 0.12). These findings highlight the importance of delivering culturally sensitive GC information to high-risk Latina BC survivors.
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Affiliation(s)
| | - Claire C Conley
- Georgetown University, Washington, District of Columbia, USA
| | | | | | - Julie Dutil
- Ponce Health Sciences University, Ponce, Puerto Rico, USA
| | | | - Charité Ricker
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Gwendolyn P Quinn
- Grossman School of Medicine, Department of OB-GYN New York, New York University, New York, New York, USA
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Villavicencio EA, Maldonado A, Crocker RM, Guan Y, Stallman C, Garcia DO. Communicating PNPLA3 genetic risk status for NAFLD among Mexican-origin men. Front Public Health 2023; 10:1090101. [PMID: 36684893 PMCID: PMC9846364 DOI: 10.3389/fpubh.2022.1090101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction The burden of non-alcoholic fatty liver disease (NAFLD) continues to disproportionately impact under-resourced communities in the U.S., particularly Mexican-origin populations. Genetic polymorphisms such as the rs738409 C/G variant in patatin-like phospholipase domain-containing 3 (PNPLA3) have been associated with higher prevalence of and progression along the NAFLD spectrum. This qualitative study conducted in the U.S. Southwest aimed to assess Mexican-origin men's experience receiving genetic testing for PNPLA3 risk carrier status. Methods Semi-structured interviews were conducted with 17 Mexican-origin men whose NAFLD status and genetic predisposition were determined as part of a previous cross-sectional study. The interview guide included questions exploring participants' insights on how genetic risk status was delivered, how the information influenced their motivation for lifestyle modification to reduce NAFLD risk, and any knowledge sharing that occurred with family members after learning of their PNPLA3 risk status. Interviews were conducted and audio recorded in English (n = 6) and Spanish (n = 11) and uploaded into NVivo software for data analysis and interpretation. Guided by the Health Belief Model, a thematic analysis approach was used to identify primary themes. Results Results highlighted men's preference for receiving this type of genetic risk information through a letter sent to their homes. General comprehension of PNPLA3 risk status was deemed high and most men stated sharing their genetic predisposition to NAFLD with their immediate family members. Participants also indicated that family and awareness of this genetic risk acted as primary motivators for implementing behavior changes (e.g., diet, physical activity) toward the prevention of more severe liver conditions. Discussion Findings from this qualitative study suggest the feasibility of communicating genetic risk for NAFLD among Mexican-origin men. Future strategies for the dissemination of genetic risk results among Mexican-origin individuals should consider familial and cultural appropriate strategies.
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Affiliation(s)
- Edgar A. Villavicencio
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Adriana Maldonado
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Rebecca M. Crocker
- Center for Border Health Disparities, Health Sciences, University of Arizona, Tucson, AZ, United States
| | - Yue Guan
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Chris Stallman
- Genetic Counseling Graduate Program, University of Arizona, Tucson, AZ, United States
| | - David O. Garcia
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Calderon-Casellas C, Lacson JCA, Forgas SM, Doyle SH, Del Rio J, Feliciano AR, Kim Y, Roetzheim RG, Sutton SK, Vadaparampil ST, Soto-Torres B, Kanetsky PA. Assessment of skin cancer precision prevention materials among Hispanics in Florida and Puerto Rico. PATIENT EDUCATION AND COUNSELING 2022; 105:3143-3150. [PMID: 35778318 DOI: 10.1016/j.pec.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess Hispanic participants' ratings of intervention materials and examine differences by language preference. METHODS Participants on a skin cancer prevention trial were randomized to receive generic (n = 457) or precision prevention materials conveying average (n = 195) or higher genetic risk (n = 268) based on MC1R genotype. Three months after receiving either English or Spanish language prevention materials, participants reported amount read, believability and clarity of materials, and intention to change preventive behavior. RESULTS Participants reported high levels on all four outcomes, but the precision prevention groups noted lower clarity than the generic group (p = 3.2 ×10-6). Participants preferring Spanish provided consistently higher scores than those preferring English. Among English-preferring participants, those in the precision prevention groups scored lower on all measures than those in the generic group. CONCLUSIONS Skin cancer prevention materials were well-received by Hispanic participants. Higher scores among participants preferring Spanish may indicate acquiescence bias, or that translated prevention materials met their linguistic needs. Participants in the precision prevention groups with English language preference may have challenges in the uptake of genetic risk results. PRACTICE IMPLICATIONS Availability of Spanish materials may have facilitated higher scores. Additional strategies should be explored to optimize participants' believability and clarity of precision prevention materials.
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Affiliation(s)
| | - John Charles A Lacson
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Stephanie M Forgas
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Scarlet H Doyle
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jocelyn Del Rio
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Richard G Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Susan T Vadaparampil
- Department of Health and Behavioral Outcomes, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
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Makhnoon S, Maki KG, Yu R, Peterson SK, Shete S. Are beliefs about the importance of genetics for cancer prevention and early detection associated with high risk cancer genetic testing in the U.S. Population? Prev Med Rep 2022; 27:101781. [PMID: 35378849 PMCID: PMC8976149 DOI: 10.1016/j.pmedr.2022.101781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/18/2022] [Accepted: 03/26/2022] [Indexed: 11/10/2022] Open
Abstract
Public attitudes towards germline genetic testing for inherited cancers have been found to be generally positive. Past research demonstrated that diverse causal beliefs and contextual factors are associated with uptake of genetic testing. However, it is unclear how beliefs about genetically informed cancer prevention and early detection ultimately shape testing behaviors. We used data from the National Health Information National Trends Survey (HINTS 5 Cycle 4) to evaluate these beliefs and the relationship between beliefs related to cancer genetics and participation in cancer genetic testing. Overall, 5.24% of the total weighted sample underwent cancer genetic testing, of whom 70.5% (n = 141) had no personal history of cancer, whereas others had a personal diagnosis of breast, ovarian, or colorectal cancer (23.0%), or other cancers (6.5%). In adjusted multivariable analysis, testing was positively associated with personal history of breast, ovarian, or colorectal cancer (OR = 28.37, 95% CI: 10.19–79.04), female sex (OR = 2.97, 95% CI: 1.41–6.26), having high cancer worry (OR = 4.78, 95%: 2.19–10.45), and negatively associated with being Hispanic (OR = 0.37, 95%: 0.16–0.86) or non-Hispanic Asian (OR = 0.12, 95% CI: 0.04–0.33). Belief in the importance of genetics for early detection of cancer was associated with testing (OR = 18.03, 95% CI: 4.07–79.79), whereas belief in the importance of genetics for cancer prevention was not. The association between testing and belief about the importance of genetics for early detection of cancer, but not cancer prevention, is a surprising finding that warrants further research. Better understanding of these beliefs and their potential impact on test uptake may inform population genetic testing efforts.
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10
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Participation in genetic research among Latinx populations by Latin America birth-residency concordance: a global study. J Community Genet 2021; 12:603-615. [PMID: 34378176 DOI: 10.1007/s12687-021-00538-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022] Open
Abstract
Latinx populations are underrepresented in DNA-based research, and risk not benefiting from research if underrepresentation continues. Latinx populations are heterogenous; reflect complex social, migration, and colonial histories; and form strong global diasporas. We conducted a global study using a survey tool (Amazon's Mechanical Turk portal) to ascertain willingness to participate in genetic research by Latin America birth-residency concordance. Participants in the global study identified as Latinx (n=250) were classified as the following: (1) born/live outside of Latin America and the Caribbean (LAC), (2) born within/live outside LAC, and (3) born/live within LAC. Latinx were similarly likely to indicated they would participate DNA-based research as their non-Latinx counterparts (52.8% vs. 56.2%, respectively). Latinx born and living in LAC were significantly more willing to participate in DNA-based research than Latinx born and living outside of LAC (OR: 2.5; 95% CI: 1.3, 4.9, p<.01). Latinx indicating they would participate in genetic research were more likely to trust researchers (<.05), believe genetic research could lead to better understanding of disease (<.05), and that genetic research could lead to new treatments (p<.05) when compared with Latinx not interested in participating in genetic research. In summary, significant variation exists in genetic research interest among Latinx based on where they were born and live, suggesting that this context itself independently influences decisions about participation. Cultivating and investing in a research ecosystem that addresses, values, and respects Latinx priorities, circumstances, and researchers would likely increase research participation and, even more importantly, potentially impact the inequitable health disparities disproportionately represented in Latinx communities.
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11
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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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12
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Cheema AW, Sutton EJ, Beck AT, Cuellar I, Moreno Garzon GG, Hernandez V, Lindor NM, Shaibi GQ, Kullo IJ, Sharp RR. Experiences of Latino Participants Receiving Neutral Genomic Screening Results: A Qualitative Study. Public Health Genomics 2021; 24:44-53. [PMID: 33592611 PMCID: PMC10291848 DOI: 10.1159/000513219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of the study was to characterize experiences of Latino participants receiving genomic screening results. METHODS Participants were recruited at a federally qualified health center in the USA. In-person, semi-structured interviews were conducted in either Spanish or English by a bilingual, bicultural interviewer. Questions focused on motivations for pursuing genomic sequencing, concerns about receiving genomic screening results, and perceived benefits of receiving genomic information. Interviews were audio-recorded, transcribed, and translated. RESULTS Fifty individuals completed an interview; 39 were conducted in Spanish. Participants described mixed motivations for pursuing genomic screening. Participants viewed the benefits of genomic screening in relation to not only their personal health but to the health of their families and their communities. Participants tended to have few concerns about genomic screening. Those concerns related to potential loss of privacy, misuses of genomic information, and the possibility of receiving distressing results. Some participants had misunderstandings about the scope of the test and the potential implications of their results. Most felt it was better to know about a genetic predisposition to disease than to remain uninformed. Participants felt that genomic screening was worthwhile. DISCUSSION This is one of the first studies to examine the experiences of Latino individuals receiving genomic screening results. Our results suggest that many Latino patients in the US see value in genomic screening and have limited concerns about its potential to cause harm. These results inform ongoing efforts to increase the availability of genomic medicine to underrepresented populations and add to our understanding of sociocultural drivers in the adoption of precision medicine.
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Affiliation(s)
- Amal W Cheema
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Erica J Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Annika T Beck
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Idali Cuellar
- Biospecimens Accessioning and Processing, Mayo Clinic, Scottsdale, Arizona, USA
| | | | | | - Noralane M Lindor
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA,
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA,
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13
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Hurtado-de-Mendoza A, Gómez-Trillos S, Graves KD, Carrera P, Campos C, Anderson L, Gronda A, Orellana H, Peshkin BN, Schwartz MD, Cupertino P, Ostrove N, Luta G, Gonzalez N, Sheppard VB. Process evaluation of a culturally targeted video for Latinas at risk of hereditary breast and ovarian cancer. J Genet Couns 2020; 30:730-741. [PMID: 33222313 DOI: 10.1002/jgc4.1361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022]
Abstract
This paper presents a process evaluation of a culturally targeted narrative video about hereditary breast and ovarian cancer (HBOC) for Latina women at risk for HBOC. Spanish-speaking Latina women at risk for HBOC participated in a single arm study (n = 40). Participants watched the video developed by the authors and responded to surveys. We used mixed methods to assess theoretical constructs that are hypothesized mediators of narrative interventions (i.e., transportation or engagement, identification with characters, emotions) and implementation outcomes (e.g., acceptability). Descriptive statistics summarized theoretical constructs and implementation outcomes. We conducted Mann-Whitney U tests to assess the differences in theoretical and implementation outcomes between participants who were affected versus. unaffected and participants with different levels of education and health literacy. We used the consensual qualitative research framework to analyze qualitative data. Participants' mean age was 47.1 years (SD = 9.48). Most participants were high school graduates or less (62.5%). Acceptability of the video was extremely high (Md = 10.0, IQR = 0.2, scale 1-10). Most (82.5%) suggested video dissemination be through social media. Participants were highly engaged (Md = 5.7, IQR = 1.5, scale 1-7), strongly identified with the main character (Md = 8.7, IQR = 2.6, scale 1-10), and reported experiencing mostly positive emotions (Md = 9.5, IQR = 2.8, scale 1-10). Participants with low health literacy and affected participants reported a significantly higher identification with the main character (p<.05). Qualitative data reinforced the quantitative findings. Women reported gaining knowledge, correcting misconceptions, and feeling empowered. Our culturally targeted video is highly acceptable and targets mechanisms of behavior change for narrative interventions. The video is easily disseminable and can be used as an education tool for patients including affected and unaffected women and patients with different education and health literacy levels. Future studies should test the impact of the video in enhancing genetic counseling and testing uptake.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Kristi D Graves
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Pilar Carrera
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Lyndsay Anderson
- School of Nursing, College of Health and Human Services, California State University, Sacramento, CA, USA
| | - Andrés Gronda
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Halyn Orellana
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Beth N Peshkin
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Marc D Schwartz
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Paula Cupertino
- Cancer Prevention and Control Program, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - George Luta
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA.,Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | | | - Vanessa B Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, Richmond, VA, USA
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14
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Chavez-Yenter D, Chou WYS, Kaphingst KA. State of recent literature on communication about cancer genetic testing among Latinx populations. J Genet Couns 2020; 30:911-918. [PMID: 33142015 DOI: 10.1002/jgc4.1351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 12/30/2022]
Abstract
Cancer-related genetic testing (hereafter CGT) has transformed cancer prevention, treatment, and care. Researchers debate whether diffusion and use of genetic testing will reduce or widen cancer health disparities through effects on improving or worsening cancer-related mortality, morbidity, and outcomes that disproportionately affect racial and ethnic minority populations. Cancer disparities by race and ethnicity have been associated with social determinants of health and healthcare access and experience. However, little research has explored how communication about CGT may contribute to these disparities. As such, the goal of this study was to characterize the literature published between 2010 and 2017 on communication about CGT among Latinx populations through a secondary analysis of papers identified in a larger scoping review. We found thirteen (2.5%) of 513 papers in the parent scoping review had over 50% Latinx representation; only nine of these (69%) had fully Latinx comprised study cohorts. The majority of the 13 identified studies (n = 9) were conducted to assess knowledge and attitudes regarding CGT. Most studies included services or materials in both Spanish and English. Few studies assessed language preference or acculturation or compared outcomes across sub-ethnicities. We identified opportunities for researchers to explore differences in outcomes by language preference and acculturation, and between sub-ethnicities in future studies. Leveraging a greater understanding of the heterogeneity within the Latinx population will allow genetics researchers and providers to improve utilization of CGT and therein health outcomes to advance health equity.
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Affiliation(s)
- Daniel Chavez-Yenter
- Department of Communication, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Wen-Ying Sylvia Chou
- Health Communication and Informatics Research Branch, National Cancer Institute, Rockville, MD, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
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15
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Knerr S, Ceballos RM, Chan KCG, Beresford SAA, Bowen DJ. Women's beliefs about what causes obesity: variation by race/ethnicity and acculturation in a Washington State sample. ETHNICITY & HEALTH 2020; 25:243-254. [PMID: 29243503 PMCID: PMC6125226 DOI: 10.1080/13557858.2017.1414156] [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: 05/09/2016] [Accepted: 11/19/2017] [Indexed: 06/07/2023]
Abstract
Objective: Individuals' beliefs about the causes of multifactorial health conditions (causal attributions) shape how they conceptualize and respond to health threats and are therefore important for health promotion. Studies of racial/ethnic and cultural variation in obesity causal beliefs, however, are scarce. To address this gap, this study described beliefs about the underlying causes of obesity (genetic inheritance, diet, and physical activity) in Hispanic and non-Hispanic White women participating in a longitudinal cohort study in South King County, Washington State (n = 1,002).Design: Analysis of baseline survey data. Self-reported obesity causal beliefs were compared by race/ethnicity and acculturation indicators (survey language and nativity) using marginal effect estimates generated from multinomial logistic regression models.Results: Hispanic women had a higher probability of not believing 'at all' in inheritance and physical activity as causes of obesity - an absolute increase of 33% and 5% over non-Hispanic White women, respectively. Both acculturation indicators were also associated with a higher probability of not believing 'at all' in inheritance as a cause of obesity, though Hispanic women who completed the survey in English and were born in the United States had genetic causal beliefs similar to non-Hispanic White women. Behavioral attributions did not vary by acculturation indicators in Hispanic women.Conclusions: Differences in obesity casual beliefs, particularly genetic attributions, exist and may be important for developing and delivering effective obesity-related health promotion interventions. Identifying the determinants and public health consequences of cultural variation in obesity attributions should be the focus of future research.
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Affiliation(s)
- Sarah Knerr
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | | | - Kwun Chuen Gary Chan
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Shirley A A Beresford
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, USA
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16
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Gómez‐Trillos S, Sheppard VB, Graves KD, Song M, Anderson L, Ostrove N, Lopez K, Campos C, Gonzalez N, Hurtado‐de‐Mendoza A. Latinas’ knowledge of and experiences with genetic cancer risk assessment: Barriers and facilitators. J Genet Couns 2019; 29:505-517. [DOI: 10.1002/jgc4.1201] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Sara Gómez‐Trillos
- Lombardi Comprehensive Cancer Center Georgetown University Medical Center Washington District of Columbia
- The Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research Washington District of Columbia
| | - Vanessa B. Sheppard
- Department of Health Behavior and Policy Virginia Commonwealth University School of Medicine Richmond Virginia
| | - Kristi D. Graves
- Lombardi Comprehensive Cancer Center Georgetown University Medical Center Washington District of Columbia
- The Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research Washington District of Columbia
| | - Minna Song
- Lombardi Comprehensive Cancer Center Georgetown University Medical Center Washington District of Columbia
| | - Lyndsay Anderson
- Department of Nursing California State University Sacramento California
| | | | - Katherine Lopez
- Lombardi Comprehensive Cancer Center Georgetown University Medical Center Washington District of Columbia
| | | | | | - Alejandra Hurtado‐de‐Mendoza
- Lombardi Comprehensive Cancer Center Georgetown University Medical Center Washington District of Columbia
- The Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research Washington District of Columbia
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17
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Hurtado-de-Mendoza A, Graves KD, Gómez-Trillos S, Carrera P, Campos C, Anderson L, Luta G, Peshkin BN, Schwartz MD, Cupertino AP, Gonzalez N, Sheppard VB. Culturally Targeted Video Improves Psychosocial Outcomes in Latina Women at Risk of Hereditary Breast and Ovarian Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4793. [PMID: 31795362 PMCID: PMC6926842 DOI: 10.3390/ijerph16234793] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 12/17/2022]
Abstract
Latina women at risk of hereditary breast and ovarian cancer (HBOC) have lower awareness, knowledge, and use of genetic counseling and testing services (GCT) than non-Latina Whites. Few interventions have been developed to reduce these disparities among at-risk Latinas. This pilot study assessed the impact of a culturally targeted narrative video developed by our team. The study included 40 Latina immigrants living in the United States who were at risk of HBOC, including affected and unaffected women. We assessed pre-post differences in psychosocial outcomes. Participants were 47.35 years old on average (SD = 9.48). Most (70%) were unaffected with cancer, had an annual income of $40,000 or less (65%), an education of High School or less (62.5%), and were uninsured (77.5%). The video significantly enhanced knowledge (p < 0.001), positive attitudes (p < 0.05), anticipatory positive emotions (p < 0.05), and intentions to participate in counseling (p < 0.001). Importantly, the video also significantly reduced negative attitudes (p < 0.05), and attitudinal ambivalence (p < 0.001). The culturally targeted video shows preliminary evidence in improving psychosocial outcomes related to GCT uptake in Latinas at risk for HBOC. This intervention is a promising easily-disseminable strategy to address disparities in GCT utilization.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Kristi D. Graves
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Pilar Carrera
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Claudia Campos
- Nueva Vida, DC Office—801 N Pitt St., Suite 113, Alexandria, VA 22314, USA;
| | - Lyndsay Anderson
- College of Health and Human Services, School of Nursing, California State University, Sacramento, CA 95819, USA;
| | - George Luta
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Department of Biostatistics, Bioinformatics and Biomathematics, 4000 Reservoir Rd., NW, Washington, DC 20057, USA
| | - Beth N. Peshkin
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Marc D. Schwartz
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA; (K.D.G.); (S.G.-T.); (G.L.); (B.N.P.); (M.D.S.)
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA
| | - Ana-Paula Cupertino
- Cancer Prevention and Control Program, John Theurer Cancer Center, Hackensack University Medical Center, 40 Prospect Avenue, Office number 316, Hackensack, NJ 07601, USA;
| | - Nathaly Gonzalez
- Capital Breast Care Center, 1000 New Jersey Ave, SE, Washington, DC 20003, USA;
| | - Vanessa B. Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, Richmond, VA 23298, USA;
- Massey Cancer Center, Office of Health Equity and Disparities Research, Richmond, VA 23298, USA
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18
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Hurtado-de-Mendoza A, Graves KD, Gómez-Trillos S, Song M, Anderson L, Campos C, Carrera P, Ostrove N, Peshkin BN, Schwartz MD, Ficca N, Cupertino AP, Gonzalez N, Otero A, Huerta E, Sheppard VB. Developing a culturally targeted video to enhance the use of genetic counseling in Latina women at increased risk for hereditary breast and ovarian cancer. J Community Genet 2019; 11:85-99. [PMID: 31104207 DOI: 10.1007/s12687-019-00423-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/25/2019] [Indexed: 01/28/2023] Open
Abstract
Disparities for genetic cancer risk assessment (GCRA) for hereditary breast and ovarian cancer (HBOC) persist between Latina and non-Hispanic Whites. There are few tested culturally targeted interventions. We developed a culturally targeted video to enhance GCRA uptake in at-risk Latinas. Interviews with healthcare providers (n = 20) and at-risk Latinas (n = 20) were conducted as formative research to inform the development of the video. Findings from the formative research, health behavior conceptual models, and evidence-based risk communication strategies informed the messages for the script. Then, we conducted a focus group with at-risk Latinas (n = 7) to obtain feedback for final refinement of the script. The final video was piloted for acceptability and potential dissemination in a sample of Latino community health workers (CHWs) (n = 31). Providers and at-risk Latinas suggested using simple language and visual aids to facilitate comprehension. Participants in the focus group identified areas for further clarification (e.g., cost). The result was an 18-min video that illustrates "Rosa's" story. Rosa learns about HBOC risk factors and overcomes barriers to attend genetic counseling. CHWs reported high overall satisfaction with the video (M = 9.61, SD = .88, range 1-10). A culturally targeted video has the potential to reach underserved populations with low literacy and English proficiency.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA. .,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA.
| | - Kristi D Graves
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Sara Gómez-Trillos
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Minna Song
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA
| | - Lyndsay Anderson
- Department of Nursing, California State University, Sacramento, USA
| | - Claudia Campos
- Nueva Vida, DC Office-Alexandria, 206 N. Washington St. Suite 300, Alexandria, VA, 22314, USA
| | - Pilar Carrera
- Department of Psychology, Universidad Autonoma de Madrid, Madrid, Spain
| | | | - Beth N Peshkin
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Marc D Schwartz
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Nan Ficca
- National Conservatory of Dramatic Arts, Washington, DC, USA
| | - Ana-Paula Cupertino
- Cancer Prevention and Control Program, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Nathaly Gonzalez
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA.,Capital Breast Cancer Center, 1000 New Jersey Ave, SE, Washington, DC, USA
| | - Andrea Otero
- Instituto de Medicina Oncológica y Molecular de Asturias (IMOMA), Av. Richard Grandío, 33193, Oviedo (Asturias), Spain
| | - Elmer Huerta
- Cancer Preventorium, Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving St, NW, Washington, DC, USA
| | - Vanessa B Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, Richmond, VA, USA
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19
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Roberts MC, Mensah GA, Khoury MJ. Leveraging Implementation Science to Address Health Disparities in Genomic Medicine: Examples from the Field. Ethn Dis 2019; 29:187-192. [PMID: 30906168 DOI: 10.18865/ed.29.s1.187] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The integration of genomic data into screening, prevention, diagnosis, and treatment for clinical and public health practices has been slow and challenging. Implementation science can be applied in tackling the barriers and challenges as well as exploring opportunities and best practices for integrating genomic data into routine clinical and public health practice.In this article, we define the state of disparities in genomic medicine and focus predominantly on late-stage research findings. We use case studies from genetic testing for cardiovascular diseases (familial hypercholesterolemia) and cancer (Lynch syndrome and hereditary breast and ovarian cancer syndrome) in high-risk populations to consider current disparities and related barriers in turning genomic advances into population health impact to advance health equity. Finally, we address how implementation science can address these translational barriers and we discuss the strategic importance of collaborative multi-stakeholder approaches that engage public health agencies, professional societies, academic health and research centers, community clinics, and patients and their families to work collectively to improve population health and reduce or eliminate health inequities.
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Affiliation(s)
- Megan C Roberts
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia
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20
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Cragun D, Weidner A, Kechik J, Pal T. Genetic Testing Across Young Hispanic and Non-Hispanic White Breast Cancer Survivors: Facilitators, Barriers, and Awareness of the Genetic Information Nondiscrimination Act. Genet Test Mol Biomarkers 2019; 23:75-83. [PMID: 30676117 DOI: 10.1089/gtmb.2018.0253] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS This study compared facilitators and barriers to genetic testing and determined awareness about the Genetic Information Nondiscrimination Act (GINA) across young Hispanic and non-Hispanic white (NHW) breast cancer (BC) survivors. MATERIALS AND METHODS Women diagnosed with BC of age ≤50 years in 2009-2012 were recruited through the Florida State Cancer Registry to complete a questionnaire. RESULTS There were 1182 participants of which 61% (174/285) of Hispanic patients, and 65% (580/897) of NHW patients had BC testing. Among untested participants, the most common barriers were lack of testing recommendation (44% Hispanics, 32% NHW; p = 0.02) and cost-related concerns (41% Hispanics, 40% NHW; p = 0.83). Among tested participants, the top facilitators were as follows: (1) "To benefit my family's future" (70% Hispanic, 68% NHW), (2) "My doctor recommended testing" (60% Hispanic, 54% NHW), and (3) "Minimal cost to me" (59% Hispanic, 72% NHW). Only 27% of tested and 15% of untested women were aware of GINA; misuse of test results was reported as a barrier for only 6.5%. CONCLUSIONS Rates of genetic testing recommendation are lower among Hispanics, but both groups reported additional barriers. Most are unaware of GINA, yet misuse is not a highly cited barrier. Findings suggest the need to educate providers on the importance of recommending testing to all who meet criteria; increase awareness of newer options for more affordable testing; and bolster facilitators that may increase testing uptake.
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Affiliation(s)
- Deborah Cragun
- 1 Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida.,2 Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Anne Weidner
- 3 Vanderbilt University Medical Center, Department of Medicine, Division of Genetic Medicine, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Joy Kechik
- 1 Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida
| | - Tuya Pal
- 3 Vanderbilt University Medical Center, Department of Medicine, Division of Genetic Medicine, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
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21
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Hurtado-de-Mendoza A, Graves K, Gómez-Trillos S, Anderson L, Campos C, Evans C, Stearns S, Zhu Q, Gonzalez N, Sheppard VB. Provider's Perceptions of Barriers and Facilitators for Latinas to Participate in Genetic Cancer Risk Assessment for Hereditary Breast and Ovarian Cancer. Healthcare (Basel) 2018; 6:healthcare6030116. [PMID: 30227649 PMCID: PMC6164735 DOI: 10.3390/healthcare6030116] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/24/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022] Open
Abstract
The Comprehensive Cancer Network (NCCN) recommends genetic cancer risk assessment (GCRA) referral to women at high risk of hereditary breast and ovarian cancer. Latinas affected by breast cancer have the second highest prevalence of BRCA1/2 mutations after Ashkenazi Jews. Compared to non-Hispanic Whites, Latinas have lower GCRA uptake. While some studies have identified barriers for GCRA use in this population, few studies have focused on health care providers' perspectives. The purpose of the study was to examine providers' perceptions of barriers and facilitators for at-risk Latina women to participate in GCRA and their experiences providing services to this population. We conducted semi-structured interviews with 20 healthcare providers (e.g., genetic counselors, patient navigators) recruited nationally through snowballing. Interviews were transcribed. Two coders independently coded each interview and then met to reconcile the codes using Consensual Qualitative Research guidelines. Providers identified several facilitators for GCRA uptake (e.g., family, treatment/prevention decisions) and barriers (e.g., cost, referrals, awareness, stigma). Genetic counselors described important aspects to consider when working with at-risk Latina including language barriers, obtaining accurate family histories, family communication, and testing relatives who live outside the US. Findings from this study can inform future interventions to enhance uptake and quality of GCRA in at-risk Latina women to reduce disparities.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA.
| | - Kristi Graves
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA.
| | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA.
| | - Lyndsay Anderson
- Department of Nursing, California State University, Sacramento, CA 95819-6096, USA.
| | - Claudia Campos
- Nueva Vida, DC Office-Alexandria, 206 N. Washington St. Suite 300, Alexandria, VA 22314, USA.
| | - Chalanda Evans
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Selma Stearns
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA.
| | - Qi Zhu
- Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC 20007, USA.
| | - Nathaly Gonzalez
- Capital Breast Cancer Center, 1000 New Jersey Ave, SE, Washington, DC 20003, USA.
| | - Vanessa B Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, Richmond, VA 23219, USA.
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22
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Amendola LM, Berg JS, Horowitz CR, Angelo F, Bensen JT, Biesecker BB, Biesecker LG, Cooper GM, East K, Filipski K, Fullerton SM, Gelb BD, Goddard KA, Hailu B, Hart R, Hassmiller-Lich K, Joseph G, Kenny EE, Koenig BA, Knight S, Kwok PY, Lewis KL, McGuire AL, Norton ME, Ou J, Parsons DW, Powell BC, Risch N, Robinson M, Rini C, Scollon S, Slavotinek AM, Veenstra DL, Wasserstein MP, Wilfond BS, Hindorff LA, Plon SE, Jarvik GP, Jarvik GP. The Clinical Sequencing Evidence-Generating Research Consortium: Integrating Genomic Sequencing in Diverse and Medically Underserved Populations. Am J Hum Genet 2018; 103:319-327. [PMID: 30193136 DOI: 10.1016/j.ajhg.2018.08.007] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/15/2018] [Indexed: 01/26/2023] Open
Abstract
The Clinical Sequencing Evidence-Generating Research (CSER) consortium, now in its second funding cycle, is investigating the effectiveness of integrating genomic (exome or genome) sequencing into the clinical care of diverse and medically underserved individuals in a variety of healthcare settings and disease states. The consortium comprises a coordinating center, six funded extramural clinical projects, and an ongoing National Human Genome Research Institute (NHGRI) intramural project. Collectively, these projects aim to enroll and sequence over 6,100 participants in four years. At least 60% of participants will be of non-European ancestry or from underserved settings, with the goal of diversifying the populations that are providing an evidence base for genomic medicine. Five of the six clinical projects are enrolling pediatric patients with various phenotypes. One of these five projects is also enrolling couples whose fetus has a structural anomaly, and the sixth project is enrolling adults at risk for hereditary cancer. The ongoing NHGRI intramural project has enrolled primarily healthy adults. Goals of the consortium include assessing the clinical utility of genomic sequencing, exploring medical follow up and cascade testing of relatives, and evaluating patient-provider-laboratory level interactions that influence the use of this technology. The findings from the CSER consortium will offer patients, healthcare systems, and policymakers a clearer understanding of the opportunities and challenges of providing genomic medicine in diverse populations and settings, and contribute evidence toward developing best practices for the delivery of clinically useful and cost-effective genomic sequencing in diverse healthcare settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA; Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA.
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23
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Carlo MI, Giri VN, Paller CJ, Abida W, Alumkal JJ, Beer TM, Beltran H, George DJ, Heath EI, Higano CS, McKay RR, Morgans AK, Patnaik A, Ryan CJ, Schaeffer EM, Stadler WM, Taplin ME, Kauff ND, Vinson J, Antonarakis ES, Cheng HH. Evolving Intersection Between Inherited Cancer Genetics and Therapeutic Clinical Trials in Prostate Cancer: A White Paper From the Germline Genetics Working Group of the Prostate Cancer Clinical Trials Consortium. JCO Precis Oncol 2018; 2018. [PMID: 30761386 DOI: 10.1200/po.18.00060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose Advances in germline genetics, and related therapeutic opportunities, present new opportunities and challenges in prostate cancer. The Prostate Cancer Clinical Trials Consortium Germline Genetics Working Group was established to address genetic testing for men with prostate cancer, especially those with advanced disease undergoing testing for treatment-related objectives and clinical trials. Methods The Prostate Cancer Clinical Trials Consortium Germline Genetics Working Group met monthly to discuss the current state of genetic testing of men with prostate cancer for therapeutic or clinical trial purposes. We assessed current institutional practices, developed a framework to address unique challenges in this population, and identified areas of future research. Results Genetic testing practices in men with prostate cancer vary across institutions; however, there were several areas of agreement. The group recognized the clinical benefits of expanding germline genetic testing, beyond cancer risk assessment, for the goal of treatment selection or clinical trial eligibility determination. Genetic testing for treatment selection should ensure patients receive appropriate pretest education and consent and occur under auspices of a research study whenever feasible. Providers offering genetic testing should be able to interpret results and recommend post-test genetic counseling for patients. When performing tumor (somatic) genomic profiling, providers should discuss the potential for uncovering germline mutations and recommend appropriate genetic counseling. In addition, family members may benefit from cascade testing and early cancer screening and prevention strategies. Conclusion As germline genetic testing is incorporated into practice, further development is needed in establishing prompt testing for time-sensitive treatment decisions, integrating cascade testing for family, ensuring equitable access to testing, and elucidating the role of less-characterized germline DNA damage repair genes, individual gene-level biologic consequences, and treatment response prediction in advanced disease.
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Affiliation(s)
- Maria I Carlo
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Veda N Giri
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Channing J Paller
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Wassim Abida
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Celestia S Higano
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Alicia K Morgans
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Charles J Ryan
- University of California San Francisco, San Francisco, CA
| | | | | | | | | | - Jacob Vinson
- Prostate Cancer Clinical Trials Consortium, New York, NY
| | | | - Heather H Cheng
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
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24
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Apathy NC, Menser T, Keeran LM, Ford EW, Harle CA, Huerta TR. Trends and Gaps in Awareness of Direct-to-Consumer Genetic Tests From 2007 to 2014. Am J Prev Med 2018; 54:806-813. [PMID: 29656919 DOI: 10.1016/j.amepre.2018.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/30/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Direct-to-consumer genetic tests for inherited disease risks have gained recent approvals from the Food and Drug Administration, and interest in these tests has continued to grow. Broad use of these tests coupled with planning and discussion with health providers regarding genetic risks and potential protective behavior changes have been proposed as preventive tools to reduce health disparities and improve equity in health outcomes. However, awareness of direct-to-consumer genetic testing has historically demonstrated differences by education, income, and race; these disparities could jeopardize potential benefits by limiting access and use. METHODS The national survey data from the Health Information National Trends Survey was analyzed to understand how overall awareness of direct-to-consumer genetic testing and disparities in awareness across sociodemographic groups have changed since 2007. RESULTS The findings showed persistent disparities, as well as a widening gap in awareness between Hispanics and non-Hispanic whites (OR2007 =1.52, OR2014 =0.58, pchange =0.0056), despite overall increases in awareness over time. CONCLUSIONS Given these findings, policies regulating direct-to-consumer genetic tests should prioritize equitable distribution of benefits by including provisions that counteract prevailing disparities in awareness.
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Affiliation(s)
- Nate C Apathy
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Lindsay M Keeran
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio
| | - Eric W Ford
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher A Harle
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio; Department of Biomedical Informatics, Ohio State University, Columbus, Ohio.
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25
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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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26
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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: 172] [Impact Index Per Article: 24.6] [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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Lynce F, Graves KD, Jandorf L, Ricker C, Castro E, Moreno L, Augusto B, Fejerman L, Vadaparampil ST. Genomic Disparities in Breast Cancer Among Latinas. Cancer Control 2017; 23:359-372. [PMID: 27842325 DOI: 10.1177/107327481602300407] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer diagnosed among Latinas in the United States and the leading cause of cancer-related death among this population. Latinas tend to be diagnosed at a later stage and have worse prognostic features than their non-Hispanic white counterparts. Genetic and genomic factors may contribute to observed breast cancer health disparities in Latinas. METHODS We provide a landscape of our current understanding and the existing gaps that need to be filled across the cancer prevention and control continuum. RESULTS We summarize available data on mutations in high and moderate penetrance genes for inherited risk of breast cancer and the associated literature on disparities in awareness of and uptake of genetic counseling and testing in Latina populations. We also discuss common genetic polymorphisms and risk of breast cancer in Latinas. In the treatment setting, we examine tumor genomics and pharmacogenomics in Latina patients with breast cancer. CONCLUSIONS As the US population continues to diversify, extending genetic and genomic research into this underserved and understudied population is critical. By understanding the risk of breast cancer among ethnically diverse populations, we will be better positioned to make treatment advancements for earlier stages of cancer, identify more effective and ideally less toxic treatment regimens, and increase rates of survival.
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Affiliation(s)
- Filipa Lynce
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA.
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29
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Breast cancer genetic counseling among Dutch patients from Turkish and Moroccan descent: participation determinants and perspectives of patients and healthcare professionals. J Community Genet 2017; 8:97-108. [PMID: 28083845 PMCID: PMC5386912 DOI: 10.1007/s12687-016-0290-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 12/23/2016] [Indexed: 02/02/2023] Open
Abstract
Lower participation rates in cancer genetic counseling are observed among different ethnic minorities. The goal of our study is to gain insight into determinants of Turkish and Moroccan patients’ participation in breast cancer genetic counseling and DNA testing, from the point of view of healthcare professionals and patients. Questionnaire-based telephone interviews about awareness, perceptions, and reasons for (non-) participation in cancer genetic counseling were conducted with 78 Dutch breast cancer patients from Turkish and Moroccan descent. The interviews were held in Arabic, Berber, Turkish, or Dutch by bilingual research assistants. Additionally, 14 breast cancer patients participated in one of two focus group meetings, and two focus groups were held with 11 healthcare professionals. SPSS and QSR Nvivo were used to examine the quantitative and qualitative data, respectively. Half of the total group of patients (N = 78) and 79% of patients eligible for genetic counseling and testing (N = 33) were aware of the possibility of genetic counseling. The most important determinants for nonparticipation in genetic counseling were experienced difficulties in patient-doctor communication, cultural factors (e.g., social norms), limited health literacy, limited knowledge of the family cancer history, and anxiety about cancer. Religious beliefs and knowing personal and family members’ breast cancer risks were motives to obtain genetic counseling. Despite the fact that our study showed that Moroccan and Turkish women reported several personal motives to obtain genetic counseling and testing (GCT), patients and healthcare professionals experience significant language and health literacy difficulties, which make it harder to fully access health care such as genetic counseling and testing.
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30
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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: 34] [Impact Index Per Article: 4.3] [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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Kinney AY, Steffen LE, Brumbach BH, Kohlmann W, Du R, Lee JH, Gammon A, Butler K, Buys SS, Stroup AM, Campo RA, Flores KG, Mandelblatt JS, Schwartz MD. Randomized Noninferiority Trial of Telephone Delivery of BRCA1/2 Genetic Counseling Compared With In-Person Counseling: 1-Year Follow-Up. J Clin Oncol 2016; 34:2914-24. [PMID: 27325848 PMCID: PMC5012661 DOI: 10.1200/jco.2015.65.9557] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The ongoing integration of cancer genomic testing into routine clinical care has led to increased demand for cancer genetic services. To meet this demand, there is an urgent need to enhance the accessibility and reach of such services, while ensuring comparable care delivery outcomes. This randomized trial compared 1-year outcomes for telephone genetic counseling with in-person counseling among women at risk of hereditary breast and/or ovarian cancer living in geographically diverse areas. PATIENTS AND METHODS Using population-based sampling, women at increased risk of hereditary breast and/or ovarian cancer were randomly assigned to in-person (n = 495) or telephone genetic counseling (n = 493). One-sided 97.5% CIs were used to estimate the noninferiority effects of telephone counseling on 1-year psychosocial, decision-making, and quality-of-life outcomes. Differences in test-uptake proportions for determining equivalency of a 10% prespecified margin were evaluated by 95% CIs. RESULTS At the 1-year follow-up, telephone counseling was noninferior to in-person counseling for all psychosocial and informed decision-making outcomes: anxiety (difference [d], 0.08; upper bound 97.5% CI, 0.45), cancer-specific distress (d, 0.66; upper bound 97.5% CI, 2.28), perceived personal control (d, -0.01; lower bound 97.5% CI, -0.06), and decisional conflict (d, -0.12; upper bound 97.5% CI, 2.03). Test uptake was lower for telephone counseling (27.9%) than in-person counseling (37.3%), with the difference of 9.4% (95% CI, 2.2% to 16.8%). Uptake was appreciably higher for rural compared with urban dwellers in both counseling arms. CONCLUSION Although telephone counseling led to lower testing uptake, our findings suggest that telephone counseling can be effectively used to increase reach and access without long-term adverse psychosocial consequences. Further work is needed to determine long-term adherence to risk management guidelines and effective strategies to boost utilization of primary and secondary preventive strategies.
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Affiliation(s)
- Anita Y Kinney
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC.
| | - Laurie E Steffen
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Barbara H Brumbach
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Wendy Kohlmann
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Ruofei Du
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Ji-Hyun Lee
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Amanda Gammon
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Karin Butler
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Saundra S Buys
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Antoinette M Stroup
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Rebecca A Campo
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Kristina G Flores
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Jeanne S Mandelblatt
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Marc D Schwartz
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
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Dutil J, Golubeva VA, Pacheco-Torres AL, Diaz-Zabala HJ, Matta JL, Monteiro AN. The spectrum of BRCA1 and BRCA2 alleles in Latin America and the Caribbean: a clinical perspective. Breast Cancer Res Treat 2015; 154:441-53. [PMID: 26564481 PMCID: PMC4661195 DOI: 10.1007/s10549-015-3629-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/02/2015] [Indexed: 02/07/2023]
Abstract
Hereditary cancer predisposition gene testing allows the identification of individuals at high risk of cancer that may benefit from increased surveillance, chemoprevention, and prophylactic surgery. In order to implement clinical genetic strategies adapted to each population's needs and intrinsic genetic characteristic, this review aims to present the current status of knowledge about the spectrum of BRCA pathogenic variants in Latin American populations. We have conducted a comprehensive review of 33 studies published between 1994 and 2015 reporting the prevalence and/or spectrum of BRCA1 (OMIM 113705) and BRCA2 (OMIM 600185) variants. The combined sample size for these studies consisted of 4835 individuals from 13 countries in Latin America and the Caribbean, as well as in Hispanics in the United States. A total of 167 unique pathogenic variants have been reported in the existing literature. In unselected breast cancer cases, the prevalence ranged from 1.2 to 27.1%. Some countries presented a few recurrent pathogenic variants, while others were characterized by diverse, non-recurrent variants. The proportion of BRCA pathogenic variants shared between Hispanics in the United States and Latin American populations was estimated at 10.4%. Within Latin America and the Caribbean, 8.2% of the BRCA variants reported were present in more than one country. Countries with high prevalence of BRCA pathogenic variants may benefit from more aggressive testing strategies, while testing of recurrent variant panels might present a cost-effective solution for improving genetic testing in some, but not all, countries.
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Affiliation(s)
- Julie Dutil
- Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA.
| | - Volha A Golubeva
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | - Jaime L Matta
- Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
| | - Alvaro N Monteiro
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Hamilton JG, Shuk E, Arniella G, González CJ, Gold GS, Gany F, Robson ME, Hay JL. Genetic Testing Awareness and Attitudes among Latinos: Exploring Shared Perceptions and Gender-Based Differences. Public Health Genomics 2015; 19:34-46. [PMID: 26555145 DOI: 10.1159/000441552] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/07/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Latinos, whose views are infrequently examined in genomic research, may be at risk of missing out on the benefits of genomic medicine. AIMS To explore this possibility, we conducted a qualitative study of awareness and attitudes about genetic testing among Latinos with lower acculturation in New York City. METHODS We conducted four focus groups (7 English-speaking men, 5 Spanish-speaking men, 13 English-speaking women and 13 Spanish-speaking women) to explore factors that influence the adoption of new innovations through the discussion of genetic testing in general, and a hypothetical vignette describing a genetic test for skin cancer risk, in particular. RESULTS Through inductive thematic text analysis of focus group transcripts, our multidisciplinary team identified themes within knowledge and attitudes, communication and sources of information, anticipated responses, factors that may increase adoption, and barriers to adoption of genetic testing. Specifically, a majority of participants expressed some degree of uncertainty regarding the purpose of genetic tests and information these tests provide, rarely discussed genetic testing with others in their social networks, and expressed concerns about the misuse of and possible adverse emotional responses to genetic information. However, participants also expressed high levels of interest in receiving a skin cancer genetic test in response to the vignette and believed that receiving actionable health information was a primary reason to consider testing. Gender-based differences in perceived barriers to testing emerged. CONCLUSIONS The results highlight beliefs and barriers that future interventions could target to help ensure that Latinos have adequate understanding of and access to genomic medicine advances.
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Affiliation(s)
- Jada G Hamilton
- Behavioral Sciences Service, Memorial Sloan Kettering Cancer Center, New York, N.Y., USA
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Senier L, Shields M, Lee R, Nicoll L, Falzon D, Wiecek E. Community-Based Family Health History Education: The Role of State Health Agencies in Engaging Medically Underserved Populations in Understanding Genomics and Risk of Chronic Disease. Healthcare (Basel) 2015; 3:995-1017. [PMID: 27417809 PMCID: PMC4934627 DOI: 10.3390/healthcare3040995] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/05/2015] [Accepted: 10/14/2015] [Indexed: 12/22/2022] Open
Abstract
Although family health history (FHH) collection has been recognized as an influential method for assessing a person's risk of chronic disease, studies have shown that people who are low-income, from racial and ethnic minorities, and poorly educated are less likely to collect their FHH or share it with a medical professional. Programs to raise public awareness about the importance of FHH have conventionally targeted patients in primary care clinics or in the general community, but few efforts have been made to coordinate educational efforts across settings. This paper describes a project by the Connecticut Department of Public Health's Genomics Office to disseminate training materials about FHH as broadly as possible, by engaging partners in multiple settings: a local health department, a community health center, and two advocacy organizations that serve minority and immigrant populations. We used a mixed methods program evaluation to examine the efficacy of the FHH program and to assess barriers in integrating it into the groups' regular programming. Our findings highlight how a state health department can promote FHH education among underserved communities.
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Affiliation(s)
- Laura Senier
- Department of Sociology and Anthropology, Northeastern University, 360 Huntington Ave Boston, MA 02115, USA.
- Department of Health Sciences, Northeastern University, 360 Huntington Ave Boston, MA 02115, USA.
| | - Michael Shields
- Department of Sociology and Anthropology, Northeastern University, 360 Huntington Ave Boston, MA 02115, USA.
| | - Rachael Lee
- Department of Sociology and Anthropology, Northeastern University, 360 Huntington Ave Boston, MA 02115, USA.
| | - Lauren Nicoll
- Department of Sociology and Anthropology, Northeastern University, 360 Huntington Ave Boston, MA 02115, USA.
| | - Danielle Falzon
- Department of Sociology and Anthropology, Northeastern University, 360 Huntington Ave Boston, MA 02115, USA.
| | - Elyssa Wiecek
- School of Pharmacy, Northeastern University, 140 Fenway, 360 Huntington Ave Boston, MA 02115, USA.
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Sussner KM, Edwards T, Villagra C, Rodriguez MC, Thompson HS, Jandorf L, Valdimarsdottir HB. BRCA genetic counseling among at-risk Latinas in New York City: new beliefs shape new generation. J Genet Couns 2015; 24:134-48. [PMID: 25120034 PMCID: PMC4399761 DOI: 10.1007/s10897-014-9746-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
Abstract
Despite the life-saving information that genetic counseling can provide for women at hereditary breast and/or ovarian cancer (HBOC) risk, Latinas disproportionately underuse such services. Understanding Latinas' beliefs and attitudes about BRCA genetic counseling may be the key to better health promotion within this underserved, at-risk group. We conducted 12 focus groups (N = 54) with at-risk Latina women in New York City, followed by 30 in-depth interviews among a subset of the focus group women. Both were professionally transcribed, translated where applicable and data analysis was completed by two coders trained in qualitative methods. Results revealed personal and community knowledge about BRCA genetic counseling was relatively low, although women felt largely positive about counseling. The main motivator to undergo genetic counseling was concerns about learning family members' cancer status, while the main barrier was competing demands. Generational differences were apparent, with younger women (approximately <55 years) reporting that they were more interested in educating themselves about counseling and other ways to prevent cancer. Younger women were also less likely to ascribe to traditionally Latino-centered cultural beliefs which could serve as barriers (e.g. machismo, fatalismo, destino) to undergoing genetic counseling. Participants were largely enthusiastic about educational efforts to increase awareness of genetic counseling among Latinos. Revealing the beliefs and attitudes of underserved Latinas may help shape culturally appropriate educational materials and promotion programs to increase BRCA genetic counseling uptake within this underrepresented community.
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Affiliation(s)
- Katarina M Sussner
- Department of Oncological Sciences, Division of Cancer Prevention and Control, Icahn School of Medicine at Mount Sinai, New York, NY, USA,
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Kinney AY, Butler KM, Schwartz MD, Mandelblatt JS, Boucher KM, Pappas LM, Gammon A, Kohlmann W, Edwards SL, Stroup AM, Buys SS, Flores KG, Campo RA. Expanding access to BRCA1/2 genetic counseling with telephone delivery: a cluster randomized trial. J Natl Cancer Inst 2014; 106:dju328. [PMID: 25376862 DOI: 10.1093/jnci/dju328] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The growing demand for cancer genetic services underscores the need to consider approaches that enhance access and efficiency of genetic counseling. Telephone delivery of cancer genetic services may improve access to these services for individuals experiencing geographic (rural areas) and structural (travel time, transportation, childcare) barriers to access. METHODS This cluster-randomized clinical trial used population-based sampling of women at risk for BRCA1/2 mutations to compare telephone and in-person counseling for: 1) equivalency of testing uptake and 2) noninferiority of changes in psychosocial measures. Women 25 to 74 years of age with personal or family histories of breast or ovarian cancer and who were able to travel to one of 14 outreach clinics were invited to participate. Randomization was by family. Assessments were conducted at baseline one week after pretest and post-test counseling and at six months. Of the 988 women randomly assigned, 901 completed a follow-up assessment. Cluster bootstrap methods were used to estimate the 95% confidence interval (CI) for the difference between test uptake proportions, using a 10% equivalency margin. Differences in psychosocial outcomes for determining noninferiority were estimated using linear models together with one-sided 97.5% bootstrap CIs. RESULTS Uptake of BRCA1/2 testing was lower following telephone (21.8%) than in-person counseling (31.8%, difference = 10.2%, 95% CI = 3.9% to 16.3%; after imputation of missing data: difference = 9.2%, 95% CI = -0.1% to 24.6%). Telephone counseling fulfilled the criteria for noninferiority to in-person counseling for all measures. CONCLUSIONS BRCA1/2 telephone counseling, although leading to lower testing uptake, appears to be safe and as effective as in-person counseling with regard to minimizing adverse psychological reactions, promoting informed decision making, and delivering patient-centered communication for both rural and urban women.
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Affiliation(s)
- Anita Y Kinney
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS).
| | - Karin M Butler
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Marc D Schwartz
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Jeanne S Mandelblatt
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Kenneth M Boucher
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Lisa M Pappas
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Amanda Gammon
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Wendy Kohlmann
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Sandra L Edwards
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Antoinette M Stroup
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Saundra S Buys
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Kristina G Flores
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Rebecca A Campo
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
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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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Riosmena F, Everett BG, Rogers RG, Dennis JA. Negative Acculturation and Nothing More? Cumulative Disadvantage and Mortality during the Immigrant Adaptation Process among Latinos in the United States. INTERNATIONAL MIGRATION REVIEW 2014; 49:443-478. [PMID: 28104925 PMCID: PMC5241135 DOI: 10.1111/imre.12102] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Foreign- and U.S.-born Hispanic health deteriorates with increasing exposure and acculturation to mainstream U.S. society. Because these associations are robust to (static) socioeconomic controls, negative acculturation has become their primary explanation. This overemphasis, however, has neglected important alternative structural explanations. Examining Hispanic mortality using the 1998–2006 U.S. National Health Interview Survey-Linked Mortality File according to nativity, immigrant adaptation measures, and health behaviors, this study presents indirect but compelling evidence that suggests negative acculturation is not the only or main explanation for this deterioration.
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Affiliation(s)
- Fernando Riosmena
- Population Program, Institute of Behavioral Science, and Geography Department, University of Colorado at Boulder
| | | | - Richard G. Rogers
- Population Program, Institute of Behavioral Science, and Department of Sociology, University of Colorado at Boulder
| | - Jeff A. Dennis
- Department of Social Sciences, University of Texas–Permian Basin
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Awareness of cancer susceptibility genetic testing: the 2000, 2005, and 2010 National Health Interview Surveys. Am J Prev Med 2014; 46:440-8. [PMID: 24745633 PMCID: PMC4042677 DOI: 10.1016/j.amepre.2014.01.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 12/18/2013] [Accepted: 01/03/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Genetic testing for several cancer susceptibility syndromes is clinically available; however, existing data suggest limited population awareness of such tests. PURPOSE To examine awareness regarding cancer genetic testing in the U.S. population aged ≥25 years in the 2000, 2005, and 2010 National Health Interview Surveys. METHODS The weighted percentages of respondents aware of cancer genetic tests, and percent changes from 2000-2005 and 2005-2010, overall and by demographic, family history, and healthcare factors were calculated. Interactions were used to evaluate the patterns of change in awareness between 2005 and 2010 among subgroups within each factor. To evaluate associations with awareness in 2005 and 2010, percentages were adjusted for covariates using multiple logistic regression. The analysis was performed in 2012. RESULTS Awareness decreased from 44.4% to 41.5% (p<0.001) between 2000 and 2005, and increased to 47.0% (p<0.001) in 2010. Awareness increased between 2005 and 2010 in most subgroups, particularly among individuals in the South (pinteraction=0.03) or with a usual place of care (pinteraction=0.01). In 2005 and 2010, awareness was positively associated with personal or family cancer history and high perceived cancer risk, and inversely associated with racial/ethnic minorities, age 25-39 or ≥60 years, male gender, lower education and income levels, public or no health insurance, and no provider contact in 12 months. CONCLUSIONS Despite improvement from 2005 to 2010, ≤50% of the U.S. adult population was aware of cancer genetic testing in 2010. Notably, disparities persist for racial/ethnic minorities and individuals with limited health care access or income.
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HUANG HONG, APOUEY BÉNÉDICTE, ANDREWS JAMES. Racial and Ethnic Disparities in Awareness of Cancer Genetic Testing Among Online Users: Internet Use, Health Knowledge, and Socio-Demographic Correlates. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2014. [DOI: 10.1080/15398285.2014.869165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sussner KM, Jandorf L, Thompson HS, Valdimarsdottir HB. Barriers and facilitators to BRCA genetic counseling among at-risk Latinas in New York City. Psychooncology 2013; 22:1594-604. [PMID: 22987526 PMCID: PMC3541466 DOI: 10.1002/pon.3187] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/10/2012] [Accepted: 08/17/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite underuse of genetic services for hereditary breast and/or ovarian cancer risk among Latinas (including counseling and testing for BRCA mutations), there is little known about the barriers and facilitators to BRCA genetic counseling among this group. It is imperative to first understand factors that may impede Latinas seeking BRCA genetic counseling, as it is considered a prerequisite to testing. METHODS Quantitative telephone interviews (N=120) were conducted with at-risk Latinas in New York City to investigate interest, barriers, and beliefs about BRCA genetic counseling. Statistical analyses examined predictors of intention to undergo BRCA genetic counseling. RESULTS Despite moderate levels of awareness, Latinas held largely positive beliefs, attitudes, and knowledge about BRCA genetic counseling. Perceived barriers included logistic concerns (e.g., where to go, cost/health insurance coverage), emotional concerns (e.g., fear, distress), and competing life concerns (e.g., too many other things to worry about, too busy taking care of children or family members). Multivariate results showed that the strongest predictor of intention to undergo BRCA genetic counseling was competing life concerns; Latinas with more competing life concerns were less likely to intend to undergo BRCA genetic counseling (p=0.0002). Other significant predictors of intention included perceived risk of carrying a BRCA mutation (p=0.01) and referral by their physician (p=0.02). CONCLUSION Educational efforts to promote BRCA genetic counseling among at-risk Latinas and increase referrals by their physicians should incorporate discussion of perceived barriers to counseling, such as competing life concerns that Latinas may need to overcome in order to seek genetic counseling.
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Affiliation(s)
- Katarina M Sussner
- Department of Oncological Sciences, Cancer Prevention and Control, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Amin TT, Al-Wadaani HA, Al-Quaimi MM, Aldairi NA, Alkhateeb JM, Al-Jaafari AAL. Saudi women's interest in breast cancer gene testing: possible influence of awareness, perceived risk and socio-demographic factors. Asian Pac J Cancer Prev 2012; 13:3879-87. [PMID: 23098487 DOI: 10.7314/apjcp.2012.13.8.3879] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Development of effective educational strategies should accompany increases in public awareness and the availability of genetic testing for breast cancer (BC). These educational strategies should be designed to fulfill the knowledge gap while considering factors that influence women's interest in order to facilitate decision making. OBJECTIVE To determine the possible correlates of Saudi women's interest in BC genes testing including socio-demographics, the level of awareness towards BC genes, the family history of BC and the perceived personal risk among adult Saudi women in Al Hassa, Saudi Arabia. SUBJECTS AND METHODS This cross-sectional study was carried out during the second BC community-based campaign in Al Hassa, Saudi Arabia. All Saudi women aged ≥ 18 years (n=781) attending the educational components of the campaign were invited to a personal interview. Data collection included gathering information about socio- demographics, family history of BC, the perceived personal risk for BC, awareness and attitude towards BC genes and the women's interest in BC genes testing. RESULTS Of the included women (n=599), 19.5% perceived higher risk for BC development, significantly more among < 40 years of age, and with positive family history of BC before 50 years of age. The participants demonstrated a poor level of awareness regarding the inheritance, risk, and availability of BC genetic testing. The median summated knowledge score was 1.0 (out of 7 points) with a knowledge deficit of 87.8%. The level of knowledge showed significant decline with age (> 40 years). Of the included women 54.7% expressed an interest in BC genetic testing for assessing their BC risk. Multivariate regression model showed that being middle aged (Odds Ratio 'OR'=1.88, confidence intervals 'C.I'=1.14-3.11), with higher knowledge level (OR=1.67, C.I=1.08-2.57) and perceiving higher risk for BC (OR=2.11, C.I=1.61-2.76) were the significant positive correlates for Saudi women interest in BC genetic testing. CONCLUSION Saudi women express high interest in genetic testing for BC risk despite their poor awareness. This great interest may reflect the presence of inappropriate information regarding BC genetic testing and its role in risk analysis.
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Affiliation(s)
- Tarek Tawfik Amin
- Community Medicine and Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt.
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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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Chalela P, Pagán JA, Su D, Muñoz E, Ramirez AG. Breast cancer genetic testing awareness, attitudes and intentions of Latinas living along the US-Mexico border: a qualitative study. ACTA ACUST UNITED AC 2012; 2. [PMID: 25473590 DOI: 10.4172/2161-0711.1000152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Genetic testing for breast cancer may facilitate better-informed decisions regarding cancer prevention, risk reduction, more effective early detection, and better determination of risk for family members. Despite these potential benefits, significant portions of the US population-particularly Latinas-lack awareness of genetic testing for breast cancer susceptibility. Among women who are tested, less than 4% are Latina. To uncover reasons for Latinas' low participation, this study explores awareness, attitudes and behavioral intentions to undergo genetic testing among average-risk Latinas along the Texas-Mexico border. METHODS Eight focus groups were conducted with 58 Latinas aged 19-69 living in Hidalgo County, a largely Latino region of South Texas. Focus group discussions were digitally recorded, transcribed and analyzed using qualitative content analysis to assess, categorize and interpret them. Two experienced study team members analyzed transcripts to identify major concepts grouped into theme categories. RESULTS Participants mostly had less than a high-school education (43%), spoke primarily Spanish (52%), were of Mexican-American origin (90%) and had a family income of $30,000 or less (75%). Focus groups found that most participants had positive attitudes and strong interest in genetic testing, yet lacked general awareness and knowledge about genetic testing, its risks, benefits, and limitations. Participants also identified several key cultural-based influencers, such as family, religious beliefs and fear of testing. CONCLUSION The delivery of culturally adapted risk information is needed to increase and ensure Latinas' understanding of breast cancer genetic testing during their decision-making processes. Key Latino values-religiosity, importance of family and the influential role of health care providers in health decisions-should also be considered when designing interventions targeting this specific group. Further research is needed to identify effective ways to communicate genetic risk susceptibility information to Latinas to help them make informed testing decisions.
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Affiliation(s)
- Patricia Chalela
- Institute for Health Promotion Research, The University of Texas Health Science Center at San Antonio, 7411 John Smith Drive, Suite 1000, San Antonio, TX 78229
| | - José A Pagán
- Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd. Fort Worth, TX 76107
| | - Dejun Su
- Department of Sociology, The South Texas Border Health Disparities Center, University of Texas-Pan American, 1201 West University Drive, Edinburg, TX 78539
| | - Edgar Muñoz
- Institute for Health Promotion Research, The University of Texas Health Science Center at San Antonio, 7411 John Smith Drive, Suite 1000, San Antonio, TX 78229
| | - Amelie G Ramirez
- Institute for Health Promotion Research, The University of Texas Health Science Center at San Antonio, 7411 John Smith Drive, Suite 1000, San Antonio, TX 78229,
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Language use and adherence to multiple cancer preventive health behaviors among Hispanics. J Immigr Minor Health 2011; 13:849-59. [PMID: 21431332 DOI: 10.1007/s10903-011-9456-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hispanics have lower cancer mortality rates than non-Hispanic Whites and Blacks, despite demographic profiles previously associated with higher cancer mortality. Differences in adherence to multiple cancer-preventive behaviors by acculturation may offer one explanation for this "Hispanic paradox," but the relationship is not well understood. We examined this relationship using the 2000 National Health Interview Survey, which provides cross-sectional data on a nationally representative sample of US Hispanics. Multinomial logistic regression models estimated relationships between language use (a measure of acculturation) and patterns of adherence, by gender, to multiple cancer-preventive health behaviors using adherence scores. Hispanics had greater odds of adherence to multiple behaviors compared to Non-Hispanics (OR = 2.76 [2.27, 3.36]). Hispanics with greater English language use had lower odds of adherence (OR = 0.45 [0.29, 0.69]). Women were more adherent than men (P < 0.01) and their language use was associated with patterns of behavioral adherence more so than among men. Differences by gender and language use were identified in patterns of adherence to behavioral recommendations among the Hispanic population. Greater English language use was negatively associated with tobacco, alcohol, fruit and vegetable recommendation adherence but not with exercise. Study findings support evidence behaviors occur in combination and contributes to understanding of the role of language use in patterns of behavioral adherence.
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Weitzel JN, Blazer KR, MacDonald DJ, Culver JO, Offit K. Genetics, genomics, and cancer risk assessment: State of the Art and Future Directions in the Era of Personalized Medicine. CA Cancer J Clin 2011; 61:327-59. [PMID: 21858794 PMCID: PMC3346864 DOI: 10.3322/caac.20128] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Scientific and technologic advances are revolutionizing our approach to genetic cancer risk assessment, cancer screening and prevention, and targeted therapy, fulfilling the promise of personalized medicine. In this monograph, we review the evolution of scientific discovery in cancer genetics and genomics, and describe current approaches, benefits, and barriers to the translation of this information to the practice of preventive medicine. Summaries of known hereditary cancer syndromes and highly penetrant genes are provided and contrasted with recently discovered genomic variants associated with modest increases in cancer risk. We describe the scope of knowledge, tools, and expertise required for the translation of complex genetic and genomic test information into clinical practice. The challenges of genomic counseling include the need for genetics and genomics professional education and multidisciplinary team training, the need for evidence-based information regarding the clinical utility of testing for genomic variants, the potential dangers posed by premature marketing of first-generation genomic profiles, and the need for new clinical models to improve access to and responsible communication of complex disease risk information. We conclude that given the experiences and lessons learned in the genetics era, the multidisciplinary model of genetic cancer risk assessment and management will serve as a solid foundation to support the integration of personalized genomic information into the practice of cancer medicine.
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Affiliation(s)
- Jeffrey N Weitzel
- Division of Clinical Cancer Genetics, Department of Population Sciences, City of Hope, Duarte, CA.
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Underutilization of BRCA1/2 testing to guide breast cancer treatment: black and Hispanic women particularly at risk. Genet Med 2011; 13:349-55. [PMID: 21358336 DOI: 10.1097/gim.0b013e3182091ba4] [Citation(s) in RCA: 207] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Women with early-onset (age ≤40 years) breast cancer are at high risk of carrying deleterious mutations in the BRCA1/2 genes; genetic assessment is thus recommended. Knowledge of BRCA1/2 mutation status is useful in guiding treatment decisions. To date, there has been no national study of BRCA1/2 testing among newly diagnosed women. METHODS We used administrative data (2004-2007) from a national sample of 14.4 million commercially insured patients to identify newly diagnosed, early-onset breast cancer cases among women aged 20-40 years (n = 1474). Cox models assessed BRCA1/2 testing, adjusting for covariates and differential lengths of follow-up. RESULTS Overall, 30% of women aged 40 years or younger received BRCA1/2 testing. In adjusted analyses, women of Jewish ethnicity were significantly more likely to be tested (hazard ratio = 2.83, 95% confidence interval: 1.52-5.28), whereas black women (hazard ratio = 0.34, 95% 0.18-0.64) and Hispanic women (hazard ratio = 0.52, 95% confidence interval: 0.33-0.81) were significantly less likely to be tested than non-Jewish white women. Those enrolled in a health maintenance organization (hazard ratio = 0.73, 95% confidence interval: 0.54-0.99) were significantly less likely to receive BRCA1/2 testing than those point of service insurance plans. Testing rates increased sharply for women diagnosed in 2007 compared with 2004. CONCLUSIONS In this national sample of patients with newly diagnosed breast cancer at high risk for BRCA1/2 mutations, genetic assessment was low, with marked racial differences in testing.
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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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Awareness and preferences regarding BRCA1/2 genetic counseling and testing among Latinas and non-Latina white women at increased risk for hereditary breast and ovarian cancer. J Genet Couns 2011; 20:625-38. [PMID: 21691939 DOI: 10.1007/s10897-011-9376-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 05/26/2011] [Indexed: 01/02/2023]
Abstract
This study was an investigation of awareness, cognitions, and psychosocial and educational needs related to genetic counseling and testing among Latinas and non-Latina whites at increased risk for having a BRCA1/2 mutation. Sixty-three Latina and eighty-four non-Latina white women completed telephone surveys employing a mixture of quantitative and qualitative questions assessing awareness, benefits, risks, barriers, and genetic counseling communication preferences regarding BRCA1/2 testing. Among participants who had not previously had genetic counseling/testing, 56.9% of Latinas (29/51) and 34.8% of non-Latina white participants (24/69) were unaware of the availability of BRCA1/2 testing. In multivariate logistic regression analysis, Latina ethnicity was the only statistically significant independent factor associated with lack of awareness (OR = 0.42; 95% CI = 0.19-0.35). No appreciable differences were noted between ethnic groups regarding perceived benefits of BRCA1/2 testing or desired genetic counseling topics. These findings underscore the importance of increasing awareness of cancer genetic counseling and genetic testing among both Latina and non-Latina white populations.
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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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