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Tiller J, Bakshi A, Dowling G, Keogh L, McInerney-Leo A, Barlow-Stewart K, Boughtwood T, Gleeson P, Delatycki MB, Winship I, Otlowski M, Lacaze P. Community concerns about genetic discrimination in life insurance persist in Australia: A survey of consumers offered genetic testing. Eur J Hum Genet 2024; 32:286-294. [PMID: 37169978 PMCID: PMC10923945 DOI: 10.1038/s41431-023-01373-1] [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: 01/10/2023] [Revised: 03/16/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
Fears of genetic discrimination in life insurance continue to deter some Australians from genetic testing. In July 2019, the life insurance industry introduced a partial, self-regulated moratorium restricting the use of genetic results in underwriting, applicable to policies up to certain limits (eg AUD$500,000 for death cover).We administered an online survey to consumers who had taken, or been offered, clinical genetic testing for adult-onset conditions, to gather views and experiences about the moratorium and the use of genetic results in life insurance, including its regulation.Most respondents (n = 367) had undertaken a genetic test (89%), and had a positive test result (76%; n = 243/321). Almost 30% (n = 94/326) reported testing after 1 July 2019. Relatively few respondents reported knowing about the moratorium (16%; n = 54/340) or that use of genetic results in life insurance underwriting is legal (17%; n = 60/348). Only 4% (n = 14/350) consider this practice should be allowed. Some respondents reported ongoing difficulties accessing life insurance products, even after the moratorium. Further, discrimination concerns continue to affect some consumers' decision-making about having clinical testing and applying for life insurance products, despite the Moratorium being in place. Most respondents (88%; n = 298/340) support the introduction of legislation by the Australian government to regulate this issue.Despite the introduction of a partial moratorium in Australia, fears of genetic discrimination persist, and continue to deter people from genetic testing. Consumers overwhelmingly consider life insurers should not be allowed to use genetic results in underwriting, and that federal legislation is required to regulate this area.
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Affiliation(s)
- Jane Tiller
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- Murdoch Children's Research Institute, Parkville, Australia.
- Australian Genomics, Melbourne, Australia.
| | - Andrew Bakshi
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Grace Dowling
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Aideen McInerney-Leo
- The University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Tiffany Boughtwood
- Murdoch Children's Research Institute, Parkville, Australia
- Australian Genomics, Melbourne, Australia
| | | | - Martin B Delatycki
- Murdoch Children's Research Institute, Parkville, Australia
- Victorian Clinical Genetics Services, Parkville, Australia
| | - Ingrid Winship
- Department of Medicine, the University of Melbourne, Melbourne, Australia
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia
| | - Margaret Otlowski
- Faculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, Australia
| | - Paul Lacaze
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Walsh C, Leavey G, McLaughlin M. Information provision to caregivers of children with rare dermatological disorders: an international multimethod qualitative study. BMJ Open 2023; 13:e070840. [PMID: 37419636 PMCID: PMC10335406 DOI: 10.1136/bmjopen-2022-070840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/23/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVE To identify service-provided information needs among dermatological caregivers of patients living with ichthyosis. DESIGN This is the first online international qualitative study to explore caregiver-reported service-provided information needs, using transnational focus groups (n=6), individual interviews (n=7) and in-depth emails (n=5). NVivo facilitated the coding process and Framework Analysis was applied. SETTING Caregivers were recruited through two online ichthyosis support groups and resided across 10 countries and 5 continents (USA, Greece, Netherlands, Ireland, UK, Canada, India, Philippines, Switzerland and Australia). PARTICIPANTS A purposive sample of 8 male and 31 female caregivers participated (mean age range 35-44 years). Participants were aged 18 years old or older and fluent in English. Participants cared for a total of 46 children (1:1 ratio for child gender and clinical classification of disease severity). Participants represented all stages along the care continuum, including neonatal intensive care unit and bereavement. RESULTS This study advances understanding of how to optimise information-sharing across hospital, community and online settings at three points along the care continuum (screening, active caregiving and survivorship). Timely, personalised and appropriate service-provided information support was considered key in influencing the self-efficacy, coping ability and psychosocial well-being of both the caregiver and their child. The modification of information support, through feedback loops, can result in a different bidirectional psychosocial impact for the caregiver and the affected child. CONCLUSION Our findings provide a novel insight into how existing gaps between caregiver expectations and needs, in terms of information support, can be addressed. As information support is a modifiable factor, improved healthcare education around these themes should become an urgent public health matter to inform future educational and psychosocial interventions.
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Affiliation(s)
- Carleen Walsh
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Derry, UK
| | - Gerard Leavey
- Director of Bamford Centre for Mental Health and Wellbeing, Ulster University, Derry, UK
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Wallingford CK, Kovilpillai H, Jacobs C, Turbitt E, Primiero CA, Young MA, Brockman DG, Soyer HP, McInerney-Leo AM, Yanes T. Models of communication for polygenic scores and associated psychosocial and behavioral effects on recipients: A systematic review. Genet Med 2023; 25:1-11. [PMID: 36322150 DOI: 10.1016/j.gim.2022.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study aimed to systematically review current models for communicating polygenic scores (PGS) and psycho-behavioral outcomes of receiving PGSs. METHODS Original research on communicating PGSs and reporting on psycho-behavioral outcomes was included. Search terms were applied to 5 databases and were limited by date (2009-2021). RESULTS In total, 28 articles, representing 17 studies in several disease settings were identified. There was limited consistency in PGS communication and evaluation/reporting of outcomes. Most studies (n = 14) presented risk in multiple ways (ie, numerically, verbally, and/or visually). Three studies provided personalized lifestyle advice and additional resources. Only 1 of 17 studies reported using behavior change theory to inform their PGS intervention. A total of 8 studies found no evidence of long-term negative psychosocial effects up to 12 months post result. Of 14 studies reporting on behavior, 9 found at least 1 favorable change after PGS receipt. When stratified by risk, 7 out of 9 studies found high PGS was associated with favorable changes including lifestyle, medication, and screening. Low-risk PGS was not associated with maladaptive behaviors (n = 4). CONCLUSION PGS has the potential to benefit health behavior. High variability among studies emphasizes the need for developing standardized guidelines for communicating PGSs and evaluating psycho-behavioral outcomes. Our findings call for development of best communication practices and evidence-based interventions informed by behavior change theories.
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Affiliation(s)
- Courtney K Wallingford
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Hannah Kovilpillai
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Clare A Primiero
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Mary-Anne Young
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | | | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia; Dermatology Department, The Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Aideen M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Tatiane Yanes
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia.
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Motivations and Barriers to Participation in a Randomized Trial on Melanoma Genomic Risk: A Mixed-Methods Analysis. J Pers Med 2022; 12:jpm12101704. [PMID: 36294843 PMCID: PMC9605418 DOI: 10.3390/jpm12101704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 01/24/2023] Open
Abstract
The evolution of polygenic scores for use in for disease prevention and control compels the development of guidelines to optimize their effectiveness and promote equitable use. Understanding the motivations and barriers to participation in genomics research can assist in drafting these standards. We investigated these in a community-based randomized controlled trial that examined the health behavioral impact of receiving personalized melanoma genomic risk information. We examined participant responses in a baseline questionnaire and conducted interviews post-trial participation. Motivations differed in two ways: (1) by gender, with those identifying as women placing greater importance on learning about their personal risk or familial risk, and how to reduce risk; and (2) by age in relation to learning about personal risk, and fear of developing melanoma. A barrier to participation was distrust in the handling of genomic data. Our findings provide new insights into the motivations for participating in genomics research and highlight the need to better target population subgroups including younger men, which will aid in tailoring recruitment for future genomic studies.
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Venning B, Saya S, De Abreu Lourenco R, Street DJ, Emery JD. Preferences for a polygenic test to estimate cancer risk in a general Australian population. Genet Med 2022; 24:2144-2154. [PMID: 35947108 DOI: 10.1016/j.gim.2022.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE There is significant interest in the use of polygenic risk score (PRS) tests to improve cancer risk assessment and stratified prevention. Our current understanding of preferences regarding different aspects of this novel testing approach is limited. This study examined which attributes of a PRS test most influence the likelihood of testing. METHODS A discrete choice experiment was developed to elicit preferences for different aspects of a PRS test by surveying an online sample of the Australian population. Preferences were assessed using mixed logistic regression, latent class analysis, and marginal willingness to pay. RESULTS The 1002 surveyed respondents were more likely to choose a PRS test that was more accurate, tested for multiple cancer types, and enabled cancer risk reduction through lifestyle modification, screening, or medication. There was also a preference for testing through a primary care physician rather than online or through a genetic specialist. A test that did not impact life insurance eligibility or premiums was preferred over the one that did. CONCLUSION This study found that the Australian population prefer a PRS test that is highly accurate, tests for multiple cancers, has noninvasive risk reduction measures, and is performed through primary care.
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Affiliation(s)
- Brent Venning
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.
| | - Sibel Saya
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, New South Wales, Australia
| | - Deborah J Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, New South Wales, Australia
| | - Jon D Emery
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
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Smit AK, Allen M, Beswick B, Butow P, Dawkins H, Dobbinson SJ, Dunlop KL, Espinoza D, Fenton G, Kanetsky PA, Keogh L, Kimlin MG, Kirk J, Law MH, Lo S, Low C, Mann GJ, Reyes-Marcelino G, Morton RL, Newson AJ, Savard J, Trevena L, Wordsworth S, Cust AE. Impact of personal genomic risk information on melanoma prevention behaviors and psychological outcomes: a randomized controlled trial. Genet Med 2021; 23:2394-2403. [PMID: 34385669 PMCID: PMC8629758 DOI: 10.1038/s41436-021-01292-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose We evaluated the impact of personal melanoma genomic risk information on sun-related behaviors and psychological outcomes. Methods In this parallel group, open, randomized controlled trial, 1,025 Australians of European ancestry without melanoma and aged 18–69 years were recruited via the Medicare database (3% consent). Participants were randomized to the intervention (n = 513; saliva sample for genetic testing, personalized melanoma risk booklet based on a 40-variant polygenic risk score, telephone-based genetic counseling, educational booklet) or control (n = 512; educational booklet). Wrist-worn ultraviolet (UV) radiation dosimeters (10-day wear) and questionnaires were administered at baseline, 1 month postintervention, and 12 months postbaseline. Results At 12 months, 948 (92%) participants completed dosimetry and 973 (95%) the questionnaire. For the primary outcome, there was no effect of the genomic risk intervention on objectively measured UV exposure at 12 months, irrespective of traditional risk factors. For secondary outcomes at 12 months, the intervention reduced sunburns (risk ratio: 0.72, 95% confidence interval: 0.54–0.96), and increased skin examinations among women. Melanoma-related worry was reduced. There was no overall impact on general psychological distress. Conclusion Personalized genomic risk information did not influence sun exposure patterns but did improve some skin cancer prevention and early detection behaviors, suggesting it may be useful for precision prevention. There was no evidence of psychological harm.
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Affiliation(s)
- Amelia K Smit
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Martin Allen
- Electrical and Computer Engineering, University of Canterbury, Christchurch, New Zealand
| | - Brooke Beswick
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Sydney, Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Hugh Dawkins
- Division of Genetics, School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia.,School of Medicine, The University of Notre Dame, Notre Dame, NSW, Australia
| | | | - Kate L Dunlop
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Sydney, Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Georgina Fenton
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Sydney, Australia
| | - Peter A Kanetsky
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Louise Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Michael G Kimlin
- Queensland University of Technology, School of Biomedical Sciences, Brisbane, QLD, Australia
| | - Judy Kirk
- Westmead Clinical School and Westmead Institute for Medical Research, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Matthew H Law
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Cynthia Low
- Consumer representative, Brisbane, QLD, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,The John Curtin School of Medical Research, ANU College of Health and Medicine, ANU, ACT, Canberra, Australia
| | - Gillian Reyes-Marcelino
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Sydney, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ainsley J Newson
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Jacqueline Savard
- School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Lyndal Trevena
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Wordsworth
- Health Economics Research Centre, The University of Oxford, Oxford, UK
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Sydney, Australia. .,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
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Banerjee SC, Sussman A, Schofield E, Guest DD, Dailey YS, Schwartz MR, Buller DB, Hunley K, Kaphingst K, Berwick M, Hay JL. "Let's Talk about Skin Cancer": Examining Association between Family Communication about Skin Cancer, Perceived Risk, and Sun Protection Behaviors. JOURNAL OF HEALTH COMMUNICATION 2021; 26:576-585. [PMID: 34612176 PMCID: PMC8513818 DOI: 10.1080/10810730.2021.1966686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Family communication about skin cancer risk may motivate protective behaviors. However, it is unclear how widespread such communication might be. In this study, we describe prevalence and patterns (across environmental, personal, and behavioral factors) of family communication about skin cancer across N = 600 diverse (79% female, 48% Hispanic, 44% non-Hispanic White) primary care patients from Albuquerque, New Mexico, a geographical location with year-round sun exposure. Over half reported discussing general cancer (77%) and skin cancer risks (66%) with their families. The most frequent target of skin cancer risk communication included doctors (54%), followed by friends/coworkers (49%), spouse/partner (43%), other family members (38%), sisters (36%), mothers (36%), daughters (33%), sons (32%), father (24%), and brothers (22%). On average, participants reported having talked to three family members about skin cancer risks. The most frequently discussed content of skin cancer risk communication was the use of sun protection (89%), followed by the personal risk of skin cancer (68%), who had skin cancer in the family (60%), family risk of skin cancer (59%), time of sun exposure (57%), and skin cancer screening (57%). A family or personal history of cancer, higher perceived risk, higher health literacy, being non-Hispanic, having higher education or income, and proactive sun protective behavior were associated with greater family communication about general cancer and skin cancer risks. These study findings have implications for interventions that encourage discussions about skin cancer risk, sun protection, and skin cancer screening that lead to adoption of sun-safe behaviors.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Kim Kaphingst
- University of Utah, Huntsman Cancer Center, Salt Lake City, UT, USA
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Fear of cancer recurrence in patients undergoing germline genome sequencing. Support Care Cancer 2021; 29:7289-7297. [PMID: 34036439 DOI: 10.1007/s00520-021-06311-9] [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: 12/10/2020] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Fear of cancer recurrence/occurrence (FCR/O) is prevalent and associated with poorer psychological outcomes but can also motivate individuals to pursue genomic information about cancer risk. Guided by Protection Motivation Theory, this study investigated FCR/O prevalence and associated factors among probands previously diagnosed with a cancer of likely heritable origin, and their relatives, who had agreed to have germline genome sequencing. METHODS Three hundred and forty-eight probands and 167 relatives completed the Concerns about Recurrence Questionnaire (adapted for occurrence for some relatives) within 1 month of agreeing to undertake genome sequencing. Linear regressions investigated demographic, disease, attitude and behavioral associations with FCR/O. RESULTS Probands demonstrated greater FCR compared to relatives. In probands, greater FCR was associated with being female, non-English speaking at home, less time since diagnosis, greater intention to change behavior if gene variant found, lower perceived ability to cope with results, higher perceived susceptibility to having a recurrence, and more negative attitudes towards uncertainty. For relatives with cancer, greater FCR was associated with being male, greater intention to change behavior if a gene variant found, and higher perceived susceptibility to recurrence. In relatives without cancer, greater FCO was associated with not having had genetic testing prior to this study, lower perceived ability to cope with results, and higher perceived susceptibility to developing cancer. CONCLUSION Current findings on FCR/O prevalence and associated demographic and attitudinal variables in those who pursue genomic risk information might be used to target interventions that can prevent adverse psychological outcomes in vulnerable patients.
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Tiller J, McInerney-Leo A, Belcher A, Boughtwood T, Gleeson P, Delatycki M, Barlow-Stewart K, Winship I, Otlowski M, Keogh L, Lacaze P. Study protocol: the Australian genetics and life insurance moratorium-monitoring the effectiveness and response (A-GLIMMER) project. BMC Med Ethics 2021; 22:63. [PMID: 34020638 PMCID: PMC8138092 DOI: 10.1186/s12910-021-00634-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background The use of genetic test results in risk-rated insurance is a significant concern internationally, with many countries banning or restricting the use of genetic test results in underwriting. In Australia, life insurers’ use of genetic test results is legal and self-regulated by the insurance industry (Financial Services Council (FSC)). In 2018, an Australian Parliamentary Inquiry recommended that insurers’ use of genetic test results in underwriting should be prohibited. In 2019, the FSC introduced an industry self-regulated moratorium on the use of genetic test results. In the absence of government oversight, it is critical that the impact, effectiveness and appropriateness of the moratorium is monitored. Here we describe the protocol of our government-funded research project, which will serve that critical function between 2020 and 2023. Methods A realist evaluation framework was developed for the project, using a context-mechanism-outcome (CMO) approach, to systematically assess the impact of the moratorium for a range of stakeholders. Outcomes which need to be achieved for the moratorium to accomplish its intended aims were identified, and specific data collection measures methods were developed to gather the evidence from relevant stakeholder groups (consumers, health professionals, financial industry and genetic research community) to determine if aims are achieved. Results from each arm of the study will be analysed and published in peer-reviewed journals as they become available. Discussion The A-GLIMMER project will provide essential monitoring of the impact and effectiveness of the self-regulated insurance moratorium. On completion of the study (3 years) a Stakeholder Report will be compiled. The Stakeholder Report will synthesise the evidence gathered in each arm of the study and use the CMO framework to evaluate the extent to which each of the outcomes have been achieved, and make evidence-based recommendations to the Australian federal government, life insurance industry and other stakeholders. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00634-2.
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Affiliation(s)
- Jane Tiller
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. .,Murdoch Children's Research Institute, Parkville, VIC, Australia. .,Victorian Clinical Genetics Services, Parkville, VIC, Australia.
| | - Aideen McInerney-Leo
- The University of Queensland Diamantina Institute, The University of Queensland Dermatology Research Centre, Brisbane, QLD, Australia
| | - Andrea Belcher
- Australian Genomics, Parkville, VIC, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Tiffany Boughtwood
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Australian Genomics, Parkville, VIC, Australia
| | | | - Martin Delatycki
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Victorian Clinical Genetics Services, Parkville, VIC, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ingrid Winship
- Department of Medicine, University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Margaret Otlowski
- Faculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, TAS, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Paul Lacaze
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Taber JM, Aspinwall LG, Drummond DM, Stump TK, Kohlmann W, Champine M, Cassidy P, Leachman SA. Priority of Risk (But Not Perceived Magnitude of Risk) Predicts Improved Sun-Protection Behavior Following Genetic Counseling for Familial Melanoma. Ann Behav Med 2021; 55:24-40. [PMID: 32415830 PMCID: PMC7880221 DOI: 10.1093/abm/kaaa028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Understanding multiple components of risk perceptions is important because perceived risk predicts engagement in prevention behaviors. PURPOSE To examine how multiple components of risk perceptions (perceived magnitude of and worry about risk, prioritization of the management of one's risk) changed following genetic counseling with or without test reporting, and to examine which of these components prospectively predicted improvements in sun-protection behavior 1 year later. METHODS A prospective, nonrandomized study design was used. Participants were 114 unaffected members of melanoma-prone families who (i) underwent genetic testing for a CDKN2A/p16 mutation (n = 69) or (ii) were at comparably elevated risk based on family history and underwent genetic counseling but not testing (no-test controls, n = 45). Participants reported risk perception components and sun-protection behavior at baseline, immediately following counseling, and 1 month and 1 year after counseling. RESULTS Factor analysis indicated three risk components. Carriers reported increased perceived magnitude and priority of risk, but not cancer worry. No-test controls showed no changes in any risk perception. Among noncarriers, priority of risk remained high at all assessments, whereas magnitude of risk and cancer worry decreased. Of the three risk components, greater priority of risk uniquely predicted improved self-reported sun protection 1 year post-counseling. CONCLUSIONS Priority of risk (i) seems to be a component of risk perceptions distinguishable from magnitude of risk and cancer worry, (ii) may be an important predictor of daily prevention behavior, and (iii) remained elevated 1 year following genetic counseling only for participants who received a positive melanoma genetic test result.
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Affiliation(s)
- Jennifer M Taber
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, UT
| | | | - Tammy K Stump
- Department of Preventive Medicine, Northwestern University, Evanston, IL
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Marjan Champine
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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11
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Direct-to-consumer genetic risk scoring for melanoma improves adherence to sun-protective behaviors among increased-risk groups: Results from a prospective United States cohort study. J Am Acad Dermatol 2021; 85:1035-1038. [PMID: 33476728 DOI: 10.1016/j.jaad.2021.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/28/2020] [Accepted: 01/07/2021] [Indexed: 11/22/2022]
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Saya S, McIntosh JG, Winship IM, Clendenning M, Milton S, Oberoi J, Dowty JG, Buchanan DD, Jenkins MA, Emery JD. A Genomic Test for Colorectal Cancer Risk: Is This Acceptable and Feasible in Primary Care? Public Health Genomics 2020; 23:110-121. [PMID: 32688362 DOI: 10.1159/000508963] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/26/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Genomic tests can predict risk and tailor screening recommendations for colorectal cancer (CRC). Primary care could be suitable for their widespread implementation. OBJECTIVE We aimed to assess the feasibility and acceptability of administering a CRC genomic test in primary care. METHODS Participants aged 45-74 years recruited from 4 Australian general practices were offered a genomic CRC risk test. Participants received brief verbal information about the test comprising 45 CRC-associated single-nucleotide polymorphisms, before choosing whether to undertake the test. Personalized risks were given to testers. Uptake and knowledge of the genomic test, cancer-specific anxiety (Cancer Worry Scale), psychosocial impact (Multidimensional Impact of Cancer Risk Assessment [MICRA] score), and impact on CRC screening behaviour within 6 months were measured. RESULTS In 150 participants, test uptake was high (126, 84%), with 125 (83%) having good knowledge of the genomic test. Moderate risk participants were impacted more by the test (MICRA mean: 15.9) than average risk participants (mean: 9.5, difference in means: 6.4, 95% confidence interval (CI): 1.5, 11.2, p = 0.01), but all scores were low. Average risk participants' cancer-specific anxiety decreased (mean differences from baseline: 1 month -0.5, 95% CI: -1.0, -0.1, p = 0.03; 6 months -0.6, 95% CI: -1.0, -0.2, p = 0.01). We found limited evidence for genomic testers being more likely to complete the risk-appropriate CRC screening than non-testers (41 vs. 17%, odds ratio = 3.4, 95% CI: 0.6, 34.8, p = 0.19), but some mediators of screening behaviour were altered in genomic testers. CONCLUSIONS Genomic testing for CRC risk in primary care is acceptable and likely feasible. Further development of the risk assessment intervention could strengthen the impact on screening behaviour.
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Affiliation(s)
- Sibel Saya
- Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia, .,Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia,
| | - Jennifer G McIntosh
- Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia.,Department of Software Systems & Cybersecurity, Monash University, Melbourne, Victoria, Australia
| | - Ingrid M Winship
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Genomic Medicine & Family Cancer Clinic, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Mark Clendenning
- Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shakira Milton
- Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Jasmeen Oberoi
- Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - James G Dowty
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel D Buchanan
- Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Genomic Medicine & Family Cancer Clinic, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark A Jenkins
- Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jon D Emery
- Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia.,The Primary Care Unit, University of Cambridge, Cambridge, United Kingdom
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13
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Yanes T, McInerney-Leo AM, Law MH, Cummings S. The emerging field of polygenic risk scores and perspective for use in clinical care. Hum Mol Genet 2020; 29:R165-R176. [DOI: 10.1093/hmg/ddaa136] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
Abstract
Genetic testing is used widely for diagnostic, carrier and predictive testing in monogenic diseases. Until recently, there were no genetic testing options available for multifactorial complex diseases like heart disease, diabetes and cancer. Genome-wide association studies (GWAS) have been invaluable in identifying single-nucleotide polymorphisms (SNPs) associated with increased or decreased risk for hundreds of complex disorders. For a given disease, SNPs can be combined to generate a cumulative estimation of risk known as a polygenic risk score (PRS). After years of research, PRSs are increasingly used in clinical settings. In this article, we will review the literature on how both genome-wide and restricted PRSs are developed and the relative merit of each. The validation and evaluation of PRSs will also be discussed, including the recognition that PRS validity is intrinsically linked to the methodological and analytical approach of the foundation GWAS together with the ethnic characteristics of that cohort. Specifically, population differences may affect imputation accuracy, risk magnitude and direction. Even as PRSs are being introduced into clinical practice, there is a push to combine them with clinical and demographic risk factors to develop a holistic disease risk. The existing evidence regarding the clinical utility of PRSs is considered across four different domains: informing population screening programs, guiding therapeutic interventions, refining risk for families at high risk, and facilitating diagnosis and predicting prognostic outcomes. The evidence for clinical utility in relation to five well-studied disorders is summarized. The potential ethical, legal and social implications are also highlighted.
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Affiliation(s)
- Tatiane Yanes
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Aideen M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Matthew H Law
- Statistical Genetics Lab, QIMR Berghofer Medical Research Institute, Herston QLD 4006, Australia
- Faculty of Health, School of Biomedical Sciences, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove QLD 4059, Australia
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14
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Lo SN, Smit AK, Espinoza D, Cust AE. The Melanoma Genomics Managing Your Risk Study randomised controlled trial: statistical analysis plan. Trials 2020; 21:594. [PMID: 32605576 PMCID: PMC7329549 DOI: 10.1186/s13063-020-04351-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/25/2020] [Indexed: 01/11/2023] Open
Abstract
Background The Melanoma Genomics Managing Your Risk Study is a randomised controlled trial that aims to evaluate the efficacy of providing information on personal genomic risk of melanoma in reducing ultraviolet radiation (UV) exposure, stratified by traditional risk group (low or high phenotypic risk) in the general population. The primary outcome is objectively measured total daily Standard Erythemal Doses at 12 months. Secondary outcomes include UV exposure at specific time periods, self-reported sun protection and skin-examination behaviours, psychosocial outcomes, and ethical considerations surrounding offering genomic testing at a population level. A within-trial and modelled economic evaluation will be undertaken from an Australian health system perspective to assess the cost-effectiveness of the intervention. Objective To publish the pre-determined statistical analysis plan (SAP) before database lock and the start of analysis. Methods This SAP describes the data synthesis, analysis principles and statistical procedures for analysing the outcomes from this trial. The SAP was approved after closure of recruitment and before completion of patient follow-up. It outlines the planned primary analyses and a range of subgroup and sensitivity analyses. Health economic outcomes are not included in this plan but will be analysed separately. The SAP will be adhered to for the final data analysis of this trial to avoid potential analysis bias that may arise from knowledge of the outcome data. Results This SAP is consistent with best practice and should enable transparent reporting. Conclusion This SAP has been developed for the Melanoma Genomics Managing Your Risk Study and will be followed to ensure high-quality standards of internal validity and to minimise analysis bias. Trial registration Prospectively registered with the Australian New Zealand Clinical Trials Registry, ID: ACTR N12617000691347. Registered on 15 May 2017.
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Affiliation(s)
- Serigne N Lo
- The University of Sydney, Melanoma Institute Australia, Sydney, NSW, Australia
| | - Amelia K Smit
- The University of Sydney, Melanoma Institute Australia, Sydney, NSW, Australia.,The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, Sydney, NSW, Australia.,The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, NSW, Australia
| | - David Espinoza
- The University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Anne E Cust
- The University of Sydney, Melanoma Institute Australia, Sydney, NSW, Australia. .,The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, Sydney, NSW, Australia.
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15
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Smit AK, Reyes-Marcelino G, Keogh L, Dunlop K, Newson AJ, Cust AE. Implementation considerations for offering personal genomic risk information to the public: a qualitative study. BMC Public Health 2020; 20:1028. [PMID: 32600382 PMCID: PMC7325160 DOI: 10.1186/s12889-020-09143-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/18/2020] [Indexed: 12/17/2022] Open
Abstract
Background Genomic risk information, based on common genomic susceptibility variants associated with risk of complex diseases such as cancer, may be incorporated into personalised prevention and screening strategies. We aimed to engage with members of the public, who are important stakeholders in this process, to further inform program development and other implementation outcomes such as acceptability and appropriateness. Methods Semi-structured interviews were undertaken with 30 participants (aged 24–69 years, 50% female) recruited from a pilot trial in which they received personalised genomic risk information for melanoma. We explored participants’ views and attitudes towards offering general personal genomic risk information to the broader population. The data were analysed thematically. Results Two overarching themes relevant to implementation considerations were identified. Firstly, participants’ preferences for accepting an offer of genomic risk information were based on family history, disease incidence and the possibility of prevention. Secondly, participants felt that the processes for offering risk information should be based on individual preferences, triaged according to risk and be supported by a health professional trained in genomics. Conclusions Participants felt that offering personal genomic risk information to the general population to inform prevention and early detection recommendations is acceptable, particularly for common, complex conditions such as cancer. Understanding participants’ preferences for receiving genomic risk information will assist with communication strategies and health workforce planning. We anticipate that these findings will contribute to the development of implementation strategies for incorporating genomic risk information into routine clinical practice.
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Affiliation(s)
- Amelia K Smit
- Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, The University of Sydney, Sydney, Australia. .,Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, Australia. .,Melanoma Institute Australia, The University of Sydney, Sydney, Australia.
| | - Gillian Reyes-Marcelino
- Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, The University of Sydney, Sydney, Australia
| | - Louise Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Kate Dunlop
- Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, The University of Sydney, Sydney, Australia
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, Australia
| | - Anne E Cust
- Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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16
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Smit AK, Reyes-Marcelino G, Keogh L, Cust AE, Newson AJ. 'There is a lot of good in knowing, but there is also a lot of downs': public views on ethical considerations in population genomic screening. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2019-105934. [PMID: 32434901 DOI: 10.1136/medethics-2019-105934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
Publics are key stakeholders in population genomic screening and their perspectives on ethical considerations are relevant to programme design and policy making. Using semi-structured interviews, we explored social views and attitudes towards possible future provision of personalised genomic risk information to populations to inform prevention and/or early detection of relevant conditions. Participants were members of the public (n=30) who had received information on their personal genomic risk of melanoma as part of a research project. The focus of the analysis presented here is participants' views regarding ethical considerations relevant to population genomic screening more generally. Data were analysed thematically and four key themes related to ethical considerations were identified: (i) personal responsibility for health: 'forewarned is forearmed'; (ii) perceptions of, and responses to, genetic fatalism; (iii) implications for parenting and reproduction; (iv) divided views on choosing to receive genomic risk information. Ethical considerations underlying these themes include the valorisation of information and choice, paternalism, non-directiveness and increasing responsibilisation of individuals in health and healthcare. These findings arguably indicate a thin public conceptualisation of population genomic testing, which draws heavily on how these themes tend to be described in existing social discourses. Findings suggest that further public engagement is required to increase complexity of debate, to consider (for example) the appropriate place of individual and social interests in population genomic testing. Further discernment of relevant ethical approaches, drawing on ethical frameworks from both public health and clinical settings, will also assist in determining the appropriate implementation of population genomic screening for complex conditions.
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Affiliation(s)
- Amelia K Smit
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Gillian Reyes-Marcelino
- Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anne E Cust
- Faculty of Medicine and Health, Sydney School of Public Health, Cancer Epidemiology and Prevention Research, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, New South Wales, Australia
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17
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Hay JL, Zielaskowski K, Meyer White K, Kaphingst K, Robers E, Guest D, Sussman A, Talamantes Y, Schwartz M, Rodríguez VM, Li Y, Schofield E, Bigney J, Hunley K, Buller D, Berwick M. Interest and Uptake of MC1R Testing for Melanoma Risk in a Diverse Primary Care Population: A Randomized Clinical Trial. JAMA Dermatol 2019; 154:684-693. [PMID: 29801061 DOI: 10.1001/jamadermatol.2018.0592] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Germline variants in the MC1R gene are common and confer moderate melanoma risk in those with varied skin types. Approaches to precision skin cancer prevention that include genetic information may promote risk awareness and risk reduction in the general population, including Hispanics. Objective To examine prevalence of interest in and uptake of MC1R testing in the general population and examine patterns across demographic and skin cancer risk factors. Design, Setting, and Participants A randomized clinical trial examined interest in and uptake of MC1R testing among patients at University of New Mexico General Internal Medicine clinics. Study participants were randomized to either a usual-care condition (National Cancer Institute skin cancer pamphlet for diverse skin types) or an MC1R test offer. Participants were registered clinic patients (≥6 months) and English or Spanish fluent. Of the 600 participants recruited to the overall trial, the present study included those 499 participants randomized to the MC1R test offer. Interventions Participants were presented with the option to log onto the study website to read 3 educational modules presenting the rationale, benefits, and drawbacks of MC1R testing. Main Outcomes and Measures Main outcomes include website log on (yes vs no), saliva test kit request (yes vs no), and saliva test kit return for MC1R testing (yes vs no). Demographic and skin cancer risk factors were examined as potential predictors of test interest and uptake. Results Of the 499 participants (220 [44%] non-Hispanic white, 242 [48%] Hispanic, 396 [79%] female; mean [SD] age, 54 [14.3] years), 232 (46%) elected to learn about MC1R testing by logging onto the website; 204 (88%) of those who logged on decided to request testing; and 167 (82%) of those who requested testing returned the kit. The strongest predictors of website log on were race/ethnicity and education (non-Hispanic whites were more likely to log on [odds ratio for Hispanics vs non-Hispanic whites, 0.5; 95% CI, 0.3-0.7], as were more highly educated individuals [odds ratio for more than high school vs high school or less, 2.7; 95% CI, 1.7-4.3]). The strongest predictor of ordering the test was sunburn history (odds ratio, 5.4; 95% CI, 2.3-12.9 vs no sunburn history). Conclusions and Relevance There were moderately high levels of MC1R test interest and uptake in this diverse sample. Addressing potential barriers to testing may be warranted as genomic information becomes integrated into general population approaches to the precision prevention of skin cancer. Trial Registration ClinicalTrials.gov identifier: NCT03130569.
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Affiliation(s)
- Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kate Zielaskowski
- Clinical Research Finance, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kirsten Meyer White
- Division of Epidemiology, Department of Internal Medicine, University of New Mexico, Albuquerque
| | - Kimberly Kaphingst
- Department of Communication, University of Utah, Salt Lake City.,Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Erika Robers
- New Mexico Translation and Transcription, Albuquerque
| | - Dolores Guest
- CRTC Population Sciences Academic Unit, University of New Mexico, Albuquerque
| | - Andrew Sussman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque
| | - Yvonne Talamantes
- CRTC Population Sciences Academic Unit, University of New Mexico, Albuquerque
| | - Matthew Schwartz
- CRTC Population Sciences Academic Unit, University of New Mexico, Albuquerque
| | | | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica Bigney
- Department of General Internal Medicine, University of New Mexico, Albuquerque
| | - Keith Hunley
- Department of Anthropology, University of New Mexico, Albuquerque
| | | | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico, Albuquerque.,Department of Dermatology, University of New Mexico, Albuquerque
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18
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Hay JL, Meyer White K, Sussman A, Kaphingst K, Guest D, Schofield E, Dailey YT, Robers E, Schwartz MR, Zielaskowski K, Li Y, Buller D, Hunley K, Berwick M. Psychosocial and Cultural Determinants of Interest and Uptake of Skin Cancer Genetic Testing in Diverse Primary Care. Public Health Genomics 2019; 22:58-68. [PMID: 31437847 DOI: 10.1159/000501985] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 07/07/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Translational research in genomics has limited reach and requires efforts to broaden access and utility in diverse populations. Skin cancer is common and rates are rising, including among Hispanics. Germline variants in the melanocortin-1 receptor (MC1R) gene are common in the population and confer moderate risk for melanoma and basal cell cancers across skin types. Feedback about MC1R risk status may promote skin cancer risk awareness and risk reduction. AIMS We examined the level of interest in pursuing MC1R testing, and patterns of interest across skin cancer perceived threat and control attitudes, cultural beliefs (family influence on health, health system distrust, cancer fatalism, skin cancer misconceptions), and health literacy. METHODS We used a study website to inform primary care patients in Albuquerque, NM about the benefits and drawbacks of MC1R testing. Website logon, request of a saliva test kit, and return of the test kit (yes vs. no) were primary assessments of study interest and uptake. RESULTS Of 499 participants provided with a test offer, 33% requested and returned the test. Lower family influence on participants' health was an important factor both overall and within ethnicity subgroups, and may indicate that primary care patients interested in skin cancer genetic testing see themselves as proactive health seekers, independent from family encouragement. Lower self-efficacy for skin cancer prevention was also an important characteristic of those who tested. CONCLUSION As evidence for common genetic markers for skin cancer accumulates, these findings suggest characteristics of those most likely to pursue genetic testing for skin cancer risk.
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Affiliation(s)
- Jennifer L Hay
- Memorial Sloan Kettering Cancer Center, New York, New York, USA,
| | | | | | - Kim Kaphingst
- Huntsman Cancer Center, University of Utah, Salt Lake City, Utah, USA
| | - Dolores Guest
- University of New Mexico, Albuquerque, New Mexico, USA
| | | | | | - Erika Robers
- University of New Mexico, Albuquerque, New Mexico, USA
| | | | | | - Yuelin Li
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Keith Hunley
- University of New Mexico, Albuquerque, New Mexico, USA
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19
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Morton RL, Asher R, Peyton E, Tran A, Smit AK, Butow PN, Kimlin MG, Dobbinson SJ, Wordsworth S, Keogh L, Cust AE. Risk attitudes and sun protection behaviour: Can behaviour be altered by using a melanoma genomic risk intervention? Cancer Epidemiol 2019; 61:8-13. [DOI: 10.1016/j.canep.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/24/2019] [Accepted: 05/07/2019] [Indexed: 11/16/2022]
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20
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Genetic discrimination by Australian insurance companies: a survey of consumer experiences. Eur J Hum Genet 2019; 28:108-113. [PMID: 31281182 PMCID: PMC6906286 DOI: 10.1038/s41431-019-0426-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/18/2019] [Accepted: 04/30/2019] [Indexed: 11/09/2022] Open
Abstract
We report previously undocumented evidence of genetic discrimination by Australian insurance companies, obtained through direct consumer reports. We surveyed 174 consumers with cancer-predisposing variants, recruited by cancer organisations Lynch Syndrome Australia and Pink Hope. Questions related to experiences accessing risk-rated insurance after genetic testing. Results indicate that both legal (permitted under current regulation) and illegal discrimination is occurring. Although some respondents had not applied for risk-rated insurance, or had insurance in place before genetic testing (n = 100), those seeking new policies (n = 74) commonly experienced difficulties obtaining insurance (86%, 64/74). Of those experiencing difficulties, 50% (32/64) had no prior history or symptoms of cancer, and had undertaken risk reduction through surveillance and/or preventative surgery. Seventy-seven percent (49/64) reported difficulties related to life insurance. Follow-up telephone interviews with four respondents further described cases of apparent illegal breaches. All reports of discrimination identified were, to our knowledge, previously unreported in the literature. The number of cases suggests a systemic problem with the Australian life insurance industry. We support calls for government oversight of the inherently conflicted model of industry self-regulation in Australia, and an immediate ban on the use of genetic test results in insurance underwriting.
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21
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McInerney-Leo AM, Finnane A. The personal touch: does the communication method affect response to melanoma genetic risk? Br J Dermatol 2019; 180:1288-1289. [PMID: 31157440 DOI: 10.1111/bjd.17884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A M McInerney-Leo
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, 4102, Australia
| | - A Finnane
- School of Public Health, The University of Queensland, Herston, Queensland, 4006, Australia
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22
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Fenton GL, Smit AK, Keogh L, Cust AE. Exploring the emotional and behavioural reactions to receiving personalized melanoma genomic risk information: a qualitative study. Br J Dermatol 2019; 180:1390-1396. [PMID: 30580464 DOI: 10.1111/bjd.17582] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND There is a need for greater understanding of the spectrum of emotional and behavioural reactions that individuals in the general population may experience in response to genomic testing for melanoma risk. OBJECTIVES To explore how individuals in the general population respond to receiving personalized genomic risk of melanoma. METHODS Semistructured interviews were undertaken with 30 participants (aged 24-69 years, 50% female, 12 low risk, eight average risk, 10 high risk) recruited from a pilot trial in which they received personalized melanoma genomic risk information. We explored participants' emotional and behavioural responses to receiving their melanoma genomic risk information. The qualitative data were analysed thematically. RESULTS Many participants reported a positive response to receiving their melanoma genomic risk, including feelings of happiness, reassurance and gaining new knowledge to help manage their melanoma risk. Some participants reported short-term negative emotional reactions that dissipated over time. Most individuals, particularly those who received average or high-risk results, reported making positive behaviour changes to reduce their melanoma risk. Emotional and behavioural responses were linked to participants' expectations for their risk result, their pre-existing perception of their own melanoma risk, their existing melanoma preventive behaviours and their genomic risk category. CONCLUSIONS Personalized melanoma genomic risk information alongside education and lifestyle counselling is favourably received by people without a personal history and unselected for a family history of melanoma. Participants described increased knowledge and awareness around managing skin cancer risk and improved sun protection and skin examination behaviours. Any initial feelings of distress usually dissipated over time.
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Affiliation(s)
- G L Fenton
- Cancer Epidemiology and Prevention Research, The University of Sydney, NSW, Australia
| | - A K Smit
- Cancer Epidemiology and Prevention Research, The University of Sydney, NSW, Australia.,Melanoma Institute Australia (MIA), The University of Sydney, NSW, Australia.,Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - L Keogh
- Melbourne School of Population and Global Health, The University of Melbourne, Vic., Australia
| | - A E Cust
- Cancer Epidemiology and Prevention Research, The University of Sydney, NSW, Australia.,Melanoma Institute Australia (MIA), The University of Sydney, NSW, Australia
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23
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GP attitudes to and expectations for providing personal genomic risk information to the public: a qualitative study. BJGP Open 2019; 3:bjgpopen18X101633. [PMID: 31049413 PMCID: PMC6480852 DOI: 10.3399/bjgpopen18x101633] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/20/2018] [Indexed: 01/16/2023] Open
Abstract
Background As part of a pilot randomised controlled trial examining the impact of personal melanoma genomic risk information on behavioural and psychosocial outcomes, GPs were sent a booklet containing their patient’s genomic risk of melanoma. Aim Using this booklet as an example of genomic risk information that might be offered on a population-level in the future, this study explored GP attitudes towards communicating genomic risk information and resources needed to support this process. Design & setting Semi-structured interviews were conducted with 22 Australian GPs. Method The interviews were recorded and transcribed, and data were analysed thematically. Results GPs in this sample believed that communicating genomic risk may become a responsibility within primary care and they recommended a shared decisionmaking approach to guide the testing process. Factors were identified that may influence how and when GPs communicate genomic risk information. GPs view genomics-based risk as one of many disease risk factors and feel that this type of information could be applied in practice in the context of overall risk assessment for diseases for which prevention and early detection strategies are available. They believe it is important to ensure that patients understand their genomic risk and do not experience long-term adverse psychological responses. GPs desire clinical practice guidelines that specify recommendations for genomic risk assessment and patient management, point-of-care resources, and risk prediction tools that include genomic and traditional risk factors. Conclusion These findings will inform the development of resources for preparing GPs to manage and implement genomic risk information in practice.
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Yanes T, Willis AM, Meiser B, Tucker KM, Best M. Psychosocial and behavioral outcomes of genomic testing in cancer: a systematic review. Eur J Hum Genet 2019; 27:28-35. [PMID: 30206354 PMCID: PMC6303287 DOI: 10.1038/s41431-018-0257-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/26/2018] [Accepted: 08/09/2018] [Indexed: 01/23/2023] Open
Abstract
Psychosocial and behavioral outcomes of genetic testing in oncology are well known, however, it is unclear how these findings will generalize to more complex genomic testing. The aim of this systematic review was to assess the psychosocial and behavioral outcomes of cancer genomic testing. Studies were selected for inclusion if they were published from January 2003 to January 2017 and addressed psychological and behavioral outcomes of cancer genomic testing in adults. A review of four databases identified 9620 abstracts, with 22 publications meeting the inclusion criteria. Of the included articles, 11 studies reported on outcomes of germline testing, with three articles assessing panel testing and eight SNP testing. No studies assessed the outcomes of WGS or WES. Eleven articles assessed the outcomes of somatic testing, including testing for cancer prognosis and for personalized therapies. Studies were biased toward breast cancer and Caucasian women with high education and socioeconomic status. While studies demonstrated limited adverse psychological outcomes associated with genomic testing, a lack of consistency in psychosocial measures precluded any meta-analysis. Changes in health behavior following positive results were limited, and in some cases risk perception was not altered following genomic testing. There is limited evidence of adverse psychosocial outcomes and changes in health behavior following genomic testing to assess cancer risk. Findings from this review highlight the need for longitudinal research with superior methodological and theoretical design.
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Affiliation(s)
- Tatiane Yanes
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia.
- School of Psychiatry, Faculty of Medicine, UNSW, Sydney, Australia.
| | - Amanda M Willis
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
| | - Katherine M Tucker
- Prince of Wales Clinical School, Faculty of Medicine, UNSW, Sydney, Australia
- Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, Australia
| | - Megan Best
- Psycho-oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
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25
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Cust AE, Mishra K, Berwick M. Melanoma - role of the environment and genetics. Photochem Photobiol Sci 2018; 17:1853-1860. [PMID: 30113042 DOI: 10.1039/c7pp00411g] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Melanoma rates have increased in populations that are mainly European. The main etiologic factor is ultraviolet radiation, from the sun as well as artificial tanning devices. Host factors such as skin color, number of nevi, hair and eye color and tanning ability are critical factors in modifying an individual's response to the sun. Genetic factors interact with host factors and environmental factors to increase risk. This review summarizes our current knowledge of environment and genetics on melanoma risk and on gene-environment interaction.
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Affiliation(s)
- Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia
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26
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Tiller J, Keogh L, Wake S, Delatycki M, Otlowski M, Lacaze P. Genetics, Insurance and Professional Practice: Survey of the Australasian Clinical Genetics Workforce. Front Public Health 2018; 6:333. [PMID: 30542646 PMCID: PMC6277853 DOI: 10.3389/fpubh.2018.00333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/31/2018] [Indexed: 12/12/2022] Open
Abstract
In Australia and New Zealand, by contrast with much of the developed world, insurance companies can use genetic test results to refuse cover or increase premiums for mutually-rated insurance products, including life, income protection and disability insurance. Genetics professionals regularly discuss insurance implications with clients and report the issue as a clinical challenge, yet no studies have examined clinical practices or opinions. This study surveyed genetic counsellors and clinical geneticists from Australia and New Zealand to (i) investigate variability in professional practice across the Australasian clinical genetic workforce relating to the insurance implications of genetic testing, and (ii) ascertain views regarding current regulation of the issue. There was considerable variability in training and clinical policies, especially around the communication of insurance implications. Almost half of participants reported receiving no training on the insurance implications of genetic testing, and almost 40% were unsure whether they could adequately advise clients. A number of deficits in professional knowledge and understanding of the issue were identified. Widespread concerns regarding regulation of this area were reported, with < 10% of Australian participants considering current Australian regulations as adequate to protect clients from genetic discrimination. The findings from this study highlight scope for greater education, consistency and professional training on the issue of genetics and insurance in Australasia, and strong agreement about the need for regulatory reform.
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Affiliation(s)
- Jane Tiller
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Samantha Wake
- The University of Melbourne, Melbourne, VIC, Australia
| | - Martin Delatycki
- Victorian Clinical Genetics Services, Parkville, VIC, Australia
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Royal Children's Hospital, Parkville, VIC, Australia
| | - Margaret Otlowski
- Faculty of Law, Centre for Law and Genetics, University of Tasmania, Hobart, TAS, Australia
| | - Paul Lacaze
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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27
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Manchanda R, Gaba F. Population Based Testing for Primary Prevention: A Systematic Review. Cancers (Basel) 2018; 10:cancers10110424. [PMID: 30400647 PMCID: PMC6266041 DOI: 10.3390/cancers10110424] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 10/24/2018] [Accepted: 10/31/2018] [Indexed: 12/29/2022] Open
Abstract
The current clinical model for genetic testing is based on clinical-criteria/family-history (FH) and a pre-defined mutation probability threshold. It requires people to develop cancer before identifying unaffected individuals in the family to target prevention. This process is inefficient, resource intensive and misses >50% of individuals or mutation carriers at risk. Population genetic-testing can overcome these limitations. It is technically feasible to test populations on a large scale; genetic-testing costs are falling and acceptability and awareness are rising. MEDLINE, EMBASE, Pubmed, CINAHL and PsychINFO databases were searched using free-text and MeSH terms; retrieved reference lists of publications were screened; additionally, web-based platforms, Google, and clinical-trial registries were searched. Quality of studies was evaluated using appropriate check-lists. A number of studies have evaluated population-based BRCA-testing in the Jewish population. This has been found to be acceptable, feasible, clinically-effective, safe, associated with high satisfaction rates and extremely cost-effective. Data support change in guidelines for population-based BRCA-testing in the Jewish population. Population panel testing for BRCA1/BRCA2/RAD51C/RAD51D/BRIP1/PALB2 gene mutations is the most cost-effective genetic-testing strategy in general-population women and can prevent thousands more breast and ovarian cancers than current clinical-criteria based approaches. A few ongoing studies are evaluating population-based genetic-testing for multiple cancer susceptibility genes in the general population but more implementation studies are needed. A future population-testing programme could also target other chronic diseases.
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Affiliation(s)
- Ranjit Manchanda
- Barts Cancer Institute, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK.
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London EC1A 7BE, UK.
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 149 Tottenham Court Road, London W1T 7DN, UK.
| | - Faiza Gaba
- Barts Cancer Institute, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK.
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London EC1A 7BE, UK.
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28
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Smit AK, Newson AJ, Best M, Badcock CA, Butow PN, Kirk J, Dunlop K, Fenton G, Cust AE. Distress, uncertainty, and positive experiences associated with receiving information on personal genomic risk of melanoma. Eur J Hum Genet 2018; 26:1094-1100. [PMID: 29706632 DOI: 10.1038/s41431-018-0145-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/06/2018] [Accepted: 03/20/2018] [Indexed: 12/13/2022] Open
Abstract
The aim of this research was to understand how genomics-based personal melanoma risk information impacts psychological and emotional health outcomes in the general population. In a pilot randomized controlled trial, participants (n = 103) completed the Multidimensional Impact of Cancer Risk Assessment (MICRA) questionnaire, 3 months after receiving personal melanoma genomic risk information. Mean scores for MICRA items and subscales were stratified by genomic risk group (low, average, high), gender, education, age, and family history of melanoma. P values were obtained from t-tests and analysis of variance tests. We found that overall, participants (mean age: 53 years, range: 21-69; 52% female) had a total MICRA mean score of 18.6 (standard deviation: 11.1, range: 1-70; possible range: 0-105). The high genomic risk group had higher mean scores for the total (24.2, F2,100 = 6.7, P = 0.0019), distress (3.3, F2,100 = 9.4, P = 0.0002) and uncertainty (8.5, F2,100 = 6.5, P = 0.0021) subscales compared with average (17.6, 1.1, and 4.5, respectively) and low-risk groups (14.1, 0.5, and 2.5, respectively). Positive experiences scores were consistent across risk groups. In conclusion, MICRA scores for the total, distress and uncertainty subscales in our study were relatively low overall, but people who receive a high genomic risk result may benefit from increased support following testing.
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Affiliation(s)
- Amelia K Smit
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia. .,Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, Sydney, Australia. .,Melanoma Institute Australia, The University of Sydney, Sydney, Australia.
| | - Ainsley J Newson
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Megan Best
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia
| | - Caro-Anne Badcock
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Judy Kirk
- Westmead Clinical School, and Westmead Institute for Medical Research, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Kate Dunlop
- The Centre for Genetics Education, NSW Health, Sydney, Australia
| | - Georgina Fenton
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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29
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Cust AE, Fenton GL, Smit AK, Espinoza D, Dobbinson S, Brodie A, Dang HTC, Kimlin MG. Validation of Questionnaire and Diary Measures of Time Outdoors Against an Objective Measure of Personal Ultraviolet Radiation Exposure. Photochem Photobiol 2018; 94:815-820. [DOI: 10.1111/php.12893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Anne E Cust
- Cancer Epidemiology and Prevention Research; Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
- Melanoma Institute Australia; The University of Sydney; Sydney NSW Australia
| | - Georgina L Fenton
- Cancer Epidemiology and Prevention Research; Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
| | - Amelia K Smit
- Cancer Epidemiology and Prevention Research; Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
- Melanoma Institute Australia; The University of Sydney; Sydney NSW Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre; The University of Sydney; Sydney NSW Australia
| | | | - Alison Brodie
- The University of the Sunshine Coast; Maroochydore Qld Australia
| | | | - Michael G Kimlin
- The University of the Sunshine Coast; Maroochydore Qld Australia
- Cancer Council Queensland; Brisbane Qld Australia
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30
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Kanetsky PA, Hay JL. Marshaling the Translational Potential of MC1R for Precision Risk Assessment of Melanoma. Cancer Prev Res (Phila) 2018; 11:121-124. [PMID: 29246956 PMCID: PMC5839988 DOI: 10.1158/1940-6207.capr-17-0255] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/30/2017] [Accepted: 12/07/2017] [Indexed: 01/27/2023]
Abstract
Melanoma rates have been increasing in the United States, and neither primary (sun protection and avoidance) nor secondary (skin examination) prevention is practiced consistently, even by those with melanoma risk factors. Inherited variation at MC1R is a robust marker for increased risk of melanoma, even among individuals with "sun-resistant" phenotypes. Although MC1R conveys important information about inherited melanoma risk for a broad spectrum of individuals, concerns that MC1R feedback could have negative consequences, including increased distress about melanoma, inappropriate use of health services, and development of a false sense of security, are valid and require empirical examination. The time is right for high-quality research focusing on the translation of MC1R genotype into clinical and public health practice. If studies show MC1R genetic risk screening is effective at motivating behavior change, more melanomas may be detected at earliest stages for which surgical excision is highly curative or a large number of melanomas may be prevented altogether. While other genetic markers for melanoma susceptibility may emerge in the coming years, the burgeoning research agenda on the public health translational potential of MC1R genetic risk screening will inform and usefully advance current and future precision risk assessment of melanoma. Cancer Prev Res; 11(3); 121-4. ©2017 AACR.
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Affiliation(s)
- Peter A Kanetsky
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
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31
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Tiller J, Otlowski M, Lacaze P. Should Australia Ban the Use of Genetic Test Results in Life Insurance? Front Public Health 2017; 5:330. [PMID: 29322039 PMCID: PMC5733354 DOI: 10.3389/fpubh.2017.00330] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/22/2017] [Indexed: 11/27/2022] Open
Abstract
Under current Australian regulation, life insurance companies can require applicants to disclose all genetic test results, including results from research or direct-to-consumer tests. Life insurers can then use this genetic information in underwriting and policy decisions for mutually rated products, including life, permanent disability, and total income protection insurance. Over the past decade, many countries have implemented moratoria or legislative bans on the use of genetic information by life insurers. The Australian government, by contrast, has not reviewed regulation since 2005 when it failed to ensure implementation of recommendations made by the Australian Law Reform Commission. In that time, the Australian life insurance industry has been left to self-regulate its use of genetic information. As a result, insurance fears in Australia now are leading to deterred uptake of genetic testing by at-risk individuals and deterred participation in medical research, both of which have been documented. As the potential for genomic medicine grows, public trust and engagement are critical for successful implementation. Concerns around life insurance may become a barrier to the development of genomic health care, research, and public health initiatives in Australia, and the issue should be publicly addressed. We argue a moratorium on the use of genetic information by life insurers should be enacted while appropriate longer term policy is determined and implemented.
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Affiliation(s)
- Jane Tiller
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Margaret Otlowski
- Centre for Law and Genetics, Faculty of Law, University of Tasmania, Hobart, TAS, Australia
| | - Paul Lacaze
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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32
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Development and Evaluation of a Telephone Communication Protocol for the Delivery of Personalized Melanoma Genomic Risk to the General Population. J Genet Couns 2017; 27:370-380. [DOI: 10.1007/s10897-017-0183-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/21/2017] [Indexed: 12/13/2022]
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33
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Direct-to-Consumer Genetic Testing in the Personalized Medicine Era. POINT OF CARE 2017. [DOI: 10.1097/poc.0000000000000146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Smit A, Keogh L, Newson A, Butow P, Dunlop K, Morton R, Kirk J, Espinoza D, Cust A. Does personalized melanoma genomic risk information trigger conversations about skin cancer prevention and skin examination with family, friends and health professionals? Br J Dermatol 2017. [DOI: 10.1111/bjd.15744] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A.K. Smit
- Cancer Epidemiology and Prevention Research Sydney School of Public Health The University of Sydney Australia
- Centre for Values Ethics and the Law in Medicine Sydney School of Public Health The University of Sydney Australia
| | - L.A. Keogh
- Melbourne School of Population and Global Health The University of Melbourne Australia
| | - A.J. Newson
- Centre for Values Ethics and the Law in Medicine Sydney School of Public Health The University of Sydney Australia
| | - P.N. Butow
- Centre for Medical Psychology and Evidence‐based Decision‐making School of Psychology The University of Sydney Australia
| | - K. Dunlop
- The Centre for Genetics Education NSW Health Sydney Australia
| | - R.L. Morton
- NHMRC Clinical Trials Centre The University of Sydney Australia
- Melanoma Institute Australia The University of Sydney Australia
| | - J. Kirk
- Westmead Clinical School and Westmead Institute for Medical Research Sydney Medical School The University of Sydney Australia
| | - D. Espinoza
- NHMRC Clinical Trials Centre The University of Sydney Australia
| | - A.E. Cust
- Cancer Epidemiology and Prevention Research Sydney School of Public Health The University of Sydney Australia
- Melanoma Institute Australia The University of Sydney Australia
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