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Ramirez Leon D, Martinez D, Rivera Rivera J, Fuzzell L, Vadaparampil S, Rogers H, Gabram S, Snyder C, Guan Y. Assessing interventions promoting the uptake of cancer-related genomic services within the Latino community: A scoping review using the RE-AIM framework. Cancer Med 2024; 13:e7440. [PMID: 38989639 PMCID: PMC11237879 DOI: 10.1002/cam4.7440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 06/11/2024] [Accepted: 06/18/2024] [Indexed: 07/12/2024] Open
Abstract
Cancer genomic services (CGS) can support genetic risk-stratified cancer prevention and treatment. Racial/ethnic minority groups are less likely to access and utilize CGS compared with non-Hispanic Whites. Little research has described characteristics of interventions targeted at CGS among Latinos. This scoping review aimed to (1) describe interventions promoting uptake of CGS among Latinos in the United States and Latin America, (2) describe intervention adaptations for Latino participants, and (3) summarize intervention implementation factors suggested by reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. We conducted a search in English and Spanish of literature published between 2005 and 2022 across PubMed and Latin American and Caribbean Health Sciences Literature databases. Sixteen of 2344 papers met the inclusion criteria of the analysis. Efforts to promote CGS among Latino communities were limited in the US and lower in Latin America. This review highlights the need for in-depth exploration of acculturation-informed interventions and better reporting on implementation factors to enhance their scalability across diverse settings.
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Affiliation(s)
- Dayanna Ramirez Leon
- Department of Behavioral, Social, and Health Education SciencesRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
| | - Denise Martinez
- Department of Behavioral, Social, and Health Education SciencesRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
| | - Jessica Rivera Rivera
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Lindsay Fuzzell
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Susan Vadaparampil
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Hannah Rogers
- Woodruff Health Sciences Center LibraryEmory UniversityAtlantaGeorgiaUSA
| | - Sheryl Gabram
- Georgia Center for Oncology Research and EducationAtlantaGeorgiaUSA
| | - Cindy Snyder
- Georgia Center for Oncology Research and EducationAtlantaGeorgiaUSA
| | - Yue Guan
- Department of Behavioral, Social, and Health Education SciencesRollins School of Public Health, Emory UniversityAtlantaGeorgiaUSA
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Hwang YH, Yoo TK, Lee SB, Kim J, Ko BS, Kim HJ, Lee JW, Son BH, Chung IY. Implementation of BRCA Test among Young Breast Cancer Patients in South Korea: A Nationwide Cohort Study. Cancer Res Treat 2024; 56:802-808. [PMID: 38374698 PMCID: PMC11261184 DOI: 10.4143/crt.2023.1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/18/2024] [Indexed: 02/21/2024] Open
Abstract
PURPOSE This study aimed to investigate the frequency of BRCA testing and related factors among young breast cancer patients (age < 40 years) in South Korea. MATERIALS AND METHODS We conducted a nationwide retrospective cohort study using data from the Health Insurance Review and Assessment claims. Newly diagnosed breast cancer patients younger than 40 were included. Annual BRCA testing ratios (number of BRCA test recipients/the number of patients undergoing breast cancer surgery in each year) were analyzed by region and health care delivery system. We investigated the location of breast cancer diagnosis and BRCA testing. RESULTS From January 2010 to December 2020, there were 25,665 newly diagnosed young breast cancer patients, of whom 12,186 (47.5%) underwent BRCA testing. The BRCA testing ratios increased gradually from 0.084 (154/1,842) in 2010 to 0.961 (1,975/2,055) in 2020. Medical aid (vs. health insurance) and undergoing surgery in metropolitan cities or others (vs. Seoul), general hospitals, and clinics (vs. tertiary hospitals) were associated with a lower likelihood of BRCA testing. While 97.8% of the patients diagnosed in Seoul underwent BRCA testing in Seoul, 22.9% and 29.2% of patients who were diagnosed in metropolitan areas and other regions moved to Seoul and underwent BRCA testing, respectively. CONCLUSION The frequency of BRCA testing has increased over time in South Korea, with Seoul showing a particularly high rate of testing. About one-quarter of patients diagnosed with breast cancer outside of Seoul moved to Seoul and underwent BRCA testing.
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Affiliation(s)
- Yung-Huyn Hwang
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Kyung Yoo
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Seok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kinney AY, Walters ST, Lin Y, Lu SE, Kim A, Ani J, Heidt E, Le Compte CJ, O'Malley D, Stroup A, Paddock LE, Grumet S, Boyce TW, Toppmeyer DL, McDougall JA. Improving Uptake of Cancer Genetic Risk Assessment in a Remote Tailored Risk Communication and Navigation Intervention: Large Effect Size but Room to Grow. J Clin Oncol 2023; 41:2767-2778. [PMID: 36787512 PMCID: PMC10414736 DOI: 10.1200/jco.22.00751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 11/21/2022] [Accepted: 01/04/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE Cancer genetic risk assessment (CGRA) is recommended for women with ovarian cancer or high-risk breast cancer, yet fewer than 30% receive recommended genetic services, with the lowest rates among underserved populations. We hypothesized that compared with usual care (UC) and mailed targeted print (TP) education, CGRA uptake would be highest among women receiving a phone-based tailored risk counseling and navigation intervention (TCN). METHODS In this three-arm randomized trial, women with ovarian or high-risk breast cancer were recruited from statewide cancer registries in Colorado, New Jersey, and New Mexico. Participants assigned to TP received a mailed educational brochure. Participants assigned to TCN received the mailed educational brochure, an initial phone-based psychoeducational session with a health coach, a follow-up letter, and a follow-up navigation phone call. RESULTS Participants' average age was 61 years, 25.4% identified as Hispanic, 5.9% identified as non-Hispanic Black, and 17.5% lived in rural areas. At 6 months, more women in TCN received CGRA (18.7%) than those in TP (3%; odds ratio, 7.4; 95% CI, 3.0 to 18.3; P < .0001) or UC (2.5%; odds ratio, 8.9; 95% CI, 3.4 to 23.5; P < .0001). There were no significant differences in CGRA uptake between TP and UC. Commonly cited barriers to genetic counseling were lack of provider referral (33.7%) and cost (26.5%), whereas anticipated difficulty coping with test results (14.0%) and cost (41.2%) were barriers for genetic testing. CONCLUSION TCN increased CGRA uptake in a group of geographically and ethnically diverse high-risk breast and ovarian cancer survivors. Remote personalized interventions that incorporate evidence-based health communication and behavior change strategies may increase CGRA among women recruited from statewide cancer registries.
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Affiliation(s)
- Anita Y. Kinney
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Yong Lin
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
| | - Shou-En Lu
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
| | - Arreum Kim
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Julianne Ani
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Emily Heidt
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Denalee O'Malley
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- School of Medicine, Rutgers University, The State University of New Jersey, Newark, NJ
| | - Antoinette Stroup
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Lisa E. Paddock
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sherry Grumet
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Tawny W. Boyce
- UNM Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM
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Roldós MI, Orazem J, Fortunato-Tavares T. Longitudinal trends (2011-2020) of premature mortality and years of potential life loss (YPLL) and associated covariates of the 62 New York State counties. Int J Equity Health 2023; 22:89. [PMID: 37193975 DOI: 10.1186/s12939-023-01902-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 04/27/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND New York State (NYS) is the 27th largest state and the 4th most populous state in the U.S., with close to 20 million people in 62 counties. Territories with diverse populations present the best opportunity to study health outcomes and associated covariates, and how these differ across different populations and groups. The County Health Ranking and Roadmaps (CHR&R) ranks counties by linking the population's characteristics and health outcomes and contextual factors in a synchronic approach. METHODS The goal of this study is to analyze the longitudinal trends in NYS counties of age-adjusted premature mortality rate and years of potential life loss rate (YPLL) from 2011-2020 using (CHR&R) data to identify similarities and trends among the counties of the state. This study used a weighted mixed regression model to analyze the longitudinal trend in health outcomes as a function of the time-varying covariates and clustered the 62 counties according to the trend over time in the covariates. RESULTS Four clusters of counties were identified. Cluster 1, which represents 33 of the 62 counties in NYS, contains the most rural counties and the least racially and ethnically diverse counties. Clusters 2 and 3 mirror each other in most covariates and Cluster 4 is comprised of 3 counties (Bronx, Kings/Brooklyn, Queens) representing the most urban and racial and ethnic diverse counties in the state. CONCLUSION The analysis clustered counties according to the longitudinal trends of the covariates, and by doing so identified clusters of counties that shared similar trends among the covariates, to later examine trends in the health outcomes through a regression model. The strength of this approach lies in the predictive feature of what is to come for the counties by understanding the covariates and setting prevention goals.
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Affiliation(s)
- Maria Isabel Roldós
- Department of Health Equity, Administration and Technology, School of Health Sciences, Human Services and Nursing, New York, USA.
- City University of New York (CUNY) Institute for Health Equity, New York, USA.
- Lehman College, City University of New York (CUNY), New York, USA.
| | - John Orazem
- City University of New York (CUNY) Institute for Health Equity, New York, USA
- Lehman College, City University of New York (CUNY), New York, USA
| | - Talita Fortunato-Tavares
- City University of New York (CUNY) Institute for Health Equity, New York, USA
- Department of Speech-Language Hearing Sciences, School of Health Sciences, Human Services and Nursing, New York, USA
- Affiliated faculty, CUNY Institute for Health Equity, New York, NY, USA
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Dibble KE, Connor AE. Residential Locale Is Associated with Disparities in Genetic Testing-Related Outcomes Among BRCA1/2-Positive Women. J Racial Ethn Health Disparities 2023; 10:718-729. [PMID: 35178668 PMCID: PMC8853067 DOI: 10.1007/s40615-022-01259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND While research on hereditary genetic testing for BRCA1/2 mutations continues to emerge, there remain unanswered questions regarding access to testing and cancer-related care. Our study determined the associations between race/ethnicity, residential locale, and genetic testing provider and related outcomes among US women with BRCA1/2 genetic mutations. METHODS One hundred ninety-three BRCA1/2-positive women from vulnerable health backgrounds were recruited via private national Facebook BRCA1/2-oriented support groups and completed an online survey. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression for the associations between race/ethnicity, residential locale, and genetic testing-related outcomes. RESULTS Women ranged in age (18-75, M = 39.5, SD = 10.7), and most were non-Hispanic white (66.3%) and lived in a suburban locale (54.9%). Women living in suburban areas were significantly less likely (aOR, .369, 95% CI, .177-.771) to receive behavioral referrals after genetic testing compared to those living in an urban locale. Women living in rural areas and suburban areas were 4.72 times more likely (95% CI, 1.48-15.1, p = .009) and 2.61 times more likely (95% CI, 1.05-6.48, p = .038), respectively, to receive genetic testing from a primary care provider versus private genetic testing office/hospital compared to women in urban locales. Associations between race/ethnicity and genetic testing outcomes were not statistically significant. Residential locale did not predict the odds of undergoing surgery for risk reduction or surveillance for early detection. CONCLUSION Our study identifies disparities in genetic testing resources among women living in suburban and rural areas. These findings can be used to inform future care, research, and community resources that may impact services relating to genetic testing within these locales.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Avonne E Connor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, 21205, USA
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Hamad Y, Nickel KB, Burnett YJ, Hamad T, George IA, Olsen MA. Prevalence and risk factors associated with readmission with acute kidney injury in patients receiving vancomycin outpatient parenteral antimicrobial therapy. J Clin Pharm Ther 2022; 47:2188-2195. [PMID: 36257600 PMCID: PMC10336722 DOI: 10.1111/jcpt.13790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/30/2022] [Accepted: 09/24/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Vancomycin is commonly used during outpatient parenteral antimicrobial therapy (OPAT). Therapeutic drug monitoring (TDM) of vancomycin is recommended to ensure effective and safe therapy, as use has been associated with acute kidney injury (AKI). METHODS The MarketScan® Commercial Database was queried from 2010 to 2016 to identify patients aged 18-64 years discharged from an inpatient hospitalization on vancomycin OPAT. The primary endpoint was hospital readmission with AKI within 6 weeks of index hospital discharge. TDM was defined as at least one vancomycin level obtained during outpatient therapy. Bivariate analysis was used to examine associations with outcomes; significant factors were incorporated into a multivariable logistic regression model. RESULTS A total of 14,196 patients were included in the study; median age was 54 years and 53.8% were male. Readmission with AKI occurred in 385 (2.7%) and was independently associated with chronic kidney disease (aOR 2.63 [95%CI 1.96-3.52]), congestive heart failure (1.81 [1.34-2.44]), chronic liver disease (1.74 [1.17-2.59]), hypertension (1.73 [1.39-2.17]), septicemia (1.61 [1.30-2.00]), and concomitant OPAT with IV penicillins (1.73 [1.21-2.49]) while skin and soft tissue infection (0.67 [0.54-0.83]) and surgical site infection (0.74 [0.59-0.93]) were associated with lower risk of readmission with AKI. TDM was not associated with lower risk of readmission with AKI. CONCLUSION Chronic kidney disease, congestive heart failure, hypertension, chronic liver disease, septicemia, and concomitant OPAT with IV penicillins were significantly associated with higher risk of readmission with AKI during vancomycin OPAT.
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Affiliation(s)
- Yasir Hamad
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
- Department of Critical Care Medicine, National Institute of Health Clinical Center, Bethesda, MD
| | - Katelin B Nickel
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
| | - Yvonne J Burnett
- University of Health Sciences and Pharmacy in St. Louis, St. Louis, Missouri
| | - Tarig Hamad
- Università della Calabria, Department of Pharmacy and Health and Nutrition Sciences, Rende, Italy
| | - Ige A George
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
| | - Margaret A Olsen
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
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Chen Z, Roy K, Khushalani JS, Puddy RW. Trend in rural-urban disparities in access to outpatient mental health services among US adults aged 18-64 with employer-sponsored insurance: 2005-2018. J Rural Health 2022; 38:788-794. [PMID: 35001435 PMCID: PMC9661493 DOI: 10.1111/jrh.12644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE This study estimates the rural-urban differences in outpatient service utilization and expenditures for depression, anxiety disorder, and substance use disorder, and the evolving mental health provider mix for privately insured US adults aged 18-64 during 2005-2018. METHODS We used the IBM MarketScan Commercial Claims and Encounters Database for individuals covered by employer-sponsored health insurance, from 2005 to 2018, with a yearly total number of beneficiaries ranging from 17.5 to 53.1 million. Claims for nonelderly adults with mental health and substance abuse coverage are included. Outcomes include rates of outpatient service utilization for depression, anxiety disorder, and substance use disorder; counts of outpatient visits; expenditure and share of the out-of-pocket cost; and the mental health services provider mix. FINDINGS Rural enrollees were less likely than urban enrollees to use outpatient mental health services for depression by 1.2% (percentage points) in 2005 and 0.6% in 2018. Among those who used outpatient mental health services, rural enrollees had fewer outpatient visits than their urban counterparts (difference: 1.8-2.4 visits for depression, 1.2-1.7 visits for anxiety disorder, and 0.7-2.1 visits for substance use disorder). Rural patients paid less per year for mental health outpatient visits of the 3 conditions but incurred a higher share of out-of-pocket expenses. Rural and urban patients differ in the mix of mental health providers, with rural enrollees relying more on primary care providers than urban enrollees. CONCLUSIONS Rural-urban disparities in access to mental health services persist during 2005-2018 among a population with private insurance.
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Affiliation(s)
- Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
- School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, Ningbo, China
| | - Kakoli Roy
- National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jaya Shankar Khushalani
- Policy Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard W. Puddy
- Policy Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Khoury MJ, Bowen S, Dotson WD, Drzymalla E, Green RF, Goldstein R, Kolor K, Liburd LC, Sperling LS, Bunnell R. Health equity in the implementation of genomics and precision medicine: A public health imperative. Genet Med 2022; 24:1630-1639. [PMID: 35482015 PMCID: PMC9378460 DOI: 10.1016/j.gim.2022.04.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 12/24/2022] Open
Abstract
Recent reviews have emphasized the need for a health equity agenda in genomics research. To ensure that genomic discoveries can lead to improved health outcomes for all segments of the population, a health equity agenda needs to go beyond research studies. Advances in genomics and precision medicine have led to an increasing number of evidence-based applications that can reduce morbidity and mortality for millions of people (tier 1). Studies have shown lower implementation rates for selected diseases with tier 1 applications (familial hypercholesterolemia, Lynch syndrome, hereditary breast and ovarian cancer) among racial and ethnic minority groups, rural communities, uninsured or underinsured people, and those with lower education and income. We make the case that a public health agenda is needed to address disparities in implementation of genomics and precision medicine. Public health actions can be centered on population-specific needs and outcomes assessment, policy and evidence development, and assurance of delivery of effective and ethical interventions. Crucial public health activities also include engaging communities, building coalitions, improving genetic health literacy, and building a diverse workforce. Without concerted public health action, further advances in genomics with potentially broad applications could lead to further widening of health disparities in the next decade.
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Affiliation(s)
- Muin J Khoury
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Scott Bowen
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA
| | - W David Dotson
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA
| | - Emily Drzymalla
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ridgely F Green
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA
| | - Robert Goldstein
- Office of the Associate Director of Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, GA; Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Katherine Kolor
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA
| | - Leandris C Liburd
- Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Rebecca Bunnell
- Office of Science, Centers for Disease Control and Prevention, Atlanta, GA
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Pace LE, Tung N, Lee YS, Hamilton JG, Gabriel C, Revette A, Raja S, Jenkins C, Braswell A, Morgan K, Levin J, Block J, Domchek SM, Nathanson K, Symecko H, Spielman K, Karlan B, Kamara D, Lester J, Offit K, Garber JE, Keating NL. Challenges and Opportunities in Engaging Primary Care Providers in BRCA Testing: Results from the BFOR Study. J Gen Intern Med 2022; 37:1862-1869. [PMID: 34173196 PMCID: PMC9198181 DOI: 10.1007/s11606-021-06970-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Engaging primary care providers (PCPs) in BRCA1/2 testing and results disclosure would increase testing access. The BRCA Founder OutReach (BFOR) study is a prospective study of BRCA1/2 founder mutation screening among individuals of Ashkenazi Jewish descent that sought to involve participants' PCPs in results disclosure. We used quantitative and qualitative methods to evaluate PCPs' perspectives, knowledge, and experience disclosing results in BFOR. METHODS Among PCPs nominated by BFOR participants to disclose BRCA1/2 results, we assessed the proportion agreeing to disclose. To examine PCP's perspectives, knowledge, and willingness to disclose results, we surveyed 501 nominated PCPs. To examine PCPs' experiences disclosing results in BFOR, we surveyed 101 PCPs and conducted 10 semi-structured interviews. RESULTS In the BFOR study overall, PCPs agreed to disclose their patient's results 40.5% of the time. Two hundred thirty-four PCPs (46.7%) responded to the initial survey. Responding PCPs were more likely to agree to disclose patients' results than non-responders (57.3% vs. 28.6%, p<0.001). Among all respondents, most felt very (19.7%) or somewhat (39.1%) qualified to share results. Among PCPs declining to disclose, insufficient knowledge was the most common reason. In multivariable logistic regression, feeling qualified was the only variable significantly associated with agreeing to disclose results (OR 6.53, 95% CI 3.31, 12.88). In post-disclosure surveys (response rate=55%), PCPs reported largely positive experiences. Interview findings suggested that although PCPs valued the study-provided educational materials, they desired better integration of results and decision support into workflows. CONCLUSION Barriers exist to incorporating BRCA1/2 testing into primary care. Most PCPs declined to disclose their patients' BFOR results, although survey respondents were motivated and had positive disclosure experiences. PCP training and integrated decision support could be beneficial. TRIAL REGISTRATION ClinicalTrials.gov (NCT03351803), November 24, 2017.
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Affiliation(s)
- Lydia E Pace
- Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Nadine Tung
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Yeonsoo S Lee
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | | | | | | | - Sahitya Raja
- Rush Medical College at Rush University, Chicago, IL, USA
| | | | | | - Kelly Morgan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey Levin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeremy Block
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan M Domchek
- Basser Center for BRCA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine Nathanson
- Basser Center for BRCA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Heather Symecko
- Basser Center for BRCA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelsey Spielman
- Basser Center for BRCA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Beth Karlan
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Daniella Kamara
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jenny Lester
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Nancy L Keating
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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10
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Guo F, Scholl M, Fuchs EL, Berenson AB, Kuo YF. BRCA testing and testing results among women 18–65 years old. Prev Med Rep 2022; 26:101738. [PMID: 35242503 PMCID: PMC8866899 DOI: 10.1016/j.pmedr.2022.101738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 01/22/2022] [Accepted: 02/16/2022] [Indexed: 11/01/2022] Open
Abstract
BRCA testing rate increased from 2007 to 2017. Documented positive test rate was decreasing 2007 to 2017. The trend in documented positive test rate differed across races/ethnicities. It suggests of a divergent application of the same testing criteria.
Since the 1990 s discovery of BRCA1 and BRCA2 pathogenic variants in breast or ovarian cancer patients, genetic testing has been recommended as part of a targeted, individualized approach for cancer prevention and treatment in eligible individuals. The aim of this study was to assess trends in BRCA test rates and results among adult women aged 18 to 65 in the US between 2007 and 2017. Using Clinformatics© Data Mart (CDM) Electronic Health Records, we included 223,211 women 18–65 years old with documented BRCA testing results from 1/1/2007–9/30/2017. Positive results indicated the presence of pathogenic variantss. BRCA test rates increased significantly from 34 per 100,000 women in 2007 to 488 per 100,000 women in 2016 (APC 30.8, 95% confidence interval 26.6–35.1). Documented positive results decreased from 86.1% in 2007 to 78.0% in 2017(APC −0.6, 95% confidence interval −1.4–0.2). From 2007 to 2017, decreasing trends in the rates of documented positive results were observed among all three age groups (18–39, 40–54, and 55–65 years; largest in 40–54 group). In 2015–2017, women with positive test results were less likely to be non–Hispanic Whites, cancer patients, or living in the Northeast or an area with average household income ≥$50,000. Between 2007 and 2017, increasing use of BRCA testing for cancer prevention and treatment occurred, correlating to the observed decreasing documented positive test rate. The utilization of testing and corresponding test results differed significantly across races/ethnicities, suggestive of a divergent application of the same testing criteria.
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Mittendorf KF, Knerr S, Kauffman TL, Lindberg NM, Anderson KP, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Zepp JM, Syngal S, Wilfond BS, Goddard KAB. Systemic Barriers to Risk-Reducing Interventions for Hereditary Cancer Syndromes: Implications for Health Care Inequities. JCO Precis Oncol 2021; 5:PO.21.00233. [PMID: 34778694 PMCID: PMC8585306 DOI: 10.1200/po.21.00233] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kathleen F. Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sarah Knerr
- School of Public Health, University of Washington, Seattle, WA
| | - Tia L. Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Nangel M. Lindberg
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | | | - Marian J. Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Jamilyn M. Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sapna Syngal
- Dana Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Katrina A. B. Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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Buckenmaier SS, Mollica MA, Freedman A, Kent EE, de Moor JS. Information Sources Used by Oncologists to Understand Multi-marker Tumor Panel Tests for Cancer Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1105-1114. [PMID: 32415436 DOI: 10.1007/s13187-020-01742-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Precision medicine using multi-marker tumor panel (MMTP) testing can help inform cancer treatment decisions. Oncologists' knowledge of these tests and their ability to find up-to-date information about their application in clinical care is essential. This study aimed to (1) describe information sources used by oncologists to learn about new genomic tests and (2) examine characteristics associated with the use of each information source. The National Cancer Institute's National Survey of Precision Medicine in Cancer Treatment surveyed a nationally representative sample of oncologists about MMTP testing. We examined the use of 11 information sources among oncologists that reported using MMTP tests (n = 1222). Bivariate analyses were used to examine whether information sources differed by oncologist- and practice-level characteristics and type of MMTP test. Most oncologists reported using peer-reviewed medical literature (88.8%), scientific conferences (87.9%), and medical professional societies (83.8%) to learn about MMTPs. In contrast, government websites, FDA inserts, and foundation resources were each used by < 36% of oncologists. The use of information sources differed by oncologist and practice characteristics. For example, a greater percentage of oncologists with an academic affiliation used peer-reviewed medical literature and scientific conferences, as compared to those without an academic affiliation (p = 0.006). As the number and type of MMTP tests increase, providing oncologists with current information about their appropriate application is essential. Further understanding of how oncologists use specific information sources may improve the dissemination and effective implementation of new MMTPs and help tailor educational interventions based on provider characteristics.
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Affiliation(s)
- Susan S Buckenmaier
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, Outcomes Research Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9762, USA.
| | - Michelle A Mollica
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, Outcomes Research Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9762, USA
| | - Andrew Freedman
- Division of Cancer Control and Population Sciences, Epidemiology and Genomics Research Program, Clinical and Translational Epidemiology Branch, 9609 Medical Center Drive, Bethesda, MD, 20892-9762, USA
| | - Erin E Kent
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, 9609 Medical Center Drive, Bethesda, MD, 20892-9762, USA
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Pera MF, Cain MM, Emerick A, Katz S, Hirsch NA, Sherman BW, Bravata DM. Social Determinants of Health Challenges Are Prevalent Among Commercially Insured Populations. J Prim Care Community Health 2021; 12:21501327211025162. [PMID: 34120503 PMCID: PMC8207279 DOI: 10.1177/21501327211025162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To evaluate the prevalence of social determinants of health (SDoH) factors in a large commercially-insured population and to characterize the prevalence of common conditions (eg, diabetes, behavioral health issues) and addressable health services utilization concerns (eg, lack of preventive care) for which employers offer no- and low-cost benefit programs. METHODS We identified groups with SDoH challenges within a commercially-insured population of 5.1 M through administrative data and self-report. Using medical claims and health assessment data, we identified populations with SDoH needs who had common conditions for which employers often provide no- or low-cost benefit programs (ie, diabetes, behavioral health conditions, high-risk pregnancy, overweight/obesity). Additionally, we sought populations with common addressable health services utilization concerns such as avoidable emergency room visits, lack of preventive care services, or non-adherence to medications. We used univariate analyses to describe the prevalence of SDoH risks in the population of interest. RESULTS Twenty-seven percent of this commercially-insured population live in a zip code where the median income is at or below 200% of the Federal Poverty Line. Respondents identified cost (55%) and family, school, or work responsibilities (26%) as key barriers to care. ER overutilization rates are higher in lower income zip codes than wealthier zip codes (34% vs 9%) as is the prevalence of diabetes, overweight/obesity, and behavioral issues, and decreased use of preventive services. Fifteen percent of the study population live in a low-access food area. There is considerable variability in access to employer-sponsored resources to address these needs (70% of employers provide behavioral health programs; 63% provide telehealth programs, but only 1% offer healthy food programs and less than 0.5% offer either child care or transportation support programs). CONCLUSIONS Commercially insured populations could benefit from employer-sponsored programs or benefits that address key SDoH barriers such as financial support, healthy food programs, child-care, and transportation.
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Affiliation(s)
| | | | | | | | | | - Bruce W Sherman
- Case Western Reserve University, Cleveland, OH, USA.,National Alliance of Healthcare Purchaser Coalitions, Washington, DC, USA
| | - Dena M Bravata
- Castlight Health, San Francisco, CA, USA.,Stanford University School of Medicine, Palo Alto, CA, USA
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Modell SM, Allen CG, Ponte A, Marcus G. Cancer genetic testing in marginalized groups during an era of evolving healthcare reform. J Cancer Policy 2021; 28:100275. [PMID: 35559905 PMCID: PMC8224823 DOI: 10.1016/j.jcpo.2021.100275] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/31/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Affordable Care Act and subsequent reforms pose tradeoffs for racial-ethnic, rural, and sex-related groups in the United States experiencing disparities in BRCA1/2 genetic counseling and testing and colorectal cancer screening, calling for policy changes. METHODS A working group of the American Public Health Association Genomics Forum Policy Committee engaged in monthly meetings to examine ongoing literature and identify policy alternatives in the coverage of cancer genetic services for marginalized groups. 589 items were collected; 408 examined. Efforts continued from February 2015 through September 2020. RESULTS African Americans and Latinos have shown 7-8 % drops in uninsured rates since the Exchanges opened. The ACA has increased BRCA1/2 test availability while several disparities remain, including by sex. Rural testing and screening utilization rates have improved. Medicaid expansion and the inclusion of Medicare in the ACA have resulted in mixed improvements in colorectal cancer screening rates in marginalized groups. CONCLUSION Cancer genetic testing and screening to date have only partially benefited from healthcare reforms. Sensitivity to cost concerns and further monitoring of emerging data are needed. A reduction in disparities depends on the availability of private insurance, Medicaid and Medicare to the marginalized. Attention to value-based design and the way cancer benefits are translated into actual testing and screening are crucial. POLICY SUMMARY The findings suggest the need for further benefits-related health agency interpretation of and amendments to the ACA, continued Medicaid and innovative Medicare expansion, and incorporation of cancer services values-based considerations at several levels, aimed at reducing group disparities.
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Affiliation(s)
- Stephen M Modell
- Epidemiology, University of Michigan School of Public Health, M5409 SPH II, 1415 Washington Hts., Ann Arbor, MI, 48109, United States.
| | - Caitlin G Allen
- Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA, 30322, United States
| | - Amy Ponte
- Genedu Health Solutions, 47 Petigru Dr., Beaufort, SC, 29902, United States
| | - Gail Marcus
- Genetics and Newborn Screening Unit, North Carolina Department of Health and Human Services, C/O CDSA of the Cape Fear, 3311 Burnt Mill Dr., Wilmington, NC, 28403, United States
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Gamble CR, Huang Y, Wright JD, Hou JY. Precision medicine testing in ovarian cancer: The growing inequity between patients with commercial vs medicaid insurance. Gynecol Oncol 2021; 162:18-23. [PMID: 33958212 DOI: 10.1016/j.ygyno.2021.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Precision medicine technologies have significant impact in the care of patients with ovarian cancer. Compared to affluent patients, socioeconomically vulnerable patients are less likely to have access to this testing. There is little data that demonstrate this inequity over time. METHODS We used the IBM Truven Health MarketScan Research Database to identify patients in the United States who underwent surgery for ovarian cancer between 2011 and 2017. The presence of claims for precision medicine testing within six months of surgery was assessed for each patient. Precision medicine testing included both molecular genetic testing (BRCA limited or full sequencing, somatic and germline testing) as well as ancillary pathology tests (immunohistochemistry, microsatellite instability). Demographic data was extracted. RESULTS We identified 27,181 patients who met eligibility. Of these, 88.6% had commercial insurance, and 11.4% had Medicaid. While the proportion of patients who underwent precision medicine testing increased over time for both cohorts (47.0% to 66.6% for commercially insured, 41.4% to 57.6% for Medicaid insured, p < 0.0001), the inequity in testing rates widened (5.6% disparity to 9.0%, p < 0.0001). This was driven by growing inequity in germline and somatic genetic testing (7.6% disparity to 21.3%, p < 0.0001). CONCLUSIONS There is widening inequity in precision medicine testing rates between commercially insured and Medicaid insured poate patients with ovarian cancer.
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Affiliation(s)
- Charlotte R Gamble
- Columbia University College of Physicians and Surgeons, United States of America; New York Presbyterian Hospital, United States of America.
| | - Yongmei Huang
- Columbia University College of Physicians and Surgeons, United States of America; Joseph L. Mailman School of Public Health, Columbia University, United States of America
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - June Y Hou
- Columbia University College of Physicians and Surgeons, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
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Dragojlovic N, Kopac N, Borle K, Tandun R, Salmasi S, Ellis U, Birch P, Adam S, Friedman JM, Elliott AM, Lynd LD. Utilization and uptake of clinical genetics services in high-income countries: A scoping review. Health Policy 2021; 125:877-887. [PMID: 33962789 DOI: 10.1016/j.healthpol.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 02/11/2021] [Accepted: 04/14/2021] [Indexed: 12/23/2022]
Abstract
Ongoing rapid growth in the need for genetic services has the potential to severely strain the capacity of the clinical genetics workforce to deliver this care. Unfortunately, assessments of the scale of this health policy challenge and potential solutions are hampered by the lack of a consolidated evidence base on the growth in genetic service utilization. To enable health policy research and strategic planning by health systems in this area, we conducted a scoping review of the literature on the utilization and uptake of clinical genetics services in high-income countries published between 2010 and 2018. One-hundred-and-ninety-five unique studies were included in the review. Most focused on cancer (85/195; 44%) and prenatal care (50/195; 26%), which are consistently the two areas with the greatest volume of genetic service utilization in both the United States and other high-income countries. Utilization and uptake rates varied considerably and were influenced by contextual factors including health system characteristics, provider knowledge, and patient preferences. Moreover, growth in genetic service utilization appears to be driven to a significant degree by technological advances and the integration of new tests into clinical care. Our review highlights both the policy challenge posed by the rapid growth in the utilization of genetic services and the variability in this trend across clinical indications and health systems.
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Affiliation(s)
- Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Nicola Kopac
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Kennedy Borle
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Rachel Tandun
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Shahrzad Salmasi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ursula Ellis
- Woodward Library, University of British Columbia, 2198 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Patricia Birch
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Shelin Adam
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Jan M Friedman
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | | | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; BC Women's Hospital Research Institute, H214 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, 588-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6.
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A Comparison of Patient-Reported Outcomes Following Consent for Genetic Testing Using an Oncologist- or Genetic Counselor-Mediated Model of Care. ACTA ACUST UNITED AC 2021; 28:1459-1471. [PMID: 33917963 PMCID: PMC8167594 DOI: 10.3390/curroncol28020138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
Simple Summary Genetic testing for hereditary cancer risk is usually arranged by a genetic counselor after talking about possible risks and benefits. To increase access to genetic testing, oncologists have started to order genetic testing. This survey study compared patient outcomes following genetic testing ordered by a genetic counselor or an oncologist. Genetic counselor-mediated genetic testing was associated with higher patient knowledge, as well as higher experience and understanding of genetic testing. Differences were noted in the type of psychological concerns reported, with individuals having genetic counselor-mediated testing being more likely to express concerns about having a hereditary cancer predisposition and those having oncologist-mediated testing more likely to express concerns regarding general emotions. Overall, oncologist-mediated genetic testing appears to provide a streamlined alternative to genetic testing; however, all individuals may benefit from post-test genetic counseling to address any knowledge gaps and provide additional psychological support. Abstract This study compares knowledge, experience and understanding of genetic testing, and psychological outcomes among breast and ovarian cancer patients undergoing multi-gene panel testing via genetic counselor-mediated (GMT) or oncologist-mediated (OMT) testing models. A pragmatic, prospective survey of breast and ovarian cancer patients pursuing genetic testing between January 2017 and August 2019 was conducted at the Princess Margaret Cancer Centre in Toronto, Canada. A total of 120 (80 GMT; 40 OMT) individuals completed a survey administered one week following consent to genetic testing. Compared to OMT, the GMT cohort had higher median knowledge (8 vs. 9; p = 0.025) and experience/understanding scores (8.5 vs. 10; p < 0.001) at the time of genetic testing. Significant differences were noted in the potential psychological concerns experienced, with individuals in the GMT cohort more likely to screen positive in the hereditary predisposition domain of the Psychosocial Aspects of Hereditary Cancer tool (55% vs. 27.5%; p = 0.005), and individuals in the OMT cohort more likely to screen positive in the general emotions domain (65.0% vs. 38.8%; p = 0.007). The results of this study suggest that OMT can be implemented to streamline genetic testing; however, post-test genetic counseling should remain available to all individuals undergoing genetic testing, to ensure any psychologic concerns are addressed and that individuals have a clear understanding of relevant implications and limitations of their test results.
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Oosthuizen J, Kotze MJ, Van Der Merwe N, Myburgh EJ, Bester P, van der Merwe NC. Globally Rare BRCA2 Variants With Founder Haplotypes in the South African Population: Implications for Point-of-Care Testing Based on a Single-Institution BRCA1/2 Next-Generation Sequencing Study. Front Oncol 2021; 10:619469. [PMID: 33643918 PMCID: PMC7908826 DOI: 10.3389/fonc.2020.619469] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/23/2020] [Indexed: 12/16/2022] Open
Abstract
Breast cancer patients historically benefitted from population-based genetic research performed in South Africa, which led to the development of founder-based BRCA1/2 diagnostic tests. With the advent of next-generation sequencing (NGS) technologies, the clinical utility of limited, targeted genetic assays were questioned. The study focused on mining NGS data obtained from an extensive single-institution NGS series (n=763). The aims were to determine (i) the prevalence of the most common recurrent/founder variants in patients referred for NGS directly; and (ii) to explore the data for inferred haplotypes associated with previous and potential new recurrent/founder variants. The identification of additional founder variants was essential for promoting and potentially advancing to rapid founder-based BRCA1/2 point-of-care (POC) technology as a time- and cost-effective alternative. NGS revealed actionable BRCA1/2 variants in 11.1% of patients tested (BRCA1 - 4.7%; BRCA2 - 6.4%), of which 22.4% represented variants currently screened for using first-tier targeted genetic testing. A retrospective investigation into the overall mutation-positive rate for an extended cohort (n=1906), which included first-tier test results, revealed that targeted genetic testing identified 74% of all pathogenic variants. This percentage justified the use of targeted genetic testing as a first-tier assay. Inferred haplotype analysis confirmed the founder status of BRCA2 c.5771_5774del (rs80359535) and c.7934del (rs80359688) and revealed an additional African founder variant (BRCA2 c.582G>A - rs80358810). A risk-benefit analysis using a questionnaire-based survey was performed in parallel to determine genetic professionals' views regarding POC testing. This was done to bridge the clinical implementation gap between haplotype analysis and POC testing as a first-tier screen during risk stratification of breast and ovarian cancer patients. The results reflected high acceptance (94%) of BRCA1/2 POC testing when accompanied by genetic counselling. Establishing the founder status for several recurrent BRCA2 variants across ethnic groups supports unselected use of the BRCA POC assay in all SA breast/ovarian cancer patients by recent local and international public health recommendations. Incorporating POC genotyping into the planned NGS screening algorithm of the Department of Health will ensure optimal use of the country's recourses to adhere to the set standards for optimal care and management for all breast cancer patients.
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Affiliation(s)
- Jaco Oosthuizen
- Division of Human Genetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.,Division of Human Genetics, National Health Laboratory Service, Universitas Hospital, Bloemfontein, South Africa
| | - Maritha J Kotze
- Department of Pathology, Division of Chemical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,Division of Chemical Pathology, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Nicole Van Der Merwe
- Department of Pathology, Division of Chemical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - Phillip Bester
- Division of Virology, National Health Laboratory Service, Universitas Hospital, Bloemfontein, South Africa
| | - Nerina C van der Merwe
- Division of Human Genetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.,Division of Human Genetics, National Health Laboratory Service, Universitas Hospital, Bloemfontein, South Africa
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Telehealth technology: Reducing barriers for rural residents seeking genetic counseling. J Am Assoc Nurse Pract 2020; 32:190-192. [PMID: 32132456 DOI: 10.1097/jxx.0000000000000373] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many rural residents do not receive genetic counseling or testing when needed because of health care access barriers, such as lack of providers in rural areas and the requirement for rural residents to travel to larger cities for these services. Telehealth technology can reduce these barriers by allowing rural residents to receive genetic counseling through a two-way interactive audio/video secure connection in a local clinic setting or in their homes. Telegenetics is a satisfactory solution for both patient and provider and provides benefits for rural patients despite ethical, legal, and reimbursement considerations.
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Abstract
PURPOSE Testing for BRCA1/2 mutations has increased among privately insured women in the United States. However, little is known about testing rates or trends among women with Medicaid. We sought to determine whether BRCA1/2 testing rates differed between women with private insurance compared with women with Medicaid in a state where both insurance types cover the test, and to compare testing trends from 2011 to 2015. METHODS We conducted a retrospective cohort study of medical claims from January 2011 through June 2015. We included Massachusetts women aged 18-64 with private insurance or Medicaid and at least 12 months of continuous enrollment. We used multivariable linear regression to examine the association of insurance type, age, and time with testing rates. RESULTS Mean monthly BRCA1/2 testing rates were lower among women with Medicaid compared with those with private insurance. Among privately insured women, mean monthly rates rose from 9.3 per 100,000 in 2011 to 18.4 per 100,000 in 2015, while among Medicaid-insured women, rates increased from 3.7 to 14.7. There was no difference in the monthly rate of increase in both groups (P=0.07). In adjusted analyses, rates were lower among Medicaid-insured women (7 fewer tests per month than privately insured women, P<0.001), and differed by age, with women aged 44-54 most likely to receive testing and women 18-34 the least likely. CONCLUSION BRCA1/2 testing rates were lower among women insured by Medicaid compared with those with private insurance, though rates increased from 2011 to 2015 among both groups of women at a similar rate.
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Knerr S, Bowles EJA, Leppig KA, Buist DSM, Gao H, Wernli KJ. Trends in BRCA Test Utilization in an Integrated Health System, 2005-2015. J Natl Cancer Inst 2020; 111:795-802. [PMID: 30753636 DOI: 10.1093/jnci/djz008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/08/2018] [Accepted: 01/15/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Genetic testing to determine BRCA status has been available for over two decades, but there are few population-based studies of test diffusion. We report 10-year trends in BRCAtesting in an integrated health-care system with long-standing access to genetic services. METHODS A cohort of women aged 18 years and older was created to ascertain BRCA testing (n = 295 087). Annual testing rates between 2005 and 2015 were calculated in all women with and without incident (ie, newly diagnosed) breast and ovarian cancers and in clinically eligible subgroups by family cancer history, personal cancer history, and age at diagnosis. Secular trends were assessed using Poisson regression. Women tested early (2005-2008), midway (2009-2012), and late (2013-2015) in the study period were compared in cross-sectional analyses. RESULTS Between 2005 and 2015, annual testing rates increased from 0.6/1000 person-years (pys) (95% confidence interval [CI] = 0.4 to 0.7/1000 pys) to 0.8/1000 pys (95% CI = 0.6 to 1.0/1000 pys) in women without incident breast or ovarian cancers. Rates decreased from 71.5/1000 pys (95% CI = 42.4 to 120.8/1000 pys) to 44.4/1000 pys (95% CI = 35.5 to 55.6/1000 pys) in women with incident diagnoses, despite improvements in provision of timely BRCA testing during this time frame. We found no evidence of secular trends in clinically eligible subgroups including women with family history indicating increased hereditary cancer risk, but no personal cancer history. At the end of the study period, 97.0% (95% CI = 96.6% to 97.3%) of these women remained untested. CONCLUSION Many eligible women did not receive BRCA testing despite having insurance coverage and access to specialty genetic services, underscoring challenges to primary and secondary hereditary cancer prevention.
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Affiliation(s)
- Sarah Knerr
- See the Notes section for the authors' affiliations
| | | | | | | | - Hongyuan Gao
- See the Notes section for the authors' affiliations
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van der Merwe NC, Oosthuizen J, Theron M, Chong G, Foulkes WD. The contribution of large genomic rearrangements in BRCA1 and BRCA2 to South African familial breast cancer. BMC Cancer 2020; 20:391. [PMID: 32375709 PMCID: PMC7203887 DOI: 10.1186/s12885-020-06917-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pathogenic variants that occur in the familial breast cancer genes (BRCA1/2) lead to truncated ineffective proteins in the majority of cases. These variants are mostly represented by small deletions/insertions, nonsense- and splice-site variants, although some larger pathogenic rearrangements occur. Currently, their contribution to familial breast cancer (BC) and ovarian cancer (OVC) in South Africa (SA) is unknown. METHODS Seven hundred and forty-four patients affected with BC or OVC were screened for larger genomic rearrangements (LGRs) by means of multiplex ligation-dependent probe amplification or Next Generation Sequencing using the Oncomine™ BRCA research assay. RESULTS The patients represented mostly medium to high-risk families, but also included lower risk patients without a family history of the disease, diagnosed at an early age of onset (< 40 years). Eight LGRs were detected (1.1%); seven in BRCA1 with a single whole gene deletion (WGD) detected for BRCA2. These eight LGRs accounted for 8.7% of the 92 BRCA1/2 pathogenic variants identified in the 744 cases. The pathogenic LGRs ranged from WGDs to the duplication of a single exon. CONCLUSIONS Larger rearrangements in BRCA1/2 contributed to the overall mutational burden of familial BC and OVC in SA. Almost a quarter of all pathogenic variants in BRCA1 were LGRs (7/30, 23%). The spectrum observed included two WGDs, one each for BRCA1 and BRCA2.
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Affiliation(s)
- Nerina C. van der Merwe
- Division of Human Genetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Division of Human Genetics, National Health Laboratory Services, Universitas Academic Hospital, Bloemfontein, South Africa
| | - Jaco Oosthuizen
- Division of Human Genetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Division of Human Genetics, National Health Laboratory Services, Universitas Academic Hospital, Bloemfontein, South Africa
| | - Magdalena Theron
- Division of Human Genetics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Division of Human Genetics, National Health Laboratory Services, Universitas Academic Hospital, Bloemfontein, South Africa
| | - George Chong
- Lady Davis Institute and Segal Cancer Centre, Jewish General Hospital, Montréal, QC Canada
| | - William D. Foulkes
- Lady Davis Institute and Segal Cancer Centre, Jewish General Hospital, Montréal, QC Canada
- Research Institute of the McGill University Health Centre, Montréal, QC Canada
- Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, Montréal, QC Canada
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23
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Fisher ER, Pratt R, Esch R, Kocher M, Wilson K, Lee W, Zierhut HA. The role of race and ethnicity in views toward and participation in genetic studies and precision medicine research in the United States: A systematic review of qualitative and quantitative studies. Mol Genet Genomic Med 2019; 8:e1099. [PMID: 31867882 PMCID: PMC7005620 DOI: 10.1002/mgg3.1099] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/18/2019] [Accepted: 12/10/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Racial/ethnic minority populations in the United States are consistently underrepresented in genetic research. Large-scale public participation is required to ensure discoveries from precision medicine research are applicable to everyone. To evaluate views toward and facilitators of participation among minority populations in the United States, we conducted a systematic review of literature. METHODS Six databases were searched for articles published from 2005 to 2018 assessing minority populations' views and/or willingness to participate in genetic research. A thematic framework was applied to extracted data to synthesize findings, and the Socio-Ecological Model was used to evaluate papers. RESULTS Review of 2,229 titles and abstracts identified 27 papers (n = 8 qualitative, n = 19 quantitative). Themes included knowledge of genetics, engagement in research, facilitators and barriers to participation, and cultural considerations. Understanding of genetics was low, yet the majority of participants were willing to participate in genetic research among all populations included in the literature (range: 57%-97%). Recommendations for research included utilizing community-based participatory approaches, evaluating participants' informational needs, incentivizing participation, and providing direct benefits (e.g., genetic test results). CONCLUSION Results could influence future study designs that incorporate all levels of the Socio-Ecological Model and better meet the needs of underrepresented groups, thereby ensuring precision medicine research findings are applicable to all.
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Affiliation(s)
- Elena R Fisher
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Riley Esch
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - Megan Kocher
- University of Minnesota Libraries, Minneapolis, MN, USA
| | - Katie Wilson
- University of Minnesota Libraries, Minneapolis, MN, USA
| | - Whiwon Lee
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Heather A Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
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24
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Garcia C, Harrison K, Ring KL, Sullivan MW, Rauh LA, Modesitt SC. Genetic counseling referral for ovarian cancer patients: a call to action. Fam Cancer 2019; 18:303-309. [PMID: 30993488 DOI: 10.1007/s10689-019-00129-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The hereditary contribution to ovarian cancer has been increasingly recognized over the past decade, with a 2014 Society of Gynecologic Oncology (SGO) recommendation for all women with epithelial ovarian cancer to be considered for genetic testing. The objective of the study was to determine if disparities exist in genetic referrals and characterize referral patterns over time. A retrospective cohort study included all women diagnosed with invasive epithelial ovarian cancer at the University of Virginia from 2004 to 2015. Clinicopathologic data were abstracted from the electronic medical record and analyzed for association with genetic referral and testing. We identified 696 cases, with a median age of 62 years and a median follow up of 25.2 months (range 1-115). Thirty-four percent were referred for genetic counseling with an 80% genetic testing rate in those women. Referrals increased from a rate of 8% in 2004 to 68% in 2015. On multivariable analysis, papillary serous histology (OR 1.6, 95% CI 1.0-2.6), stage III disease (OR 3.4, 95% CI 1.6-7.5), ovarian cancer family history (OR 2.6, 95% CI 1.5-4.6), breast cancer family history (OR 1.7, 95% CI 1.1-2.5), and diagnosis after 2014 (OR 2.3, 95% CI 1.3-4.1) remained significantly associated with genetics referral. Older age and living > 100 miles away were associated with decreased referral (OR 0.97, 95% CI 0.95-0.99 per year and OR 0.49, 95% CI 0.28-0.86). As only 68% of women with epithelial ovarian cancer were referred in 2015 innovative strategies such as Medicare coverage for counseling are still needed to universalize testing.
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Affiliation(s)
- Christine Garcia
- Thorton Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
| | - Kara Harrison
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kari L Ring
- Thorton Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
| | - Mackenzie W Sullivan
- University of Virginia School of Medicine, Charlottesville, VA, USA. .,Division of Gynecologic Oncology, University of Virginia Health System, University of Virginia School of Medicine, 1240 Lee Street, Box 800712, Charlottesville, VA, 22908-0712, USA.
| | - Lisa A Rauh
- Thorton Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
| | - Susan C Modesitt
- Thorton Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
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25
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Zahnd WE, McLafferty SL, Eberth JM. Multilevel analysis in rural cancer control: A conceptual framework and methodological implications. Prev Med 2019; 129S:105835. [PMID: 31520673 PMCID: PMC7136953 DOI: 10.1016/j.ypmed.2019.105835] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/19/2019] [Accepted: 09/06/2019] [Indexed: 12/22/2022]
Abstract
Rural populations experience a myriad of cancer disparities ranging from lower screening rates to higher cancer mortality rates. These disparities are due in part to individual-level characteristics like age and insurance status, but the physical and social context of rural residence also plays a role. Our objective was two-fold: 1) to develop a multilevel conceptual framework describing how rural residence and relevant micro, macro, and supra-macro factors can be considered in evaluating disparities across the cancer control continuum and 2) to outline the unique considerations of multilevel statistical modeling in rural cancer research. We drew upon several formative frameworks that address the cancer control continuum, population-level disparities, access to health care services, and social inequities. Micro-level factors comprised individual-level characteristics that either predispose or enable individuals to utilize health care services or that may affect their cancer risk. Macro-level factors included social context (e.g. domains of social inequity) and physical context (e.g. access to care). Rural-urban status was considered a macro-level construct spanning both social and physical context, as "rural" is often characterized by sociodemographic characteristics and distance to health care services. Supra-macro-level factors included policies and systems (e.g. public health policies) that may affect cancer disparities. Our conceptual framework can guide researchers in conceptualizing multilevel statistical models to evaluate the independent contributions of rural-urban status on cancer while accounting for important micro, macro, and supra-macro factors. Statistically, potential collinearity of multilevel model predictive variables, model structure, and spatial dependence should also be considered.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Suite 204, Columbia, SC 29210, United States of America.
| | - Sara L McLafferty
- Department of Geography and Geographic Information Science, University of Illinois Urbana-Champaign, 1301 W. Green Street Urbana, IL 61801, United States of America.
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Suite 204, Columbia, SC 29210, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America; Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America.
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26
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Cline MS, Babbi G, Bonache S, Cao Y, Casadio R, de la Cruz X, Díez O, Gutiérrez-Enríquez S, Katsonis P, Lai C, Lichtarge O, Martelli PL, Mishne G, Moles-Fernández A, Montalban G, Mooney SD, O’Conner R, Ootes L, Özkan S, Padilla N, Pagel KA, Pejaver V, Radivojac P, Riera C, Savojardo C, Shen Y, Sun Y, Topper S, Parsons MT, Spurdle AB, Goldgar DE. Assessment of blind predictions of the clinical significance of BRCA1 and BRCA2 variants. Hum Mutat 2019; 40:1546-1556. [PMID: 31294896 PMCID: PMC6744348 DOI: 10.1002/humu.23861] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/31/2022]
Abstract
Testing for variation in BRCA1 and BRCA2 (commonly referred to as BRCA1/2), has emerged as a standard clinical practice and is helping countless women better understand and manage their heritable risk of breast and ovarian cancer. Yet the increased rate of BRCA1/2 testing has led to an increasing number of Variants of Uncertain Significance (VUS), and the rate of VUS discovery currently outpaces the rate of clinical variant interpretation. Computational prediction is a key component of the variant interpretation pipeline. In the CAGI5 ENIGMA Challenge, six prediction teams submitted predictions on 326 newly-interpreted variants from the ENIGMA Consortium. By evaluating these predictions against the new interpretations, we have gained a number of insights on the state of the art of variant prediction and specific steps to further advance this state of the art.
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Affiliation(s)
| | - Giulia Babbi
- Biocomputing Group, FaBiT Department, University of
Bologna, Bologna, Italy
| | - Sandra Bonache
- Oncogenetics Group, Vall d’Hebron Institute of
Oncology (VHIO), Barcelona, Spain
| | - Yue Cao
- Texas A&M University, College Station, TX, USA
| | - Rita Casadio
- Biocomputing Group, FaBiT Department, University of
Bologna, Bologna, Italy
| | - Xavier de la Cruz
- Clinical and Translational Bioinformatics Research Unit,
Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de
Barcelona, Barcelona, Spain
- Institució Catalana de Recerca i Estudis
Avançats (ICREA), Barcelona, Spain
| | - Orland Díez
- Oncogenetics Group, Vall d’Hebron Institute of
Oncology (VHIO), Barcelona, Spain
- Clinical and Translational Bioinformatics Research Unit,
Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de
Barcelona, Barcelona, Spain
| | | | | | - Carmen Lai
- Department of Biochemistry & Molecular Biology, Baylor
College of Medicine, Houston, TX, USA
| | - Olivier Lichtarge
- Department of Medical and Human Genetics, Baylor College
of Medicine, Houston, TX, USA
- Department of Biochemistry & Molecular Biology, Baylor
College of Medicine, Houston, TX, USA
- Department of Pharmacology, Baylor College of Medicine,
Houston, TX, USA
- Computational and Integrative Biomedical Research
Center, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Alejandro Moles-Fernández
- Clinical and Translational Bioinformatics Research Unit,
Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Gemma Montalban
- Clinical and Translational Bioinformatics Research Unit,
Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de
Barcelona, Barcelona, Spain
| | | | | | - Lars Ootes
- Clinical and Translational Bioinformatics Research Unit,
Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Selen Özkan
- Clinical and Translational Bioinformatics Research Unit,
Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Natalia Padilla
- Clinical and Translational Bioinformatics Research Unit,
Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de
Barcelona, Barcelona, Spain
| | | | | | - Predrag Radivojac
- Indiana University, Bloomington, IN, USA
- Northeastern University, Boston, MA, USA
| | - Casandra Riera
- Clinical and Translational Bioinformatics Research Unit,
Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de
Barcelona, Barcelona, Spain
| | | | - Yang Shen
- Texas A&M University, College Station, TX, USA
| | - Yuanfei Sun
- Texas A&M University, College Station, TX, USA
| | | | | | | | - David E. Goldgar
- Huntsman Cancer Institute, University of Utah, Salt Lake
City, UT, USA
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27
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Genetic Testing for Breast Cancer Susceptibility Should Be Offered before Unilateral Abdominally Based Free Flap Breast Reconstruction. Plast Reconstr Surg 2019; 144:12-20. [PMID: 31246791 DOI: 10.1097/prs.0000000000005693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pathogenic mutations have been identified in approximately 10 percent of patients who present with breast cancer. Notably, failure to identify deleterious genetic mutations has particular implications for patients undergoing abdominally based breast reconstruction, as the donor site can be used only once. The authors sought to determine: (1) how many patients underwent genetic testing before unilateral abdominally based free flap breast reconstruction; (2) how often deleterious mutations were detected after abdominally based free flap breast reconstruction; and (3) the cost-effectiveness of expanding genetic testing in this patient population. METHODS The authors retrospectively identified all patients who underwent unilateral abdominally based free flap breast reconstruction at Brigham and Women's Hospital/Dana-Farber Cancer Institute between 2007 and 2016. Chart review was performed to collect relevant demographic and clinical data. Relevant hospital financial data were obtained. RESULTS Of the 713 who underwent free flap breast reconstruction, 160 patients met inclusion criteria, and mean follow-up was 5.8 years. Three patients (1.9 percent of 160) underwent contralateral surgery after completing reconstruction, two of whom had BRCA2 and one with ATM mutation. One hundred eleven patients met National Comprehensive Cancer Network guidelines for genetic testing, but of those only 55.9 percent (62 patients) were tested. Financial data revealed that testing every patient in the cohort would result in a net savings of $262,000. CONCLUSIONS During a relatively short follow-up period, a small percentage of patients were diagnosed with pathogenic mutations and underwent contralateral mastectomy and reconstruction. However, because of the costliness of surgery and the decreased cost of genetic testing, it is cost-effective to test every patient before unilateral abdominally based free flap breast reconstruction.
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28
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Zha N, Alabousi M, Abdullah P, Freitas V, Linthorst R, Muhn N, Alabousi A. Breast Cancer Screening in High-Risk Patients during Pregnancy and Breastfeeding: A Systematic Review of the Literature. JOURNAL OF BREAST IMAGING 2019; 1:92-98. [PMID: 38424914 DOI: 10.1093/jbi/wby015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 03/02/2024]
Abstract
There are currently no clear guidelines for high-risk breast cancer screening during the pregnancy and breastfeeding periods. The objective of this systematic review (SR) was to assess the available evidence pertaining to breast cancer screening recommendations in this population with the aim of supporting future guidelines. We performed a SR of the literature using the electronic databases MEDLINE and Embase. Predetermined inclusion and exclusion criteria were used during the abstract screening and full-text data extraction phases. We retrieved 2,274 abstracts after removal of duplicates, from which 16 studies were included based on predetermined eligibility criteria. Most of the studies found were narrative reviews and expert opinions. Clinical breast exam (CBE) was recommended by 12 studies during pregnancy and by 6 studies in the breastfeeding period. Mammography was recommended in the breastfeeding period by 2 studies. Magnetic resonance imaging was recommended in the breastfeeding period by 2 studies. Ultrasound was considered not appropriate for screening in this population. The information extracted from this SR is based primarily on expert opinion and anecdotal evidence, which explains the lack of standardized guidelines for high-risk breast cancer screening in this population. However, expert opinion may be a surrogate outcome for high-risk breast cancer screening recommendations in this subset of patients, and as such, may justify the clinical management to be tailored accordingly. This SR summarizes the evidence pertaining to high-risk breast cancer screening during pregnancy and breastfeeding, which could serve as a catalyst for future research on the topic.
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Affiliation(s)
- Nanxi Zha
- McMaster University, Department of Radiology, Hamilton, ON, Canada
| | - Mostafa Alabousi
- McMaster University, Department of Radiology, Hamilton, ON, Canada
| | - Peri Abdullah
- York University, Department of Kinesiology & Health Science, Toronto, ON, Canada
| | - Vivianne Freitas
- University of Toronto, Joint Department of Medical Imaging, Toronto, ON, Canada
| | - Rhys Linthorst
- McMaster University, DeGroote School of Medicine, Hamilton, ON, Canada
| | - Narry Muhn
- McMaster University, Department of Radiology, Hamilton, ON, Canada
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29
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Green RF, Ari M, Kolor K, Dotson WD, Bowen S, Habarta N, Rodriguez JL, Richardson LC, Khoury MJ. Evaluating the role of public health in implementation of genomics-related recommendations: a case study of hereditary cancers using the CDC Science Impact Framework. Genet Med 2019; 21:28-37. [PMID: 29907802 PMCID: PMC6295277 DOI: 10.1038/s41436-018-0028-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/20/2018] [Indexed: 01/21/2023] Open
Abstract
Public health plays an important role in ensuring access to interventions that can prevent disease, including the implementation of evidence-based genomic recommendations. We used the Centers for Disease Control and Prevention (CDC) Science Impact Framework to trace the impact of public health activities and partnerships on the implementation of the 2009 Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Lynch Syndrome screening recommendation and the 2005 and 2013 United States Preventive Services Task Force (USPSTF) BRCA1 and BRCA2 testing recommendations.The EGAPP and USPSTF recommendations have each been cited by >300 peer-reviewed publications. CDC funds selected states to build capacity to integrate these recommendations into public health programs, through education, policy, surveillance, and partnerships. Most state cancer control plans include genomics-related goals, objectives, or strategies. Since the EGAPP recommendation, major public and private payers now provide coverage for Lynch Syndrome screening for all newly diagnosed colorectal cancers. National guidelines and initiatives, including Healthy People 2020, included similar recommendations and cited the EGAPP and USPSTF recommendations. However, disparities in implementation based on race, ethnicity, and rural residence remain challenges. Public health achievements in promoting the evidence-based use of genomics for the prevention of hereditary cancers can inform future applications of genomics in public health.
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Affiliation(s)
- Ridgely Fisk Green
- Carter Consulting and Office of Public Health Genomics, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
| | - Mary Ari
- Office of the Director, Office of the Associate Director for Science, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Kolor
- Office of Public Health Genomics, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - W David Dotson
- Office of Public Health Genomics, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott Bowen
- Office of Public Health Genomics, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nancy Habarta
- Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Muin J Khoury
- Office of Public Health Genomics, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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30
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Long AS, Hanlon AL, Pellegrin KL. Socioeconomic variables explain rural disparities in US mortality rates: Implications for rural health research and policy. SSM Popul Health 2018; 6:72-74. [PMID: 30225336 PMCID: PMC6138992 DOI: 10.1016/j.ssmph.2018.08.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/05/2022] Open
Abstract
Objectives Rural disparities in age-adjusted mortality are growing in the United States. While socioeconomic variables have been found to explain significant variation in life expectancy across US counties, previous research has not examined the role of socioeconomic variables in explaining rural mortality disparities. The purpose of this study was to quantify the rural mortality disparity after controlling for socioeconomic variables. Methods Recursive partitioning, or tree regression, was used to fit models predicting premature mortality across counties in the United States, adjusted for age, median income, and percent in poverty in 4 time periods (from 2004 to 2012) with and without inclusion of an urban-rural variable. Results We found median income and percent in poverty explained about 50% of the variation in age-adjusted premature mortality rates across US counties in each of the four time periods. After controlling for these socioeconomic variables, rural mortality disparities largely disappeared, explaining less than 2% of the variance in premature mortality. Conclusions Addressing poverty and other socioeconomic issues should be a priority to improve health in rural communities. Interventions designed to target social determinants of health in rural areas are needed to address the growing rural mortality disparity that is largely explained by measures of poverty and income. Researchers examining rural health disparities should routinely include socioeconomic variables in their analyses.
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Affiliation(s)
- Alexander S Long
- Center for Rural Health Science, Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, 34 Rainbow Drive, Hilo, HI 96720, USA
| | | | - Karen L Pellegrin
- Center for Rural Health Science, Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, 34 Rainbow Drive, Hilo, HI 96720, USA
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