1
|
Turner AR, Lane BR, Rogers D, Lipkus I, Weaver K, Danhauer SC, Zhang Z, Hsu FC, Noyes SL, Adams T, Toriello H, Monroe T, McKanna T, Young T, Rodarmer R, Kahnoski RJ, Tourojman M, Kader AK, Zheng SL, Baer W, Xu J. Randomized trial finds that prostate cancer genetic risk score feedback targets prostate-specific antigen screening among at-risk men. Cancer 2016; 122:3564-3575. [PMID: 27433786 PMCID: PMC5247411 DOI: 10.1002/cncr.30162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/16/2016] [Accepted: 04/21/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Prostate-specific antigen (PSA) screening may reduce death due to prostate cancer but leads to the overdiagnosis of many cases of indolent cancer. Targeted use of PSA screening may reduce overdiagnosis. Multimarker genomic testing shows promise for risk assessment and could be used to target PSA screening. METHODS To test whether counseling based on the family history (FH) and counseling based on a genetic risk score (GRS) plus FH would differentially affect subsequent PSA screening at 3 months (primary outcome), a randomized trial of FH versus GRS plus FH was conducted with 700 whites aged 40 to 49 years without prior PSA screening. Secondary outcomes included anxiety, recall, physician discussion at 3 months, and PSA screening at 3 years. Pictographs versus numeric presentations of genetic risk were also evaluated. RESULTS At 3 months, no significant differences were observed in the rates of PSA screening between the FH arm (2.1%) and the GRS-FH arm (4.5% with GRS-FH vs. 2.1% with FH: χ2 = 3.13, P = .077); however, PSA screening rates at 3 months significantly increased with given risk in the GRS-FH arm (P = .013). Similar results were observed for discussions with physicians at 3 months and PSA screening at 3 years. Average anxiety levels decreased after the individual cancer risk was provided (P = .0007), with no differences between groups. Visual presentation by pictographs did not significantly alter comprehension or anxiety. CONCLUSIONS This is likely the first randomized trial of multimarker genomic testing to report genomic targeting of cancer screening. This study found little evidence of concern about excess anxiety or overuse/underuse of PSA screening when multimarker genetic risks were provided to patients. Cancer 2016;122:3564-3575. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Aubrey R. Turner
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Brian R. Lane
- Spectrum Health Hospital System, Grand Rapids, MI, 49546
- Michigan State University College of Human Medicine, Grand Rapids, MI 49546
| | - Dan Rogers
- Van Andel Research Institute, Grand Rapids, MI
| | | | - Kathryn Weaver
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Suzanne C. Danhauer
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Zheng Zhang
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | | | - Tamara Adams
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Helga Toriello
- Spectrum Health Hospital System, Grand Rapids, MI, 49546
| | - Thomas Monroe
- Spectrum Health Hospital System, Grand Rapids, MI, 49546
| | - Trudy McKanna
- Spectrum Health Hospital System, Grand Rapids, MI, 49546
| | - Tracey Young
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Ryan Rodarmer
- Spectrum Health Hospital System, Grand Rapids, MI, 49546
| | | | | | - A. Karim Kader
- Department of Surgery, University of California San Diego, San Diego, CA
| | - S. Lilly Zheng
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - William Baer
- Grand Valley Medical Specialists, Grand Rapids, MI
| | - Jianfeng Xu
- Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| |
Collapse
|