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Sarki M, Ming C, Aissaoui S, Bürki N, Caiata-Zufferey M, Erlanger TE, Graffeo-Galbiati R, Heinimann K, Heinzelmann-Schwarz V, Monnerat C, Probst-Hensch N, Rabaglio M, Zürrer-Härdi U, Chappuis PO, Katapodi MC. Intention to Inform Relatives, Rates of Cascade Testing, and Preference for Patient-Mediated Communication in Families Concerned with Hereditary Breast and Ovarian Cancer and Lynch Syndrome: The Swiss CASCADE Cohort. Cancers (Basel) 2022; 14:cancers14071636. [PMID: 35406409 PMCID: PMC8997156 DOI: 10.3390/cancers14071636] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 12/30/2022] Open
Abstract
Cascade screening for Tier 1 cancer genetic conditions is a significant public health intervention because it identifies untested relatives of individuals known to carry pathogenic variants associated with hereditary breast and ovarian cancer (HBOC) and Lynch syndrome (LS). The Swiss CASCADE is a family-based, open-ended cohort, including carriers of HBOC- and LS-associated pathogenic variants and their relatives. This paper describes rates of cascade screening in relatives from HBOC- and LS- harboring families, examines carriers' preferences for communication of testing results, and describes theory-based predictors of intention to invite relatives to a cascade screening program. Information has been provided by 304 index cases and 115 relatives recruited from September 2017 to December 2021. On average, 10 relatives per index case were potentially eligible for cascade screening. Approximately 65% of respondents wanted to invite relatives to the cohort, and approximately 50% indicated a preference for patient-mediated communication of testing results, possibly with the assistance of digital technology. Intention to invite relatives was higher for first- compared to second- and third-degree relatives, but was not different between syndromes or based on relatives' gender. The family environment and carrying pathogenic variants predicts intention to invite relatives. Information helps optimize delivery of tailored genetic services.
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Affiliation(s)
- Mahesh Sarki
- Department of Clinical Research, University of Basel, 4055 Basel, Switzerland; (M.S.); (C.M.)
| | - Chang Ming
- Department of Clinical Research, University of Basel, 4055 Basel, Switzerland; (M.S.); (C.M.)
| | - Souria Aissaoui
- Breast Center, Cantonal Hospital Fribourg, 1752 Fribourg, Switzerland;
- GENESUPPORT, The Breast Centre, Hirslanden Clinique de Grangettes, 1224 Geneva, Switzerland
| | - Nicole Bürki
- Women’s Clinic, University Hospital Basel, 4031 Basel, Switzerland; (N.B.); (V.H.-S.)
| | - Maria Caiata-Zufferey
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland;
| | | | | | - Karl Heinimann
- Institute for Medical Genetics and Pathology, University Hospital Basel, 4031 Basel, Switzerland;
- Research Group Human Genomics, Department of Biomedicine, University of Basel, 4031 Basel, Switzerland
| | | | - Christian Monnerat
- Department of Medical Oncology, Hospital of Jura, 2800 Delemont, Switzerland;
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, University of Basel, 4123 Allschwil, Switzerland;
| | - Manuela Rabaglio
- Department of Medical Oncology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland;
| | - Ursina Zürrer-Härdi
- Department of Medical Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland;
| | - Pierre Olivier Chappuis
- Unit of Oncogenetics, Division of Oncology, University Hospitals of Geneva, 1205 Geneva, Switzerland;
- Division of Genetic Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Maria C. Katapodi
- Department of Clinical Research, University of Basel, 4055 Basel, Switzerland; (M.S.); (C.M.)
- Correspondence: ; Tel.: +41-61-207-04-30
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Lacson JCA, Doyle SH, Qian L, Del Rio J, Forgas SM, Valavanis S, Carvajal R, Gonzalez-Calderon G, Kim Y, Roetzheim RG, Sutton SK, Vadaparampil ST, Kanetsky PA. A Randomized Trial of Precision Prevention Materials to Improve Primary and Secondary Melanoma Prevention Activities among Individuals with Limited Melanoma Risk Phenotypes. Cancers (Basel) 2021; 13:3143. [PMID: 34201795 DOI: 10.3390/cancers13133143] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Inherited genetic variation at the MC1R gene is associated with increased risk of melanoma among non-Hispanic whites (NHWs), especially among those with skin and pigmentation characteristics that are associated with average to lower melanoma risk, for whom MC1R genetic testing may reveal unrecognized melanoma risk. We conducted a randomized trial to examine whether providing MC1R genetic risk information together with precision prevention materials would increase primary and secondary melanoma preventive behaviors compared to providing generic prevention materials only. We found that among participants with MC1R variants associated with higher risk of melanoma, the intervention increased shade-seeking or using an umbrella, increased wearing sleeved shirts, and decreased sunburns among their young children. We conclude that MC1R genetic testing and precision prevention materials may increase the practice of some sun-protective behaviors. Abstract Inherited variation at MC1R is associated with elevated melanoma risk among non-Hispanic whites (NHWs). MC1R genetic testing may unmask previously unrecognized disease risk, especially among individuals with few melanoma phenotypic risk factors. We recruited NHW individuals with limited phenotypic risk factors from two primary care clinics in west-central Florida. Participants (n = 1134) were randomized within MC1R genotype risk group (average/higher) to receive mailed precision prevention (i.e., intervention) or generic prevention materials. Participants reported hours of weekday and weekend sun exposure, frequency of intentional outdoor tanning and sun protection behaviors, number of sunburns, indoor tanning episodes, and skin examinations at baseline, and after 6 and 12 months. Among MC1R higher-risk participants, the intervention increased the likelihood of often or always wearing a shirt with sleeves (OR = 1.49, p = 0.03) and seeking shade or using an umbrella (OR = 1.42, p = 0.046), and it decreased the number of sunburns among their young children (β = −0.13, p = 0.03). Intervention effects were not noted among MC1R average-risk participants. Moderation analyses identified intervention effects within subgroups in average-risk and higher-risk participants. Precision prevention information conveying MC1R testing results can increase the practice of some sun protection behaviors among at-risk individuals with limited melanoma risk phenotypes and may provide a cross-generational tool to counteract increasing incidence of melanoma.
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Duggal P, Ladd-Acosta C, Ray D, Beaty TH. The Evolving Field of Genetic Epidemiology: From Familial Aggregation to Genomic Sequencing. Am J Epidemiol 2019; 188:2069-2077. [PMID: 31509181 PMCID: PMC7036654 DOI: 10.1093/aje/kwz193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 12/21/2022] Open
Abstract
The field of genetic epidemiology is relatively young and brings together genetics, epidemiology, and biostatistics to identify and implement the best study designs and statistical analyses for identifying genes controlling risk for complex and heterogeneous diseases (i.e., those where genes and environmental risk factors both contribute to etiology). The field has moved quickly over the past 40 years partly because the technology of genotyping and sequencing has forced it to adapt while adhering to the fundamental principles of genetics. In the last two decades, the available tools for genetic epidemiology have expanded from a genetic focus (considering 1 gene at a time) to a genomic focus (considering the entire genome), and now they must further expand to integrate information from other “-omics” (e.g., epigenomics, transcriptomics as measured by RNA expression) at both the individual and the population levels. Additionally, we can now also evaluate gene and environment interactions across populations to better understand exposure and the heterogeneity in disease risk. The future challenges facing genetic epidemiology are considerable both in scale and techniques, but the importance of the field will not diminish because by design it ties scientific goals with public health applications.
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Affiliation(s)
- Priya Duggal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christine Ladd-Acosta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Debashree Ray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Cerda Diez M, E. Cortés D, Trevino-Talbot M, Bangham C, Winter MR, Cabral H, Norkunas Cunningham T, M. Toledo D, J. Bowen D, K. Paasche-Orlow M, Bickmore T, Wang C. Designing and Evaluating a Digital Family Health History Tool for Spanish Speakers. Int J Environ Res Public Health 2019; 16:E4979. [PMID: 31817849 PMCID: PMC6950582 DOI: 10.3390/ijerph16244979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022]
Abstract
Digital family health history tools have been developed but few have been tested with non-English speakers and evaluated for acceptability and usability. This study describes the cultural and linguistic adaptation and evaluation of a family health history tool (VICKY: VIrtual Counselor for Knowing Your Family History) for Spanish speakers. In-depth interviews were conducted with 56 Spanish-speaking participants; a subset of 30 also participated in a qualitative component to evaluate the acceptability and usability of Spanish VICKY. Overall, agreement in family history assessment was moderate between VICKY and a genetic counselor (weighted kappa range: 0.4695 for stroke-0.6615 for heart disease), although this varied across disease subtypes. Participants felt comfortable using VICKY and noted that VICKY was very likeable and possessed human-like characteristics. They reported that VICKY was very easy to navigate, felt that the instructions were very clear, and thought that the time it took to use the tool was just right. Spanish VICKY may be useful as a tool to collect family health history and was viewed as acceptable and usable. The study results shed light on some cultural differences that may influence interactions with family history tools and inform future research aimed at designing and testing culturally and linguistically diverse digital systems.
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Affiliation(s)
- Maria Cerda Diez
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
| | - Dharma E. Cortés
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA 02141, USA;
- Department of Psychiatry, Harvard Medical School, Cambridge, MA 02139, USA
| | - Michelle Trevino-Talbot
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
| | - Candice Bangham
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA 02118, USA;
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Tricia Norkunas Cunningham
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
| | - Diana M. Toledo
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA;
| | - Deborah J. Bowen
- Department of Bioethics and Humanities, School of Public Health, University of Washington, Seattle, WA 98195, USA;
| | | | - Timothy Bickmore
- College of Computer and Information Science, Northeastern University, Boston, MA 02115, USA;
| | - Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
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Katapodi MC, Viassolo V, Caiata-Zufferey M, Nikolaidis C, Bührer-Landolt R, Buerki N, Graffeo R, Horváth HC, Kurzeder C, Rabaglio M, Scharfe M, Urech C, Erlanger TE, Probst-Hensch N, Heinimann K, Heinzelmann-Schwarz V, Pagani O, Chappuis PO. Cancer Predisposition Cascade Screening for Hereditary Breast/Ovarian Cancer and Lynch Syndromes in Switzerland: Study Protocol. JMIR Res Protoc 2017; 6:e184. [PMID: 28931501 PMCID: PMC5628286 DOI: 10.2196/resprot.8138] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/15/2017] [Accepted: 07/15/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Breast, colorectal, ovarian, and endometrial cancers constitute approximately 30% of newly diagnosed cancer cases in Switzerland, affecting more than 12,000 individuals annually. Hundreds of these patients are likely to carry germline pathogenic variants associated with hereditary breast ovarian cancer (HBOC) or Lynch syndrome (LS). Genetic services (counseling and testing) for hereditary susceptibility to cancer can prevent many cancer diagnoses and deaths through early identification and risk management. OBJECTIVE Cascade screening is the systematic identification and testing of relatives of a known mutation carrier. It determines whether asymptomatic relatives also carry the known variant, needing management options to reduce future harmful outcomes. Specific aims of the CASCADE study are to (1) survey index cases with HBOC or LS from clinic-based genetic testing records and determine their current cancer status and surveillance practices, needs for coordination of medical care, psychosocial needs, patient-provider and patient-family communication, quality of life, and willingness to serve as advocates for cancer genetic services to blood relatives, (2) survey first- and second-degree relatives and first-cousins identified from pedigrees or family history records of HBOC and LS index cases and determine their current cancer and mutation status, cancer surveillance practices, needs for coordination of medical care, barriers and facilitators to using cancer genetic services, psychosocial needs, patient-provider and patient-family communication, quality of life, and willingness to participate in a study designed to increase use of cancer genetic services, and (3) explore the influence of patient-provider communication about genetic cancer risk on patient-family communication and the acceptability of a family-based communication, coping, and decision support intervention with focus group(s) of mutation carriers and relatives. METHODS CASCADE is a longitudinal study using surveys (online or paper/pencil) and focus groups, designed to elicit factors that enhance cascade genetic testing for HBOC and LS in Switzerland. Repeated observations are the optimal way for assessing these outcomes. Focus groups will examine barriers in patient-provider and patient-family communication, and the acceptability of a family-based communication, coping, and decision-support intervention. The survey will be developed in English, translated into three languages (German, French, and Italian), and back-translated into English, except for scales with validated versions in these languages. RESULTS Descriptive analyses will include calculating means, standard deviations, frequencies, and percentages of variables and participant descriptors. Bivariate analyses (Pearson correlations, chi-square test for differences in proportions, and t test for differences in means) will assess associations between demographics and clinical characteristics. Regression analyses will incorporate generalized estimating equations for pairing index cases with their relatives and explore whether predictors are in direct, mediating, or moderating relationship to an outcome. Focus group data will be transcribed verbatim and analyzed for common themes. CONCLUSIONS Robust evidence from basic science and descriptive population-based studies in Switzerland support the necessity of cascade screening for genetic predisposition to HBOC and LS. CASCADE is designed to address translation of this knowledge into public health interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03124212; https://clinicaltrials.gov/ct2/show/NCT03124212 (Archived by WebCite at http://www.webcitation.org/6tKZnNDBt).
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Affiliation(s)
- Maria C Katapodi
- Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.,University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Valeria Viassolo
- Unit of Oncogenetics and Cancer Prevention, Division of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Christos Nikolaidis
- Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Nicole Buerki
- Women's Clinic and Gynecological Oncology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Rossella Graffeo
- Institute of Oncology (IOSI) and Breast Unit (CSSI) of Southern Switzerland, Bellinzona, Switzerland
| | - Henrik Csaba Horváth
- University Clinic for Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland
| | - Christian Kurzeder
- Women's Clinic and Gynecological Oncology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Manuela Rabaglio
- University Clinic for Medical Oncology, Inselspital Bern, Bern, Switzerland
| | - Michael Scharfe
- Clinical Trials Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Corinne Urech
- Women's Clinic and Gynecological Oncology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias E Erlanger
- Clinical Trials Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Karl Heinimann
- Medical Genetics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Viola Heinzelmann-Schwarz
- Women's Clinic and Gynecological Oncology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Olivia Pagani
- Institute of Oncology (IOSI) and Breast Unit (CSSI) of Southern Switzerland, Bellinzona, Switzerland
| | - Pierre O Chappuis
- Unit of Oncogenetics and Cancer Prevention, Division of Oncology, Geneva University Hospitals, Geneva, Switzerland.,Division of Genetic Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Abstract
This commentary illustrates and discusses potential research directions for sociologists and anthropologists interested in the field of community genetics and its emerging networks of individuals genetically at risk. Community genetics-the application of medical genetics in community settings for the benefit of individuals-also involves social issues of lay-professional misunderstandings (and more recently also the different perspectives of various expert communities), stigmatization, discrimination, and medicalization. Focusing on a socio-anthropological perspective regarding the views and disagreements surrounding the definition and scope of community genetics, I overview several epistemological, methodological, and practical contributions that such perspective can offer to the study of community genetics.
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Affiliation(s)
- Aviad E Raz
- Department of Sociology and Anthropology, Ben-Gurion University, Beersheba, Israel,
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Shen TH, Carlson CS, Tarczy-Hornoch P. SNPit: a federated data integration system for the purpose of functional SNP annotation. Comput Methods Programs Biomed 2009; 95:181-9. [PMID: 19327864 PMCID: PMC2680224 DOI: 10.1016/j.cmpb.2009.02.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 02/05/2009] [Accepted: 02/23/2009] [Indexed: 05/27/2023]
Abstract
Genome wide association studies can potentially identify the genetic causes behind the majority of human diseases. With the advent of more advanced genotyping techniques, there is now an explosion of data gathered on single nucleotide polymorphisms (SNPs). The need exists for an integrated system that can provide up-to-date functional annotation information on SNPs. We have developed the SNP Integration Tool (SNPit) system to address this need. Built upon a federated data integration system, SNPit provides current information on a comprehensive list of SNP data sources. Additional logical inference analysis was included through an inference engine plug in. The SNPit web servlet is available online for use. SNPit allows users to go to one source for up-to-date information on the functional annotation of SNPs. A tool that can help to integrate and analyze the potential functional significance of SNPs is important for understanding the results from genome wide association studies.
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Affiliation(s)
- Terry H Shen
- Department of Biomedical & Health Informatics, University of Washington, Seattle, WA 98195-7240, USA.
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